Dear Mark: Power Yoga, Pelvic Floor, Keto Reset and Osteoporosis

Dear_Mark_Inline_PhotoFor today’s edition of Dear Mark, I’m answering three questions. First, is power yoga—a more “intense” version of yoga that includes strength exercises—a suitable alternative to strength training for aging women? Probably not, but that doesn’t make it bad or wrong to do. Second, what’s the deal with pelvic floor dysfunction after menopause? What’s the best way to improve that situation? And third, is the Keto Reset right for older women with osteoporosis?

Let’s find out:

Shannon asked:

Would you consider power yoga “lifting heavy things”? I do power yoga 2-3 times a week and it involves a lot of standing strength and arm/hand stands? Thanks and I love everything on Marks Daily Apple!

Not quite. Nothing can really compete with strength training and high-intensity work for building bone resilience and strength. Your bones need impact and intensity, and yoga generally doesn’t supply enough of it.

That’s why hopping in place can help strengthen hip and thigh bones in older folks. The jarring impact of landing—even from a modest height of six or eight inches—triggers bone resorption and remodeling in the legs.

That’s why lifting heavy things makes bones strong. The bone acts (along with the muscle) as a lever during the lift, which places a lot of stress on the bone. To recover from the activity and be ready for the next time it has to fulfill lever duty, the bone remodels itself, gaining density and getting stronger and more durable.

Power yoga is closely related to ashtanga yoga, long considered a more “intense” form of yoga. Yet an 8-month study found that Ashtanga yoga yielded only mild benefits to bone health. As for strength, another 8-month Ashtanga study by the same group found that it improved leg press strength but little else. It’s better than nothing, but it’s probably not enough to stave off the worst effects aging has on muscle and bone.

Still, if yoga is something you love, continue doing it. Yoga will improve your balance, coordination, flexibility, and even strength under certain contexts. Throwing in a single day or two of dedicated strength training on top of the yoga is a great way to have it all. One day a week is “enough,” two days a week is better (a recent study found that while older women training one day a week maintained strength, training twice a week was necessary to gain ever-critical lean muscle mass).

Power yoga varies a lot from place to place, so it really depends on how your instructor chooses to implement it. I just wouldn’t bank on it providing enough stimulus for your muscles and bones.

Michelle Reese wrote:

I’d like to know a little about how to strengthen and support the pelvic floor, which really gets compromised after menopause, making it hard to do the squats. I’ve really noticed the decline in function after menopause, even though I’ve been working out consistently my entire life. Thanks for doing the research and sharing today’s wisdom!

My pleasure. Thanks for reading!

Realize that the pelvic floor is a system of muscles, and muscles need to be used and loaded, lest they degenerate—which only speeds up as we age. The same thing applies to the rest of your muscle. It’s just that actively using the pelvic floor muscles is harder and less intuitive than actively engaging your biceps or hamstrings. They’re also hidden, so it’s easy to forget they even exist and need our attention.

For pelvic floor stuff, go with Katy Bowman. Check out her articles and books on the subject. Her expertise is unmatched.

Vicki M asked:

No doubt this has been discussed before…..however, for a 60 year old post menopause woman with osteoporosis (but still active, going to gym, walking etc), is Keto reset a good option?

The bad news is that this particular diet has never been studied in this particular population.

The good news is that, as a human, your species has been well-represented in the ketogenic diet literature.

In a long-term 5 year study of human adults, ketogenic dieting failed to produce any negative effects on bone health.

In a shorter study, a low-carb, high-fat diet (no word if it was “ketogenic” or not) failed to worsen bone turnover markers.

Some critics claim that ketogenic diets (and pretty much any diet that includes “evil” animal protein) “dissolve” bones by throwing off the acid/base balance, such that the body must break down bone to ameliorate the acid load. It’s not true, but if it were? In a recent study, elite female race-walkers on a ketogenic diet saw no change in their acid/base balance.

There are more wrinkles to the keto/bone health story, which I’ll explore in the near future. Stay tuned for that.

But long story short, keto reset is fine, provided you don’t just go keto and do nothing else. You still have to train (including strength training), get plenty of sleep, get vitamin D, and focus on the micronutrient content (including the bone-relevant potassium, calcium, magnesium) of your diet and not just the macronutrients.

That’s it for today, folks. Thanks for reading, writing, and commenting. Include any further questions or input you have down below and have an incredible day!

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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35 thoughts on “Dear Mark: Power Yoga, Pelvic Floor, Keto Reset and Osteoporosis”

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  1. Great questions and answers! And love the whole convo that took place with last week’s post about women’s fitness changing with age. Based on all the comments this is clearly a topic of interest to your followers. Personally, I feel amazing at 51 eating what I call a borderline keto diet (nothing is tracked or measured because that would drive me crazy,) getting plenty of movement, and lifting heavy things with my part time bartending job and some home workouts. Mindset and attitude are also so important.

    1. Seconded! Great article. Am very happy to see more posts along these lines – am 49 and also do a borderline keto diet (don’t measure anything either) and now have lost all the weight I’ve wanted to lose! I’ve never been in this situation before, lol! I too, lift twice a week during crossfit sessions plus a yoga class once a week and a teeny bit each morning plus random zumba, u-jam dance classes.

  2. Thanks for linking to Katy Bowman for the pelvic floor question. I’ve been following her for years, and as you said, her expertise on this and other topics is unmatched–as well as unconventional, and the word needs to be spread.

  3. In case you forgot, today is the end of the 1,000 day challenge!! (See blog post July 14,2015). Was hoping to see some follow up post!

    1. Same here! I had it marked on my calendar and was hoping I wasn’t the only one who remembered!

  4. Wife is a holistic biological dentist of over twenty years… she prescribes Bone Marrow, Beef Liver, sensible sunshine (or vitamin D3), fermented veggies like kimchi (or vitamin K2) and magnesium oil for virtually every patient. Yes, this makes a world of difference in tooth remineralization… it also makes a world of difference in bone remineralization and remodeling too. Combine these raw ingredients with adequate loads, good things tend to happen for bone health.

    — Vitamins A, D, and K2 cooperate synergistically not only with each other, but also with essential minerals like magnesium and zinc, with dietary fat, and with key metabolic factors like thyroid hormone —

    — Vitamins A, D, and K2 interact synergistically to support energy metabolism, immune health, provide for adequate growth, support strong bones and teeth, and protect soft tissues from calcification —

    — Magnesium is required for the production of all proteins, including those that interact with vitamins A and D —

    1. Does she do video consultations? I have questions about my dental health and would love to speak to a professional with her primal mindset.

      1. Many of you have already seen this… I didn’t retype any of it, but… there is an UPDATE at the end that you may find helpful.

        Our early ancestors didn’t brush… didn’t floss… didn’t get cavities. This is my “go to” line because it seems that the more we brush and floss and use fluoride, the more cavities we get. Obviously, brushing and flossing aren’t the answer, but don’t tell this to the multi-billion dollar dental industry (nor to the allopathic dentist). We all have the ability to remineralize our teeth… to withstand acidic insults… to arrest and resist decay. Nutrition giants Weston A. Price & May Mellanby published the data proving the vital importance that the fat soluble vitamins A, D and K play in tooth remineralization.

        Wife is a biological dentist (of 20 years)… I own a supplement company (yours truly). In fact, we developed a product together called “Tooth Restore” that is rich in vitamins A, D, K, magnesium, phosphorus (and others)… No, this is not a topical (nor) a toothpaste… it’s food! This is not commercially available, nor does it need to be for people to glean the benefits, because as you know, nourishing food comes first.

        — Vitamins A, D, and K2 cooperate synergistically not only with each other, but also with essential minerals like magnesium and zinc, with dietary fat, and with key metabolic factors like thyroid hormone * —

        — Vitamins A, D, and K2 interact synergistically to support energy metabolism, immune health, provide for adequate growth, support strong bones and teeth, and protect soft tissues from calcification * —

        — Magnesium is required for the production of all proteins, including those that interact with vitamins A and D * —

        Grass Fed Beef Liver is high in real, preformed vitamin A. That said, if you are deficient in vitamin D, vitamin K2 and/or magnesium, you will not see as much benefit as you could (nor) will you be optimizing other important health metrics. Do you regularly get mid day sun exposure, or take a vitamin D3 supplement? Do you eat fermented veggies like kimchi or sauerkraut or take a vitamin K2 supplement? Do you take a magnesium supplement (I personally recommend a transdermal magnesium oil spray and oral supplementation because it’s virtually impossible to get enough magnesium from diet alone).

        [ NOTE: Bone marrow is likely rich in vitamin K and the other fat-soluble nutrients, but formal tests to determine the range and amount remain to be carried out.[11] While smashing bones and sucking out the marrow fat was the hard way our ancestors obtained vitamin K, it’s not that difficult to obtain marrow bones and either oven roast 3″ pieces to serve as appetisers, or slow cook them to make them extra delicious / nutritious… or, look for a good bone marrow supplement! ]

        The take home message here is live life in harmony with nature, the way of our early ancestors… love your bone soups, look to liver, get sensible sun exposure, eat your fermented foods (natto reigns supreme) and mind your magnesium. If you want fresh breath, brush your teeth (see below). If you want oral health, nourish your body.

        People with periodontal issues (e.g. deep pockets, recurrent infection, bone loss/recession, etc) will also need additional support from whole bone extract (bone, marrow and cartilage), CoQ10 (or Beef Heart) and collagen. Ideally, we would consume these nourishing nutrients by indulging in the deliciousness of true bone broth, bone marrow and organ meats (heart is the richest source of CoQ10 that exists in nature). These additional nose-to-tail nutrients could easily be the missing link to the strength, energy and other health benefits that we are all after.

        P.S. For those that need intensive support to regain your dental strength and health, consider practicing a ketogenic diet as a “supplement” to everything above. Ketosis helps to deprive the bad bacteria of an energy source… less energy means less fermentation… means less acidic byproducts to demineralize teeth and bone (think recession)… Wife, the biological dentist, has been using this strategy with her patients for over a decade, way before it became “trendy!” It’s also incredibly helpful to swish with sea salt water throughout the day, and especially after eating and drinking, to maintain a balanced pH. Lastly, Bovine Tracheal Cartilage (BTC) has proven to be incredibly helpful with treatment resistant conditions and wound healing (tons of peer reviewed studies on these topics). If you don’t know about BTC, you need to because it works!

        – Ketogenic diet
        – Salt water rinses
        – Bovine Tracheal Cartilage (BTC)

        As far as brushing goes, by all means, do it when you feel like it… we recommend using a Bass brush (or) a chewing stick just like our early ancestors did which shows parallel, or even greater efficacy, as compared to standard brushing (see study). When we brush, we use a homemade concoction of bentonite clay, coconut oil, colloidal silver and sea salt with a dash of peppermint oil. There’s even a commercial product out there by Uncle Harry’s Natural Products that’s very similar.

        – Grass Fed Liver (and/or) Bovine Tracheal Cartilage
        – Grass Fed Bone Marrow
        – Magnesium… transdermal magnesium oil (by Ancient Minerals) applied to feet before bed and oral magnesium (by Trace Minerals; Mega Mag)
        – Vitamin D3 – get this from sensible sunshine or a supplement
        – Vitamin K2 – get this from fermented veggies, kimchi, sauerkraut or natto
        – Grass Fed Heart – get this if needing gum support too
        – Grass Fed Collagen – get this if needing gum support too

        Don’t forget to “Avoid Dangers, Like Our Early Ancestors Did.” Wife also makes her patients turn off their wifi routers at night, leave their cell phones out of the bedroom and remove electrical devices within a 12 foot radius of the bed (one’s pillow should also not be near a power outlet). If you can get away from bathing in non-native EMFs, health and healing has a better chance. Many times, all you need to do is use an EMF meter to see where the fields have biological implications and then re-position the offensive device… sometimes you may need to re-position your bed, chair or sitting area.

        1. Right now, my husband and I are into a deep remineralizing and dental health improvement project. (esp. for hubby) Our research dovetails with yours closely, but I appreciate your added details. We are eating chicken livers, (not beef) along with other supplements mentioned. Is it ok to brush with bentonite clay alone? That’s what we are currently doing. Thanks for this vital information!

      2. Hey Curtis, I tried to respond earlier with quite a lengthy comment… not sure if it will eventually post. I’ll look out for it; if it doesn’t show up, I’ll figure out a way to get the information to you. Thank you for your interest.

    2. Need advice for those of us who cant process tyramine – can’t eat fermented foods/bone broth without getting sick? How can we maintain good gut health and mineralization of bones?

      1. Include everything on the ancestral menu (liver, bone marrow, sun, magnesium, egg yolks, egg shells, egg shell membranes, ghee, etc), including adequate mechanical loads, and substitute the fermented foods with freeze-dried whole bone (bone matrix, bone marrow, cartilage goodness). I talked about this recently in another post… how our early Inuit ancestors intuitively knew to freeze-dry animal bones, pulverize them and devour. Whole bones have been on the menu for millennia upon millennia. There’s also wild fish eggs and then there’s whole, bone-in small fish.

    3. Liver King, how much beef liver and bone marrow does she prescribe per week?
      I happen to love both bone marrow and liver, but I don’t eat them every day.

      1. It depends on the individual… an already healthy person (without dental needs) can easily maintain good health with two to three servings a week of each — this happens to be what most ancestral nutrition authorities recommend (e.g. Chris Masterjohn, Nora Gedgaudas, WAPF, etc.)

        A person with intensive dental needs may work up to three to four servings a week of each. Bear in mind that the fat soluble system (especially vitamins A and D) work cooperatively and protectively together so think bigger picture, in harmony with nature.

        Zoltan, since you happen to love marrow and liver, you’ll have no problem getting enough… for others out there, get creative with recipes, make your own frozen organ pills or buy a top shelf supplement version. Whichever way you go, make sure you source pasture-raised, 100% grass fed / grass finished and never treated (nor) exposed to antibiotics, pesticides, herbicides, GMOs… you know the drill!

  5. I’m so glad to see these posts on women’s health, and especially post-menopause health. I’ve been hoping for more of these from MDA. As I approach 50, five years after surgical menopause, I’m aware that I live in a different body than I once did. I appreciate your focus on the specific needs and nuances of this stage of life.

  6. I will echo others in offering you sincere gratitude Mark, for taking post-menopausal primal woman health seriously and including us in your audience. It is so hard to find information for this sub-group. Thank you thank you thank you!!!

    1. Sue Nelson and Vive, thanks for your notes. I’ve heard the requests and have taken some time to read and research. Definitely look for more to come this year in my own blog articles and some guest posts aimed at women’s health, including post-menopausal questions.

      1. Regarding the question about the pelvic floor, Christine Kent, R.N., does a spectacular job helping women of all ages. She’s studied the pelvis extensively & encourages correct posture to help with pelvic organ prolapse, which is not just a menopausal problem. Her website is

  7. I’ve followed Marks Daily Apple for several years now. Unfortunately I have gotten off track a bit the last few years as we have added new little ones to the home. My metabolism has taken a major hit, would it be best to do a keto reset or take it slow and do the 21 Day Transformation. The discipline used to be there, and I feel like I can get it back. First go round I had lost about 80 lbs and hoping to do something close to that this go round. i am hoping that this becomes more of a lifestyle change than just a weight loss thing.

    1. Kyle, thanks for your question. The Keto Reset includes a beginning transition to Primal eating before going full keto, so either way you’ll spend the first few weeks re-acclimating to the PB diet principles. Start there and see where you’d like to go. Great to have you here. – M

  8. Thank you Mark for discussing the pelvic floor issue. I have gained 10 lbs in the last year because I am not allowed to run, jump, climb stairs do deep squats or lift heavy things. This is an amazing site. Keep up the good work.

  9. Good article. I also want to know why women seem to be the target of most bone health discussion. I’ve assumed it must have to do with estrogen. But if that were the case wouldn’t men be continually suffering bad bone health? Is there a physiological reason to this or is it a holdover from the pharmaceutical industry choosing a target market for osteoporosis prescriptions? I ask because my father shrunk down faster than my mother in old age, proportionally speaking.

  10. Thanks Mark for the reply to my question re osteoporosis. Puts my mind at rest. Look forward to hearing any more you have to say on the subject 🙂

  11. Regarding the question of how power yoga could stand in for lifting heavy things, I just ran across a study earlier this week that showed that Bikram yoga (hot yoga) improved the students’ ability to deadlift by 13.1% (increased strength). I’m not sure if Bikram and power yoga are on par with one another — but maybe Bikram could be a happy medium for the person who just does NOT want to lift anything heavier than their own body weight?? Here’s the study’s link:

  12. I’m a little late to the party!… but so pleased to read this/ & the link to Katy Bowman’s work. I’m 48 (& a half) & I hear you re pelvic floor function as we age! As well as being enrolled on the Primal Health Coach course (I’m a musician by trade) I recently trained as a Pilates teacher…Pilates is a system of exercise which will engage & train the pelvic floor and ‘core cylinder’ & practise its engagement in every single exercise. Its basically trains light pre-engagement of the pelvic floor into everyday life movements as well as in the exercises (either using just mat / props/ or even in a studio with machines), which in turn protects the spine from injury. (You’ll just engage it without even thinking about it after a bit of practice.) Funnily enough Joe Pilates’ own principles of health (from the 1940s & 50s) overlap exactly with those of the Primal Blueprint… sun, play, sleep, nutrition, healthy movement…Pilates practice will neurally re-pattern your everyday movement, so you will soon be lightly engaging the core & pelvic floor before you move, without even thinking about it.

  13. Thanks a ton for dealing this two very important topics power yoga and pelvic floor dysfunction in this informational article. Also, this post includes its various aspects of our health.