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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 03 2018

Women’s Fitness: Should It Change with Age?

By Mark Sisson
80 Comments

Inline_Woman_FitnessGenerally speaking, the basic Primal Blueprint for fitness and physical activity applies equally to men and women of all ages. Lifting heavy things works in everyone. Sprinting is a fantastic way—for anyone who’s able—to compress workouts and improve training efficiency. Improving one’s aerobic capacity through easy cardio doesn’t discriminate between the sexes. And everyone should walk, hike, garden, and perform as much low level physical activity as possible. These basic foundations—the 30,000 foot view of fitness—don’t really change across age or sex.

But the details do, especially for women.

You see, women are in a unique position. As men age, the hormonal environment degenerates. They still make the same basic hormones in the same proportions, only the absolute numbers decline. As women age, the hormonal environment shifts dramatically. The menopausal ovaries no longer produce enough follicle-stimulating hormone (FSH) and luteinizing hormone (LH) to regulate estrogen, testosterone, and progesterone, causing the latter hormones to fluctuate in novel ways.

What kind of hormonal changes and physiological developments occur in the aging woman that might affect how best to train?

  1. Atrophied muscle and reduced strength. As estrogen drops, so does muscle function.
  2. More of a “male” body fat distribution. Postmenopausal women tend to gain more belly fat.
  3. Reduced bone mass. The menopausal hormonal environment leads to a reduction in vitamin D synthesis and absorption, lower calcium levels, and reduced bone mass.
  4. Vascular changes. After menopause, arteries become stiffer. Hypertension becomes more likely.
  5. Exercise intolerance. This one’s a real bummer. You know you need to exercise more than ever to stave off some of the side effects of aging, but your aging hormonal environment is making exercise harder to tolerate.

What takeaways are there? How can you counter or mitigate some of these effects?

Exercise Can Improve Body Comp

Exercise becomes more effective at improving body composition after menopause than before. This may be a “benefit” of the more male body fat distribution patterns. After all, men’s body comp tends to respond more quickly to training than women’s.

Get Started Right Away

If you don’t have much experience with exercise, do it immediately. Don’t wait for the negative effects to accrue. Even if you’ve lived a charmed life where not exercising didn’t really impact your ability to function, that could very well change. The earlier into menopause you start training, the better. The negative changes to exercise tolerance, bone density, and muscle function take awhile to develop, and during the early post-menopause period, your ability to train and reap the benefits of that training is pretty similar to your pre-menopause ability.

Just Do Something

The perimenopausal and early menopausal years can be rough going for many women. You just feel off. You’re not sleeping well. Things are, well, different, and you don’t necessarily have a lot of support to make sense of it or adjust to it. Even though research shows that a minimal amount of exercise can have a big effect on weight gain and disease risk after menopause, sleeplessness or fatigue might be telling you not to do it. Well, that’s not going to cut it. Overcome that. There’s no easy way to say this. No tricks. Just make the decision to exercise, do so regularly for at least a couple weeks, and your exercise tolerance will go up, physical activity will be intrinsically rewarding, and everything will start to improve.

Make Sure You Eat Enough Meat, Dairy, and Other Animal Foods

Protein utilization efficiency drops the older you get, so the older you are the more protein you need to get the job done. Even studies that purport to show negative effects from meat consumption find that older adults benefit from increasing meat. Total protein and dairy protein intake also predict muscle mass and bone mass in postmenopausal women. And meat isn’t just about the protein. It’s also about the micronutrients, like iron, copper (found in organ meats), zinc (high in red meat), carnitine (high in red meat), and phosphatidylserine (high in egg yolks, present in Primal Calm)—all of which have been found to improve women’s physical performance when packaged in a convenient supplement.

Go Into Middle Age As Fit As Possible

Good fitness—aerobic capacity, muscle mass, physical strength, mobility—is a reserve against aging-related degeneration. The fitter you are when menopause hits, the more manageable the transition and the slower that degeneration will be over the subsequent decades.

Intensity Is Important

If anything, it’s more critical for the older woman to push the intensity than anyone else. She often has the most to lose in muscle mass and bone strength. Again and again, across study after study in menopausal women, “low-intensity” doesn’t work as well as higher-intensity training. It still works, mind you. But the greater intensity stuff gives extra benefits.

For instance, in a study comparing a low-intensity aerobic/resistance program to a higher-intensity aerobic/resistance program, both improved muscle strength and walking ability, but only the higher-intensity program improved dynamic balance—a major risk factor for falls.

Intensity Is Relative

By “high-intensity,” I’m not suggesting that a 62 year-old woman do high-rep bodyweight front squats or try to do a double bodyweight deadlift (unless she knows what she’s doing), just that she push the envelope ever so slightly. If your inclination is to do rows with 20 pound dumbbells, consider 25 pounders. If air squats are easy, try them with a weight vest. Sprinting doesn’t have to take place on a track; it can happen in a pool, on a tough hike, or on the bike. Things should be tough but doable.

Volume Should Be Moderate

Exercise has a way of brute forcing glucose tolerance by increasing insulin sensitivity and glucose uptake by muscles, so you’ll be better off than the women who don’t exercise at all, but there’s still a limit because menopause tends to inhibit carbohydrate metabolism and glucose tolerance. High volumes of training, especially if you’re heeding the previous advice to increase the intensity, demand a level of carbohydrate intake that your body probably isn’t prepared to handle.

Lift Heavy Things Twice a Week

You could do more, but I don’t think it’s necessary. Lifting (relatively) heavy weights provides the necessary stimulus to maintain bone density and muscle strength. Movements that engage the whole body, like deadlifts and farmer carries, will be most effective and efficient. These exercises replicate real world movements, like picking up grandkids or carrying grocery bags, that you need to perform. If you’re uncomfortable with these movements, find a good trainer.

Walk a Ton

Walking is magic for everyone, but especially post-menopausal women, for whom a three-day-a-week walking habit improves resistance to heart failure. Join a walking group. Better yet, start one in your circle of friends. Be the example, the leader. No one else will. And set a brisk pace when you do walk. The brisker, the better.

Always Choose the Stairs

Stair climbing itself is a great form of exercise for post-menopausal women, improving leg strength and endothelial function. As a mindset, “taking the stairs” is even more valuable. It’s doing the hard thing. It’s parking in the far lot and walking a quarter mile. It’s carrying your own bags. It’s a mindset to embody: “I’m strong enough, capable enough, and tough enough to take the stairs while people half my age use the elevator to go one floor.”

Compare Yourself To Who You Were Two Weeks Ago, Not the 20-Year-Olds At the Gym

The trend is everything. If you’re getting better, that’s what matters. You are not other people. We all have different situations, capacities, genetic histories, and hormonal profiles. Focus on beating your former self, even if only by a couple pounds lifted or seconds shaved from a sprint time—and nothing else.

Look Into Hormone Replacement Therapy

Since estrogen plays such a key role in women’s physiological function, many studies find exercise to be more beneficial in postmenopausal women who take HRT than in postmenopausal women who do not. It’s a highly personal choice, but I’ll have more on this topic in the future.

Aging women aren’t a different species. Menopause doesn’t really change how you should train in a fundamental way. There aren’t any magical menopause-specific exercises. It just makes certain types of training—and exercise in general—that much more important for health and overall function. You could “get away” with not training much before (not really, but you can fool yourself). Now you can’t. Now you have to exercise and move on a regular basis if you want to maintain functional capacity, take care of yourself, and stick around to enjoy your loved ones.

Thanks for reading, everyone. Take care, and I’d love to hear from any people out there with direct or indirect experience with menopause. How did your training change? How did you change?

As always, direct any questions down below.

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80 thoughts on “Women’s Fitness: Should It Change with Age?”

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  1. I find ballroom dancing, at least an hour almost every day, to have a wonderful combination of benefits: aerobic, social, and mental. It’s been proven the best way to keep mentally fit, and there’s the oxytocin benefit of touch. Highly recommended.

    1. I love ballroom dancing. My parents were both excellent dancers. And they taught me ballroom dancing at a young age. They both aged so well and stayed fit. To this day, they still dance and enjoy the art of dancing.

      1. I’ll second all of that. Ballroom and Latin American are my favourite ‘indoor recreation’.

  2. I’m 51 and don’t seem to be even close to hitting menopause. These tips are great though. Giant yes to taking the stairs…so simple but so true. And walking a ton (having a dog helps.) I also think there is a huge mindset component…people expect to slow down, so they do. They expect aches and pains, so they get them. “Goddesses Never Age” by Christiane Northrup is a great book to read about the mindset part.

    1. Elizabeth, I think maybe it – in some cases, anyway – is aligned to how fit you are? I didn’t start having any problems until I was 54. I’m now 59 and woooaaaoah, it all hit me for six! Perhaps you’ll be one of those women who just sail through everything. Hope so, for your sake!!

      1. oh, wow, Sandy, thanks for the heads up! I am telling myself that I am going to be one of those women that said through it. Have to say my whole cycle become much better when I added more fat and animal protein to my diet after being vegetarian for over 30 years. Definitely helped balance my hormones.

        1. I didn’t hit menopause until 55! With the help of Chinese herbs I never did have one of those hot flash melt downs although I did feel summery every once in a while. Exercising through it all is the ticket.

        2. I reccomend you read this interview:
          https://chriskresser.com/the-keys-to-longevity-with-peter-attia/

          Here, Peter reverses the question from “How can you live a long life?” to “How can you avoid death for as long as possible?”. Why? Because this allows us to reverse-engineer the process of aging:

          Aging is the accumulation of genetic and epigenetic insults. This increases the risk that something in your body will eventually “break” (e.g artheriosclerosis, neoplasm/cancer, or neurodegenerative diseases). Damage occurs slowly, over long periods of time, and eventually something will break and everything else will fall down with it.

          The damage of aging occurs stochastically (randomly) and builds up over time because our body isn’t that good at fixing the wear and tear that inevitably accumulates by just living for a long period of time. In other words, our focus is preventing the accumulation of the wear and tear, of the damage, and of the risk that something will go wrong down the line. Aging is a probabilistic game; if you do the right stuff and have the right lifestyle, then the risk for failure in some tissue is lower, thereby risk builds up slower over time, thereby you last a longer time before dying.

          What does that have to do with your well-being at age 51? Well, it means you managed to accumulate less aging-related damage than the norm, so you can function optimally for longer. To simplify, you’ve set yourself up to live a long life!

          1. Is there a dumbed down version of this interview? I hardly understood a work of it.

          2. I doubt there’s a dumbed down version. What didn’t you understand? I’ll try to explain.

          3. Thanks so much, Stefan. It is kind of you to stick with me on this. So here are my questions; Pillar #1 Is he recommending genetic testing for APOC3 and IGF? Pillar #2 mTor, rapamycin, streptomyces discussion. Since not everone has access to rapamycin, one contols chronic disease by eating, exercising, sleeping, hormones, etc? What is phosphatidylserine? TM to manage stress? Never heard of types of muscle fibers, does it matter??

          4. I will answer in a short amount of time; your reply went in my spam folder and I had lost track of the discussion!

      2. Im above average fit and quite about average from active standpoint. Crossfit, run, etc.. no such luck for me. I will be 51 in 30 days and going thru peri for a year. Good for you at 59 ! Hope you sail..

  3. This is one of the reasons I love Mark’s site. I find everything I need here. I want to be proactive in my health choices, so that as I age I will have a foundation to work off of. Great article!

  4. 53 year old woman here and am having so much joint pain, especially in my elbows that I’ve had to stop doing push-ups, planks and downward facing dogs. Love my yoga but having to adapt it or perhaps even abandon it. Maybe tai chi would be better. I feel like a 75 year old and too young to be having these problems.

    1. I had similar issues when I ate a primal diet that allowed for dairy. Quitting dairy was the secret that has eliminated joint pain for me. I also added Primal Collagen to my diet. But I’ve experimented many times. Two tablespoons of dairy creeps into my diet and some joint somewhere on my body starts to hurt.

    2. Pain is your body’s way of telling you to cool it. The body doesn’t heal as quickly as we age, and any kind of repetitive motion that puts stress on the joints can easily make matters worse. You might consider limiting yourself to just walking for 6 months or so. It’s good exercise while still being gentle enough to let your joints heal..

    3. Tai chi is awesome, you will love it. Good results too. Sue’s Primal Collagen recommendation will help as well.

    4. I had the same problems at a 45 and felt like i was 65…and found out I had extremely low t3.

    5. As Sue mentioned, it was the same for me. I quit all dairy and after only a week my knee pain was almost all gone. I had knee pain all my life, even as a child. Ate a lot of dairy all my life. If I had known how it impacted my health, I would have quit dairy earlier.

    6. I’m mentally preparing to do the autoimmune protocol, for I too am having lots of join pain and I know from my 23andme results that it is in my genes. Some days I am too sore to do my workouts, which is such a bummer since I’ve been active my entire life. I’m 60 now. Thanks for sharing.

  5. 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!

  6. Thank you for hitting this topic, Mark!! As a member of the target demographic, I find that there is not a lot of material out there for the aging female athlete. One thing I want to add is that post-menopausal muscles are much more rigid, and women have to warm up gently before any activities that involve impact (running, for instance) to help avoid muscle tears. Sprints become much more high-risk, and should be transitioned into gradually. Cooling down also is more important, as muscles are more prone to cramp and tear after a workout.
    Bicycling is also a problem for those of us with nerve issues in the groin. I have finally dispensed with racing saddles forever, and have gone with the broadest, softest saddle I could find!

  7. I’ll turn 64 this month, (and am female) so this topic is of special interest to me, and I appreciate your addressing it here. What I have found as I age dovetails well with what you said. I have learned that even though I can work myself up to 100 kettlebell swings (15 pound bell) a few days a week, and feel great doing it…eventually I get sick with a cold and it is back to square one. That is frustrating! I have finally learned to throttle back on the reps and stop well before I feel I have hit my “limit”. It is much more sustainable in the long run and I don’t get sick. I also then have time to do other strengthening exercises or stretches. I am folding in mobility exercises from the Gymnastic Bodies program, such as a short series of bow and an arch for core strength. Again nothing too strenuous. Small increments add up! I have also dialed back the occasional sprints. Maybe an easy “lope” is enough for me now. Standing on one leg, practicing balance….being able to squat and stand easily are important moves to retain. I have a personal rule: If I hear myself grunt when I get up off the floor, (or bend down), I need to exercise more! Those moves need to stay easy peasey, strong and fluid. Someday I hope to have grandkids and I will be able to play on the floor with them, lift them etc. I do not do HRT and have no idea if I should consider it. In times past I took natural progesterone and it really helped at one time. Not sure about any of that any more.
    ***** I think that as we age, it is very tempting to OVER exercise because we are freaked out to find ourselves getting weaker and losing our youth. Unfortunately this can lead to injury, sometimes serious injury. (Part of the reason I am cautious about sprinting now…especially since my husband and I sprint through a large grassy field with uneven ground. I really don’t want to turn my ankle). Bottom line: I am adamant about doing what I can to build and maintain strength and mobility but it needs to be in a context of respect and kindness to my aging body. After all it is the only one I have. (PS I am a certified Primal Blueprint coach).

  8. Of course fitness changes with age, for both men and women. Staying healthy and active, both mentally and physically, will definitely help, but it won’t be a cure-all. If there is such a thing as a magic bullet to slow down aging, it’s to just keep moving, but do it at a pace that you’re comfortable with. Do expect that you’ll tire more easily and your endurance won’t be what it once was. That’s just the nature of the beast, and science has yet to find a way around it.

    Regarding HRT, I’m not a fan for numerous reasons, the main one being that trying to fool Mother Nature can have unpleasant consequences.

  9. Saving this for my 56 year old wife to read tonight. Great stuff. Looking forward to more on this subject.

  10. Great post. I am currently 56 and have been enjoying the primal lifestyle for at least 8 years. I feel better then when I was in my 40s in terms of energy, weight maintenance and overall health and well being. I am so grateful to have found this lifestyle.
    As an important aside, my 19 year old daughter asked my 80 year old aunt what her secret was. Without skipping a beat, she said ‘ Inside, I don’t feel any older then 43’.

  11. Well, it’s not much but reading the article kicked my butt out into the air and sun to walk a bit. I’ve got a pulled glute or something so I basically looked like the old woman I am hobbling around the quad. Sad! But the walk helped. I did bribe myself with a kombucha at the end.

  12. A very helpful post! At 67, I have have definitely felt I had low energy tolerance for the last several years. Not that I did nothing – and at least I live in a 5th-floor walk-up – but it wasn’t intense or regular enough overall. The last few months I have been doing more – taking a workout class or two each week along with walking, tennis and some yoga – and I feel stronger and healthier. This post is a good reminder not to let up.

  13. Love how you point out how men’s hormonal environment “degenerates,” with declining numbers of the same hormones, while women’s hormonal environment “shifts dramatically.” This is such a key point – and affects all body systems…and so many aspects of life!

    I’ve exercised my entire life…but at 43 have gravitated toward what feels totally natural and effortless, in the sense that it’s just part of my day: lots of relatively fast walking (oftentimes an hour a day), lots of yoga (which includes plenty of strenuous body-weight movements, in my practice), summer hiking (up a steep mountain:). By contrast, I’ve left CF behind – it was making me feel more tired than energized.

    Personally and with my coaching clients, the number one thing truly is diet when it comes to responding to hormonal shifts. But movement (of the supportive sort) is a huge piece too. I can’t imagine my daily life without it at any age, for physical and mental-emotional health!

  14. I would be immensely grateful to hear what you and readers think are good choices in terms of HRT. Nothing that I’ve read about so far seems to be. That is very concerning.

    1. I use bio identical creams and have had good success with them. I use progesterone and small amounts of estrogen and am considering testosterone. The progesterone helps with sleep and it calms me as well as I struggled with anxiety due to fluctuating hormones. Estrogen helps with overall mood. Find a Dr. who specializes in bio identical hormones. Listen to your body if you choose to start them. I find that a lot of Dr.’s prescribe to high of a dose. Find a Dr. that starts low and builds up as needed. I personally like creams over pellets because with a cream
      You can control how much you put in your body and it’s easy to make adjustments. With pellets you can’t take them out because they are inserted into the body. You have to wait till they wear off so if your dosage is to high you can’t do anything for a few months. Hope this helps. This is such a personal decision for many but I would not be without my hormones.

      1. Tina, I am on the same. Bio identical compound hormones. When I started gaining weight and having hot flashes, And as someone who lifts and does alot of metcons, the weight gain was a blow to ego. I went to a Dr. who specializes in women’s aging process and follows a more natural HRT. So many women waste time with their primary docs.

    2. I’m perimenopausal (43) and have suffered from PMDD for some time. This last month was the first in probably a couple years that I didn’t want to die and wasn’t angry, irritable, and otherwise emotionally unstable. I credit it to keto, a natural women’s supplement, and bioidentical progesterone cream.

      I did a ton of my own research into bioidentical hormones and feel that they are safe and beneficial for me. I have worked with a couple naturopaths in this, but ultimately had to experiment on my own to figure out what worked. Although I think having a good doctor can help, you can also do it on your own. Just start low like Tina said and don’t be afraid to try new things. It took a few months for me to get here.

      Just two months ago in the second two weeks of my cycle, I’d be in hell, but I’m in halfway through those two weeks right now and have been pretty calm and happy!

  15. Great article, which I will forward onto my 74 year old mother. I started having perimenopause in my mid forties (I’m 48 now) and terrible hot flashes. My lab work showed I was estrogen dominant and eliminating dairy stopped the hot flashes cold (no pun intended!). Turns out the cows receive estrogen to lactate which is not good for the estrogen dominant woman (there is a Harvard study on this). Thought I’d pass that along (not eating dairy also stopped my asthma as well).

  16. Hormone replacement therapy comes with lots of risk and it’s surprising to hear you mention it so casually…

    1. HRT risks are overrated. Read “The Estrogen Window” by Dr. Seibel, its a great book that explains everything

    2. I had the same thought, Kristin. It seems very un-Primal, un-Mark. (Staying tuned for his follow-up article to see where he goes with that.)Menopause, to me, is “puberty in reverse”. Just like we were designed to become reproductive, we are designed to become un-reproductive…and the pendulum swings a bit as we are adapting and recalibrating either way. Usually by menopause though, we have thrown in a lot of food, stress, sleep and exercise factors that aren’t in our best interest compared to puberty. It makes no sense to me to add hormones from the outside during, or after, that adaptation but to look first to food, exercises, sleep, stress, etc., all of the “Primal” perspectives.

  17. Even though I’ve always chosen outdoor work and activities over indoor and gone hard, Mark’s piece has some relevant reminders. One is to keep up the walking speed. I’m a meat and egg consumer but should check that the amounts are adequate. Dairy is kind of my fast food when tired or busy and feel it could be displacing some amount of vegetables. Intending a couple of weeks off dairy, see if that helps a mild mucousy condition too.
    Absolutely committed to wearing out, not rusting out. Too much family exposure to senior care. I’m 64, my dad died at 65 after 2 years in a NH. From Parkinson’s, not disuse.

  18. Hmmm… interesting article and I am sure it applies to many women. Went through menopause in late 40’s, and had always been active (at the gym) but started doing triathlons at 52 so everything switched to outdoors, and continued to get stronger and healthier year by year. Now at 65, have adopted Primal eating and Primal Fitness program 8 weeks ago, have lost 12 lbs, building even more muscle and increased FTP on the bike by 20%. No aches or pains and no HRT. Would not recommend it. Many more natural routes to follow. I wouldn’t want pre menopausal women thinking that it is a tough road ahead. For the masses, probably yes, but for those followers of Primal, keto, etc and a healthful, wholistic lifestyle, it only gets better! :).

    1. The alternative medicine community has known for at least 25 years that HRT is risky and has been known to cause cancer. I once mentioned this to a friend who had begun taking Premarin–not because she was having health issues associated with menopause, but because she wanted to stay young and beautiful forever. She pooh-poohed the idea that it could cause problems, and now, some years later, she has developed breast cancer. Coincidence? Sure, maybe so, but then again, maybe not. One has to consider the fact that some chemicals just do not belong in the human body.

  19. I’ve been using Biote pellets to replace estrogen and testosterone for the last 5 years. That. along with finding a Primal way of eating, completely changed my life. I am stronger and more sexual at 63 that I was at 43. I train hard at a gym that emphasizes functional fitness and occasional HIIT, walk a ton. I easily maintain my weight and body fat in the low 20s, and have a lover who is 10 years younger than I am. I can’t say that I absolutely love getting older, but I can’t complain!

    1. Karen, you rock! And glad you brought sexuality into this convo…it’s an important part of life. I’m younger than you are, but totally agree, can’t complain about getting older. For me so many things have actually gotten better.

  20. Excellent post. 64, NBT’s Blood Calculator says 53 (yay). Paleo, high quality supplements, agree with the HRT – using OTC progesterone and bi-estro creams to avoid the problems with pills – and doing own thyroid replacement + iodine per Stop the Thyroid Madness. Overcoming autoimmune connective tissue disease is tough, along with a dislocated shoulder, CMC joints, twisted ankle and C5-7 fusion, have to choose exercise carefully and allow more time than I prefer to recover. Walking/hiking, bands, hand weights, Essentrics, Total Gym, Maxi Climber and very mindful of good posture per Gokhale.

  21. Here, here. I agree totally with ANNE. I had a pretty tough ‘peri and menopausal’ time so by age 58 went off all grains and all sugars. Now have no more hot flashes unless I break down and have more than a couple of ounces of red wine (rarely). I also have to supplement with magnesium to prevent leg cramps. Otherwise I also take 4,000 IU Vitamin D, 500-1000 mg Vit C, Collagen powder, UBIQUINOL. Cycling in and out of ketosis with occasional IF.
    Presently at 65 yrs in winter I ski both downhill and x country daily. Yoga and body weight exercises daily. Spring and summer….walking, gardening, kayaking, cycling and going barefoot most of the time or wearing Vibram 5 fingers.
    This fall will be cycle touring for 2 to 3 months in Europe 50 to 65 kms per day. This will be my third extended cycling trip!
    The only issue is vaginal dryness, which I have alleviated by using estriol vaginal creme about twice per month.
    I highly recommend Katy Bowman’s book DYNAMIC AGING which was co written with 4 septuagenarian women who have been following Katy’s ‘program’ for 10years…they are AMAZING women! My favourite pastime is climbing my 100 ft red cedar tree and hanging out up top with the birds!

  22. Hi Mark- any comments on pre-menopausal women who are on Tamoxifen post-breast cancer? Its a growing group, myself incl and Im at a loss to know how to tweak my Primal lifestyle given my new environment. Thanks!

    1. Yes, I’m a man… but you’d be surprised what I’ve learned about estrogen because of how it impacted my own life. Estrogen producing compounds are pervasive in our modern world and its far reaching affects creates concerns for both men and women. When I have this conversation with people, I always go back to the root cause narrative.

      As it relates to root cause, “supplements” aren’t the ultimate solution and neither is monotherapy anything (but you already know this) which is why you’re eating and living in alignment with the Primal Blueprint! To get healthy, and to stay healthy, we need a total system approach with diet, lifestyle and behavior.

      For instance, tt’s common that when someone “supplements” with progesterone, or any other sex steroid hormone for that matter, that the negative feedback loop, and receptor site down regulation, affects all sex steroids. This is why progesterone can offer early benefit for so many, but over time (when the body realizes what’s going on), the body senses that down stream metabolites / hormones (estrogen, cortisol, etc) are “above normal” for homeostasis so the body’s negative feedback loop starts to slow down the production of all of these hormones in an effort to reduce the offending agent. What’s more is that the receptors sites for these hormones down regulate, or become less sensitive over time, as another biological mechanism to reduce the “free” amount of these hormones, in an effort to bring the body back into balance. This may be the explanation for low hormones.

      That said, balancing estrogen naturally should be a major focus for both men and women. Bear in mind that almost everyone is bathing in phytoestrogens and xenoestrogens in the modern world… Ten years ago, I was too… I developed a lump in my chest and it grew… my estrogen was way, way higher than it should have been… yes, I had estrogen dominance. I eliminated all phytoestrogens and xenoestrogens from my life (which is why I talk about not eating nor drinking nor wearing from non-native materials) because this is yes another source of estrogen. It turns out that I am also homozygous for the COMT gene which means that I have an 80% decreased capacity to clear estrogen (thanks mom and dad!). That said, I eliminated all sources of phyto and xeno estrogens, I provided my body with all the things it needs for phase I and phase II detox (all on the About Us page here: https://ancestralsupplements.com/about-us.html) and I further supported my methalyation metabolism with lots and lots of liver and egg yolks. My estrodial (e2) went from >80 pg / ml to within 22 – 26 pg / ml, the lump totally went away and my life is way, way, way better now as a result of these learnings.

      Once again, think root cause… and yes, this is only one of them! In biological systems, it’s rarely one (or) the other that produces results (for good or bad) but rather the combination of diet, lifestyle and behavior. I suggest to continue to follow the Primal Blueprint and consider the following…

      – Do a google search “list of all phytoestrogens and xenoestrogens” and avoid these as much as you can
      – Continue or implement a primal aligned eating pattern — this is major!!
      – Consume Liver, Bone Marrow, sunshine and add in plenty of egg yolks to the tune of at least a couple a day (I do six, yes, I’m extreme!)
      – Add kimchi and/or sauerkraut – phase II detox support and vitamin K2
      – Mind your magnesium with oral and /or transdermal magnesium oil
      – Wear the uvex glasses and eliminate all ambient light
      – As always, move more…

      I’ve probably said too much… but there, I’ve said it. Maybe this will help one person… man or woman! Thanks for listening.

      1. I really love your complex systems approach with biology… It’s truly what makes biology so endlessly fascinating.

        I replied to your comment on Ben Greenfield’s STEM article — I’m interested in hearing more about your 5-day water fast “apoptotic experiment” and seeing your before and after pictures. How’s it going? Do you think it’s sustainable? What’re your experiences, successes and failures with this approach? Any cautions?

      2. Thanks Liver King…nice to have a dude contribute to this convo. And totally agree
        with you about supplements…sometimes can see initial improvement that then goes away. Lifestyle and mindset are key.

      3. I thought it was unclear whether fermented vegetables were a good source of K2. Would any raw, fermented store bought sauerkraut or kimchi be a good source?

        1. HI Tiffany! I think that you’re mistaken… there’s K2 (MK-7) that comes from bacterial fermentation and then there’s K2 (MK-4) that comes from animals.

          – K2 (MK-7). Get this from fermented veggies like homemade kimchi and sauerkraut made with Kinetic Culture (my favorite) or buy a boutique brand at the store and make sure that it’s raw, NOT pasteurized. If you can spoon some natt? into your mouth (and manage to swallow it), do it every time there’s a blue moon. You’ll also find some of this MK-7 variety in diary too.

          – K2 (MK-4 ). Get this from organ meats, bone marrow, wild fish eggs, and to a lesser degree, pasture raised (totally organic) egg yolks. You can even get this from desiccated Grass Fed Beef Brain / desiccated Bone Marrow in capsule form (yes, that’s a shameless plug!).

          If you throw in the towel all together, make sure that you’re getting a good K2 complex supplement with multiple forms of K2 (especially MK-7 and MK-4) and make sure that it’s GMO free since it will likely be coming from soy… you already know the backstory there.

  23. Hi all, I am 59 and love to workout. I am in it for the long haul. I have seen it and done it all..from Jane Fonda workouts to Crossfit. It’s amazing to see the changes over the decades! Here are a few tips from an elder.
    1. Always do your best. It will vary from ready to hit PR to just showing up.
    2. Respect the lift be it lifting a Barbie weight to a 150 lb deadlift. This will increase focus and safety. It also develops presence and a mindful attitude.
    3. Do what you love and have an arsenal of workouts to choose from. I do Crossfit, heavy weights , tai chi, yoga, total gym, walking, dance ,running occasional Zumba and prancercise?. I have learned to listen to my body and adjust accordingly.
    4. The workout does not end at the gym, nature or wherever I am. Move during the day and eat right.
    5. My own motivator is music. Give me Daft Punk Robot Live or some Fatboy Slim and I am in it. Find what moves you.
    6. Meditation.I have found that I was having a disconnect of mind and body. Meditation brings my mind and body in sync. When I connect with the breath my mind and body becomes one.
    Down 40 lbs and loving the peace I have found. Peace from N.C.

    1. Love your tips! I’m also from NC, I am only 21 but your suggestions are great in general 🙂

  24. I turned 50 recently and am not yet menopausal, to my knowledge. I strength train Monday to Friday and am trying to add in more cardio when time allows and the weather cooperates for outdoor walks/sprints. On weekends, I also sometimes do a short but intense workout of some kind when time/inspiration hits. Over the past 6 months, I have noticed a decline in the desire to work out or eat to fuel/recover from workouts. Prior to this, missing a workout would have put me into a tail spin and not getting my – at least – one gram of protein per pound of body weight would do likewise. Protein is the only macro I track. Recently, I’ve been trying to relax the hustle and bustle a bit and have been trying to eat more intuitively. I haven’t noticed any discernible difference physically or otherwise. I don’t have any real weight to lose but am noticing a bit of belly bloat throughout the day and adding/maintaining muscle and strength is getting harder. Generally, I feel pretty good with how I look and my energy levels but am finding the chase to strive for more is waning. Sometimes I do feel like that “other” species Mark eluded to …

  25. Great topic! Thanks to the paleo lifestyle and crossfit I am in the best shape of my life at age 49 and a half! I am in periomenopause now and have still lost 45 pounds over the last 2.5 years. (I am still on the pill though so haven’t dealt with hormone fluctuations, and never had kids). Other than annoying night sweats I haven’t had any of the traditional perio symptoms. The intensity of crossfit which includes lifting heavy things twice a week has really suited my body. I think incorporating a movement routine like daily yoga practice, stretching and rolling become more and more important as the years go on. I recently read Dara Torres, the olympic swimmer’s bio and she mentioned her secret to beating competitors half her age was an intense ‘mashing’ treatment of her muscles where her personal trainers basically mashed her muscles with their feet before each race.

  26. I was all about the chronic cardio and heavy lifting during my 20s and 30s. But my body became inflamed and exhausted. Now, in my mid 40s, I have eased into an exercise routine that I love, which never includes making myself go to the gym. I walk briskly and do yoga everyday, complete sprints or tabatas once a week, and do outside chores (like splitting and stacking wood) and PEMs a few times a week. I ski and hike as well. The important thing is that I move my body in ways that I love!

  27. I’m excited for the post on HRT. Would love to hear your take on that. I agree exercise is more important than ever during these inevitable changes.

  28. So glad to see this topic, and based on all the responses, others are too!! A mostly ignored demographic. I am 55 and just starting to have some changes to my menstrual cycle in the last 1.5 years. I struggle with food issues, and fall on and off the primal & keto wagon. There is an absolute connection for me with being keto and hormones. When I eat carbs & sugar, my cycle starts coming late, but when I go back to keto or primal, it regulates.

    Not sure if this was mentioned anywhere, but I think every older woman would benefit from having in-depth thyroid testing done. It think it would be shocking how often older women have thyroid deficiency.

    Regular walking makes such a difference in my mood, energy, and general well being. Will be adding farmer walking, for sure.

    Attitude-my grandma died just short of her 98th birthday, and lived by herself and was in good health up until the last year of her life. She used to say that sometimes when she looked in the mirror, she would be surprised to see an old woman, because she still felt 16.

    Please, let’s have more on this topic!!!

  29. I’m turning 40 this year and have a ways to go before menopause, but I really enjoyed this article. I hope to be well prepared for the future and be proactive. I have made some really big lifestyle changes in the last couple of years. Ketogenic eating, regular high intensity and weight lifting exercise and conscious daily movement. I feel pretty fantastic about my transformation. Lost weight, toned up my body, and am seeing great lab results. My main motivation was to not develope diabetes, like several of my family members have. In this article you said “High volumes of training, especially if you’re heeding the previous advice to increase the intensity, demand a level of carbohydrate intake that your body probably isn’t prepared to handle”, could you clarify? You were talking about carb metabolism and insulin sensitivity. Being on a low carb/keto diet has been fantastic for me, i have already seen a need for macro adjustments as my body has adapted. However, when I start going into menopause, how might my already low carb diet change?
    Love your insight on all things primal and keto.
    Thank you.

  30. I hit menopause 2 years ago. It’s definitely been a rocky ride. The hot flashes and night sweats were horrible. I am on bioidentical HRT and it’s helped a lot but, I gained a lot of weight in a short period of time. Not sure if it’s related to the HRT but I am finding that nothing is working to take it off. I have never been this heavy except when I was pregnant with my daughter 17 years ago.

    I typically go to Crossfit class 5 days a week but due to issues with 5 discs in my back, cannot lift really heavy anymore. Really struggling with best eating plan for my situation at the moment.

  31. Hi there – 65 years here and I cannot overemphasize the importance of the sprint. I cycle, snowshoe (climbing sometimes 1500 feet), walk a lot and hike. I push up the hills on my bike until I am breathing hard. Same with the climbs through the snow. It is the best! I find it is just about the only thing that fights the middle age spread I will NEVER get used to. Don’t be afraid to exercise.
    Just keep moving – and there are lots of ways to build bone. I reversed some lumbar osteopenia lifting some weight, carrying groceries, and holding up my own weight in yoga.
    As women, we do not need to accept society’s version of the “older female.” I couldn’t agree more with Mark.
    One thing I’ve learned though as I’ve gotten older is the power of recovery. I’ve learned to rest in between exertion. It’s become more elastic: exert, rest, exert, rest, etc. It sure seems to work better.

  32. Mark thanks I find this incredibly motivating. I was mountain biking until four years ago and winning races in my category, before I had major surgery to my spine. I am 70. Now my nerves keep me in pain 24 hours. I tried to train like before the surgery until doctors told me I was overdoing it. The worst advice! Now I’m battling to get back to more regular/intense training.

    1. Hi Sonja. Am very sympathetic to your plight.
      A suggestion, if I may: ease off a bit from the “battling” aspect.
      Over many decades we have been taught, and it is ingrained in our culture that “no pain, no gain” and “more is better.” regarding exercise and physical culture. Through research we are now learning that this way of thinking could NOT BE FURTHER from the truth regarding our anatomy and physiology. We were not designed to be or function in pain. Pain is our nervous system’s way of informing us that something is not right.

      I strongly recommend you go to Essentrics.com and choose a beginner easy level DVD that will slowly begin to help your muscles, joints, tendons, ligaments and fascia release, relax and simultaneously be strengthened. Begin slowly. Do not work in or through any pain. Practice daily. Consult with your MD before beginning any exercise protocol.

      Essentrics, created by Miranda Esmonde-White, is an amazing technique and easy to learn and perform. Miranda works with Olympic level and professional athletes and regular folks of all ages. This is a scientifically designed technique that is being studied by a major pain institute. People who have suffered in pain for years often attain remarkable and lasting changes in their bodies over a relatively short period of time.

      Do yourself a big favor and explore this. You can view interviews with Miranda on YouTube. The website is very informative.

      Miranda has written 2 bestselling books:

      Aging Backwards
      Forever Painless

      You can get them from your public library

      Wishing you a complete, speedy and full recovery

    2. Sonja, in addition to my previous reply to your post a highly qualified massage therapist, physical therapist or DO, who has expertise in the following bodywork modalities may be quite helpful:

      Structural Integration (Rolf Institute, Boulder, CO for info)

      CranioSacral Therapy (Upledger Institute)

      Advanced Myofascial Release techniques

      Visceral Manipulation (Barral Institute)

      Acupuncture

      Prolotherapy (requires medical doctor)

      Osteopathic physician (D.O.) who practices Osteopathic Manual Therapy including cranial osteopathy

      Best of luck!

  33. 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!

    1. Also check out Aston kinetics with Judith Aston…she has a really good short video showing one specific exercise for strengthening the pelvic floor!

  34. Hello ladies and Mark! The information presented below is given in service to all on Mark’s Daily Apple. I have absolutely no connection to what I recommend below.

    I have been a massage therapist/bodyworker for 29 years. I have and still am witness to the tremendous suffering of most Americans who lack a healthy diet and are way too sedentary. This is why I implore you to please perform some type of exercise/movement on a daily basis. Life is vitally dependent on movement right down to the cellular level.

    I am 63 years of age and have endured my share of back and musculoskeletal challenges including a lumbar stenosis, bone spurs, nerve root compressions and anterior pelvic tilt. Tried all sorts of stretching, chiropractic, massage therapy, etc. Last year I had to ponder rethinking my career the discomfort was so great.

    Then, in May of 2017, I found the “fountain of youth” for physical and mental rejuvenation. I began practicing Essentrics, a dynamic full body stretching, strengthening moderate cardio workout created by Miranda Esmonde-White. Miranda is a former professional ballerina who suffered daily with debilitating back pain for decades. (Some of you may have seen her on PBS during their fundraising events.)

    I began the gentle scientifically designed workouts and within 4 DAYS was standing with much better posture. I became completely asymptomatic after several months of performing Miranda’s 22 minute daily workouts. Every routine works all 650 muscles and 360 joints! These exercises unlock the muscles and liberate the joints along with promoting plasticity and pliability of the fascia—-the tissue in our bodies that supports and connects all structures from the cells to your organs, muscles, etc.

    I feel better now than I did in my 20’s! Am stronger, more flexible, mobile and pliable. After a hard day of work my recovery and resilience is excellent. Essentrics unlocks the muscles and liberates the joints which which will exponentially increase your energy. When muscles become freed up the bones become more properly aligned. Balance will also improve.

    The good news: Essentrics is EASY to learn and perform. Do it in your home, office, hotel room, outdoors.

    Tips: perform all exercises in bare feet ideally in front of a mirror in the beginning. This helps ensure proper form and alignment. Please NEVER attempt to work through any pain. Back off if pain occurs. Over time your range of motion will improve. Stay as relaxed as possible and remember to breathe—you will be strengthening the muslces while they are in a lengthened position. This is completely the opposite of all the type of compression movements associated with most physical activity. It is fine to continue whatever physical regimen you may currently be on but it is ESSENTIAL that you rebalance your musculoskeletal and nervous systems with Essentrics exercises. This will keep you feeling amazing, pliable, upright and strong into your 90’s.

    I plan on continuing with Essentrics for my lifetime. I will be adding in some HIIT along with more bodyweight exercises.

    Thanks to Mark’s generous sharing of his incredible knowledge I have also reset my metabolism with going keto. Feel amazing and dropped A1C level from 6.3 (a breath away from diabetes, to 5.5). Aiming for 5.0 or a bit lower. Lost 17 pounds.

    Ladies, you can all do this, too!

    Wishing everyone excellent health!

  35. Great article…thank you, Mark! Hmmm….though it seems very un-Primal, un-Mark to recommend HRT casually. (Staying tuned for the follow-up article to see where you go with that, Mark! )Menopause, to me, is “puberty in reverse”. Just like we were designed to become reproductive, we are designed to become un-reproductive…and the pendulum swings a bit (sometimes a LOT of bit) as we are adapting and recalibrating either way. Usually by menopause though, we have thrown in a lot of cummulative food, stress, sleep and exercise factors that aren’t in our best interest compared to puberty at a relatively youthful age. It makes no sense to me to add hormones from the outside during, or after, that adaptation but to look once again to food, exercises, sleep, stress (especially stress!), etc., all of the “Primal” perspectives.

    1. Hi Carrie. In an ideal world it would be wonderful to be able to pass through perimenopause, menopause and post menopausal life relying solely on our evolutionary/primal biology.

      Unfortunately, for certain women this is not possible. Through many clients referred to me over the years from integrative MDs, NDs, and certified nutritionists who have their patients on excellent proven natural health protocols there are some women who still suffer immensely when going through these hormonal changes.(I am massage therapist who practices a variety of therapies including lymph drainage therapy, craniosacral therapy and visceral work).

      When placed on bioidentical HRT they received excellent relief and got their lives back. Most of these ladies initially went through the usual route of dietary changes, proper supplementation including botanicals, homeopathic remedies, along with chelation therapy for removal of heavy metals and other therapeutic interventions.

      When prescribed in an appropriate and judicious manner by a practitioner with solid expertise and experience, bioidentical HRT can be a life saver.

      1. Absolutely! I could not agree more, Marion. “When prescribed in an appropriate and judicious manner by a pracitioner with solid expertise and experience, bioidentical HRT can be a life saver.” Well said.

  36. What about the cellulite! I have been menopausal for 7yrs now and I am 51 soon. My problem is my skin tone and cellulite continues to decline. I exercise, have bone broth or gelatine in my coffee and eat fermented foods. Very frustrating to feel Im doing what I can without any improvement. Is it more about exercise or lack of oestrogen ? Any ideas?

  37. can I get reprints of this to give to my patients? (family practice md)

    1. Mary, welcome! And thanks for your interest in sharing this with your patients. If you go to the bottom of the article (under the final ad), you’ll see a social media bar that includes Facebook, Instagram, etc. On the right hand side of that bar, you’ll have a print option in dark gray. Sources in the print version are footnoted. Feel free to distribute these copies.

  38. When I was 56, I weighed a 164 pounds at 5’1″. I was doing some cardio and walking about 9 miles a week on a regular basis but this wasn’t even touching my weight loss problem. I went to a personal trainer and I said, can you help me? That was the day my life changed. I kept doing my cardio 3 times a week but then I started weight training. As I continued to run, the weather got nice outside so I took to running outside. By the end of the year I had ran a marathon. Never planned on running a marathon but I was running 17 miles a day on weekends, I thought why not. I completed the marathon and turned my attention back to weight lifting. I decided that I needed a weight lift goal. I decided to try and achieve the 500lb club which is to bench, squat and deadlift a total of 500lbs. Right now I am at 400lbs. Anyhow, I weigh less that 125lbs, my body is so sculpted that even I don’t even recognize it. Others who have seen my transformation have been inspired to start exercising. It’s been an amazing experience, I am so happy my body responded to weight training and running. I feel like I am in the best shape that I have ever been in all my life at 57. Don’t give up ladies…you got this!

  39. I turned 65 this year. Every year on my birthday and other times throughout the year I do a “run” up a three mile hill. It is a slow run, but a run nonetheless. I started jogging at 40 and kept it up until my knees started to complain, and now I mostly walk. I average 7,000 to 10,000 steps every day. I walk to town to buy groceries and often bring back 7 to ten pounds back in my backpack. Getting “old” is tough. Often my body hurts, its normal for me to stiffen up when sitting or sleeping. I try to ignore these aches and pains and go walkabout regularly every morning, sometimes a short walk after dinner as well. Stretching seems to help. My goal is to be able to run up my hill at 70 and go from there. I’ve been eating paleo style for seven years now and have very few carbs, mostly in vegetables. I eat breakfast after my walk in the morning. I’ve also started an art business which keeps my mind active.