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Good cooking is art and science. You’re measuring, you’re tasting, you’re following recipes, you’re following intuition. You’re adding a dash of this, a level teaspoon of that. It’s clinical and sensual at once. For this kind of good cooking to occur, pleasurable cooking, the kitchen needs to disappear. It must get out of the way and become an extension of your body. You shouldn’t have to think about what to use or where to grab it; you just know it. A messy, disjointed lab or workspace is hell.

The ideal kitchen is just that, of course, an ideal. It’s probably not attainable or maintainable. Something will always come up to mar the optimality, like a toddler hanging on your ankle or the dirty dishes from last night or that damn spatula that always blocks the drawer from opening. But we can aim for it and get as close as possible.

These tips aren’t specific to Primal. They’re not specific at all; I won’t tell you which dishes to make. They are general guidelines that will increase the efficiency of any home cook.

First, Remove Clutter

Clutter gets in the way. The more stuff you have in your kitchen, the more likely something is going to end up on your counters when you’re trying to set up your mise en place, slow you down when grabbing that pot you need.

For Cookware, Quality Over Quantity

We’ve all stayed at that vacation rental whose description promises a “fully stocked kitchen” only to have cupboards and drawers stuffed with dozens of scratched teflon pans, aluminum skillets, rusty cast iron, and cheap stainless steel. Technically the description was accurate, but at what cost? You’re banging and clattering around just to get at the good stuff.

You want the cooking session to go smoothly, elegantly, with grace? Keep only high-quality cookware, and less of it, and you’ll glide through the kitchen. Buy fewer items of higher quality.

Stainless steel, not aluminum.

Cast iron and carbon steel, not nonstick.

Use Multi-Use Tools Whenever Possible

Single-use kitchen tools are fun to use when you need one—and that’s it. Otherwise, they collect dust and get in the way. How often do you need a garlic press? Do you really need that avocado slicer? Or that apple peeler—really?

Obviously, if you use the tool all the time, keep it around. If you’re running a crepery out of your kitchen, keep the crepe pan. But if you only bust out the single use contraption once or twice a year, give it up.

An Instant Pot is the perfect example of a complex kitchen tool that replaces many: your slow cooker, rice cooker, yogurt maker, and stove top pressure cooker. A sharp chef’s knife is the perfect example of a simple kitchen tool that replaces many complex single-use tools.

Get Nesting Storage Containers

Glass storage containers are really hit or miss. They’re inert, thus far better than plastic, but too many of them stack rather than nest, creating precarious piles of glassware. They take up too much room in the drawers, they’re liable to fall over and break, and they always end up messy and disorganized.

When you nest, you save space, and your containers are more secure.

I like these nesting glass containers from Rubbermaid.

Throw Out Old Spices

Once exposed to air, spices degrade quickly. Go through your spice drawer/bin/shelf and inspect each spice with a sniff. If it has no discernible aroma, toss it. If there are duplicates, keep the one that’s fresher. There’s nothing more annoying than taking an extra ten minutes to scour your cluttered spice drawer for the last ingredient.

When you’re cooking, or getting ready to cook, keep these tips in mind.

Clean As You Go

If you’ve ever faced the chaos of a post-dinner party kitchen, you know the value of cleaning up as you cook. It takes a little more effort at first, but it makes the cooking experience flow more smoothly, and it reduces chaos and clutter. Few people manage to religiously adhere to this one. That’s okay. You don’t have to clean everything as you go. Cleaning even just a few items as you cook will lighten the load you face at the end and reduce clutter in your workspace. Everything helps.

Have A “Peel Bowl”

When you’re cutting onions, peeling shallots, smashing garlic, or doing any kind of vegetable prep, you end up with a ton of sticky waste material that gets everywhere and mixes in with the veggies you’re keeping. Keep a large bowl next to the work area for direct deposits of vegetable cuttings. Instead of accumulating on the cutting board, they go right into the bowl. If you compost, you could just have a small compost bin nearby to chuck everything directly in.

Keep Your Salt In a Wide-Mouthed Glass

I keep kosher salt in an open wide-mouthed glass about 2.5 inches in diameter. This allows me to grab pinches whenever I need it, and it gives me perfect control over the amount of salt I wish to apply. If I’m cooking something involved, I’ll usually use a separate glass with all the salt I’ll need for that cooking session. I can dip into the salt without washing my hands in between applications, because I’ll just wash the glass at the end.

Have Very Hot Water on Hand

Hot water can very quickly come to a boil. Eminently useful for cooking for obvious reasons.

Hot water can be used to clean dishes. Better to use a little near-boiling water than let your sink run.

You can bring a pot to boil, then cover it. It’ll stay warm for a long time. You can also keep water warm in your Instant Pot using the “warm” setting, which hits about 160°F.

Immediately Soak or Wipe Gelatinous Saucy Dishes

I love a good reduction using bone broth or added gelatin. You reduce until the collagenous viscosity coats the spoon. It’s the secret of many restaurant sauces—high quality bone broth reduced to a syrup.

However, if you leave that pan or those dishes for more than a few minutes without cleaning them, exposure to cooler air quickly hardens the sauce and makes cleaning it extremely difficult. Wipe those dishes clean right away, perhaps with your tongue.

For general kitchen efficiency, keep these tips in mind.

Keep an Overabundance Of Dish Towels

You can never have too many dish towels. They’re less wasteful than going through half a roll of paper towels, they seem to “mop up” spills and sticky fingers better than anything else, and they can double as pot holders. Get the cheapest ones you can find that still absorb liquids; nothing worse than those towels that just push the spill around.

Come Up With Some “Kitchen Rules,” and Stick To Them

One of mine is “keep the counters cleared at the end of the day.” This gives me a clean, fresh start every morning. I may not eat breakfast very often, but I don’t like coming out to a dirty, cluttered counter in the morning.

Another is “clean the coffee maker right away.” This also gives me a better start in the morning. My day goes much more smoothly when I can start out with a clean French press that’s ready to accept coffee and water. Cleaning it right away also means the grounds come out more easily. They have less time to adhere to the walls.

Purge Your Fridge Every Week and Your Pantry Every Month

You shouldn’t be embarrassed for guests to open your fridge. Check the back for old leftovers. Dig through the cheese drawer for mold that’s not supposed to be there. Discard slimy greens. A clean, organized fridge is a pleasure to encounter and will make cooking that much easier.

Same goes for your pantry. Pantry items won’t go bad so easily, but it’s really easy to just keep stacking stuff on top of stuff until you can’t find anything and the pantry door won’t even close.

Just be an adult about the state of your fridge and pantry. You know when it’s getting out of hand. Don’t ignore it.

That’s what I’ve got, folks. It keeps my kitchen running pretty smoothly. What about you? I’d love to hear tips and tricks from my intrepid readers, and so would my readers.

Thanks for reading, everyone. Don’t miss the final New Year giveaway with tomorrow’s feature. Take care.

The post Primal Kitchen Efficiency: 13 Tips for Daily Organization and Smooth Cooking appeared first on Mark’s Daily Apple.

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Behavioral disorders: A pandemic disabling our children

It is normal for children to be energetic and occasionally distracted, upset, or argumentative. However, when these behaviors become disruptive and cause harm to the child or others, a diagnosis of a behavioral disorder may be made. Recent research indicates that one in six children in the United States is afflicted with developmental and behavioral disorders, including attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, autism spectrum disorder (ASD), anxiety disorder, learning disorders, and conduct disorders. (1)

According to neurology experts Philippe Grandjean and Philip Landrigan in a 2014 report in The Lancet Neurology, “a silent pandemic of neurodevelopmental toxicity” is disabling children around the world and contributing to the meteoric rise of ADHD, ASD, and other behavioral disorders. (2) What is responsible for the rapidly rising rates of behavioral disorders in children? Research indicates that heavy metal exposure promotes neurodevelopmental toxicity and may be one of the underlying causes of childhood behavioral disorders.

Mercury

Childhood exposure to mercury occurs primarily through the consumption of seafood, vaccines containing thimerosal, and dental amalgams. Mercury is a potent neurotoxin that directly passes through the blood–brain barrier and accumulates in brain tissue and the spinal cord, disrupting neurological function. Children are especially susceptible to the harmful effects of mercury, and a growing body of research indicates that mercury exposure is associated with an increased risk of behavioral disorders.

• Prenatal mercury exposure, measured through samples of cord blood, is associated with ADHD symptoms in children. (3)
• Postnatal mercury exposure from thimerosal in vaccines has been linked to ASD, ADD, ADHD, and tic disorder. (4, 5, 6)
• A systematic review of 44 studies concluded that mercury levels were significantly higher in the whole blood, red blood cells, and brains of autistic subjects compared to controls. (7)
• Mercury content in ambient air is linked to an increased prevalence of autism in children. (8)
• Even low levels of mercury are harmful to the developing brain and have been associated with learning disabilities. (9)

Heavy metals may play a role in your child’s behavioral disorder. Learn how to reduce your exposure.

Lead

Lead is a pervasive environmental toxin that adversely affects the developing nervous system in children. Children may be exposed to lead through paint chips, dust, and water pipes in homes built prior to 1978, as well as dirt, drinking water, and air pollution. (10)

• In animal studies, prenatal exposure to lead has been found to alter synapses in the brain, impairing neurotransmission and learning behaviors. (11)
• Children who grew up near the location of a former lead refinery were found to have a higher risk of ADHD. (12)
• Even very low levels of lead have adverse effects on the brain and behavior in children. Blood lead levels less than 1.8µg/dL, well below the CDC’s recommended threshold of 5µg of lead per dL of blood, are associated with an increased risk of ADHD. This suggests that there is no safe limit for lead exposure in children. (13)

Manganese

Manganese is a heavy metal that is required by the body in small amounts to create antioxidant enzymes, for the metabolism of carbohydrates and amino acids, and to promote bone development and wound healing. It can be found in foods such as green leafy vegetables, tea, and legumes. However, manganese toxicity can occur when manganese dust from sources such as chemical manufacturing and welding is inhaled or when high levels of manganese are present in drinking water.

• Manganese exposure has been linked to ADHD. (14)
• Children exposed to high levels of manganese through drinking water have been found to experience diminished intellectual function and behavioral problems. (15, 16, 17)

Aluminum

Aluminum is a pervasive heavy metal used as an adjuvant in vaccines, as a food additive, and in metal cookware, beverage cans, antacids, and antiperspirants. Research has found high levels of aluminum in the brain tissue of deceased individuals with autism; the aluminum was most concentrated in immune cells of the brain, suggesting that aluminum elicits a neuroimmune response. (18) A significant correlation also exists between the amounts of aluminum adjuvant administered to children in vaccines and the prevalence of autism spectrum disorder, further supporting the theory that aluminum adversely impacts the developing brain. (19)

Arsenic

Arsenic has become a common contaminant in soil and groundwater due to its prevalence as a byproduct of industrial manufacturing processes. Arsenic is also present at high levels in conventionally raised poultry, which is fed arsenic-containing drugs, and in rice from India and areas outside of California. Urine arsenic levels have been associated with decreased IQ in children. (20)

How heavy metals harm the brain

Heavy metals pass through the blood–brain barrier and accumulate in brain tissue. Once in the brain, they harm neurological function through several mechanisms.

• Heavy metals displace essential minerals such as zinc and iron that are required for neurotransmitter production. (21)
• Heavy metals induce oxidative stress, which reduces neuronal plasticity and impairs learning and behavior. (22)
• Aluminum accumulates in immune cells of the brain. This may provoke an inflammatory immune response that ultimately affects neurological function and behavior. (23)

Heavy metal testing

Heavy metal testing is a controversial topic because each of the currently available methods of testing—hair, urine, and blood—has some drawbacks.

• Hair testing. Hair testing has become a popular method for assessing heavy metal status. However, using hair testing alone, we cannot know for certain whether a high level of a metal in the hair reflects a significant body burden of that metal or indicates that the patient is efficiently eliminating the metal through the hair and thus has a low level of it in the body.
• Urine testing. Urine heavy metal provocation tests, which use a chelating agent such as DMSA to provoke a release of heavy metals into the circulation, present problems similar to those with hair testing; it is possible that a metal may be high in the urine because the body is efficient at excreting it, or it may reflect a high body burden of the metal. Another problem is that reference ranges for provoked urine results have not been developed or validated.
• Blood testing. Blood testing is problematic for assessing heavy metal status because heavy metals typically circulate in the blood for only a short time before becoming sequestered in tissues.

While each of these testing methods is faulty when used alone, combining a couple of techniques may be a more accurate way to assess heavy metal toxicity. For example, you could do a provoked and an unprovoked urine test, or a hair test and a provoked urine test. Combining two tests may paint a more accurate picture of the body’s total heavy metal burden.

How to avoid heavy metals

Reducing exposure to heavy metals may lower the risk of childhood developmental disorders. Pregnant women should be conscientious about heavy metal exposure because heavy metals cross the placenta and can affect the brain of the developing fetus. Parents with young children also need to be careful since the brain is especially sensitive to toxic insults during childhood.

There are a handful of steps you can take to reduce exposure to heavy metals:

• Don’t use aluminum pans for cooking. Choose stainless steel or enameled cast iron instead.
• Choose seafood low in mercury. The Monterey Bay Aquarium’s Seafood Watch program is a helpful tool for learning which types of seafood are highest and lowest in mercury. Wild-caught Alaskan salmon, wild-caught Pacific sardines, and pole-caught albacore tuna are among the lower-mercury choices; Atlantic cod, halibut, shark, and swordfish tend to be much higher in mercury.
• Choose thimerosal-free vaccines.
• Filter your drinking and bathing water. Invest in a high-quality drinking water filtration system that removes heavy metals.
• Choose organic chicken. Conventionally raised chicken is high in arsenic.
• Limit intake of brown rice and white rice from India and areas outside of California. Rice from these regions tends to be high in arsenic. White rice from California is lower in arsenic and thus a safer option. See my article “Arsenic in Rice: How Concerned Should You Be?” for more information.
• Prevent heavy metal pollution from entering your home. If you have children and work in manufacturing, construction, or another profession that involves heavy metal exposure, bathe and change clothes immediately after work to avoid contaminating your home with heavy metals in dust, dirt, etc.

Strategies for the treatment of heavy metal toxicity in children

Research indicates that detoxification and excretory pathways responsible for detoxifying heavy metals may be impaired in children with behavioral disorders. (24) However, by enhancing detoxification pathways, replenishing essential minerals and vitamins, and supplementing with probiotics, it may be possible to alleviate heavy metal toxicity and reduce symptoms in children with behavioral disorders.

Support the glutathione pathway
The glutathione pathway is a crucial system in the body for detoxifying mercury and other heavy metals. Glutathione, often referred to as the “master antioxidant,” binds to heavy metals and facilitates their removal from the body. Research has found that ASD patients have lower glutathione levels than controls, a problem that may promote the retention of heavy metals in the body. (25) Oral and transdermal glutathione supplementation raises plasma glutathione levels in the blood of autistic children, an effect that may facilitate heavy metal detoxification. (26)

Replenish essential minerals and vitamins
When the body is deficient in essential minerals, heavy metals preferentially bind to sites normally occupied by those minerals. Replenishing the body with essential minerals can, therefore, help prevent heavy metal accumulation and increase metal excretion.

• Selenium. Selenium, an essential mineral that serves as a cofactor for the enzyme glutathione peroxidase, may benefit children with autism. (27)
• Zinc. Another essential mineral, zinc, alleviates heavy metal toxicity by competing with heavy metals for binding sites on cells and enzymes. Research indicates that zinc replenishment is beneficial for kids with autism and ADHD. (28) To replenish zinc levels, I suggest feeding your children zinc-rich foods, such as oysters, rather than zinc supplements, which may not be safe for children over the long term.
• Iron. Iron competes with heavy metals for intestinal absorption, and iron sufficiency downregulates transporters that bring heavy metals into intestinal cells and the systemic circulation. Restoration of iron levels has been found to relieve ADHD symptoms in children. (29) I recommend feeding your kids organ meats and shellfish to ensure optimal iron levels.
• Vitamin B. Replenishment of vitamin B6 may also alleviate heavy metal toxicity. B6 supplementation reduces the accumulation of lead in body tissues. When combined with magnesium, it has been found to improve symptoms of ADHD. (30, 31) The top dietary sources of vitamin B6 are liver and other organ meats, egg yolks, nuts, bananas, and avocados. (32)

The power of probiotics
Several studies indicate that probiotics alleviate heavy metal toxicity. Research indicates that Lactobacillus rhamnosus and L. plantarum, commonly found in probiotic supplements and fermented foods, protect against heavy metal toxicity. (33, 34) These findings also suggest that a healthy gut microbiome may protect against heavy metal toxicity.

Chelation therapy: Use with caution

Chelation therapy involves the use of synthetic chelating agents such as CaNa₂ EDTA and DMSA and may be necessary to remove certain metals like lead. However, there are significant concerns about the safety and efficacy of chelation. Chelation depletes essential minerals and has the potential to redistribute heavy metals within the body. These effects may be especially harmful to children. For this reason, chelation should only be done under the guidance of a qualified healthcare professional. Avoidance of heavy metals and the use of nutritional detoxification strategies such as those mentioned above may be a gentler and safer method for reducing a child’s heavy metal burden.

Now I want to hear from you. Do you have a child with a behavioral disorder? Do you think heavy metals might be impacting your child’s health and behavior? What strategies have you tried for treating heavy metal toxicity? Let me know in the comments below.

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“Some people continue to suffer uncomfortable digestive problems despite omitting the foods they may be intolerant to. If there are no definite test results pointing at an allergy or intolerance, then you’ll most likely be diagnosed with irritable bowel syndrome (IBS).

Scientists Peter Gibson and Susan Shepherd at Moash University in Australia researched the reasons behind the vicious cycle of bloating, diarrhea, constipation, and discomfort. They came upon some evidence proving that certain sugars could actually be the cause of many of these ailments: ‘Fermentable Oligo-Di-Monosaccharides and Polyols,’ thus founding the term FODMAP.

Fermentable: these types of sugar have the ability and tendency to ferment in our intestines, resulting in bloating and diarrhea.

Oligosaccharides: fructans (FOS), wheat, rye, onions, garlic, galactans (GOS) (legumes), chickpeas.

Disaccharide: sucrose, maltose, lactose.

Monosaccharide: fructose, glucose, and galactose.

Polyol: sorbitol, mannitol, xylitol, maltitol (sugar substitutes).

It is not possible to completely avoid each and everyone one of these types of sugar, since they are found naturally in the food we eat. It would be wise to avoid eating foods containing large amounts of these sugars for a certain amount of time, simply to see if they could be the reasons behind the problems you may be experiencing.

Research has proven that there is a certain daily limit of FODMAPs that can be tolerated. If you’ve eaten your daily limit in lactose already, then it’s no wonder that when you eat the same berries that you ate the day before with no negative effects, all of a sudden they cause you discomfort. Try picturing your FODMAP limit, applying it throughout the day, distributed evenly in each meal. If you go over your limit, then you are bound to have negative reactions.

The pure food Paleo diet eliminates the consumption of fructose and galctan by eliminating grains. Legumes are also avoided with the occasional exception. You are able to test fruits after a grace period, using the guide to see which fruits are better tolerated than others. It all depends on moderation.”

—From Fruit Belly: A 4-Day Quick Fix To Relieve Bloating Caused by High Carb, High Fruit Diets by Romy Dollé

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Chicken and turkey are popular for being high in protein and low in saturated fats making a mealtime staple for athletes as well as in many healthy eating households. Falling back on the same old recipes starts to become mundane and a little too routine.

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An ear ache might initially seem like something you can ignore and hope that it’ll go away, over time it can make your life almost unbearable. That constant throbbing never leaves your side, distracting you from your work, preventing you from doing the sports and hobbies you love, and even getting in the way of […]

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Diastasis recti abdominis (DRA) is one of the more notable changes that takes place during pregnancy. To accommodate the growing baby, the abdomen expands, stretching the skin, muscles and connective tissue (including the linea alba). As the abdomen expands in pregnancy and the linea alba stretches, the distance between the two sides of the rectus abdominis muscles (the inter-recti distance) usually increases.

This is a normal process in pregnancy and should not be considered to be abnormal or pathological.

If you delve into the research into diastasis recti during pregnancy, you will see that most women have some degree of separation in their final trimester. We don’t want you to obsess over your tummy muscles in pregnancy, but feel that it is a good idea to monitor your abdominal wall for any bulging of the linea alba between the two sides of the rectus abdominis muscles during exercise or daily activities.

The simple way to do this is to look and feel: place your fingers just above your belly button and feel for any bulging along the midline during activity. If you are wearing a tight T-shirt, sometimes you may be able to see the outline of the abdominal muscles, and if bulging occurs it will usually be obvious. For many women, it presents like a ridge running vertically between the six-pack muscles. If bulging is evident during a particular exercise, you can choose to eliminate that exercise or modify your technique. If you cannot see or feel on yourself, you can get a qualified health or fitness professional to check for you. Good alignment and breathing may help you control intra-abdominal pressure more effectively and eliminate the bulge.

Again, we don’t want you to obsess over your tummy muscles and be checking them constantly, but rather to be aware of DRA and monitor for bulging.

For some women, diastasis recti can manifest as pelvic pain or back pain. The pelvic joints rely on the passive and active structures for stability — this includes the ligaments, joint surfaces, joint capsules, muscles and connective tissue. Significant weakening of the linea alba may reduce the ability of the abdominal musculature to provide optimal stability to the pelvic joints and may lead to pain in some women. It’s important to acknowledge though that research shows that there is not more low back or pelvic pain in women with diastasis recti, so as always we need to look at each personal individually [1].

Is Diastasis Recti the Same as a Hernia?

A diastasis recti isn’t the same as a hernia, and should be approached differently.

Some women experience a more pronounced diastasis recti than others. As you roll over in bed, you might notice a large bulge that appears at the midline of your abdomen. As you start to get up from a chair or out of the car, you might feel discomfort along the linea alba as the tissue strains to maintain the pressure.

If you notice a large diastasis recti, you may want to see a physiotherapist that works with pregnant women. Often, the physiotherapist will perform an assessment and make recommendations for exercise and give specific strengthening exercises or an external support as required.

In contrast, you may notice a small, localized bulge with coughing or certain movements, which might be indicative of an umbilical hernia. A hernia is a weakness in the connective tissue which causes bulging of organs in response to an increase in intra-abdominal pressure. For instance, if you cough, sneeze, or lift something heavy, tissues may herniate through the weak point, causing pain. If you suspect a hernia, we recommend that you see a medical professional for assessment and guidance.

Can Diastasis Recti Be Avoided?

This is one of those ten-million-dollar questions, and there is no definitive answer. Some studies show that women who exercise regularly through pregnancy have a reduced risk of having a significant diastasis in pregnancy. However, there are some issues with those studies in terms of the number of subjects involved and how they were selected. A longitudinal study published in 2015 showed that there was no difference in the incidence of diastasis recti at six months between those who exercised pre-pregnancy and during pregnancy [1].

It’s believed that most, if not all women experience some separation of the linea alba during pregnancy. Pretty much every woman will have a diastasis of greater than 16 millimeters by weeks 35 to 39 of her pregnancy [1].

At this point in time, what makes a diastasis more pronounced during pregnancy isn’t known, but it is believed that genetics probably play a large role. One study looked at multiple risk factors, comparing women with and without DRA, and found that there was no difference between prepregnancy body mass index (BMI), weight gain, baby’s birth weight or abdominal circumference between the two groups [1].

It is difficult to predict who will experience a more significant DRA, so don’t beat yourself up over it if you do have a large gap.

Although there is currently no research to support this, it seems prudent to make modifications to exercises and other physical activity in order to potentially reduce the severity of this abdominal separation.This might include eliminating higher-level abdominal exercises but ultimately it will vary depending on the individual.

By the third trimester (and sometimes by the middle of the second), many women opt to remove loaded rectus abdominis exercises such as planks, crunches, and sit-ups due to weakness in the abdominal wall or obvious diastasis recti. Some women can continue with these exercises without any problems, however, and we do not make blanket rules when it comes to abdominal exercise in pregnancy.

Another modification we often recommend is reducing the load used when exercising as the pregnancy progresses. When you take into account all the changes happening in the abdominal wall and pelvic floor, it is no surprise that you may be feeling weaker in the final trimester. Rest assured that it is normal to feel the need to use lighter weights as your due date approaches. You should never feel like a failure for doing so. Studies actually show that the abdominal muscles are unable to produce as much force in the final trimester as in earlier stages of pregnancy or your pre-pregnant state — so you really shouldn’t expect your weights to remain the same [2].

We don’t want to scare you, and these adaptations are not permanent, but the consequences of pushing beyond the capacity of the abdominal wall and pelvic floor may be.

Healing Diastasis Recti After Pregnancy

As mentioned above, the distance between the rectus abdominis muscles, also known as the inter-recti distance, widens in pregnant women in their third trimester. In the postnatal period, some women’s diastasis recti will “heal” without any intervention (assuming that no additional stress or aggravation of the separation exists).

More than half remain abnormally wide eight weeks after delivery, and although some recover by six months, many have not recovered at even one year. A study in Norway followed over 300 women through the first 12 months after giving birth to assess the recovery from diastasis recti [3]. In the study, diastasis recti was defined as a palpated separation of two finger breadths or greater, either 4.5 centimeters above, or 4.5 centimeters below the navel. Results showed that almost one-third of women had at least a mild separation at 12 months postpartum (and consequently that two-thirds didn’t — which, according to the study, means that the diastasis recti had “healed”).

Prevalence of diastasis recti abdominis categorized as normal, mild, moderate and severe.

What Does Healing Mean For Diastasis Recti?

Here’s where things get tricky. How studies like the one mentioned above define “healing” might not always be the healing that most women actually need. For example, what that study, and many others, define as “healing” refers to the distance between the two sides of the rectus abdominis becoming narrower, a closing of the gap. This distance used to be considered the gold standard for measuring healing of diastasis recti, with the overall aim of management being to reduce the wide of the gap.

However, many experts now recognize that the biggest concern in diastasis recti isn’t purely the separation. Rather, it’s the loss of density and ability to produce tension in the linea alba that can compromise the function of the abdominal wall. For some women, the linea alba is very thin and wide and does not transfer force between the two sides of the abdominal wall effectively.

Therefore, it’s important to remember that even if your linea alba remains wide, it may be still possible to regain what’s most important: function. On the flip side, just because the gap between the linea alba has narrowed or closed, doesn’t necessarily mean you’ve regained optimal function. We believe that working to regain optimal function of the abdominal wall is crucial because if the deep central stability system doesn’t functionally recover, it could potentially lead to problems with organ and postural support. For some women this may mean that they feel weak, can’t perform as well as they used to or they may experience pain in the back, pelvis or limbs.

A large diastasis recti can cause your abdomen to still appear somewhat pregnant because there is less support for the abdominal contents. Many women lament having what they call a “pooch” or “mummy tummy” which they believe is due to excess abdominal fat. In reality, it’s sometimes a result of a linea alba that is thin and wide, with the abdominal contents dropping forward in standing.

For some women, the appearance of the abdominal wall is not concerning as long as it functions well. For others, the aesthetics are the prime concern and the trigger for seeking assistance from a health or fitness professional. Just as exercise during pregnancy may help minimize the severity of diastasis recti, most women require some retraining of the abdominal and pelvic floor muscles during the postnatal period to help restore optimal function.

The amount of rehab and the length of healing time your diastasis recti will require will depend on your genetics, age, number of pregnancies, and the size of your babies during those pregnancies. For some women, just a gradual return to activities and self-monitoring is all that is required, but for those with more significant diastasis or concerns, a more individualized program may be recommended.

Assessing Your Diastasis Recti

A pelvic health physiotherapist can help you with assessing and treating your diastasis recti, and depending on the severity, you may only need a session or two in conjunction with following a postnatal training program (like our Moms Gone Strong program). Working with a professional who is trained in treating diastasis recti will allow you to monitor how well your diastasis is healing so there’s no guesswork, and you know how long you need to continue your diastasis rehab protocol. You can also learn how to assess your own diastasis recti in this article by Jessie Mundell — although we still recommend seeing a pelvic health physio for an assessment at least once.

To Brace or Not to Brace? Belly Wraps and Other Postpartum Supports

Many women like to wear belly wraps to help the linea alba heal following pregnancy. Splinting, bracing, or wearing a support garment is a popular recommendation in the management of diastasis recti. There are a number theories supporting this recommendation including but not limited to: supporting the abdomen, bringing the rectus abdominis muscles closer together, giving gentle compression to help with swelling, offering support to the lumbar spine, and giving women more confidence in their body.

At this stage, research does not clearly demonstrate whether or not external supports are truly effective. Some experts believe that the use of splinting, bracing, and wearing of a support garment may have more adverse effects, such as increased pressure on the pelvic floor, encouraging reliance on an external device, and reducing muscle strength and activation through the abdominal musculature. Others believe that use of an external support may reduce tension on the healing linea alba and result in a better outcome.

To our knowledge there are no studies showing that bracing is beneficial for managing your diastasis recti, but we believe that these are useful guidelines in deciding on whether or not to use a support.

Wraps may be helpful if:

• You can’t rest very much in the six weeks following delivery and you feel that you need some extra support. This could be because you have a toddler or because you have a cough that stresses your abdominal wall.
• You are having back, pelvic, or pubis symphysis pain. The compression from the wrap can help relieve the pain in some cases.
• You’ve had a C-section and need to support the incision.
• You are exercising and want a little bit more support.
• You have a separation wider than three fingers.

Wraps may be harmful if:

• You wrap the support too tightly or you use one made of rigid material which limits abdominal movement and may put excess pressure on your pelvic floor.
• You don’t perform rehab exercises because you think the wrap will do everything for you.
• You wrap the support from top (ribs) to bottom (upper pelvis), which can also increase pressure on the pelvic floor.

If you choose to use an abdominal wrap, use one that you find comfortable and supportive, but not restrictive. You should be able to take full breaths while wearing your support wrap. That said, because there isn’t any definitive data as to whether or not belly wraps are helpful in recovery, we recommend that you discuss wraps with your pelvic health physiotherapist to determine what’s best for you.

Belly wraps are simply not a solution on their own. To strengthen and retrain your abdominal wall  you will still have to do rehab exercises.

Other supportive garments that you may consider include pelvic supports and compression shorts. Pelvic supports wrap around the pelvis to help support the pelvic joints and help relieve pain in the pelvis. These will not have much impact on the diastasis itself but may help relieve pain in the pelvic joints. Compression shorts look a bit like biking shorts or shapewear (like SPANX), but they feature medical grade compression and work to support your abdominal wall following pregnancy.

Some women prefer compression shorts instead of wraps, binders, and other garments simply because they offer support to the perineum as well as to the abdominal area, as they support from the bottom up. (Remember, applying pressure from the top down can increase pressure on the pelvic floor.) They also don’t shift or bunch like some other wraps or binders, and they are easier to wear than many wraps or binders — just pull them on, and you’re good to go.

That said, what’s most important is that you choose the option that feels most comfortable to you, and that your pelvic health physiotherapist is in agreement with your choice. Sometimes a simple elastic tubular bandage can be all that you need!

When to See a Physical Therapist for Your Diastasis Recti

• You have a diastasis of wider than two fingers.
• You have a deep diastasis of more than 1 centimeter.
• You have minimal tension in the gap.
• You have concerns regarding your abdominal muscles.
• You experience bulging along the linea alba with exercise.

Remember that even if you gave birth 10 years ago, you can still address this issue, so don’t write yourself off just because you are some years postpartum.

A diastasis is not a contraindication to general exercise, but you can work closely with a physical therapist to make sure you’re moving well and exercising safely.

References

1. Fernandes da Mota PG, Pascoal AGBA, Carita AIAD, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther. 2015 Feb 20(1):200–5.http://www.mskscienceandpractice.com/article/S1356-689X(14)00181-7/fulltext
2. Gilleard, WL, Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period., Phys Ther. 1996 Jul;76(7):750-62. https://www.ncbi.nlm.nih.gov/pubmed/8677279
3. Sperstad, JB, Tennfjord, MK, Hilde, G, Ellström-Engh, M, Bø, K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Sep;50(17):1092–6. http://bjsm.bmj.com/content/50/17/1092.info

The post Does Everyone Get Diastasis Recti in Pregnancy? appeared first on Girls Gone Strong.

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Day 291 Of 360

Rest as needed between sets. If set requires interruption, adjust as little as needed to complete next set uninterrupted. When scheme is listed as “5 x 5″, it always refers to “Sets” x “Reps.”

Reminder: Position and range of motion- most specifically, a straight, strong lock-out- always govern weight.

Then:

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Chicken and turkey are popular for being high in protein and low in saturated fats making a mealtime staple for athletes as well as in many healthy eating households. Falling back on the same old recipes starts to become mundane and a little too routine.

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