This salt alternative could help reduce blood pressure. So why are so few people using it?
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One in three Australian adults has high blood pressure (hypertension). Excess salt (sodium) increases the risk of high blood pressure so everyone with hypertension is advised to reduce salt in their diet.
But despite decades of strong recommendations we have failed to get Australians to cut their intake. It’s hard for people to change the way they cook, season their food differently, pick low-salt foods off the supermarket shelves and accept a less salty taste.
Now there is a simple and effective solution: potassium-enriched salt. It can be used just like regular salt and most people don’t notice any important difference in taste.
Switching to potassium-enriched salt is feasible in a way that cutting salt intake is not. Our new research concludes clinical guidelines for hypertension should give patients clear recommendations to switch.
What is potassium-enriched salt?
Potassium-enriched salts replace some of the sodium chloride that makes up regular salt with potassium chloride. They’re also called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.
Potassium chloride looks the same as sodium chloride and tastes very similar.
Potassium-enriched salt works to lower blood pressure not only because it reduces sodium intake but also because it increases potassium intake. Insufficient potassium, which mostly comes from fruit and vegetables, is another big cause of high blood pressure.
What is the evidence?
We have strong evidence from a randomised trial of 20,995 people that switching to potassium-enriched salt lowers blood pressure and reduces the risks of stroke, heart attacks and early death. The participants had a history of stroke or were 60 years of age or older and had high blood pressure.
An overview of 21 other studies suggests much of the world’s population could benefit from potassium-enriched salt.
The World Health Organisation’s 2023 global report on hypertension highlighted potassium-enriched salt as an “affordable strategy” to reduce blood pressure and prevent cardiovascular events such as strokes.
What should clinical guidelines say?
We teamed up with researchers from the United States, Australia, Japan, South Africa and India to review 32 clinical guidelines for managing high blood pressure across the world. Our findings are published today in the American Heart Association’s journal, Hypertension.
We found current guidelines don’t give clear and consistent advice on using potassium-enriched salt.
While many guidelines recommend increasing dietary potassium intake, and all refer to reducing sodium intake, only two guidelines – the Chinese and European – recommend using potassium-enriched salt.
To help guidelines reflect the latest evidence, we suggested specific wording which could be adopted in Australia and around the world:
Why do so few people use it?
Most people are unaware of how much salt they eat or the health issues it can cause. Few people know a simple switch to potassium-enriched salt can help lower blood pressure and reduce the risk of a stroke and heart disease.
Limited availability is another challenge. Several Australian retailers stock potassium-enriched salt but there is usually only one brand available, and it is often on the bottom shelf or in a special food aisle.
Potassium-enriched salts also cost more than regular salt, though it’s still low cost compared to most other foods, and not as expensive as many fancy salts now available.
Jimmy Dean/Unsplash
A 2021 review found potassium-enriched salts were marketed in only 47 countries and those were mostly high-income countries. Prices ranged from the same as regular salt to almost 15 times greater.
Even though generally more expensive, potassium-enriched salt has the potential to be highly cost effective for disease prevention.
Preventing harm
A frequently raised concern about using potassium-enriched salt is the risk of high blood potassium levels (hyperkalemia) in the approximately 2% of the population with serious kidney disease.
People with serious kidney disease are already advised to avoid regular salt and to avoid foods high in potassium.
No harm from potassium-enriched salt has been recorded in any trial done to date, but all studies were done in a clinical setting with specific guidance for people with kidney disease.
Our current priority is to get people being managed for hypertension to use potassium-enriched salt because health-care providers can advise against its use in people at risk of hyperkalemia.
In some countries, potassium-enriched salt is recommended to the entire community because the potential benefits are so large. A modelling study showed almost half a million strokes and heart attacks would be averted every year in China if the population switched to potassium-enriched salt.
What will happen next?
In 2022, the health minister launched the National Hypertension Taskforce, which aims to improve blood pressure control rates from 32% to 70% by 2030 in Australia.
Potassium-enriched salt can play a key role in achieving this. We are working with the taskforce to update Australian hypertension management guidelines, and to promote the new guidelines to health professionals.
In parallel, we need potassium-enriched salt to be more accessible. We are engaging stakeholders to increase the availability of these products nationwide.
The world has already changed its salt supply once: from regular salt to iodised salt. Iodisation efforts began in the 1920s and took the best part of 100 years to achieve traction. Salt iodisation is a key public health achievement of the last century preventing goitre (a condition where your thyroid gland grows larger) and enhancing educational outcomes for millions of the poorest children in the world, as iodine is essential for normal growth and brain development.
The next switch to iodised and potassium-enriched salt offers at least the same potential for global health gains. But we need to make it happen in a fraction of the time.
Xiaoyue Xu (Luna), Scientia Lecturer, UNSW Sydney; Alta Schutte, SHARP Professor of Cardiovascular Medicine, UNSW Sydney, and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global Health
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Cashew Nuts vs Coconut – Which is Healthier?
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Our Verdict
When comparing cashew nuts to coconut, we picked the cashews.
Why?
It can be argued this isn’t a fair comparison, as coconuts aren’t true nuts, but it’s at the very least a useful comparison, because they have very similar (often the same) culinary uses, so deciding between one or the other is something people will often do.
In terms of macros, cashews have 6x the protein and more than 2x the fiber, as well as slightly more fat (but the fats are healthy, as are those of coconut, by the way) and 2x the carbs. Depending on what you’re looking for, this head-to-head could come out differently, but we say it’s a win for cashews.
You may be wondering: if cashews have more of all those things, what are coconuts made of? And the answer is that coconuts have 8x the water (and yes, this is counting the coconut meat only, not including the milk inside). Of course, if you get dessicated coconut, then it won’t have that, but we’re comparing fresh to fresh.
In the category of vitamins, cashews have a lot more of vitamins B1, B2, B3, B5, B6, E, and K. Meanwhile, coconut has more vitamin C, but it’s not a lot. An easy win for cashews here.
When it comes to minerals, cashews have rather more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, and zinc. On the other hand, coconut has more sodium. Another easy win for cashews.
Cashews also have the lower glycemic index.
All in all, cashews win the day.
Want to learn more?
You might like to read:
Take care!
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A Cold Shower A Day Keeps The Doctor Away?
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A Cold Shower A Day Keeps The Doctor Away?
This is Dutch extreme athlete Wim Hof, also known as “The Iceman”! He’s broken many world records mostly relating to the enduring the cold, for example:
- climbing Mount Kilimanjaro in shorts
- running a half-marathon above the Arctic Circle barefoot
- standing in a container completely covered with ice cubes for more than 112 minutes
You might not want to do yoga in your pyjamas on an iceberg, but you might like…
- better circulatory health
- reduced risk of stroke
- a boosted immune system
- healthier skin
- more energy and alertness
…and things like that. Wim Hof’s method is not just about extreme athletic achievements; most of what he does, the stuff that can benefit the rest of us, is much more prosaic.
The Wim Hof Method
For Wim Hof, three things are key:
- Breathing (See: Wim Hof Method Breathing Exercises)
- Commitment (See: How to Increase Willpower)
- Cold therapy (See: Benefits of Cold Therapy)
Today, we’re going to be focusing on the last one there.
What are the benefits of Cold Therapy?
Once upon a time, we didn’t have central heating, electric blankets, thermal underwear, and hot showers. In fact, once upon a time, we didn’t have houses or clothes. We used to be a lot more used to the elements! And while it’s all well and good to enjoy modern comforts, it has left our bodies lacking practice.
Practice at what? Most notably: vasodilation and vasoconstriction, in response to temperature changes. Either:
- vasodilation, because part of our body needs more blood to keep it warm and nourished, or
- vasoconstriction, because part of our body needs less blood running through it to get cooled down.
Switching between the two gives the blood vessels practice at doing it, and improves vascular muscle tone. If your body doesn’t get that practice, your blood vessels will be sluggish at making the change. This can cause circulation problems, which in turn have a big impact in many other areas of health, including:
- cardiovascular disease
- stroke risk
- mood instability
- nerve damage in extremities
On the flipside, if the blood vessels do get regular practice at dilating and constricting, you might enjoy lower risk of those things, and instead:
- improved immune response
- healthier skin
- better quality sleep
- more energy and alertness
- improved sexual performance/responsiveness
So, how to get that, without getting extreme?
As today’s title suggests, “a cold shower a day” is a great practice.
You don’t have to jump straight in, especially if you think your circulation and vascular responses might be a bit sluggish in the first instance. In fact, Wim Hof recommends:
- Week 1: Thirty seconds of cold water at the end of a warm shower each morning
- Week 2: One minute of cold water at the end of a warm shower each morning
- Week 3: A minute and a half of cold water at the end of a warm shower each morning
- Week 4: Two minutes of cold water at the end of a warm shower each morning
How cold is cold?
The benefits of cold exposure begin at around 16ºC / 60ºF, so in most places, water from the cold water mains is sufficiently cold.
As your body becomes more used to making the quick-change on a vascular level, the cold water will seem less shocking to your system. In other words, on day 30 it won’t hit you like it did on day one.
At that point, you can either continue with your two-minutes daily cold shower, and reap the benefits, or if you’re curious to push it further, that’s where ice baths come in!
Can anyone do it, or are any conditions contraindicated?
As ever, we’re a health and productivity newsletter, not doctors, let alone your doctors. Nothing here is medical advice. However, Wim Hof himself says:
❝Listen to your body, and never force the practices. We advise against doing Wim Hof Method if you are dealing with any of the following:
- Epilepsy
- High blood pressure
- Coronary heart disease
- A history of serious healthy issues like heart failure or stroke
- Pregnancy*
- Childhood*❞
*There is simply not enough science regarding the effects of cold exposure on people who are pregnant, or children. Obviously, we don’t expect this to be remedied anytime soon, because the study insitutions’ ethics boards would (rightly!) hold up the study.
As for the other conditions, and just generally if unsure, consult a doctor.
As you can see, this does mean that a limitation of Cold Therapy is that it appears to be far better as a preventative, since it helps guard against the very conditions that could otherwise become contraindications.
We haven’t peppered today’s main feature with study papers, partly because Wim Hof’s own website has kindly collated a collection of them (with links and summaries!) onto one page:
Further reading: The Science Behind The Wim Hof Method
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An unbroken night’s sleep is a myth. Here’s what good sleep looks like
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What do you imagine a good night’s sleep to be?
Often when people come into our sleep clinic seeking treatment, they share ideas about healthy sleep.
Many think when their head hits the pillow, they should fall into a deep and restorative sleep, and emerge after about eight hours feeling refreshed. They’re in good company – many Australians hold the same belief.
In reality, healthy sleep is cyclic across the night, as you move in and out of the different stages of sleep, often waking up several times. Some people remember one or more of these awakenings, others do not. Let’s consider what a healthy night’s sleep looks like.
Bricolage/Shutterstock Sleep cycles are a roller-coaster
As an adult, our sleep moves through different cycles and brief awakenings during the night. Sleep cycles last roughly 90 minutes each.
We typically start the night with lighter sleep, before moving into deeper sleep stages, and rising again into rapid eye movement (REM) sleep – the stage of sleep often linked to vivid dreaming.
If sleeping well, we get most of our deep sleep in the first half of the night, with REM sleep more common in the second half of the night.
Deepest sleep usually happens during the first half of the night. Verin/Shutterstock Adults usually move through five or six sleep cycles in a night, and it is entirely normal to wake up briefly at the end of each one. That means we might be waking up five times during the night. This can increase with older age and still be healthy. If you’re not remembering these awakenings that’s OK – they can be quite brief.
What does getting a ‘good’ sleep actually mean?
You’ll often hear that adults need between seven and nine hours of sleep per night. But good sleep is about more than the number of hours – it’s also about the quality.
For most people, sleeping well means being able to fall asleep soon after getting into bed (within around 30 minutes), sleeping without waking up for long periods, and waking feeling rested and ready for the day.
You shouldn’t be feeling excessively sleepy during the day, especially if you’re regularly getting at least seven hours of refreshing sleep a night (this is a rough rule of thumb).
But are you noticing you’re feeling physically tired, needing to nap regularly and still not feeling refreshed? It may be worthwhile touching base with your general practitioner, as there a range of possible reasons.
Common issues
Sleep disorders are common. Up to 25% of adults have insomnia, a sleep disorder where it may be hard to fall or stay asleep, or you may wake earlier in the morning than you’d like.
Rates of common sleep disorders such as insomnia and sleep apnoea – where your breathing can partially or completely stop many times during the night – also increase with age, affecting 20% of early adults and 40% of people in middle age. There are effective treatments, so asking for help is important.
Beyond sleep disorders, our sleep can also be disrupted by chronic health conditions – such as pain – and by certain medications.
There can also be other reasons we’re not sleeping well. Some of us are woken by children, pets or traffic noise during the night. These “forced awakenings” mean we may find it harder to get up in the morning, take longer to leave bed and feel less satisfied with our sleep. For some people, night awakenings may have no clear cause.
A good way to tell if these awakenings are a problem for you is by thinking about how they affect you. When they cause feelings of frustration or worry, or are impacting how we feel and function during the day, it might be a sign to seek some help.
If waking up in the night is interfering with your normal day-to-day activities, it may indicate a problem. BearFotos/Shutterstock We also may struggle to get up in the morning. This could be for a range of reasons, including not sleeping long enough, going to bed or waking up at irregular times – or even your own internal clock, which can influence the time your body prefers to sleep.
If you’re regularly struggling to get up for work or family needs, it can be an indication you may need to seek help. Some of these factors can be explored with a sleep psychologist if they are causing concern.
Can my smart watch help?
It is important to remember sleep-tracking devices can vary in accuracy for looking at the different sleep stages. While they can give a rough estimate, they are not a perfect measure.
In-laboratory polysomnography, or PSG, is the best standard measure to examine your sleep stages. A PSG examines breathing, oxygen saturation, brain waves and heart rate during sleep.
Rather than closely examining nightly data (including sleep stages) from a sleep tracker, it may be more helpful to look at the patterns of your sleep (bed and wake times) over time.
Understanding your sleep patterns may help identify and adjust behaviours that negatively impact your sleep, such as your bedtime routine and sleeping environment.
And if you find viewing your sleep data is making you feel worried about your sleep, this may not be useful for you. Most importantly, if you are concerned it is important to discuss it with your GP who can refer you to the appropriate specialist sleep health provider.
Amy Reynolds, Associate Professor in Clinical Sleep Health, Flinders University; Claire Dunbar, Research Associate, Sleep Health, Flinders University; Gorica Micic, Postdoctoral Research Fellow, Clinical Psychologist, Flinders University; Hannah Scott, Research Fellow in Sleep Health, Flinders University, and Nicole Lovato, Associate Professor, Adelaide Institute for Sleep Health, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Science of HIIT – by Ingrid Clay
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We previously reviewed another book in this series, Science of Yoga. This one’s about HIIT: High Intensity Interval Training!
We’ve written about HIIT before too, but our article doesn’t have the same amount of room as a book, so…
This one lays out 90 key HIIT exercises that you can do at home without special equipment. By “without special equipment”, we mean: there are a few exercises that use dumbbells, but if you don’t want to get/use dumbbells, you can improvize (e.g. with water bottles as weights) or skip those. All the rest require just your body!
The illustrations are clear and the explanations excellent. The book also dives into (as the title promises) the science of HIIT, and why it works the way it does to give results that can’t be achieved with other forms of exercise.
Bottom line: if you’ve been wanting to do HIIT but have not yet found a way of doing it that suits your lifestyle, this book gives many excellent options.
Click here to check out Science of HIIT, and level-up yours!
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Is Chiropractic All It’s Cracked Up To Be?
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Is Chiropractic All It’s Cracked Up To Be?
Yesterday, we asked you for your opinions on chiropractic medicine, and got the above-depicted, below-described set of results:
- 38% of respondents said it keeps us healthy, and everyone should do it as maintenance
- 33% of respondents said it can correct some short-term skeletal issues, but that’s all
- 16% of respondents said that it’s a dangerous pseudoscience and can cause serious harm
- 13% of respondents said that it’s mostly just a combination of placebo and endorphins
Respondents also shared personal horror stories of harm done, personal success stories of things cured, and personal “it didn’t seem to do anything for me” stories.
What does the science say?
It’s a dangerous pseudoscience and can cause harm: True or False?
False and True, respectively.
That is to say, chiropractic in its simplest form that makes the fewest claims, is not a pseudoscience. If somebody physically moves your bones around, your bones will be physically moved. If your bones were indeed misaligned, and the chiropractor is knowledgeable and competent, this will be for the better.
However, like any form of medicine, it can also cause harm; in chiropractic’s case, because it more often than not involves manipulation of the spine, this can be very serious:
❝Twenty six fatalities were published in the medical literature and many more might have remained unpublished.
The reported pathology usually was a vascular accident involving the dissection of a vertebral artery.
Conclusion: Numerous deaths have occurred after chiropractic manipulations. The risks of this treatment by far outweigh its benefit.❞
Source: Deaths after chiropractic: a review of published cases
From this, we might note two things:
- The abstract doesn’t note the initial sample size; we would rather have seen this information expressed as a percentage. Unfortunately, the full paper is not accessible, and nor are many of the papers it cites.
- Having a vertebral artery fatally dissected is nevertheless not an inviting prospect, and is certainly a very reasonable cause for concern.
It’s mostly just a combination of placebo and endorphins: True or False?
True or False, depending on what you went in for:
- If you went in for a regular maintenance clunk-and-click, then yes, you will get your clunk-and-click and feel better for it because you had a ritualized* experience and endorphins were released.
- If you went in for something that was actually wrong with your skeletal alignment, to get it corrected, and this correction was within your chiropractor’s competence, then yes, you will feel better because a genuine fault was corrected.
*this is not implying any mysticism, by the way. Rather it means simply that placebo effect is strongest when there is a ritual associated with it. In this case it means going to the place, sitting in a pleasant waiting room, being called in, removing your shoes and perhaps some other clothes, getting the full attention of a confident and assured person for a while, this sort of thing.
With regard to its use to combat specifically spinal pain (i.e., perhaps the most obvious thing to treat by chiropractic spinal manipulation), evidence is slightly in favor, but remains unclear:
❝Due to the low quality of evidence, the efficacy of chiropractic spinal manipulation compared with a placebo or no treatment remains uncertain. ❞
Source: Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain
It can correct some short-term skeletal issues, but that’s all: True or False?
Probably True.
Why “probably”? The effectiveness of chiropractic treatment for things other than short-term skeletal issues has barely been studied. From this, we may wish to keep an open mind, while also noting that it can hardly claim to be evidence-based—and it’s had hundreds of years to accumulate evidence. In all likelihood, publication bias has meant that studies that were conducted and found inconclusive or negative results were simply not published—but that’s just a hypothesis on our part.
In the case of using chiropractic to treat migraines, a very-related-but-not-skeletal issue, researchers found:
❝Pre-specified feasibility criteria were not met, but deficits were remediable. Preliminary data support a definitive trial of MCC+ for migraine.❞
Translating this: “it didn’t score as well as we hoped, but we can do better. We got some positive results, and would like to do another, bigger, better trial; please fund it”
Source: Multimodal chiropractic care for migraine: A pilot randomized controlled trial
Meanwhile, chiropractors’ claims for very unrelated things have been harshly criticized by the scientific community, for example:
Misinformation, chiropractic, and the COVID-19 pandemic
About that “short-term” aspect, one of our subscribers put it quite succinctly:
❝Often a skeletal correction is required for initial alignment but the surrounding fascia and muscles also need to be treated to mobilize the joint and release deep tissue damage surrounding the area. In combination with other therapies chiropractic support is beneficial.❞
This is, by the way, very consistent with what was said in the very clinically-dense book we reviewed yesterday, which has a chapter on the short-term benefits and limitations of chiropractic.
A truism that holds for many musculoskeletal healthcare matters, holds true here too:
❝In a battle between muscle and bone, muscle will always win❞
In other words…
Chiropractic can definitely help put misaligned bones back where they should be. However, once they’re there, if the cause of their misalignment is not treated, they will just re-misalign themselves shortly after you walking out of your session.
This is great for chiropractors, if it keeps you coming back for endless appointments, but it does little for your body beyond give you a brief respite.
So, by all means go to a chiropractor if you feel so inclined (and you do not fear accidental arterial dissection etc), but please also consider going to a physiotherapist, and potentially other medical professions depending on what seems to be wrong, to see about addressing the underlying cause.
Take care!
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Steps For Keeping Your Feet A Healthy Foundation
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Important Steps For Good Health
This is Dr. Kelly Starrett. He’s a physiotherapist, author, speaker, trainer. He has been described as a “celebrity” and “founding father” of CrossFit. He mostly speaks and writes about mobility in general; today we’re going to be looking at what he has to say specifically about our feet.
A strong foundation
“An army marches on its stomach”, Napoleon famously wrote.
More prosaically: an army marches on its feet, and good foot-care is a top priority for soldiers—indeed, in some militaries, even so much as negligently getting blisters is a military offense.
Most of us are not soldiers, but there’s a lesson to be learned here:
Your feet are the foundation for much of the rest of your health and effectiveness.
KISS for feet
No, not like that.
Rather: “Keep It Simple, Stupid”
Dr. Starrett is not only a big fan of not overcomplicating things, but also, he tells us how overcomplicating things can actively cause problems. When it comes to footwear, for example, he advises:
❝When you wear shoes, wear the flat kind. If you’re walking the red carpet on Oscar night, fine, go ahead and wear a shoe with a heel. Once in a while is okay.
But most of the time, you should wear shoes that are flat and won’t throw your biological movement hardware into disarray.
When you have to wear shoes, whether it’s running shoes, work shoes, or combat boots, buy the flat kind, also known as “zero drop”—meaning that the heel is not raised above the forefoot (at all).
What you want to avoid, or wean yourself away from, are shoes with the heels raised higher off the ground than the forefeet.❞
Of course, going barefoot is great for this, but may not be an option for all of us when out and about. And in the home, going barefoot (or shod in just socks) will only confer health benefits if we’re actually on our feet! So… How much time do you spend on your feet at home?
Allow your feet to move like feet
By evolution, the human body is built for movement—especially walking and running. That came with moving away from hanging around in trees for fruit, to hunting and gathering between different areas of the savannah. Today, our hunting and gathering may be done at the local grocery store, but we still need to keep our mobility, especially when it comes to our feet.
Now comes the flat footwear you don’t want: flip-flops and similar
If we wear flip-flops, or other slippers or shoes that hold onto our feet only at the front, we’re no longer walking like we’re supposed to. Instead of being the elegant product of so much evolution, we’re now walking like those AT-AT walkers in Star Wars, you know, the ones that fell over so easily?
Our feet need to be able to tilt naturally while walking/running, without our footwear coming off.
Golden rule for this: if you can’t run in them, you shouldn’t be walking in them
Exception: if for example you need something on your feet for a minute or two in the shower at the gym/pool, flip-flops are fine. But anything more than that, and you want something better.
Watch your step
There’s a lot here that’s beyond the scope of what we can include in this short newsletter, but:
If we stand or walk or run incorrectly, we’re doing gradual continual damage to our feet and ankles (potentially also our knees and hips, which problems in turn have a knock-on effect for our spine, and you get the idea—this is Bad™)
Some general pointers for keeping things in good order include:
- Your weight should be mostly on the balls of your feet, not your heels
- Your feet should be pretty much parallel, not turned out or in
- When standing, your center of gravity should be balanced between heel and forefoot
Quick tip for accomplishing this last one: Stand comfortably, your feet parallel, shoulder-width apart. Now, go up on your tip-toes. When you’ve done so, note where your spine is, and keep it there (apart from in its up-down axis) when you slowly go back to having your feet flat on the ground, so it’s as though your spine is sliding down a pole that’s fixed in place.
If you do this right, your center of gravity will now be perfectly aligned with where it’s supposed to be. It might feel a bit weird at first, but you’ll get used to it, and can always reset it whenever you want/need, by repeating the exercise.
If you’d like to know more from Dr. Starrett, you can check out his website here 🙂
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