A doctor implements innovation in his medical practice by using AR technology to analyze a model double helix.

Medical Innovation — Our Approach

I’m a huge fan of physician Peter Attia, author of the book Outlive. He’s used his popularity to reshape the vocabulary of preventative medicine.

Attia defines “healthspan” as the number of years we can live with a high level of function, as opposed to “lifespan,” which is the number of years we’re alive regardless of health status.

He’s also coined the terms “Medicine 2.0” and “Medicine 3.0.” The former, a reactive, disease-based approach, treats existing illnesses. The latter prevents illness from developing by using a far-sighted approach.

Attia has become one of the best-known proponents of the “Longevity Medicine” movement, focusing on how to help people lead longer and more fulfilling lives. Prevention has always been a core aspect of primary care medicine, but Peter Attia has refocused its goals and created a growing demand for a more sophisticated level of prevention than has been available in traditional medicine.

Inspired by Peter Attia, I want to bring state-of-the-art preventative healthcare to Banner Peak Health, practice Medicine 3.0, and maximize patients’ healthspan.

Introducing the Metric-Driven Empowerment Cycle

I studied political economy as an undergraduate, focusing on how political and economic forces shape our society. I’ve retained this vantage point throughout my medical career.

In my last blog post, I described the term “diagnostic desert,” analogous to the term “food desert,” which is the scarcity of grocery stores in lower socio-economic neighborhoods. With no lucrative drug, surgery, or diagnostic procedure, vast areas of our healthcare system are underserved.

Most preventative healthcare falls into this category. Tragically, our current system incentivizes doctors to prescribe patients medication rather than work with those patients to help them live healthier lives.

Pharmacology plays a vital role in prevention, particularly in reducing the risk of hypertension and elevated cholesterol. However, our most potent tools for overall risk reduction stem from how we eat, sleep, exercise, and handle stress.

Practicing medicine at this level appears old-fashioned and low-tech. However, recent technological advances have enabled convenient, real-time, continuous monitoring of biomarkers in these areas. A small ring can measure the physiology of your sleep. A patch on your arm can record how your blood sugar varies throughout the day. By recording actionable data, these technologies provide the tools to fine tune and enhance the wearer’s health.

Harnessing these technological tools, we can follow a reiterative process to increase healthspan:

  1. Identify the health status to be improved
  2. Optimally measure the health status
  3. Use the diagnostic information to modify behavior
  4. Watch the new behavior improve health status
  5. Rinse and repeat

This cycle represents the foundation of preventative care at Banner Peak Health. We call it the Metric-Driven Empowerment Cycle (MDEC).

Infographic: Medical Innovation — Our Approach

For example, we have a general sense of the quantity of sleep we get. When was bedtime? When did the alarm go off? Any awakenings during the night? However, our quality of sleep is unknown. By definition, we are unconscious when we sleep. Sleep is made up of restorative phases, such as REM and deep sleep, which conditions such as obstructive sleep apnea can disrupt.

Now, consumer wearables and medical devices allow the ongoing assessment of sleep quantity and quality. This technology allows us to diagnose potential problems and monitor and adjust treatment strategies.

Optimizing metabolic health offers another important area for monitoring technology. We know that elevated glucose (sugar) levels are associated with diabetes mellitus, which is a risk factor for many bad outcomes, including heart disease and strokes. However, pre-diabetes, a condition of insulin resistance but not full-fledged diabetes, can confer a significant risk of these bad outcomes as well. An estimated one in three adults in the United States is pre-diabetic.

New wearable technology can diagnose and manage this extremely common, “hidden” risk factor. A continuous glucose monitor remains on the skin for 10–14 days, noting glucose levels every five minutes. The monitor sends that data to a smartphone, which allows highly personalized diagnosis and treatment.

It’s yet another example of the MDEC:

Quote: Medical Innovation — Our Approach

Final Thoughts

The Metric-Driven Empowerment Cycle provides a new paradigm of care at Banner Peak Health. Now, we can offer the highest quality of care for our patients: medical care that prioritizes prevention and empowers patients by blending the latest medical technology with an old-fashioned determination to work hard.

We want patients to live longer and better!

A woman sits calmly on her blue couch, properly measuring her blood pressure at home for an accurate reading.

Own Your Blood Pressure (and Get More Accurate Readings)

Asking, “What’s my blood pressure?” is like asking, “What’s the weather like in Omaha, Nebraska?”

The weather in Omaha can change from minute to minute and depends on many variables, including the season and time of day. Your blood pressure is the same and can vary depending on a wide array of variables including emotions, activity, sleep, pain, and beverages such as coffee and alcohol products.

Blood pressure is the pressure exerted by circulating blood against the blood vessel walls. When the heart contracts, blood pressure peaks. As the heart relaxes, blood flows into the heart chambers, reducing blood pressure.

We describe blood pressure using a larger number over a smaller number. The larger number is the peak blood pressure during the squeeze, or the systolic phase. The smaller number is the low point of pressure as the heart relaxes, or the diastolic phase.

Our current definition of “normal” blood pressure is less than 120 over 80. “High blood pressure,” or hypertension, occurs in stages and puts you at a greater risk for a constellation of bad health outcomes, including:

  • Kidney failure
  • Stroke
  • Heart failure
  • Heart attack
  • Heart arrhythmia

Therefore, it’s vital to accurately measure blood pressure and treat it in order to help prevent these clinical outcomes.

It’s also essential to understand that the journey to these bad outcomes begins with mildly elevated pressure, which leads to stiffer blood vessels that require higher blood pressure to move the blood, which causes the vessels to stiffen further, and so on. The progressive loss of elasticity becomes a feed-forward loop. The earlier we can interrupt the pattern of elevated blood pressure, the more we can reduce the risk of bad outcomes.

The Challenge of Measuring Accurately

Returning to our weather metaphor, just as the weather changes constantly, so does your blood pressure. Throughout the day, your blood pressure goes through peaks and valleys, resembling a seismogram during an earthquake.

The variability results from circumstances such as your activity level, food and drink choices (caffeine and alcohol can affect blood pressure), stress level, and technicalities regarding how you measure your blood pressure.

To record “accurate” blood pressure, a person:

  • Should be at rest for at least five minutes
  • Must abstain from caffeine, alcohol, and cold medicines
  • Must sit upright in a chair that supports the torso, legs uncrossed, with their feet flat on the floor
  • Must not be in pain or dizzy
  • Must keep the blood pressure cuff at the level of their heart

Meeting the Challenge

The following common scenarios can lead to erroneous blood pressure readings:

  • Sitting in traffic on the way to the doctor (high stress increases blood pressure)
  • Experiencing a symptom (e.g., a headache)
  • Placing the blood pressure cuff lower than the heart
  • Drinking alcohol the night before
  • Drinking coffee the morning of
  • Taking an NSAID the morning of (increases blood pressure)


When I read medical literature, I ask myself whether the intervention described in the study applies to what occurs in my clinic. Sometimes, it’s not even close.

Take the SPRINT study, which demonstrated that patients with elevated blood pressure whose treatment resulted in a systolic blood pressure of less than 120 had one-third the risk of stroke, heart attack, and major adverse cardiac and cerebrovascular events compared to those who were treated to the target of 140.

This study created the rationale for our current blood pressure target guidelines. However, researchers involved in the study measured blood pressure very differently than the standard practice.

Study participants would enter a room and sit quietly for five minutes before a machine automatically took their blood pressure. They’d continue to sit quietly as the machine took their blood pressure at five-minute intervals for 15 minutes. The three measurements were averaged.

This scenario is nothing like a the usual clinical context — no nurses, no doctors entering or leaving the room, etc. It’s exceptionally difficult to replicate in a real-world application. The study’s results achieved lower blood pressure, but only in specific circumstances.

Quote Card: Own Your Blood Pressure (and Get More Accurate Readings)

Be an Active Participant

So, how can we get more accurate blood pressure readings?

First, we must understand that blood pressure readings taken in a clinical environment, such as in a doctor’s office during a standard appointment, are often inaccurate.

Patients need to measure their blood pressure on their own at home. Follow these tips:

  1. Use a high quality machine such as the OMRON cuff.
  2. Choose an environment where you can rest comfortably and meet the other requirements for an accurate reading (as listed above).
  3. Take three readings every five minutes and average the final two.
  4. Take your cuff to your doctor’s office to calibrate it with their manual cuff and stethoscope method.

Any time you have your blood pressure taken, be an active participant. Point out the conditions that may affect your reading and take steps to ensure as much accuracy as possible.

Infographic: Own Your Blood Pressure (and Get More Accurate Readings)

A woman sits on her countertop while eating yogurt, wondering, “Do I need a probiotic?”

Gut Microbiome: How Do I Know if I Need a Probiotic?

In 2022, the Global Probiotics Market was worth $77.1 billion. I hear questions like “How do I know if I need a probiotic?” from my patients almost daily.

Probiotics are live microorganisms delivered in adequate amounts to confer health benefits. Although medical literature links changes in our gut microbiome to everything from mental health to inflammatory diseases, there’s still much we need to explore.

We have yet to perform enough randomized control trials to demonstrate most of these benefits. Much like outer space, our gut microbiome remains uncharted territory.

As medical students, we ran lab experiments on ourselves to see what kind of microbiota grew in our guts. We identified around half a dozen different types of bacteria using rudimentary culture methods. Since then we’ve used genomic DNA analysis to identify many more species.

We estimate that 3,000–4,000 different species of flora (bacteria) grow in your gut. Given the tremendous numbers of bacteria and possible permutations, the resulting “biological cosmos” in our guts is nearly endless and difficult to understand completely.

Now that we’ve established the challenge of understanding this environment, let’s begin our discussion of probiotics as a possible therapeutic modality.

Infographic: Gut Microbiome: How Do I Know if I Need a Probiotic?

Probiotics Therapy Potential

Using probiotics as therapy entails introducing good bacteria to the body to alter the existing balance of bacteria in the gut.

The bacteria in our gut are involved in a wide array of processes that can effect our health, including:

  • Maintaining immune function
  • Helping break down food into beneficial components
  • Displacing harmful bacteria from the gut environment
  • Maintaining the integrity of the digestive tract’s lining
  • Involvement in complex hormone signaling

Probiotics present potential in many therapeutic realms, and we continue to study them for many benefits, such as:

  • Reducing the risk of antibiotic-associated diarrhea
  • Improving digestive capabilities
  • Improving immune response
  • Reducing serum cholesterol
  • Reducing the risk of cancer
  • Reducing inflammatory bowel disease symptoms
  • Reducing allergy symptoms

But Does It Work?

Because gut bacteria have so much individual variability, it’s challenging to definitively document probiotics’ benefits. It’s also difficult to establish those benefits through randomized control trials, so the surrounding literature is weak.

However, when considering the risk vs. benefit ratio, taking probiotics is inexpensive and very safe. We’re not talking about chemotherapy or brain surgery. Therefore, I’m open-minded to probiotics.

Quote: Gut Microbiome: How Do I Know if I Need a Probiotic?

My Take and Today’s Takeaways

When a patient asks me, “How do I know if I need a probiotic?” or “Should I take probiotics?” my answer is, “Let’s give it a shot.” We can try a relatively short three-month trial and assess for improvement in symptoms.

One brand I recommend is Garden of Life, which has high counts of a lot of different species. Selecting a probiotic is like buying a lottery ticket. A probiotic with a greater variety of strains improves the odds of picking a winning combination.

The potential to provide tremendous therapeutic benefits with a safe intervention is very exciting. This is a complex story — one we’re still writing. Stay tuned for updates.

Dr. Barry Rotman smiles at the camera as he holds the ends of a black stethoscope that is draped around his neck.

From Barry Rotman, MD: My New Role at Banner Peak Health

When I was a young child in the 1960s, I wanted to be an astronaut because the Apollo program fascinated me. This phase passed, and I contemplated other professions such as lawyer, therapist, and public policy analyst.

As an undergraduate, I studied political economy before deciding to become a doctor. In medical school, I considered specialties such as psychiatry, ophthalmology, and family practice before choosing internal medicine.

As an internal medicine doctor, I’ve had a wonderful career with a meaningful, direct impact on my patients. A third of a century later, I’m still refining “what I want to be when I grow up.”

The intellectual construct of internal medicine involves acquiring medical knowledge across many disciplines to treat patients’ wide range of problems. After decades spent studying what others have discovered, I’m now more fascinated by exploring new approaches to medicine, and I have a theory about where to look for answers.

Given the economic structure of healthcare in our society, medical advances that involve pharmaceuticals, surgical techniques, or expensive diagnostic modalities are disproportionately supported in terms of research, money, and implementation in our system, leaving many areas underserved. To describe this phenomenon, I’ve coined the term “diagnostic desert,” analogous to the term “food desert,” which is the scarcity of grocery stores in neighborhoods of low socioeconomic status.

With no lucrative drug, surgery, or diagnostic procedure, vast areas of healthcare remain underserved. The result: a “diagnostic desert.” Anyone who has sought care for chronic pain, insomnia, or menopause (to name a few examples) knows the paucity of resources for high-quality care in these areas.

Fortunately, there are other routes for healthcare innovation, such as sports medicine and consumer wearables. Individuals and sports teams create a market for new products and techniques that generate novel solutions for healthcare outside of traditional medicine.

A prime example of this new technology is photoplethysmography (PPG). Millions of people wear PPG fitness devices that shine LED light below the surface of the skin. The light bounces against our blood vessels and sends reflected light back for analysis, providing information about cardiac status, pulmonary function, sleep quality, and the autonomic nervous system.

For example, the 5-gram Oura Ring I wear, paired with my smartphone, generates an enormous amount of physiological data about me. When I was a medical student in the 1980s, an entire room filled with multiple machines would have been required to generate a comparable amount of data. PPG technology has the potential to transform our understanding of the human body by allowing us to move from studying individuals for limited amounts of time to having millions of people continuously monitor their health data.

Paradoxically, as medical technology advances, we generate data faster than we can explain its meaning and translate the information into treatments. For example, millions of people wear Apple Watches that record every heartbeat and recognize those suggestive of atrial fibrillation, even without symptoms. This massive population-based screening provides a very different perspective on the illness than diagnosing individuals who seek medical care for symptoms of atrial fibrillation. This raises questions: Who needs further evaluation? What burden of atrial fibrillation requires treatment?

PPG technology also shifts the focus of medical discoveries from test tubes, animal labs, or academic centers to the interaction between patient and physician. Online educational tools support these devices, which are sold directly to consumers and provide people with actionable information about their health. However, I believe their maximum value stems from incorporating the information into the patient-physician relationship, further enhancing personalized healthcare. In fact, for certain conditions, these wearable products provide better insights than any available medical technique.

For example, it’s common knowledge that stress is bad for you. Healthcare providers constantly admonish patients to reduce their stress. However, you can’t manage what you don’t measure. For the last few years, consumer devices such as Whoop, Oura, and the Apple Watch have quantified the physiology of stress in real-time using heart rate variability (HRV) assessments.

As a 50-year athlete and a 34-year physician with 17 years of concierge medicine experience, I’m well suited for investigating this realm. I strive to learn many valuable techniques that can bring innovative and groundbreaking healthcare to Banner Peak Health.

I’ve assumed the title of “Chief Innovation Officer” to describe my new responsibilities. I’m tremendously excited about moving into this new role. I now know “what I want to do when I grow up!”

Please continue to follow the blog to learn more about my discoveries.

Infographic: From Barry Rotman, MD: My New Role at Banner Peak Health

Two sets of hands cradle a red toy heart, representing signs of a healthy heart and the importance of VO2 Max testing.

VO2 Max: The Diagnostic Crystal Ball

The heart is one of the most studied organs. A variety of diagnostic modalities can help gauge your risk of a heart attack.

The traditional standard is a stress test, which involves getting hooked up to wires while running on a treadmill on a progressively steep incline. A doctor or assistant monitors your heart’s electrical activity and blood pressure.

Unfortunately, this test will only detect a diseased coronary artery (lumen or pipe) with 70% obstruction.

A more sensitive test is a coronary artery calcium score, which uses an ultra-fast CT scan to examine calcium deposits in atherosclerotic deposits in blood vessels. It’s more sensitive than a stress test and can detect evidence of atherosclerosis before the lumen or pipe is obstructed.

Now, our practice leverages Cleerly. This test involves intravenous dye injected into the bloodstream. A CT scan performs a 3D X-ray study (coronary artery angiogram) of the coronary arteries, which is then analyzed with a proprietary AI-guided model.

This model detects plaque within the vessel wall and the lumen and differentiates between hard and soft plaque. Hard plaque involves calcium deposits, but soft plaque doesn’t, which is why coronary artery calcium tests miss soft plaque deposits.

We have many ways of discovering what’s wrong with the heart. But what are the signs of a healthy heart?

Diagnostic testing tells us how “bad” a disease state is or how well something prevents a disease state. We often find ourselves in a dichotomy of investigating how potentially diseased the organ is versus our ability to assess how optimally the organ can function.

How bad is bad? How well is well?

Both are relevant, but I want to focus on how to optimize your health and prevent as much disease as possible.

What Is VO2 Max?

VO2 Max represents the maximum amount of volume of oxygen (O2 represents oxygen) your body uses per kilogram of weight in one minute. I think of it as a metric for integrating how well your entire cardiovascular system works.

VO2 Max testing involves studying your physiologic response to a standardized graded progression of work output.

A good analogy is that of a car’s horsepower, which tells you how fast the car can go, etc. It’s a system-wide metric of capability.

Infographic: VO2 Max: The Diagnostic Crystal Ball

Instead of horsepower, we’re measuring “humanpower.” VO2 captures:

  • How well your lungs bring in oxygen
  • How well your heart moves blood through your body
  • How well your muscles contract
  • How well your mitochondria perform the necessary biochemistry to create mechanical energy

VO2 Max determines the entire system’s quality. It’s a valuable measurement because it covers the entire, integrated system rather than just one part of the body. It does much more than just measure the signs of a healthy heart.

Peter Attia’s ‘Outlive’ — The Prognostic Value of VO2 Max

In his most recent book, Outlive, Peter Attia summarizes the prognostic value of VO2 Max. He compares the health benefits of physical conditioning as measured by VO2 Max with the magnitude of risk associated with other risk factors, such as smoking and diabetes.

For example, a non-cigarette smoker is 40% healthier than a cigarette smoker in the same physical condition. Meanwhile, if someone in the lowest 25th percentile of physical health started training and improved their condition to the 50th percentile, they would decrease their mortality risk by 50%.

That’s right. Getting off the sofa is better for you than quitting smoking.

I take this as a mandate to do my best to maximize everyone’s physical conditioning. You don’t have to become a marathon runner to drastically improve your health.

Quote: VO2 Max: The Diagnostic Crystal Ball

How Do You Improve VO2 Max?

We used to recommend high-intensity interval training (HIIT). We now know there are additional stages of conditioning you need to train to optimize VO2 Max.

Returning to the car metaphor, it’s like a gearbox. Each gear represents a physiologic system to be analyzed, understood, and optimized. All the gears need to work together seamlessly.

VO2 Max does more than just measure the signs of a healthy heart. It represents the health of the whole package — heart, lungs, vascular system, and more. That’s why it’s so powerful and why we’re so excited to add it to our offerings.

Stay tuned for a deep dive, coming soon.

A close-up smartphone displays various medical articles available to read, with sun reflecting off the screen.

How to Be a Critical Reader of Medical Articles in the Lay Press 

We’re officially in the throes of an “infodemic.” Every day, we’re inundated with more information than we can process about a variety of topics, especially medicine.

Why is this happening? One reason is that there exists a bias in medical literature reporting. Every individual and institution in the research process has the potential to overinflate their findings’ value, seeking to gain greater exposure from the press.

Researchers are also pressured to produce noteworthy results. Impressive studies endow prestige and enhance scientists’ and journalists’ careers. Because there’s so much at stake, there’s a tendency to mislead with less-than-accurate information.

Combine that with the press’s tendency to report overly optimistic or frightening statistics. Their goal is to get readers to click, read, and subscribe.

I want to give you the skills to navigate this infodemic of medical literature. Once you finish this post, you’ll be able to read critically and discern between relevant data and sensationalism.

Infographic: How to Be a Critical Reader of Medical Articles in the Lay Press

5 Categories of Errors

I’ve identified five categories of common medical reporting errors.

1. We’re Not Animals

We have neither fur nor tails, yet many studies found in medical literature involve animals.

Animal experimentation is part of our research method. Only a minute percentage of discoveries from animal models ever impact human healthcare. Regardless, these studies often excite the press.

Example: Taurine is an amino acid shown to improve health and extend lifespan in mice. However, because of inherent physiological differences, there’s almost no chance this will ever be relevant to humans.

2. Data’s Numerical Representation Influences Its Emotional Impact

Data often tells more than one story, and journalists are storytellers. That can be a dangerous combination.

When the press presents the same data in multiple ways, people can interpret it differently, and the information can have various emotional effects. It can even influence public policy.

Example: The Women’s Health Initiative, which began in 1991, explored hormone replacement therapy (HRT) in postmenopausal women.

One randomized part of the study examined 16,000 women. In a subset study, 678 women — 385 from the HRT group and 293 from the placebo group — received a breast cancer diagnosis.

In 2005, the press reported those results as a 23.5% increased risk of breast cancer from HRT, a frightening finding. This statistic is true, breast cancer did occur at a rate of 0.42% per year in the drug group and 0.34% in the placebo group.

However, the results are more nuanced than that. Each year, for every 1,000 women in the trial, an average of 4.2 women on HRT could expect a breast cancer diagnosis, while an average of 3.4 women on the placebo could expect the same. There was a difference of only one woman per 1,000 each year between the two groups.

The press chose to express the data in a sensational way to entice readers to click on headlines and purchase newspapers. That single statistic changed women’s healthcare for over 20 years. Doctors and patients have been fearful of estrogen replacement therapy. As a result, an entire generation of postmenopausal women have been fearful of using a relatively safe treatment.

3. Man-Bites-Dog Journalism

Science is rarely about the result of any single study but the preponderance of evidence based on the compilation of many studies. However, when a touted study contrasts prevailing wisdom, it’s more likely to appear in the press. Journalists’ prerogative is to grab attention, and contrarian headlines accomplish that.

Example: In 2017, the Independent ran an article quoting one doctor who said, “Sugar benefits your brain health.”

This article expressed the opinions of a single doctor, who states that sugar may not be as harmful as we think it is.

It only became popular because it’s an assertion that goes against prevailing wisdom. In science and medicine, beware the contrarian.

4. Association Doesn’t Equal Causation

Human beings are not lab animals, particularly regarding our diet. It’s impossible to run randomized control trials on humans because we can’t control and measure everything test subjects eat against a control group.

Therefore, we rely on epidemiologic studies, which examine differences in people’s eating habits and try to correlate them with different health outcomes. Unfortunately, this form of study is notoriously susceptible to identifying associations that aren’t necessarily causal.

Example: For many years, red wine was believed to confer a health advantage. The consumption of red wine is associated with many other healthful behaviors, such as eating fresh fruits, vegetables, and healthier oils. Therefore, red wine is a confounder — associated with better health, but not causal.

Nutrition literature is particularly prone to miraculous attributions to certain foods.

5. Anecdotal Evidence Is Rarely Scientific Evidence

Anecdotal evidence may be exciting and compelling, but it’s rarely enough to inform or change the practice of medicine.

Example: The media is full of anecdotal evidence from people who successfully combatted their COVID-19 symptoms using ivermectin or azithromycin, both of which have been proven ineffective in randomized control trials.

Quote: How to Be a Critical Reader of Medical Articles in the Lay Press

Today’s Takeaways

Before you become too excited or too frightened by a medical article, remember the following:

  1. Humans are not animals.
  2. Be leery of data expressed as percent change rather than an absolute number.
  3. Beware the contrarian. Don’t take it at face value if something goes against all conventional thinking.
  4. Association does not equal causation.
  5. Sample size matters. Don’t extrapolate universal truths from single or small sets of unique events.

There are always exceptions to these rules. Every day, the media reports valid science, and every day, they sensationalize. By being an informed, discriminating reader, you’re better equipped to find the kernels of truth and stay above the fluff.

A woman in a white sweatshirt sits meditating atop a hill on a misty day, following Banner Peak’s 12-step meditation guide.

The Banner Peak Health Meditation Cheat Sheet

I spend an inordinate amount of time writing about stress. It worsens almost every disease process in our bodies.

Emotional and physiological stress bombard us every day. Many sources of stress occur outside ourselves, and we have no control over them. We need to find coping methods to handle our stress burden.

We’ve discussed proven techniques such as exercise (particularly in natural surroundings), social support, avoiding excess alcohol, sufficient sleep, and therapy. There’s another tool we haven’t explored yet: meditation.

Meditation is a practice of relaxation that combines mental and physical techniques. There’s a vast array of meditation beliefs, practices, and traditions. Below, you’ll find the simple approach I teach my patients, which provides an easy starting point.

For many, this approach alone provides a noticeable benefit. Others pursue different or additional methods, including classes, videos, and apps. All meditation is good meditation!


Infographic: The Banner Peak Health Meditation Cheat Sheet


The Breakdown

Here’s a more detailed look at the 12 steps.

1. Carve out a few minutes from your schedule for meditation.

Before taking your first meditative breath, you’ll need to consciously decide to prioritize meditation and carve out time for it.

We often place our physical and emotional needs at the bottom of our to-do list. It may seem selfish to focus on ourselves when there are more pressing tasks. Not infrequently, I work to convince patients to attend to their own care, not only for themselves but also to have more energy to give to others.

The decision to carve out time represents a crucial first step in this process. Meditating can reframe how we view our mental and physical health in the context of investing in ourselves in order to give to others.

2. Find a comfortable, quiet place to sit.

There’s no special position necessary. Do what feels most comfortable. Remember, you’ll be in this position for several minutes.

3. Set a timer for a few minutes. (You can advance duration as you improve.)

As you become more comfortable, you’ll be pleasantly surprised by how fast the time goes!

4. Close your eyes.

It’s that simple. You do it all the time.

5. Breathe in as deeply and out as slowly as you are comfortable doing.

A slow exhalation stimulates the parasympathetic nervous system (rest and digest).

Stress stimulates the sympathetic nervous system (fight or flight), but slow, deep exhalation suppresses it, allowing relaxation.

6. Count your breaths.

The number doesn’t matter. This is a technique to take your mind off other worries.

7–8. Your mind will wander to other thoughts, and this will frustrate you.

Your mind will race to other ideas. You’ll be frustrated and may even deem yourself a failure at meditation. Don’t.

Everyone is miserable at meditation because a perfect state of meditation doesn’t exist. Even monks who devote 20 hours per day to meditation humbly refer to their practice as “striving to improve.” That is the valuable lesson of meditation.

9. Gently and without self-recrimination, let go of these thoughts.

In meditation, as in life, we’re imperfect and will make mistakes. We achieve peace of mind by acknowledging this state of being and finding solace in our commitment to giving our best effort without reaching perfection. We must show ourselves kindness when dealing with our inevitable failures.

Thus, one of the main benefits of meditation is not only our thoughts during a few minutes a day but also how we reorient our perspective on expectations we have for ourselves.

10. Return to counting breaths.

You will lose count. It’s okay. Start again.

11–12. Repeat this cycle. When the timer rings, open your eyes and slowly reorient yourself.

Try not to anticipate the sound of the timer. Allow yourself to fully immerse in the meditation and enjoy the experience. When it’s over, allow yourself time to adjust.

Quote: The Banner Peak Health Meditation Cheat Sheet


The Benefits of Meditation

In addition to the psychological benefits of meditation, a growing body of evidence addresses the physical benefits.

As we’ve discussed in prior blog posts, there is a direct connection between our thoughts and emotions and the biology of our bodies. Meditation leverages this connection in a very positive direction.

Cortisol is our most prominent stress hormone. Too much can damage every organ system we possess. Fortunately, mediation can reduce cortisol levels, offsetting the rise in our stress-filled lives.

Researchers studying the brain note that during meditation, the brain’s electrical activity can change with enhanced alpha and beta wave activity, which enhances relaxation and learning function.

There are many examples in medical literature of the health-enhancing benefits of reducing stress with meditation, including reducing pain, enhancing sleep, improving memory, and reducing the intensity of illnesses such as irritable bowel syndrome, depression, and post-traumatic stress disorder.

Starting with a few minutes a day, you can transform your outlook on life and enable your body to counter the physiological effects of excess stress.

I hope I’ve piqued your interest in meditation. Please give it a try. Best of luck, and keep me posted!

What is an InBody scan? A close-up shot shows an InBody scan device in a bright, clean exam room.

Our First Year Using an InBody Device (And What It Is)

An InBody machine provides body composition information, including fat weight, water weight, and dry lean mass (muscle, bone, and connective tissue). It allows for a more accurate description of a patient’s body composition than BMI.

This article will answer the question, “What is an InBody scan?” and explain what we’ve learned since acquiring our InBody device.

InBody at Banner Peak Health

We were excited to introduce our InBody device in January 2023.

What is an InBody scan? It’s a bioelectrical impedance analysis for determining what percent of a person is water weight, muscle weight, and fat weight.

A patient stands on the InBody device and holds an electrode in each hand. The device sends an imperceptible current across different axes generated from those four contact points.

The device calculates the resistance across each axis and diagnoses what percentage of the patient is water, fat, and muscle. It’s able to accomplish this due to a fundamental chemical difference between water and fat: water conducts electricity, while fat insulates.

Stepping on a scale doesn’t give us clinically vital information regarding the body’s composition. InBody does.

Our Biggest Insights

Anyone looking in a mirror or stepping on a scale can tell whether they’re overweight. When we started using our InBody scan, we weren’t surprised by the fat content results we saw. However, other results did surprise us.

Sometimes, patients who appeared healthy found out they weren’t as healthy as they thought. Their muscle mass was declining, and they were at risk for sarcopenia. (More on this later.)

Other patients who expected poor results because they were overweight had excellent muscle mass. Hidden in their bodies were real athletes!

We give credit where credit is due. InBody scans help us diagnose and treat every patient appropriately.

Infographic: Our First Year Using an InBody Device (And What It Is)

Muscle Mass Matters Most

You can’t tell someone’s muscle mass just by looking at them. That’s where InBody comes in handy.

Muscle mass predicts longevity and level of function in later adulthood (age 50+). If we identify and enhance muscle mass in middle age, we can improve the quality and duration of our lives.

It’s also imperative to diagnose and prevent sarcopenia — the decline in muscle mass associated with age. With InBody’s help, we can treat and correct sarcopenia more effectively.

Strength Training

When we discover a patient is at risk for sarcopenia, we recommend strength training and other regimens. For some, this means taking advantage of gym memberships or arranging sessions with a fitness instructor.

Some older patients may use wheelchairs but still need to practice strength training. We send Zoom links for exercises they can do while seated.

Protein Intake

Protein intake is also crucial for building muscle. The current recommended daily allowance (RDA) is 0.8g of protein per kilogram of body weight, according to the FDA. However, experts like Peter Attia recommend 2g per kilogram of body weight (2.5 times the RDA).

The RDA is the minimum amount necessary to stave off a disease state, while Peter Attia’s recommendation advocates maximizing your health state. I target somewhere between the two to enhance patients’ health.

Not all proteins are equal. For example:

If you’re not careful, you can exceed your recommended caloric intake. We’re exploring various supplement options as a means to avoid this.

We’re also looking into branched-chain amino acids, a potent form of amino acid supplementation that may preserve muscle mass. Because there is such a wide array of commercial products available, I’m uncomfortable making a pronouncement until I know more.

Tracking What Happens to Muscle Mass During Weight Loss

Successful weight loss involves expending more calories than you ingest. Ideally, we want fat to provide that excess energy, but we don’t always get what we want.

For most weight loss regimens, we expect to lose 75% of weight from fat and 25% from muscle mass. However, we’re finding through InBody scans that when patients use weight-loss medications like Ozempic and Mounjaro (which have GLP-receptor agonist activity), that ratio can be as high as 60% fat loss and 40% muscle loss.

For some patients, this is problematic or even dangerous. By monitoring muscle mass and recommending increased protein intake as well as strength training, we can mitigate the risk of these weight loss medications.

Quote: Our First Year Using an InBody Device (And What It Is)

Today’s Takeaways

In addition to the traditional metrics of weight and blood pressure, we now also track muscle mass. InBody provides a more nuanced look into a vital health status.

At Banner Peak Health, we’re always excited to implement new technology that helps us gain insights into each patient’s health status.

So, what is an InBody scan? It’s one of the latest tools that allows us to provide state-of-the-art medical care. It has reinforced that preserving muscle mass is essential to living a long, healthy life.

A bright blue sky with fluffy white clouds and bright sunshine symbolizes the connection between light, health, and wellness.

Your Circadian Rhythm: Synchronizing Light, Health, and Wellness

Throughout history, our species has modified our environment to meet our needs, from the advent of fire to the invention of the lightbulb. The converse has always fascinated me — how the environment impacts us.

Today, I’ll discuss the connection between light, health, and wellness.

Light and Our Biology

Every cell in our bodies is “on the clock.” Our biology synchronizes with nature — our cells inside and the daylight cycle outside.

In 2017, three scientists won the Nobel Prize in Physiology for delineating the mechanisms of our internal clocks. Our eyes contain specific receptors that have evolved to sense light not for vision but to send a signal to the suprachiasmatic nucleus of the brain, which is the master clock of our body. It then synchronizes internal clocks, which exist in practically every cell in our body. When and how light reaches our eyes has profound effects on our biology and emotions.

I recently reviewed data from the Nurses’ Health Study, which examined night owls’ and morning sparrows’ risks of diabetes. Night owls are individuals with a circadian rhythm longer than 24 hours (they stay awake later and have difficulty waking up in the morning). Morning sparrows are the opposite.

According to this study, night owls have a much higher risk of developing diabetes than morning sparrows, illustrating the dangers of living life out of synchrony with your circadian rhythm. This is just one of the potentially dangerous health outcomes that can occur when night owls must wake up early for school or work.

The pandemic, with its remote work and school options, created a vast experiment by allowing people to live in accordance with their own circadian rhythms. I’m excited to follow new studies from this period demonstrating the positive impact of this flexibility on health outcomes.

Teenagers suffer greatly from being forced to time their lives out of sync with their circadian rhythms. Among the many hormonal changes that occur during adolescence, this group’s circadian rhythms lengthen, leading teenagers to become night owls. However, schools start early, which sets students up for failure.

Medical literature shows that starting school 30–60 minutes later results in improved academic and athletic performance as well as behavioral and emotional well-being.

Quote: Your Circadian Rhythm: Synchronizing Light, Health, and Wellness

Connecting Light, Health, and Wellness

Insomnia has many causes. One common cause is circadian rhythm asynchrony. Modern society has led us to miss the timing cues from the sun. We don’t get its wake-up call in the morning, often not seeing any early morning sunshine. We bathe our eyes in artificial light well after the sun has set, reducing any signals for our body to prepare for sleep.

To return to a more natural relationship with light, you can reset your circadian rhythm by exposing your eyes to bright natural light as early in the morning as possible. Avoid wearing sunglasses during the first two hours of the day if you’re outside.

A growing body of literature also associates circadian rhythm asynchrony with emotional disorders like depression and seasonal affective disorder (SAD), the latter of which often occurs in regions with less morning light, such as the northern latitudes in the fall and winter.

Studies have shown improvement in SAD by having people use a light box that replaces the intensity of natural sunlight (10,000 LUX) for a prescribed amount of time upon waking.

When treating patients with mood disorders, I prescribe sunshine and aerobic exercise whenever possible in the morning. It’s one of the best ways to simultaneously boost light, health, and wellness.

Infographic: Your Circadian Rhythm: Synchronizing Light, Health, and Wellness

Today’s Takeaways

  1. Morning light helps with evening sleep.
  2. Whenever possible, reorganize your day around your circadian rhythm. (And let teenagers sleep in when possible!)
  3. Avoid sunglasses in the morning.
  4. “Sunny disposition” is more than a metaphor for happiness. It’s a therapeutic modality.
  5. If you experience symptoms of SAD, explore treatment options with your doctor.

We’re inextricably linked to our environment. Exposure to light influences who we are and how we live our lives.

A runner on paved path holds his knee after feeling a sharp pain, wondering, “Does a meniscus tear need surgery?”

Does a Meniscus Tear Need Surgery?

It was a warm fall afternoon, and I was running in the hills above Berkeley when I felt a sudden pain in my right knee. No negotiation possible; I had to stop running. Unfortunately, I still had to walk a few miles to my car, and that’s how my persistent pain started.

The pain persisted and I had to acknowledge that my knee wasn’t going to improve on its own. After a visit to an orthopedist and an MRI, I received my diagnosis: a degenerative meniscal tear in my right knee.

I had the same questions any patient would have in this position, including, “Does a meniscus tear need surgery?” Here’s what I’ve learned both from personal experience and medical literature.

What Is a Meniscus Tear?

The meniscus is a figure-eight-shaped fibrocartilaginous “washer” that cushions the knee between the femur (on top) and tibia (on bottom). Meniscus tears or injuries are common and result from either acute or degenerative mechanisms.

Acute injuries occur when a single force overwhelms the structural integrity of the joint, like when a 17-year-old soccer player gets slammed from the side. That acute force overloads the knee’s structural anatomy and damages the meniscus.

Degenerative injuries occur as a result of wear and tear over time. For example, in my case, I’d been running regularly for decades, and that repetitive force caused my meniscus to gradually wear down until it tore in 2005. I had a pothole inside my medial meniscus, which caused pain, low-level swelling, and walking impairment.

Does a Meniscus Tear Need Surgery? My Options

I discussed the options with my orthopedist and decided to try physical therapy. If my knee didn’t improve, we’d consider surgery.

I embarked on six to eight weeks of physical therapy, including exercises to strengthen my quadriceps and increase my hamstring flexibility. I also refrained from putting force on my knee by running.

Within two to three months, I was back to baseline function and could bike, hike, and run.

Quote: Does a Meniscus Tear Need Surgery?

Don’t Shoot the Messenger… Listen to It

Medicine often falls into the cognitive trap of “shooting the messenger.” It’s an idiom from ancient Greece, when a messenger had to deliver bad news to a king and lost his life for his trouble.

In modern medicine, the injury is the messenger, not the beginning of the story. The meniscal tear communicated a problem. Why did the tear happen in the first place?

My orthopedist saw the injury as the problem and didn’t go upstream to explore what about my body, structurally or ergonomically, had created the injury.

So, I worked with a podiatrist and did a gait analysis. We modified an insole and created a lifelong physical therapy routine to strengthen my core and stabilize my leg.

I was relieved to heal without needing surgery. I heeded the message to try to build back better and avoid future injuries.

Take Two

Seventeen years later, while on vacation in Hawaii, I felt a low-level pain in my left knee. It was less severe this time, so foolishly, I continued to run for several weeks before addressing it.

After an evaluation with a sports medicine doctor and another MRI, I discovered I had another meniscal tear, this time in my left knee. However, this tear was complex. Instead of being a two-dimensional problem, part of the tissue had flipped up and occupied more of the joint space.

If my right knee had a small “pothole” in the meniscus that needed to heal, my left meniscus had the equivalent of a raised bump, like a pebble stuck between a foot and shoe.

This time I asked, “Does a meniscus tear need surgery if it’s complex?”

A Landmark Study

In 2013, the New England Journal of Medicine published a landmark study noting that arthroscopic partial medial meniscectomy (removing the damaged part of the meniscus) occurred in about 700,000 cases annually (at the time of the study), making it one of the most common orthopedic procedures performed.

My case matched perfectly with those in the study. The test population involved 35- to 36-year-olds with no underlying arthritis who had undergone a degenerative tear. Remarkably for a surgical study, the design included placebo controls. Half received the arthroscopic partial resection of part of their meniscus, and the other half underwent surgery with arthroscopy with no tissue removed.

The results showed that 12 months after surgery, there was no difference in functional capacity or pain between those who had received the real or sham surgery. This was a shocking result, demonstrating the body’s ability to heal from these types of injuries without any surgery.

The problem with partial meniscectomy has to do with the meniscus’s anatomy. Since it’s fibrocartilaginous, there’s little to no blood supply, so the part surgeons remove won’t grow back. The knee must continue to function with less of that figure-eight donut cushioning each impact between the femur and tibia. Over time, forces are applied to less of a cushion between the femur and tibia, increasing the forces applied directly to the bone and the risk of osteoarthritis.

Making My Choice

After considering the potential long-term complications of surgery and the randomized control trial’s results, I decided to give physical therapy a shot.

I wish it had gone as smoothly as it did in 2005, but there’s a difference between healing at 40 and healing at 60. The tears’ anatomies were also different, and the second, more complex tear posed a greater challenge.

I aggressively pursued physical therapy, and the fear of surgery and its attendant risk of osteoarthritis compelled me to remain diligent. I slowly regained function and reduced pain.

As of this writing, I still refrain from running. I can hike, bike, and backpack, but I modify my ergonomics.

Infographic: Does a Meniscus Tear Need Surgery?

What Was This Injury’s Message?

While working with a physical therapist, I learned that I had a reduction in right ankle flexion and tightness in my hamstrings. I’m now addressing the root causes of my left knee injury to prevent future issues.

Physical therapy is not just about regaining function after an injury. It’s about addressing why you had the injury and working to prevent future ones.

People undergoing physical therapy, and many doctors prescribing it, often miss that point. Emphasizing it will give people further incentive to do the hard work physical therapy requires.

Today’s Takeaways

  1. If you’re asking, “Does a meniscus tear need surgery?” after suffering a meniscus tear, the answer is, “Only as a last resort.” If all else fails and multiple surgeons recommend it, it’s a valid option. Until then, focus on physical therapy.
  2. Physical therapy reduces the risk of future injuries and helps correct the structural problems that led to the initial injury.

Take physical therapy seriously. Your knee’s life depends on it.