Two feet stand on a scale with a tape measure curled on the ground nearby, representing BMI vs. body composition.

BMI vs. Body Composition: What’s the Difference and Why Should You Care?

Being overweight correlates with a long list of bad health outcomes, including but not limited to:

  • Increased risk of diabetes
  • Coronary artery disease
  • Stroke
  • Cancer
  • Wear-and-tear osteoarthritis of the joints

Fat is necessary, but excess amounts can hurt us. Therefore, we need to quantify and monitor our total weight in such a way as to prevent bad outcomes.

We need to understand the difference between BMI vs. body composition, and how we can track and learn about the latter.

What Is Our Body Composition?

The healthy range for body fat varies according to age and gender, but for men, it runs between eight and 28%. For women, it’s 21–35%.

But fat is only one component of our body composition. We’re also made of water. Men are about 60% water; women are about 55%.

Whatever isn’t water or fat is called dry lean mass: muscles, bones, connective tissues, etc. Dry lean mass is calculated by subtracting your water and fat quantities from your total body mass.

We’re all made of water, fat, and dry lean mass, but a standard scale won’t tell you exactly how much of each you carry. We need another method to determine our body composition.

What Is BMI?

Let’s discuss BMI vs. body composition. Can you use the former to determine the latter, and vice versa?

BMI (body mass index) is a mathematical ratio calculated based on a person’s total weight and height. Unfortunately, it’s flawed and inaccurate because it doesn’t consider individual body composition.

Very healthy people with increased muscle mass can be considered overweight by BMI standards. For example, an NFL player may have a high BMI (i.e., a high weight for their height) because of their tremendous muscle mass, but no one would recommend they enroll in Weight Watchers!

Infographic: BMI vs. Body Composition: What’s the Difference and Why Should You Care?

BMI vs. Body Composition

Since BMI has significant limitations, I looked into other technologies used to measure body composition. Unfortunately, there’s often a trade-off between ease of use and accuracy.

One can use a simple caliper to squeeze available subcutaneous fat at different parts of the body, then calculate the percent body fat using a table. This method is straightforward and cheap, but unfortunately, it isn’t accurate.

Another method is hydrostatic weighing, in which a patient’s body is completely submerged in water, and the displacement and density are calculated. The results are accurate, but the test is clinically impractical.

Other accurate technologies, such as a DEXA (Dual-Energy X-ray Absorptiometry) scan, are convenient but may not be geographically or financially accessible.

After weighing the pros and cons of many body composition calculators, we at Banner Peak Health decided upon InBody, a bioelectrical impedance device.

BMI vs. Body Composition: What Is Bio-Electrical Impedance?

Water conducts electricity, and fat doesn’t, a principle of which InBody takes advantage. The device measures electrical resistance across different axes of the body, from which an accurate calculation of a patient’s body composition (body mass, water, and fat) can be made.

By using this convenient, accurate tool, we address patients’ important clinical issues.

For example, patients who want to lose weight often make lifestyle changes, including dietary and exercise modifications, only to be frustrated when the number on the scale doesn’t change. InBody encourages those patients by showing them how their lifestyle changes have impacted their body. Often, their percentage of body fat decreased as their percentage of muscle increased — so while their overall weight didn’t change, the internal makeup of the body did.

Another clinical benefit of InBody relates to weight loss in aging patients. A prevalent problem called sarcopenia (the loss of muscle mass) is associated with many bad outcomes during the aging process. Fortunately, bioelectrical impedance technology allows us to monitor body composition and watch for decreases in muscle mass.

We invested in this technology because InBody allows us to offer a higher standard of preventative care. We’re delighted to provide it in our office for our members.

The Banner Peak Health Difference

When it comes to BMI vs. body composition, it’s important to take the former with a grain of salt and invest in clinically convenient technologies to determine the latter.

At Banner Peak Health, we’re proud to invest in state-of-the-art diagnostic technologies that can give us greater insight into patients’ health to further customize their treatments, better meet their healthcare needs, and maximize their quality of life.

If you’re interested in using InBody to determine your body composition, schedule an appointment today.

Quote: BMI vs. Body Composition: What’s the Difference and Why Should You Care?

A man in a white tank top holds a static plank on a yellow yoga mat to improve his core strength for cycling.

Don’t Ignore the Core: How Core Strength Is Essential for Cycling

Core strength is essential to almost all athletic performance.

In nearly all sports, the force generated from a limb (like an arm or leg) must be anchored by a strong trunk — the core. Otherwise, the force is severely diminished.

Imagine throwing a football while you’re floating in an inner tube. Now imagine throwing a football while standing firmly on the ground. The latter football will cover much more distance than the former.

But what are the core muscles? How can we as athletes improve our core strength, especially core strength for cycling? Read on to find out.

What Are the Core Muscles?

The core muscles are a system of muscles covering the pelvis, lower back, hips, and stomach.

Some have names you’ll recognize, like the gluteus maximus, while others are more obscure, like the external obliques or multifidus. Regardless of popularity, they all work together to get the job done, whether that job be teeing off successfully or throwing a football across a field.

Infographic: Don’t Ignore the Core: How Core Strength Is Essential for Cycling

How the Core Muscles Work

Each myocyte (muscle cell) contains countless layers of two overlapping molecules: actin and myosin. Biochemical reactions between these two molecules cause the cell to contract. The combined force of these myocytes creates the strength of a muscle. Thus, the more groups of muscles that create a movement, the stronger the force of the movement will be.

Golf illustrates this principle perfectly.

Many golfers believe the force behind their swing is determined solely by the mass of their arms or pelvis. They have no idea the vital role core strength plays in golf — though having a six-pack may not help your putting stroke.

The same is true in swimming. Your core anchors your arms and legs as you kick, reach, and pull. All those muscles working together generate tremendous power.

Tennis is another great example. When you watch players run across the court, serve, and hit backhand and forehand shots with incredible force, know it’s due to the engagement of their core.

But a favorite and personal example of the core’s influence is cycling.

Core Strength for Cycling: My Personal Experience

When it comes to cycling, core strength is particularly important. The core anchors the pelvis to generate the power the legs need to pump the pedals. It also keeps the torso angled forward for wind resistance.

I started cycling when I was 12, nearly 50 years ago. By age 30, I’d realized the truth behind the adage, “You have to give to your body to receive from your body.” At that point, I’d developed a workout regimen to help me maintain core strength for cycling.

Over the decades, as I’ve changed and as technology has changed, my regimen has evolved.

In my 20s, I did the sit-ups we all learned in gym class — the ones where you touch your elbow to the opposite knee. However, we now know that those sit-ups cause hyperflexion in the lumbar spine, which increases the risk of lower back injury and pain.

Now, I maintain my core strength for cycling through static planking maneuvers, and I’m proud to say I’ve never had any back problems in my nearly 50 years of riding.

Ironically, I did suffer neck pain associated with cycling several years ago. It turned out that I’d neglected my “north core” — the muscles that stabilize the shoulder girdle, upper back, and neck.

I’ve since expanded my workout regimen to address these muscles and have been able to cycle painlessly.

My advice to all athletes — cyclists in particular — is to be diligent and invest in your core strength, both of the middle core and the north core.

There are several ways to achieve this. You can seek out fitness instructors, physical therapists, Pilates classes, online videos, yoga classes, or books.

The avenues are virtually limitless, so find the one that’s best for you and stick with it. You’ll never find a better investment in athletics — and you’ll never regret it.

The Dangers of Overlooking Your Core

Maintaining your core is both offensive and defensive. Core strength training allows you to stay on the bike longer, hit the golf ball farther, etc., but it also prevents injury, especially in aging athletes.

As I’ve said before, an injured athlete is not a training athlete. Time off to recover takes you out of the game.

Maintaining a strong middle core (and north core) is one of the best preventative measures an athlete can take at any stage of life.

Quote Card: Don’t Ignore the Core: How Core Strength Is Essential for Cycling

Today’s Takeaways

If Pilates isn’t for you, rest assured there are many ways to build core strength for cycling, golf, tennis, and other sports.

Pick the right avenue for you and stay with it. You’ll be glad you did.

A man holds his head in pain as he asks himself, “Why do I get headaches after naps?”

Why Do I Get Headaches After a Nap?

There are two types of adults in the world: the ones who benefit from naps, and the ones who don’t.

If you are a “nap person,” you may be one of the many who experience grogginess after a nap. You may have even asked your doctor, “Why do I get headaches after a nap?”

Fortunately, we can help you with these questions.

Sleep has an architecture. You sleep in stages, and when you understand those stages, you’ll understand why your naps aren’t always refreshing and what you can do to change that.

The Architecture of Sleep

Sleep isn’t a random event. It’s made of four individual stages which, together, comprise a 90-minute cycle:

  • Stages one and two are light sleep.
  • Stage three is called Delta sleep, or deep sleep.
  • Stage four is REM (rapid eye movement) sleep. This is the stage in which we dream.


Infographic: Why Do I Get Headaches After a Nap?

Why Do I Get Headaches After a Nap?

Ever Googled “Why do I get headaches after a nap?” Here’s your answer: The most common cause of that dysphoric, groggy post-nap feeling is waking up mid-sleep cycle.

When you interrupt your sleep cycle, your body doesn’t have the opportunity to complete its natural process. The interruption leaves you feeling out of sync and can result in adverse symptoms, including headaches.

Preventing Headaches After Naps

If you’d like to reduce your potential for grogginess and headaches after napping, there are two techniques I recommend:

  1. When you lie down to take a nap, set an alarm for 15–20 minutes. This ensures you only spend time in the light sleep stages, making it easier to wake up and less likely you’ll experience uncomfortable side effects.
  2. If you have time, set your alarm for 90 minutes. This allows your brain to complete a full cycle but wake up before beginning a new one.


Infographic: Why Do I Get Headaches After a Nap?

Other Advice

If you nap frequently and commonly ask, “Why do I get headaches after a nap?” you may be asking the wrong question.

Perhaps you should ask whether you’re optimizing your sleep at night. For example, are you napping because you don’t sleep well at night? If so, prioritizing your nightly sleep habits should come way ahead of learning how to nap better.

We can help with that, too. Read our most recent blog post on sleep, or contact our office to schedule an appointment. We’re happy to help repair your relationship with sleep.

Today’s Takeaways

  1. Some people benefit from naps, some don’t.
  2. Sleep has an architecture of four stages, which take 90 minutes to complete.
  3. Interrupting your sleep cycle during Stages 3 and 4 can cause uncomfortable side effects such as grogginess and headaches.
  4. To avoid unwanted side effects from napping, set an alarm for 15-20 minutes so you wake up in a light sleep stage. Or, set an alarm for 90 minutes so you wake up after a complete sleep cycle.
  5. If find yourself asking “Why do I get headaches after a nap?”, don’t just focus on napping better. Optimize your nightly sleep habits, as well.

Quote: Why Do I Get Headaches After a Nap?

A woman pinches the extra skin and fat on her side while wondering, “What does a stress belly look like?”

What Is a ‘Stress Belly’ and What Does One Look Like?

You may not believe this, but not everything you read on the internet is true — especially when it comes to medical facts.

Shocking, I know.

You may have heard of something called “stress belly” and wondered what it looks like. Stress belly is a real phenomenon, but it’s very different from the images and blog posts you’ll find if you Google “what does a stress belly look like.”

Infographic: What Is a ‘Stress Belly’ and What Does One Look Like?


Those images are total BS.

There’s no way to immediately identify the cause of abdominal fat deposition simply by looking at the belly. (Plus, anyone who carries so much fat on their abdomen won’t look like a supermodel everywhere else.)

That being established, what is a stress belly, and what does a stress belly look like?

What Does a Stress Belly Look Like?

Stress belly is the result of a direct physiological link between the emotional stress you experience and increased fat deposition in your abdominal cavity.

Not everyone with abdominal obesity has a stress belly. Likewise, not everyone who experiences excess stress develops a stress belly or abdominal obesity. However, there’s enough overlap to ensure a genuine phenomenon, although it’s not explanatory for all instances.

Causes and Symptoms of Stress Belly

There are many instances of powerful, intricate relationships between our emotional state and our physical state.

A lot of literature links socioeconomic status to health outcomes. For example, if you’re struggling financially, you may not be able to consistently provide food or housing for yourself or your family. The amount of stress engendered by a lower socioeconomic status is considerable.

When we experience chronic stress, we see elevated levels of adrenaline and cortisol, a glucocorticoid which can be measured in saliva, blood, and even hair. These elevated levels correlate with worse health outcomes.

Too much cortisol can set a whole host of other hormonal changes into motion, including putting more adipose (fat) cells within the abdomen. These visceral fat cells are hormonally active, pro-inflammatory, create insulin resistance, and worsen hypertension, which are all risk factors for coronary artery disease.

They’re part of a worsening feed-forward loop that also influences hormones that regulate appetite, like leptin and ghrelin. This causes people under stress to crave comfort foods (foods high in sugar and fat), which compound obesity and continue the feed-forward loop.

Together, all these factors form an unfortunately strong and documented pathway — starting with socioeconomic status and emotional state and leading to increased fat content, heightened cardiovascular risk, and many other downstream health complications.

Risk Factors for Stress Belly

The risk factors for stress belly begin with its namesake — stress. Despite the documented link between socioeconomic status and stress, stress can affect anyone in any circumstance.

Stress isn’t always caused by emotion, either. For example, chronic pain can cause stress. It’s like kicking someone when they’re down.

Another cause of stress — and therefore excessive cortisol, or hypercortisolism — can be a lack of sleep. If you consistently fail to get the proper quantity or quality of sleep, your body generates more adrenaline and cortisol. This especially affects night shift workers, whose circadian rhythms are all out of whack.

The same thing happens when you consume alcohol. Most people equate drinking with relaxation. However, as your body metabolizes alcohol, it releases adrenaline and cortisol, which stresses your body and induces hypercortisolism.

Stress Belly Treatment

So you’ve gotten past “what does a stress belly look like?” and moved on to “how do I get rid of my stress belly?” I hear you.

The best way to combat stress belly is to identify and address its contributing factors. Then, double down as much as you can on removing or managing the factors that cause undue stress and lead to hypercortisolism.

Emotional Stress

When emotional stress weighs heavily, meditation, cognitive behavioral therapy, exercise, and other techniques and tools can relieve some of the burden. Don’t wait until you feel overwhelmed before you ask for help.

Chronic Pain

If you’re experiencing chronic pain, you may not be able to remove the pain or the source of the pain completely, but there may be ways to improve your quality of life. For instance, through meditation, therapy, or other modalities, you may be able to emotionally reframe your pain so it’s less stressful to your body.


Alcohol consumption can be simpler to limit (or omit), but not always. Alcohol is not part of the solution for stress — it’s part of the problem.

If you need help limiting or abstaining from alcohol, contact your doctor or a support group near you.


Sleep is crucial to wellness. However, improving sleep can be incredibly complicated.

If you’re having trouble sleeping, please talk to your doctor or contact us here at Banner Peak Health. We’ll be glad to speak with you.

Quote: What Is a ‘Stress Belly’ and What Does One Look Like?

Today’s Takeaways

  1. All the charts that pop up when you Google “What does a stress belly look like?” are BS.
  2. Stress belly is real. No, you can’t tell if you (or anyone else) have it just by looking.
  3. Stress belly increases the risk for a wide array of illnesses, including diabetes, high blood pressure, and coronary artery disease.
  4. Treatment for stress belly involves managing and omitting the causes of stress. These can include emotional stress, chronic pain, alcohol, and poor sleep.

A blonde woman suffering from text neck stands with poor posture looking down at her cell phone.

Text Neck: The Hidden Epidemic We Shouldn’t Ignore

Everyone’s heard the mantra of the “core,” defined as the lower back, hips, pelvis, and stomach. We all know the core is essential for movement and athletic performance.

But what about the north core?

Never heard of it? I’m not surprised.

What I define as the “north core” is the group of muscles surrounding your neck. Unfortunately, the neck is the forgotten part of the spine.

In my opinion, we focus too much on the main core — that anatomy is extremely solid. We really haven’t focused on the ergonomics and protection of the north core, even though those muscles give the neck strength and flexibility.

The seven cervical vertebrae are tiny, and we aren’t conscious of the surrounding muscles... that is, until the pain of text neck starts.

The Neglect of the North Core

Neglecting the neck can lead to a domino effect of symptoms in our musculoskeletal system.

When we ask our muscles to perform tasks they simply can’t do, they become stretched and inflamed. They spasm. As they spasm and contract, they create tension in adjacent muscle groups.

What starts as overuse of a small group of paraspinal cervical muscles turns into trapezius spasms, shoulder pain, and headaches. And it’s all driven by overuse of these little muscles.

To prevent a pain syndrome cascade, we need to better protect and be conscious of our cervical muscles.

Let’s Talk About Text Neck

There’s an epidemic of neck pain, and the driver is poor ergonomics and how we interact with screens — particularly handheld devices like phones. The condition is called text neck, and recent studies show astounding results.

Infographic: Text Neck: The Hidden Epidemic We Shouldn’t Ignore


The average human head weighs 10–12 pounds. As you tilt your head forward, you increase the force applied to the base of your neck.

As you can see in the graphic, even slight increases in tilt angle drastically increase the amount of force transmitted to your neck. By the time your head is tilted to a 45-degree angle, the force on your neck has increased fivefold!

Heavy is the head that stares at the phone.

Imagine the effect of this amount of sustained pressure over hours every day. Voilà — text neck!

What if We Ignore Text Neck?

Who doesn’t have neck pain?

My best friend once asked me to refer him to a good acupuncturist because his neck was killing him. I told him I’d refer him to a good acupuncturist if he promised to stop resting his laptop on his chest while he used it in bed.

Don’t put a Band-Aid on a bullet hole. There’s no reason to provide a small, momentarily effective treatment if you don’t do anything to address the root cause of the problem.

As I mentioned earlier, the issue with neglecting your north core is the domino effect it can cause throughout your musculoskeletal system. Overuse leads to stretching and inflammation, which leads to spasms, which leads to pain in the neck, which migrates to the shoulders and back and causes headaches.

Simply put, it’s not just about neck pain.

Stop Blaming Your Pillow for Text Neck

Often, patients ask me what the best pillow is for neck pain. When I ask why, they tell me they wake up every morning with terrible neck pain and insist it must be their pillow.

Let me assure you — it’s not your pillow’s fault.

The mechanism for generating the pain you woke up with is the muscle you overused the day before, the inflammatory process that set up overnight, and the spasm you woke up with. Just because you woke up in pain on your pillow doesn’t make it your pillow’s fault.

What We Can Do About Text Neck

First, we must be aware that text neck syndrome is real and common. The signs are frequent neck pain, headaches, shoulder pain, and pain anywhere from the top of your head to your armpit. The problem is widespread, and we need to address it.

Amazingly, there’s an app for that!

Some brilliant people have found a way to use a smartphone’s motion sensor to determine the angle at which the phone is being held. The app alerts the user with a red light when the angle of view is too severe.

Using tools like this can significantly improve your posture during device use and reduce your risk of developing text neck. Taking advantage of voice-to-text functions and voice assistants like Siri and Alexa more often can also help.

Finally, you can improve your range of motion and alleviate pain by stretching regularly. Since pain is caused by muscle spasms and tightness, stretching those muscles can help reduce pain and prevent further damage.

Quote: Text Neck: The Hidden Epidemic We Shouldn’t Ignore

Today’s Takeaways

  1. Your “north core” deserves just as much attention as your main core.
  2. Text neck is real and incredibly common.
  3. A new pillow won’t solve the problem. Instead, try posture-improvement apps, voice-to-text assistance, and stretching exercises to improve your north core strength and prevent text neck.

A child wearing a teal N-95 mask to protect against COVID stares into the distance.

COVID 2023: Are We There Yet?

For over three years, we’ve waited for the COVID pandemic to be over. An analogy to intensive care medicine seems appropriate.

I was taught that “a patient enters an intensive care unit with dramatic catastrophes and leaves with incremental, slow, methodical improvements.” That is, the beginning is more obvious than the end.

We’ve made tremendous strides in reducing the number of infections, hospitalizations, and deaths attributed to COVID. With these gains, our societal focus has shifted elsewhere. Emergent government policies to address the economic and health effects of the pandemic are being scaled back. But is the pandemic over?

On one hand, the data in Contra Costa County and at the national level demonstrate markedly reduced levels of COVID viral particles in the sewer systems, fewer people in the hospital due to COVID, and fewer people dying.

On the other hand, based on the national data from April, we’re still losing 1,300 people per week to COVID. This yields an annual death rate of 68,000 more people than the number lost to influenza in any year for the last decade. Unfortunately, the risk of COVID is still with us.

Fight On

Vaccination has been our best weapon against COVID. After three years, most of us have had multiple vaccinations and, often, a COVID infection or two. We’re beating back the pandemic because of the level of immunity generated by this process. The obvious question becomes: What is the incremental benefit of yet another vaccination?

The answer depends on your level of risk for a bad outcome from COVID.

Almost everyone currently hospitalized with COVID falls into four broad and potentially overlapping categories:

  1. Over 50
  2. Multiple comorbidities (such as obesity, diabetes, heart disease)
  3. Immunocompromised
  4. Unvaccinated or under-vaccinated

In fact, 90% of those currently hospitalized have not received the most current bivalent COVID vaccine. This version contains two strains, one against the original Wuhan variant and another against a new omicron variant. Since this vaccine’s release in fall 2022, numerous studies have demonstrated its greater efficacy than the original single-variant vaccine, which will be phased out.

Most of you have already received a bivalent COVID vaccine booster. If you haven’t, please consider getting your first dose of the bivalent COVID vaccine now.

Infographic: COVID 2023: Are We There Yet?

Who Needs a Booster?

What if you’ve already received the bivalent COVID vaccine? On April 19, 2023, the CDC updated its recommendations for booster vaccinations this spring. They identified risk groups who should receive an additional bivalent COVID vaccine, and they’ve included timing recommendations:

  • If you’re over 65 years old, you should wait four months from your last vaccination or COVID infection to receive this booster.
  • If you’re immunocompromised, you should wait at least two months from your last vaccination or COVID infection to receive this booster.

I sense a growing frustration with being asked to get a COVID vaccination again and again. We remember getting childhood vaccinations that lasted decades, and we can tolerate getting a tetanus booster every 10 years or so. However, the biology of the COVID virus and the vast numbers of infected individuals have allowed rapid evolution to occur, which continues to select for variants that can partially evade our vaccines.

We’ve been able to develop vaccines that work against these newer variants, such as the current bivalent COVID vaccine. Researchers are working to develop vaccines that target parts of the virus that don’t mutate as rapidly as the spike protein, the target of current vaccines.

Also, to compensate for the decline in efficacy over time, we increase the frequency of vaccination to get a recurring boost in our antibody levels, which are at their peak for one to six months after vaccination. Thus, recommendation for frequent vaccination allows us to extract maximum performance from our current vaccination technology, which is needed to maximally protect those at the highest risk.

Who Doesn’t Need a Booster?

It also makes sense to discuss who does NOT currently need a booster vaccination.

The incremental benefit of each additional vaccination has become ever smaller. Thus, for populations whose overall risk of a bad outcome is already very low, such as children and younger adults, a further tiny reduction isn’t worth the discomfort and rare (but not zero) risk of a serious vaccine complication.

Today’s Takeaway

Please get a COVID bivalent vaccine now if you fall into any of these categories:

  • If you’re over 50 and haven’t yet had a bivalent COVID vaccine
  • If you’re over 65 and haven’t had a COVID vaccine or infection in the last 4 months (or wait until 4 months have elapsed)
  • If you’re immunocompromised and haven’t had a COVID vaccine or infection in the last 2 months (or wait until 2 months have elapsed)

Please reach out if you have any questions or concerns.

A young woman lies in bed during the day with blankets over her head, trying to manipulate her circadian rhythm.

Circadian Rhythm Manipulation for Insomnia and Sleep Habits

Complicated problems often require complicated solutions. Problems with sleep are no exception, and they frequently require what’s called a differential diagnosis.

A differential diagnosis encourages doctors to think comprehensively across a range of possibilities to identify what factor(s) may be causing a patient’s problem. That’s how we arrive at a specific, patient-focused solution.

This is in marked opposition to what often happens in a time-pressured healthcare environment where “if-then” statements dominate. This reductionist logic boils complex problems down to linear, one-size-fits-all solutions: “If X is the problem, then Y is always the solution.”

Such reductive thinking may be fast, but it isn’t effective.

I want to clearly distinguish from this linear logic a more expansive, inclusive thought process. Doctors often translate the sentence “I can’t sleep” into the medical term “insomnia,” but what is the differential diagnosis for insomnia?

Many factors can contribute to not being able to sleep. Circadian rhythm problems are one of them.

The Circadian Rhythm

The circadian rhythm is a biological rhythm unique to each individual, lasting about 24 hours. We’re most aware of it in the context of sleep, but actually, every biological function is timed with a daily clock — digestion, reproduction, cognition, etc.

The word “circadian” comes from the Latin circa, which means “approximately,” and diem, which means “day.” Together they mean “about a day.

Let’s focus on the word “approximately.” Reflected in this word is the fact that not everyone follows the 24-hour sleep cycle exactly.

There are some individuals for whom the sleep cycle is less than 24 hours. We refer to these people as morning sparrows. They do their best thinking in the morning, have the most energy early in the day, and follow the “early to bed, early to rise” adage.

Then there are those whose circadian rhythms run longer than 24 hours — night owls. These are the individuals who don’t want the night to end. They’re most focused and animated late in the evening and have difficulty settling down and sleeping. They’re also the ones slamming the “snooze” button come morning.

Understanding and observing an individual’s circadian rhythm can yield valuable insights into potential causes of their insomnia. Let’s look at a few examples.

Quote: Circadian Rhythm Manipulation for Insomnia and Sleep Habits

The Circadian Rhythm and Insomnia

Example A: Teenagers

If you have a teenager in your life, he or she likely falls into the night owl category, unable to fall asleep at an appropriate time to wake up for school the following day.

Don’t be so quick to attribute this to laziness. Not only is there individual variation in a person’s circadian rhythm, there are also age-related variations affected by hormones. As children approach and go through adolescence, their circadian rhythms lengthen, and they’re biologically programmed to stay up later and wake up later.

This understanding provides insight into how we can help young people function better.

For example, the first thing I as a physician would suggest is that this teenager limit his or her screen time in the evening. When we look at screens, we absorb a specific blue light wavelength directly into our eyeballs. Our retinas have receptors that detect this wavelength and send our brain a signal that the sun hasn’t set yet. Our brain then knows not to initiate the hormone cascade that helps us sleep.

In short, screen time right before bed sends our bodies the opposite signal we need.

To combat this and help teenagers sleep, I recommend limiting any white/blue light that would hit the eyes.

I would also suggest using melatonin supplements, if necessary. Melatonin is a hormone released in the brain, increasing when it’s dark and decreasing when it’s light. It’s basically the hormone of darkness that enables us to sleep.

A Personal Example

When my daughter was 17, her summer break was like that of most teenagers. Left to her own biological rhythms, she was going to bed progressively later, 1 a.m. or 2 a.m. Without the confines of school, she followed her natural sleep cycle.

Well, one day, much to her horror, she realized she had to wake up and take an SAT in just three days. She didn’t have a ton of time to change her sleep pattern.

We got to work right away. First, I had her wear blue light-blocking glasses, which would mute the neurological signals from any lights she’d be exposed to. She’d wear these for two hours before bedtime. I also gave her a very low dosage, six-hour sustained-release melatonin to help shift her circadian rhythm earlier.

With these tools, she went to bed several hours earlier each night. She woke up on time by her deadline and did fine on her SAT.

The tools we have at our disposal are deceptively simple and safe, yet powerful — as is our ability to modify circadian rhythms.

Example B: Aging

A common sleeping problem in older folks is called pre-terminal insomnia. Pre means “before,” terminal means “the end” (in this case, the end of the night), and insomnia means you can’t sleep.

You’ve likely deduced that this is when people wake up in the middle of the night — 2 a.m., 3 a.m., etc. — and can’t fall back asleep. This can be caused by many factors, including depression, anxiety, and advanced sleep phase disorder, a form of circadian rhythm disorder.

Just as teenagers see their circadian rhythms lengthen as part of the hormonal changes of adolescence, as we get older, our circadian rhythms often become shorter. For example, the older a person gets, the earlier they typically prefer to hit the hay.

Sometimes, the circadian rhythm gets too short. Those poor morning sparrows’ hormones are being activated too early, and they end up waking at 2 or 3 a.m. because they’re experiencing circadian rhythm activation before dawn.

When your hormones activate before the sun rises, it’s time for intervention. In this instance, I’d recommend small quantities of rapid-acting melatonin that dissolve in the mouth, as opposed to something longer-acting, which we’d use for teenagers. Morning sparrows would take this when they wake up in the middle of the night to tell their hormones, “It’s too soon to activate!”

These older individuals also have to be careful to remain in darkness. Any light stimulus that reaches the eyes in the early morning further confuses the body by signaling that the sun is rising.

How to Tell if You’re Experiencing a Circadian Rhythm Issue

If you’re experiencing sleep problems, it could be due to issues with your circadian rhythm — but often, it’s a combination of factors.

Sleep can be very complicated. The best advice I can give is to seek out the appropriate medical care.

This isn’t a DIY fix or diagnosis. Please don’t try this at home. Sleep treatment often requires a professional.

Infographic: Circadian Rhythm Manipulation for Insomnia and Sleep Habits

Today’s Takeaways

  1. Complex problems require complex solutions. When it comes to sleep problems, differential diagnoses are important.
  2. Circadian rhythms are individual and change over time.
  3. Using appropriate medical intervention, we can shift circadian rhythms when necessary.

Sleep is complicated. If you’re having trouble sleeping, please consult your doctor or contact Banner Peak Health.

A doctor in a hallway full of natural light checks off items on his patient’s preventative care checklist.

Overlooked Screenings That Belong on Your Preventative Care Checklist

As a doctor with over 30 years of experience, I’m always seeking to better understand the overall context of my patients’ lives. This helps me better customize my care to address their health needs.

Our bodies are the vehicles, the cars, with which we transport ourselves through our lives. As a physician, I don’t just want to kick the tires and perform some maintenance; I want to know where each vehicle is headed.

For example, if I’m asked to do a preoperative evaluation on a patient for a hip surgery, I’m not just looking at their physical readiness. I also want to know whether their circumstances are conducive to a successful surgery.

Will they have adequate care at home, or are they the sole caregiver for an ailing spouse? Or, perhaps they have hidden depression that the pain and immobility of a major orthopedic surgery will exacerbate. Or, maybe they’re an athlete who’ll tell me, “You can’t take my joint; golf season’s coming up!”

The same medical question can have very different answers depending on the overall context of an individual’s life. For truly high-quality, responsive healthcare, the full picture is necessary.

The same is true in determining how to maximally leverage preventative healthcare for each patient. At its core, prevention is really about individual lifestyle. Anyone can recommend a mammogram to a woman over 40, but to really address the deeper fundamentals of prevention, you have to understand how a person lives. Then you can work with them to modify their lifestyle.

True prevention isn’t checking off boxes on a preventative care checklist in a cookie-cutter fashion. It’s a much more personalized, intimate process.

Infographic: Overlooked Screenings That Belong on Your Preventative Care Checklist

The Typical Preventative Care Checklist

You’re likely familiar with many of the items on the typical preventative care checklist in conventional medicine. You’ve heard about them your entire adult life. They include studies such as:

  • Mammograms
  • Pap smears
  • Colonoscopies
  • Prostate exams
  • Lung CTs

As practitioners of concierge medicine, we don’t believe your health is adequately protected with a simple checklist. You need something much more comprehensive for true prevention.

Of course, at Banner Peak Health, we still recommend all the above tests — but we go much deeper. And there’s no one-size-fits-all checklist for the amount of customization we do.

In addition to the tests and screenings on the standard preventative care checklist, we also take advantage of state-of-the-art screenings and equipment. Here are just a few of the ways we help our patients stay proactive about prevention:

  • Coronary artery calcium score — early detection test for cardiovascular disease risk
  • GRAIL Galleri test — early cancer detection test administered through a simple blood draw
  • InBody — body composition screening that goes beyond BMI to consider what percentage of your body weight is fat versus muscle
  • Emotional health screening tools — means of diagnosing hidden depression and anxiety. These are very intimate, and vital in understanding how to best treat other physical needs.

The unique model concierge medicine provides allows us to offer this more in-depth, customized care. We aren’t beholden to insurance companies, who would dictate what tests we can run and what equipment we can use. We’re free to prioritize your health, rather than commoditize it.

Quote: Overlooked Screenings That Belong on Your Preventative Care Checklist

Banner Peak’s Priority

Your body is your vehicle, and it needs to stay in proper working order. To make that happen, we need to know your destination. That way, we can help provide the right maintenance along the way and get you there in the best condition.

We’re proud to offer a robust preventative care checklist — but one that’s customized to every patient. By connecting with each of our patients and taking the time to learn about their lifestyles, priorities, and health goals, we’re able to offer the individualized care they need and deserve.

If our approach sounds like it would be a good fit for you, contact us today. We’d love to help!

A bearded man lies in bed with insomnia, worrying about sleep’s effect on athletic performance.

What Is Sleep’s Effect on Athletic Performance?

We know sleep is vital for all our emotional and physical endeavors — but it’s not enough to just get sleep. We need the appropriate quality and quantity of sleep.

Obstructive sleep apnea — a common form of sleep deprivation which affects 15–30% of men and 10–15% of women in North America — manifests by closing off the airway during the deeper phases of sleep, preventing air from reaching the lungs and oxygen from reaching the brain. This creates an adrenaline/stress hormone surge that prevents us from reaching the more restful stages of sleep.

I spend a good amount of time in the clinic identifying which of my patients are at risk for obstructive sleep apnea and convincing them to undergo testing and receive appropriate treatment.

To help my patients understand the importance and value of treatment — and to aid in my sales pitch — I direct them to literature that demonstrates sleep’s effect on athletic performance.

Infographic: Does Lack of Sleep Affect Athletic Performance?

Sleep’s Effect on Athletic Performance

The following are three ways sleep — or a lack thereof — can affect athletic performance.

Cognitive Ability and Physical Endurance

Golfers will do anything for an edge up.

Golf relies on cognitive abilities to strategize and calculate risk/return, physical endurance for strength and accuracy, and emotional control to manage pressure.

All these abilities can improve with adequate sleep. Data shows a statistically significant improvement in a golfer’s handicap after treatment of obstructive sleep apnea.

Training and Recovery

Let’s look at the fundamental core of fitness and working out. How do we get in shape?

When we exercise, we stress our body — by weightlifting, running, etc. That stress manifests as low-level cellular damage to our muscles. It’s the response to this stimulus, this damage, that allows our body to recover and come back stronger. This is how we build ourselves through training.

As I’ve said before, recovery is the process that makes us physically stronger, not the stimulus.

Sleep is absolutely vital to this recovery. The hormones we need to build back better — such as testosterone and growth hormone — occur in adequate quantities during sleep. That’s when our bodies recover and grow stronger.

Jet Lag and Circadian Rhythm

One potential threat to obtaining the adequate quantity and quality of sleep is jet lag.

Almost every bodily function is regulated by our own internal clock, our circadian rhythm, which is synchronized to our local time zone. With travel, there’s a risk of jet lag and impaired sleep.

In 2013, researchers analyzed over 40 years of NFL games, specifically questioning whether circadian rhythm-induced jet lag influences a team’s performance. They found that for night games played on the West Coast, the home team beat the predicted point spread twice as often.

It’s fascinating evidence linking sleep with the peak performance of professional athletes. It’s also something to keep in mind during your next trip to Vegas: Give yourself an extra day to recover before hitting the casino. You’re welcome.

Quote: Does Lack of Sleep Affect Athletic Performance?

Today’s Takeaways

  1. When you’re traveling to compete in an athletic event, be cognizant of sleep’s effect on athletic performance. Do your best to compensate for your circadian rhythm by giving yourself a few extra days to recover before you compete. In other words, you shouldn’t fly to Paris and ride in the Tour de France the next morning.
  2. Be cautious when you get up early to work out. Patients often ask me whether it’s better to get up early to work out or to sleep for an extra hour. I tell them, “Do both.” If you can get up early to work out and still get enough sleep, that’s fine, but to lose an hour of sleep for an hour of workout isn’t maximizing your potential athletic gain.
  3. Be open to discussing obstructive sleep apnea with your physician. Diagnosing this disorder and treating it effectively can yield many health benefits, including better athletic performance.

A depressed woman sits with her knees to her chest, wiping away her tears with a tissue while crying.

The Sad Triad: Depression, Poor Sleep, and Chronic Pain

For about 15 years, I studied Chinese medicine and practiced acupuncture. As such, I have a deep appreciation for the Eastern perspective on medicine, health, and wellness.

In Western medicine, we tend to sort everything into conceptual silos: “This is a neurological disease, so you have to see a neurologist.” “This is an endocrine disease, so you have to see an endocrinologist.” Cognitively, we’re splitters.

But in Eastern medicine, everything is inextricably linked, which leads to a lot of powerful explanation.

With that in mind, I’d like to introduce “the sad triad” — the link between depression, sleep deprivation, and chronic pain.

Infographic: The Sad Triad: Depression, Poor Sleep, and Chronic Pain

The Sad Triad

1. Chronic Pain

One of the most challenging aspects of any medical system is treating pain, especially chronic pain.

At first glance, many perceive the transmission of pain as linear, like the child’s game of tying two cans together with a string to transmit a signal between them.

However, the transmission and sensation of pain are much more complex. A more apt metaphor would be that of a spiderweb: a myriad of interlocking nodes in which modulating any one node changes what happens to all the other ones.

This is why I believe the Eastern view of interconnectedness is a more useful, more explanatory way to address chronic pain.

Pain’s impact on the body isn’t linear. It’s influenced by many other factors — especially the quality and quantity of sleep we get.

2. Sleep Deprivation

Being an adult often means masking our true selves for the sake of social acceptance. We sometimes get a clearer view of human nature by observing children.

For example, a toddler who’s well-rested and enjoying herself at the playground may trip and face-plant while running across the turf. While this will probably draw a shriek from the parents watching, she’ll cheerfully get back up, brush herself off, and keep running toward the next play structure.

However, anyone who’s tried to put an exhausted toddler to bed knows a barely-pinched toe can lead to a hysterical tantrum.

That’s a great illustration of how sleep influences the perception and impact of our pain. Ultimately, poor sleep is a pain multiplier.

3. Depression

The emotional context around pain also influences the pain’s impact.

Although there are no perfect analogies, the example I’ll use here is of two very similar anatomical injuries I’ve treated in two very different contexts.

The first injury occurred when a snowboarder was going for big air and blew it. He jammed his neck and weathered chronic neck pain as a result.

The other injury was the result of a car accident. A woman was rear-ended driving home from work. Because of her injuries, she also suffered chronic neck pain.

Although the two injuries aren’t anatomically very different, the perceived pain is. The snowboarder has much less perceived pain because he had agency over his situation. He himself made the decisions that led to the injury. The woman in the car accident, meanwhile, has much more perceived pain because she felt victimized by her circumstances.

Our emotions interpret pain — they influence how we experience our pain and how it impacts our lives.

A Vicious Cycle

These three realities — chronic pain, sleep deprivation, and depression — feed into each other in a tragic, debilitating way.

If pain is unrelenting and interferes with sleep, the pain becomes more perceived and more impactful. If you’re exhausted and not sleeping, you’re at risk of depression. The cycle continues.

If you’re caught in that cycle, a Western physician will likely diagnose you with chronic pain, then with sleep deprivation, then with depression. Each condition will be treated separately rather than as a whole.

Holistic Treatment

Now that we understand how these conditions are related, we can use this interrelatedness to our advantage. We can turn the vicious cycle of the sad triad into a virtuous cycle.

For example, some of our most potent chronic pain medications are also used as antidepressants. We believe these medications manipulate anti-pain properties through the same neural pathways an antidepressant would use.

I’m a minimalist when it comes to medication, but when a patient tells me their pain is affecting their sleep, I become pharmacologically aggressive. In that case, the benefits of medication far outweigh the risks.

On that note, if you yourself are caught by the sad triad and need help turning that vicious cycle into a virtuous cycle, Banner Peak Health is just a call or click away.

Quote: The Sad Triad: Depression, Poor Sleep, and Chronic Pain

Today’s Takeaways

  1. Pain severe enough to disturb sleep warrants treatment.
  2. Hidden depression can present as chronic pain.
  3. People with chronic pain often categorize good days and bad days based on their symptoms. I posit that a bad day often correlates with not having gotten enough sleep the night before. Paying more attention to sleep may lead to more good days.
  4. Taking an antidepressant to address chronic pain does not dismiss the physical reality of the pain. In no way am I trying to tell you your pain is “just in your head.”
  5. Mindfulness/stress reduction classes are an effective means of pain relief. If you can achieve control through mindfulness, you can control your pain relief.
  6. Physical exercise can also be a wonderful treatment option for the entire sad triad.