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Runner maintaining steady pace on open road during golden hour.

Zone 2 Training Benefits: The Complete Guide to Metabolic Health and Performance

Optimization

Discover key Zone 2 training benefits for metabolic health and athletic performance. Learn the science, optimal dosage, and implementation of this method.

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by Barry Rotman, MD

0 Comments20 Minutes

Smiling older woman stretching outdoors in a park, promoting an active lifestyle for heart health and lowering APOB levels.

How to Lower APOB for Cholesterol Management and Cardiovascular Health

Optimization

Learn how to lower APOB levels, the superior predictor of heart disease risk. Combat insulin resistance through weight loss, exercise, and dietary changes.

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by Barry Rotman, MD

0 Comments9 Minutes

Recently, my best friend’s 14-year-old son presented him with a PowerPoint presentation titled “Why You Should Let Me Take Creatine Supplements.” That’s when I knew creatine had become mainstream. Creatine is traditionally seen as a supplement for pubescent young men eager to develop their bodies and bodybuilders aiming to look ripped. But what about the rest of us? I looked at the research and was pleasantly surprised to discover fairly solid evidence suggesting benefits across a wide range of applications — including improved physical function in older adults and adults with chronic disease, memory enhancement, and as an adjunct to drug- and therapy-based depression treatments. (To be clear, studies didn’t show it as a stand-alone treatment for depression but as a supplement to working with a therapist and medication.) There’s also a suggestion of benefit across many other conditions, from improving function for those with muscular dystrophy to enhancing glucose control in diabetics and improving mobility for people with knee degenerative arthritis. What Exactly Is Creatine? Creatine isn’t a protein, but it’s derived from three amino acids: arginine, glycine, and methionine. It plays a role in the body’s production of adenosine triphosphate (ATP), the chemical we use to move energy within our cells. Creatine occurs naturally in animal products, and the body can manufacture some of the creatine it needs. Taking creatine as a supplement allows the body to turbocharge its energy metabolism by enabling greater availability of ATP within cells for energy-intensive tasks. These tasks can include muscle cells lifting heavy weights or brain neurons working to consolidate memory or process complicated thoughts. Why Muscle Mass Matters Many young people want to improve their muscle mass for aesthetics, but as we age, the importance of preserving muscle mass goes beyond appearance. How strong we are and how much muscle mass we have is linked to how well we preserve functional capacity and reduce fall risk as we age. We’re in the midst of an epidemic of sarcopenia — muscle mass loss. With it comes a decline in function. Therefore, any safe, tolerable method to preserve and enhance muscle strength as we age is valuable. How Creatine Works Improving Muscle Energy Metabolism Creatine improves muscle energy metabolism. Creatine is synthesized into phosphocreatine, which helps rapidly regenerate ATP during high-intensity exercise. This allows us to train more in terms of volume and intensity, leading to more stimulus that grows and maintains our muscles. This improved energy metabolism also enhances mitochondrial function, the energy-generating power plants within our cells. Activating Anabolic Pathways Creatine also activates other signals to maintain our anabolic pathway — the whole host of hormonal signals that cause us to maintain muscle mass. It increases other hormones such as insulin-like growth factor 1 (IGF-1) as well. Anti-Catabolic Effects Additionally, creatine has an anti-catabolic effect — it protects muscle from being broken down. Besides helping young bodybuilders, creatine builds and preserves muscle mass for those of us with a bit more mileage. Reducing sarcopenia has been shown to preserve functional capacity as we age. How Creatine Boosts Brain Health Enhanced Brain Energy Metabolism Just as in muscle, creatine enhances brain energy metabolism. By providing more ATP, creatine allows greater energy access for neurons’ high-energy tasks, such as cognitive processing and memory formation. Increased Synaptic Plasticity Creatine has also been shown to increase signals that allow for synaptic plasticity — how many connections each neuron has, which is how our brain works. Creatine enhances the number of synaptic connections, critical for memory and learning. Neuroprotective Effects Creatine also activates neuroprotective pathways, protecting neurons and brain cells from hazardous oxidative stress and inflammation. Downsides to Taking Creatine In healthy individuals, creatine is safe when taken at low doses (3–5 grams per day). Possible mild side effects include: GI upset Muscle cramping About 1–2 pounds of weight gain from greater fluid content within muscle cells Additionally, because creatine can put a greater strain on compromised kidneys, individuals with kidney impairment or risk factors for kidney problems (such as high blood pressure or diabetes) may need to discuss creatine supplementation with their physician. Who Should Take Creatine? I divide supplements into three categories: Known risks that probably exceed benefits Known benefits that probably exceed risks Not enough data to assess the risks or benefits For most people, creatine is in the second category. Try it and determine if it works for you. That’s what I’m doing, having recently started supplementation myself. I’ll see what happens. Final Thoughts on Creatine Supplementation There’s a vast array of supplements and medical devices available to consumers. Even for someone who’s been in the medical field for almost 40 years, like myself, it’s tough to separate the wheat from the chaff and determine what’s safe and worthwhile. I can’t imagine how hard it would be for a non-medical person to figure this all out, which is why I love my job. I get to do the research and share the results with you.

Creatine Supplementation: Not Just for Bodybuilders

Optimization

Beyond bodybuilding: Discover how creatine supplements help preserve muscle mass in aging, boost memory, and support treatments for many health conditions.

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by Barry Rotman, MD

0 Comments6 Minutes

Doctor discussing health records with a patient, representing personalized care in Walnut Creek concierge medicine.

The Evolution of Concierge Medicine in Walnut Creek: An 18-Year Perspective

Concierge Medicine

Concierge medicine in Walnut Creek has evolved over 18 years. Discover how Banner Peak Health’s group practice model enhances personalized patient care today.

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by Barry Rotman, MD

0 Comments7 Minutes

A group of people in a yoga class performing a back-bending stretch to improve flexibility and relieve lower back pain.

Effective Lower Back Stretches and Exercises to Beat Pain

Medical Conditions

Tackle your lower back pain with our proven framework: identify key medical red flags, improve ergonomics, and master three effective lower back stretches.

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by Barry Rotman, MD

0 Comments9 Minutes

A glass cup of ginger tea with floating ginger pieces next to fresh ginger root on a wooden cutting board.

The Health Benefits of Ginger Shots: A Look at the Evidence

Health

Discover science-backed ginger shot benefits for pain, heart health, nausea, and blood sugar — where grandmother’s wisdom meets modern medicine.

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by Barry Rotman, MD

0 Comments7 Minutes

Blurry woman sleeping in bed with scattered white pills.

Why the Traditional Medical Approach to Sleep Is Failing Us

Health

Discover why sleep isn’t something to “go get” with pills but a natural process that requires creating the right conditions for your body and mind.

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by Barry Rotman, MD

0 Comments11 Minutes

There’s a paradox in health I’ve observed throughout my career: Most healthy behaviors don’t deliver the best sensory experience. Running, weightlifting, flossing, and avoiding ice cream are all beneficial activities, but for most people, they don’t feel particularly pleasant in the moment. We do them because we know they’re good for us, not because they’re enjoyable. Then there’s massage therapy — a delightful exception to this rule. Massage feels good and is good for you. This unique combination makes it worth exploring in greater depth, including reviewing what toxins are released after massage. How Massage Benefits Your Body: A System-by-System Breakdown Let’s look at how massage therapy positively affects different bodily systems: Musculoskeletal System Massage reduces muscle tension and pain while improving range of motion. It can break down adhesions and stiffness that develop in muscles and connective tissue, especially after intense physical activity or prolonged periods of inactivity. Nervous System Massage promotes deep relaxation by activating the parasympathetic nervous system (your “rest and digest” mode). It can reduce muscular compression around peripheral nerves and stimulate the release of endorphins — your body’s natural painkillers. Circulatory System Massage improves blood circulation, helping to deliver oxygen and nutrients more efficiently through the body. Endocrine System Massage increases levels of hormones such as dopamine and serotonin, which are associated with improved mood. It simultaneously reduces cortisol, the primary stress hormone we want less of. These hormonal changes can lower heart rate and blood pressure, improve digestion, create deep relaxation, and reduce muscle soreness and fatigue. Lymphatic System Many people are unaware that our circulatory system actually has three sets of “plumbing,” not just two: The arterial system, which brings oxygen and nutrients to cells, propelled by the heart. The venous system, which returns blood to the heart after delivering oxygen and carries away carbon dioxide. The lymphatic system, which is often overlooked but equally important. The lymphatic system collects interstitial fluid — the fluid that bathes your individual cells. This fluid fills the spaces between cells, delivering nutrients and collecting waste products. After bathing the cells, the lymphatic system collects this fluid and eventually returns it to the venous system in the upper torso. Unlike blood, the heart doesn’t pump lymphatic fluid. Instead, it moves through the action of your muscles, which pump the fluid along lymphatic channels. This is where massage becomes particularly relevant: it’s an extremely effective way of enhancing lymphatic circulation. Source: National Cancer Institute. Components of the Lymphatic System. SEER Training Modules. Does Massage Release Toxins? The Answer Is Complicated Does getting a massage release toxins? This question is complicated, as the term “toxin” is used loosely in health conversations. What We Mean by “Toxins” If you define “toxins” as foreign substances, poisons, contaminants, pesticides, drugs, or food supplements, then no, massage doesn’t significantly impact these types of toxins. These substances have their own clearance pathways: From blood to kidneys, then excreted in urine From blood to liver to gut, then excreted in bowel movements Massage doesn’t meaningfully influence these processes for removing external toxins from your body. Metabolic Waste: The “Toxins” Massage Does Help Remove However, if you define “toxins” as the natural byproducts from cellular metabolism within your body, then yes — massage helps clear these substances. These include: Lactic acid (a byproduct of anaerobic metabolism during exercise) Cellular debris from damaged or dying cells Excess proteins and protein fragments generated during cellular activity Carbon dioxide and other metabolic byproducts Your cells create these substances. They’re bathed in interstitial fluid, and the lymphatic system transports them out. By stimulating lymphatic flow, massage serves as a “car wash” for your cells, removing these waste products more efficiently. Do Massages Release Toxins? The Bottom Line So, does getting a massage release toxins? The answer depends on what you mean by “toxins.” If you’re concerned about external contaminants and poisons, massage isn’t the solution. Your liver and kidneys handle those without much help from massage therapy. But if you’re referring to the natural waste products that accumulate in tissues from normal cellular function, then yes, massage enhances the removal of these substances by activating the lymphatic system. This distinction matters because it helps us understand the real benefits of massage without exaggerated claims. Massage therapy offers numerous evidence-based advantages for physical and mental health, regardless of how we label the substances it helps remove from your tissues. At Banner Peak Health, we believe in providing accurate information about wellness practices like massage therapy. Understanding the science behind these practices helps you make informed decisions about incorporating them into your health regimen. The next time you enjoy a massage, you can appreciate not just how good it feels but also how it supports your lymphatic system and clears cellular waste from your tissues — a rare example of a health practice that’s as pleasurable as it is beneficial.

What Toxins Are Released After Massage? Separating Fact From Fiction

Health

Discover what toxins are released after massage — metabolic waste, not external contaminants — a rare health practice that feels good and is good for you.

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by Barry Rotman, MD

0 Comments6 Minutes

Two doctors collaborating with a professional, discussing private practice vs. group practice with a book and laptop in a bright office.

The Power of the Multi-Physician Model in Concierge Medicine

Concierge Medicine

Private practice vs. group practice: How concierge groups combine personal attention with shared expertise and resources for superior patient care.

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by Barry Rotman, MD

0 Comments5 Minutes