Inside Outside

January 2005 Inside Outside Wellness Center & Medical Spa Newsletter

in this issue

	This Month's SuperSlow® Stars: Doug and Donna Jacobson Dr. Christian's Update on the 6 Components of Optimal Health & Aging, 4th Component "Exercise, Part 2" The Little Engine that Creatined? Amanda Antonini SuperSlow® Honor Roll Criteria Marketing Update - Seminars, Tsunami aid, Radio and Glossy Ads!! Amanda's SuperSlow® Techniques: The MedX Core Abdominal Machine. Botox: "How" it's done and "How" it works. Dr. Sears New Book "The Anti-Inflammation Zone" Contact Us, Suggestions, Comments

This Month's SuperSlow® Stars: Doug and Donna Jacobson

This months SuperSlow Stars are Doug and Donna Jacobson. Doug is the Art director of City Pages Magazine and Donna works at Ancira Winton Car Dealership. Without question, they have been the most faithful and disciplined couple we have had on the program, and their results speak for their efforts. Doug had been a competitive athlete in cycling and other sports and presently is an avid cyclist and rock climber. When he heard me say that I had increased my leg strength from 250lbs to 500lbs without gaining any weight or mass, he was ready to try the program. As a rock climber, he needs the strength but not the extra weight to have to carry up the climb! Many athletes are seeking more strength gains without the bulk. Fortunately, nature allows incredible strength changes to occur without actual changes in lean mass.

In Doug’s Own Words:

“As a former competitive athlete I had come to expect a relative high level of fitness for myself; a combination of age, a nagging shoulder injury and the time crunch of starting a new business and I had lost the edge. Admittedly skeptical of this style of resistance training I plunged in and became a convert and advocate for the SuperSlow program.”

And now from Donna:

“My husband and I started the SuperSlow program about 4 months ago. When I first started, I had no ambition to exercise at all. I was not happy with myself or my weight. I needed something that was going to motivate me to exercise. My husband had already been on the program and had told me about it. I was still uncertain this was for me. But after going and working out a couple of times I could already feel myself wanting to go and see what gains I could achieve. Dr. Christian’s SuperSlow program is not only fun but it certainly works. I have lost a total of 11 pounds and have gained more muscle and confidence. I love going and that’s what counts.”

Here are some graphs which demonstrate their progress.

Despite being in pretty good shape, Doug has shown considerable increases in his strength as the graph shows.

What is remarkable is that he worked out only once a week for 16 weeks to achieve all these gains. One workout a week….think about it. This is equal to only about 16X20min or 320min or only 5 hours of exercise over 4 months to realize all these gains.

During the week between his workouts he continued to cycle and noted that his endurance was much improved in addition.

He has had the most dramatic body composition changes we have seen as yet in the program. He basically traded 10lbs of fat for 10lbs of muscle as his weight is virtually unchanged.

He attributes these gains to the hard workout (he really goes for it), taking at least 120gm Protein per day faithfully and also using a Creatine Monohydrate product. We review our thoughts about this product in Dawn’s Column this month.

Donna has also shown remarkable strength changes for only 28 sessions!

The leg press is up over 100% and she is determined to do as much as Doug!

Donna has lost a total of 11 pounds, all fat and she has gained 1lb of muscle. Remarkable!

She is one of only a few who have been able to gain muscle and lose fat.

Her Body fat % has dropped 6% overall.

At this point we are going to concentrate on them continuing to get stronger and at the same time lose a little more body fat..They are both very close to being the first on our SuperSlow Honor Roll!

We are proud of you Both! Congratulations on being selected our SuperSlow® Stars of the Month and earning 4 more SuperSlow® Sessions.

Dr. Christian's Update on The 6 Components of Optimal Health and Aging

"4th Component: Exercise Part 2"

Take your Vitamin "X" Not too much, not too little.....

About 2 years ago, I began thinking about writing a book entitled the “6 Components of Optimal Health and Aging”. The work is still in progress, but my desire to make it a profound work and full of “useful information”, and my desire to “make it better” inevitably will slow it’s progress.

In forming the outline for the book, I began to stall on the chapter on Exercise. Now Part 2. Part 1 Last Month.

After the Academy and Air Traffic Control School, I was assigned as a new Brown Bar to Sewart AFB, Tennessee as a Combat Control Officer. We had a team of 24 men, and our mission was “To deploy by covert means and establish drop zones, landing zones and extraction zones” The Motto was “First In, Last Out” This was real Combat Joe stuff and it required a lot of physical activity to keep myself and the team in shape.   I jumped out of at least 100 perfectly good airplanes, from as high as 12,000 feet. The Lieutenant was usually the first out of the airplane and since I was the lightest, I would be the last to hit the ground, often drifting off the drop zone into the woods. “There goes the Lieutenant, the troops would say..” But I was strong and in good shape and no one worried about me being able to hold up. One day, one of my fellow officers broke both legs hitting the ground. The next day, I had a 3 point landing, heels, butt and head and was left with a head and neck ache for a month. I began thinking a fella could get hurt doing all this and all of a sudden the Air Force needed Doctors. I was lucky enough to get into Medical School at the the University of Alabama in Birmingham (60miles from Tuscaloosa where I grew up) and during Med School, I learned about another kind of toughness. The hours were long and sleep was dear. During Medical School there was no exercise..just developing a different kind of toughness.

After Medical School, to Wilford Hall in San Antonio. Surgery Internship required mental, emotional and physical toughnes(Much has changed in Surgical training since then). After internship, it was apparent that there would be a little more free time, not much but I got interested in Tennis. Became a pretty good player, went to tennis camps run by Rod Laver, Lou Hoad and John Newcomb. Rod Laver and Lou Hoad had the largest forearms I had ever seen. I was still very thin at this point weighing about 125-130lbs.



In 1980 as a new Staff Cardiothoracic Surgeon, and with a little more free time, I decided I wanted to run the San Antonio marathon. I had not done much running up to this point so I was basically starting from Zero. I had 3 months to train. So I began to run. They say that your collapse point is equal to 3 times your daily average so my goal was to average 10miles a day in the month before the marathon. About 45 days before the marathon I decided to make my first >15 mile run. I was to run from Loop 410 out to Helotes and back. As you know, most roads are slightly slanted on the sides to allow for drainage. But did you know, that running on a slanted side of a road places uneven stresses on the “IlioTibial Band” and you get this incredible pain called the IlioTibial Band Syndrome. I had to stop running 45 days before the Marathon. I went to an Orthopedic Surgeon and Wilford Hall and he injected me, the pain diminished some but he warned me not to run the marathon. As you know, no one ever follows a doctor’s advice and I was soon up and running again. 1 Week before the Marathon, the Syndrome flares up. Not one to give, up, I pilfered a syringe, some xylocaine and some cortisone and sat down on my living room floor and injected my own knee. A week later I ran the 26 miles in 3hr and 56 Minutes, or about 26, 9 minute miles. I had done it. The injury was my first experience with what Orthopedic Surgeons call Boomeritis, an epidemic of ankle, knee, hip and back injuries associated with steady state aerobic activity.

By the time I finished my time at Wilford Hall I weighed a whopping 132 lbs.

When I started private practice in 1984 I began a long period of working out which has increased my weight to about 160lbs, virtually all of this weight has been muscle and my current body fat % is 14.3%.

During the early 90’s I learned to Scuba. The first open water dives were to be in Cozamel and I was told that the current there was very strong and that it would be good to get into shape for the trip. I had about 3 months to get in shape and for those 3 months I did pure aerobics. When I hit the water in Cozamel my tanks would last 15-25minutes max. All that running had given me Zero endurance for this kind of activity. I had another Scuba trip to St. John, Virgin Islands planned in 3 months and I decided to do pure strength training to prepare for the trip..   During those dives my tanks were lasting up to 50minutes. I remember gliding through the water, feeling incredibly strong and I was breathing only 8-10 times per minute. What had happened? What was the difference? During my SuperSlow® Seminar, I talk about how strength training is able to maximally stimulate all muscle fibers, including the Type I Slow Twitch Endurance Fibers. The strength training was the best way to get those endurance fibers in shape and the dives were incredibly enjoyable. I haven’t Scuba Dived for years, but I bet if I got in the water now, I would have incredible endurance. The remainder of the 90’s, a lot of time in the gym, strength training, eating more and bulking up. In 1997, I became a Physician Partner with Cenegenics of Las Vegas and learned the importance of Hormone Optimization and many other wellness strategies, but my thinking about exercise still was not really clear… Until SuperSlow®…..

Next Month…..Enter Ken Hutchins and SuperSlow®.

Your partner in health,

Dr. Christian Contact Dr. Christian

The little engine that Creatined....

The Little Engine that Creatined

We have many people coming through the clinic every day for their SuperSlow workouts. Almost all of them at some point ask us how to get more out of their workout. Eating a zone snack before the workout helps for immediate energy, but recently, I have become aware of a fairly inexpensive amino acid supplement called CREATINE which also has been shown to help us work out harder. Creatine is what is called a “ergogenic (generate energy)” aid. We have more Energy to workout!! We get Creatine through diet in part. Such sources are lentils, eggs fish, garlic, meat, onions, soybeans, seeds and yogurt and our body is able to make Creatine so it is not an essential nutrient strictly speaking. Since the body has the ability to manufacture Creatine, why would it be necessary to supplement with a Creatine? I am so glad that you asked that question. (Otherwise I would not be writing this article).

First some Basic Physiology:

We eat food. Food combines with oxygen. This produces two things we need. The first is heat. 70% of the food we eat is converted to heat. That is why we are warm, 98.6 degrees, to be exact. Remember that thing called a thermometer and how when you burn wood (Oxygen plus wood (food for the fire) plus something to get it going = a nice warm fire). 30% of the food we eat is converted to a molecule called Adenosine TriPhosphate (ATP). As you know from Dr. Christian’s SuperSlow Seminar, ATP is the high energy molecule we need to make our organs function and do all those miraculous things including SuperSlow. Our muscles need ATP to contract. Our muscles don’t store much ATP at all, so we need to continuously make it and our cells do this in those things call mitochondria all the time. So even while you are sleeping this process is going on, continuously.. I think you get the picture. Now when we are exercising, the muscles need more ATP, so the machinery gets reved up and we breath more oxygen and more glucose and fat are converted to ATP and heat (That’s why you get warmer when you exercise and that’s also why you sweat, to get rid of that heat). This process of revving up the production of ATP takes a few seconds, the heart has to start beating faster, you have to start breathing faster and the blood needs to get flowing to the muscles.

What Creatine Does:

Most of the Creatine in our body is found in our muscles. Creatine combines with phosphorus to make Creatine Phosphate (CP). Stay with me now…When our muscles use ATP to generate force the ATP is converted to ADP, which is useless. The CP in our muscles can help turn ADP back to ATP very rapidly without us having to generate new ATP by burning Fat and Glucose. During the anaerobic part of our workout (that’s when it is really hard) we need our CP stores even more to produce enough ATP to continue the set. So our CP stores help us continue the workout. Our muscles are usually only about 70% full of the CP that they can store, so if we supplement with Creatine we can up the CP stores to optimal levels and that theoretically should help us workout harder. If we can workout harder, we can get stronger faster and that also might help us put on more muscle if we are eating enough protein to support the growth of new muscle.

Does Taking a Creatine Supplement Help?

There is considerable science to say yes to this question. In fact there are over 200 studies since 1993 which have looked at this question. In a consensus statement the American College of Sports Medicine concluded that, ‘‘exercise performance involving short periods of extremely powerful activity can be enhanced, especially during repeated bouts by creatine supplementation” and ‘‘creatine supplementation is associated with enhanced accrual of strength in strength-training programs.’’ Our Article of the Month is a review of 22 of the best of these studies and concluded that those who supplemented had on average an 8% improvement in strength compared to a non supplemented group and when they looked at weightlifting performance there was on average a 14% increase. The question arises as to whether these improvements actually lead to better athletic performance or not and this question has not been answered as yet. The response to supplementation is known to be variable (everything we do in life has a variable response) and this is thought due to differences in absorption of the supplement and what our baseline stores of Creatine in our muscles are.

What Type should I Take and How and should I take it.

What would be a good choice in a creatine supplement? Creatine monohydrate? Creatine phosphate? Gum? Powder? Pills? Virtually all of the studies have used Creatine Monohydrate Powder. The Creatine Monohydrate Powder is inexpensive and our choice is indicated below. Don’t buy the rather expensive Cell-Tech product as it contains a lot of sugar and a dose of it is 300Calories. The last thing we want to do is have you spending a lot of money on micronutrition products which are not essential. Stick with the simple Creatine Monohydrate Powder. It is cheap enough to justify it’s use. All of the products suggest a loading dose followed by a maintenance dose. For those who work out daily, that may be a good idea but, since we are working out only twice a week at the most, it would seem that just starting with 5gm per day would be fine. Put it in your brain shake as it seems to be absorbed and gets to the muscle cells easier when it is combined with protein and glucose.

Are there any side effects and is it safe to take long term?

Creatine taken on an empty stomach can cause an upset stomach, diarrhea and muscle cramping so we take it with our brain shake. There is no long term data about it’s safety but there is nothing at this point to suggest that it has a danger if it is taken at recommended doses. Patients with diminished kidney function should consult with their physician prior to taking Creatine.

Doug Jacobson, the male half of our SuperSlow Star team this month was a faithful user of Creatine and made rather spectacular gains working out only once a week for 16 weeks. He also worked out very intensely and regularly ate over 120gm of protein per day, so all of this works together. Possibly the Creatine helped him workout more intensely, leading to more strength and muscle gains…. That’s the theory anyway.

The little engine that Creatined…..puff, puff, puff harder…..

If you are under the age of 21, pregnant, lactating, or diabetic, is sure to discuss this and any other supplement with your doctor or health professional. Results will vary with individuals.

References:

Medline Search creatine [AND] muscle

Rawson ES, et al J Strength Cond Res. 2003 Nov;17(4):822-31.

Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance.

Read this Article. .pdf file

ABSOLUTE CREATINE
Site on Internet, Lots of Information about Creatine.

Our Recommendations:

Iron-Tec Essential Creatine Monohydrate 1200mg

Cost about $26.00 at Cost plus Nutrition.

Dose 5gm, 1 Tsp daily in Brain Shake.

Should last 240 doses or about 8 Months.

Dawn Blem

Certified Nutritional Consultant

Contact Dawn Blem

Amanda's Corner: "Announcing the SuperSlow® Honor Roll"

Who is going to be the first? Here are the Criteria!

Over the past few months we have been recognizing a SuperSlow® Star of the month. Dr. Christian and the staff have selected these Stars because of their hard work and success and to some extent because each of them came to us for different reasons and with different goals. We consider all our members to be Stars and we will continue to have a Star each month. Not all of the Stars are going to have really spectacular results in terms of body composition and strength but, nonetheless, we want to recognize special situations which benefit from our program and the reasons that they chose to work with us.

We feel it is necessary however, to create a very special category of achievement which we will call the "SuperSlow® Honor Roll". The requirements for membership on the Honor Roll will be more stringent and will require a lot more work especially on the diet/protein side. It will be something everyone can strive for and there is no time limit to getting on the Honor Roll. A few may achieve it in a 4 month program, others may take 6 months or a year.

The Requirements Being Considered Include:

1. Be a SuperSlow® Zone Inside Outside Client and declare that you have set a goal to become a member of the Honor Roll.

2. Have Pre and Post Digital Pictures taken or provide us with a Pre Picture representative of you before our program.

3. Maintain, increase, or lose no more than 10% of your baseline lean mass while at the same time meeting the initial fat loss goal set during your Initial Zone Prescription. Clients with BMI greater than 30 and a Body Fat % greater than 30 may lose up to 20% of their Lean Mass.

That's it. Sounds easy? Remember losing fat and maintaining or not losing too much muscle and especially gaining muscle while on a reduced calorie diet is not that easy. So far, only one of our SuperSlow® Stars has maintained muscle mass while losing fat, but she has not met the initial fat loss goal.

Members who achieve the Honor Roll will be recognized in the Newsletter, receive 4 extra sessions added to their program and a T-Shirt.

Who is going to be the first? Hint, Protein moves around, Carbohydrates come from the ground...

Amanda Antonini

Contact Amanda Antonini

Marketing Update: Seminars, Disaster Aid, Radio, Glossy Ads!

On 19 Jan 05 Dr. Christian gave his Seminar entitled

"The 6 Components of Optimal Health and Aging" with an emphasis on Combining the Zone Nutrition Program and SuperSlow Strength Training for the residents of Homewood Assisted Living Home at Air Force Village. On 27 Jan 05 he will speak for the American Business Women's Association, La Villita Chapter, Monthly Meeting. Homewood Residence Website

American Business Women's Association Website

Inside Outside contributed 10% of the proceeds from their End of Year and New Years Wellness and Spa Promotions to the American Red Cross and to unicef to assist with the relief effort for the Asian Tsunami Disaster.. American Red Cross Tsunami Effort Website unicef Website

Valero Energy Corporation has asked us to participate in their annual health fair on 27 Jan 2005!Health Fairs are a good opportunity for us to gain public awareness of our services.

On 19 Jan 05 Dawn Blem, Inside Outside Clinical Nutritionist was interviewed by Virginia Lovelady, Public Affairs Director of KZEP 104.5. Topics included the importance of protein and fish oil as well as SuperSlow. Her interview will be aired several times, the first being 0730, Sunday 23 Jan 05 on KZEP 105.4. There will be a series of Public Service Announcements in the next week regarding our offer of a free SuperSlow Session and DXA Body Composition. KZEP Web Site._

City Pages Magazine ran a very sophisticated ad in their January Magazine featuring Inside Outside. We are planning several more using the same theme in the coming months. Check out their Website Here._

Dr. Sears' New Book "The Anti-Inflammation Zone"

From Dr. Sears' Monthly Newsletter

The OmegaZone E-Magazine

"For years the medical establishment has been telling Americans that fighting heart disease means a war against cholesterol. Slowly but surely, like the powerful Wizard of Oz façade, the cholesterol story has been slowly eroding. Now the scientific data is shifting more to inflammation as the underlying cause of heart disease. Of course, this makes common sense since the number-one drug to prevent a heart attack is an aspirin. Although aspirin has no effect on cholesterol levels, it has a dramatic effect on reducing inflammation. Recent articles in the New England Journal of Medicine have again confirmed the importance of inflammation on heart disease. A crude indictor of inflammation, C-reactive protein, appears to be more powerful than bad cholesterol levels in predicting future heart attacks.
But what if there was an even more powerful predictor of inflammation that could predict heart attacks? As I describe in my newest book, “The Anti-Inflammation Zone,” such a blood marker exists. It is the ratio of arachidonic acid (AA) to eicosapentaenoic acid (EPA). This marker of inflammation precedes C-reactive protein by years. You could take drugs, such as statins, on a lifetime basis to reduce C-reactive protein. Of course, there are some side effects, such as memory loss, muscle weakness, neuropathy, and liver damage. But statins don’t reduce the AA/EPA ratio – they actually increase it. On the other hand, taking high-dose fish oil reduces the AA/EPA ratio, and the only known side-effect is to make you smarter. The amount of fish oil you need to reduce inflammation depends on how well you control insulin in your diet. The more you control insulin by following the Zone Diet, the less fish oil you need. On the other hand, the less you control insulin, the more fish oil you need. The choice is yours. Whatever approach (drugs or diet) you choose, just keep in mind that controlling inflammation is a much wiser medical approach to reducing heart attacks than controlling cholesterol."

Let us know if you want the AA/EPA test. The Cost is $300 and includes a consult with Dr. Christian to discuss the results. We also talk about the AA/EPA test in detail in our Omega Zone Seminar.

Visit Dr. Sears Web Site.. Join the Forums and Sign up for his Newsletter.

Amanda's SuperSlow® Technique Corner: The MedX Abdominal Machine

Here at Inside Outside we help you to build and strengthen your ab muscles with the MedX Abdominal Machine and reduce your bodyfat by focusing on your nutrition!! However, the sad truth is that no amount of exercising is going to give you perfect six-pack abs!!! You must reduce your bodyfat in order to see the muscles that we are building! For the best results, you should perform this abdominal exercise with good form as explained below….

Sit in the seat with hips as far back as possible. Push position handle down to spread thighs as wide as possible. Arch your back and pull movement arm down against your chest. Place upper arms on top of pad in a “praying position” or simply on top of the pad. Avoid using hands or arms to assist in the exercise. In the middle picture, Dr. Christian is showing poor form by simply “levering” forward with a straight back. The proper form shown in the third picture is to curl your shoulders downward towards your thighs while squeezing the thighs together of as Dr. Christian says “roll it forward”. The movement from start to full flexion should take between 8-12 seconds. Pause and squeeze for a 3 count beginning on the 3^rd rep. Do NOT pause at the starting position but lightly tap the weight stack to begin the next rep. All movement should be controlled and deliberate. You should avoid throwing or jerking the weights. Continue the exercise until you are unable to complete a repetition in good form.

Give yourself a big pat on the back for making it through another grueling Ab Machine exercise but know that your work is not complete. Now it is time to focus on what you put in your mouth or we’ll never see those great abs!!!!!!!!!!!!!

MedX Web Site

Amanda Antonini, SuperSlow® Instructor

Contact Amanda Antonini

Botox: "How" it is done and "How" it works..

Botox Special Through February. $7.50 per unit, Minimum purchase of 50 Units. 50 Units will do Forehead and Frown area or Frown Area 3 times. Or just do Frown area, 15 Units, for $125.00

"How" do we do it?

First of all, Botox injections should cause minimal to zero pain. At our clinic we will apply a topical anesthetic and use a ice cube to further numb the skin. We can see in the image that the needle is very small and is the same one used for insulin shots and we rarely insert the needle over half way. The most we would inject in one shot is shown in the syringe. This is .05cc and equals 5 units of Botox.

In this article we will focus on the use of Botox® for the Frown lines, or Glabellar Frown lines. This is the only officially FDA approved use of Botox® Cosmetic and if you read the package insert this is the only area mentioned. Physicians are however able to use a product off label and the forehead and crows feet area are the areas most often treated after the frown lines between the brows.

To Quote from the Botox® Cosmetic Web Site.

BOTOX^® Cosmetic is indicated for the temporary improvement in the appearance of moderate to severe frown lines between the brows in people 18 to 65 years of age.

BOTOX^® Cosmetic should not be used in the presence of infection at the proposed injection site(s) and in individuals with known hypersensitivity to any ingredient in the formulation.

Patients with neurological disorders such as ALS, myasthenia gravis, or Lambert-Eaton syndrome may be at increased risk of serious side effects. The most common side effects include possible bruising, headache, respiratory infection, flu syndrome, temporary eyelid droop and nausea. The eyelid drooping is caused by migration of the Botox from the treated area to an adjacent area. This is why you shouldn't rub the treated area for at least twelve hours after your Botox procedure and why you are told not to lie down for three to four hours after treatment.

Patients who are breast feeding or pregnant should not use Botox.

Frown lines are caused by the contraction of three muscles the Procerus, Depressor Supercilli, and Corrugator. These muscle depress or lower the brow toward the midline thus creating wrinkles in the skin. The Corrugator causes the vertical lines and the Procerus causes the horizontal lines.

I will use a recent client as a demonstration of the technique used for the Glabellar Frown lines.

Before Inject 15Units Botox®

3 Weeks Post Injection How long it lasts

"How" does it work?

Botox blocks the transmission of acetylcholine from the nerves to the muscle. Acetylcholine is a neurotransmitter which sends a message to the muscle telling it to contract or tense up. With the flow of acetylcholine blocked or significantly reduced, the muscle can no longer retract and it relaxes. As a result, the wrinkled areas smooth out and soften.

Treatment with BOTOX^® Cosmetic can visibly smooth and soften moderate to severe frown lines between your brows and other areas. An improvement can be seen within days and may last up to 4 months, although results may vary.

See Dr. Christian's Forehead Before/After Pictures

Botox® Cosmetic Web Site

Restylane Web Site

If your are wondering about Botulism