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Complementary Medicine

Complementary Medicine, Health and Fitness, In the News, Sports

How do you get through the NBA Finals? Practice, practice, practice (yoga)

How do you get through the NBA Finals? Practice, practice, practice (yoga)

LeBron JamesA student in a yoga class I attended in Berkeley, Calif. last Saturday asked the teacher about the origin of the Sanskrit chant we had just repeated. He explained that the words were the lyrics from the theme song to Battlestar Galactica. Inviting pop-culture references into the sometimes-serious space of the studio is a terrific way to normalize the complementary medicine practice. So is welcoming 6’8″, 250-pound athletes to an activity often stereotyped as being for the petite, female and flexible.

That is to say that LeBron James takes yoga. In case you somehow missed it, the Miami Heat star got sidelined by cramps near the end of Game 1 of the NBA Finals. A piece on Sports Illustrated‘s Point Forward describes how yoga played a role in James’ recovery and preparation for the next game of the series:

[Readying his body for Game 2] included, among a more extensive hydration regimen, James’ decision to attend a Sunday morning yoga class at the Heat’s team hotel in San Antonio.

“Yoga isn’t just about the body, it’s also about the mind and it’s a technique that has really helped me,” James told Brian Windhorst (then of the Cleveland Plain-Dealer) in 2009. “You do have to focus because there’s some positions that can really hurt you at times if you aren’t focused and breathing right.”

Upon his arrival in Miami, James also credited yoga for his supernatural level of endurance. Only Kevin Durant has logged more total minutes since James joined the Heat in 2011.

The piece notes that James’ teammate Dwayne Wade and the Heat’s playoffs opponents, the San Antonio Spurs, are among the other NBA affiliates who stand in Mountain Pose.

Previously: Third down and ommm: How an NFL team uses yoga and other tools to enhance players’ well-beingNIH to host Twitter chat on science of yoga and Expert argues that for athletes, “sleep could mean the difference between winning and losing”
Via Tiffany Russo Yoga
Photo by ASSOCIATED PRESS

Complementary Medicine, Health and Fitness, In the News, Mental Health

Research brings meditation’s health benefits into focus

Research brings meditation's health benefits into focus

Allyson meditationThe effects of meditation aren’t all in your head; they influence your body and spirit, too. That’s according to a Huffington Post piece and infographic summarizing results from a range of studies showing how the practice of the mind can have far-reaching effects in a person. Being in the moment offers not only the potential to reduce sensitivity to pain, ease stress and increase focus, the piece notes, but also to lower blood pressure, boost the immune system and invite restorative sleep.

As discussed here previously, meditation may play a role in shaping other aspects of life. Laura Schocker writes:

Cultivates willpower. Stanford health psychologist Kelly McGonigal, Ph.D. told Stanford Medicine’s SCOPE blog in 2011 that both physical exercise and meditation can help train the brain for willpower:

Meditation training improves a wide range of willpower skills, including attention, focus, stress management, impulse control and self-awareness. It changes both the function and structure of the brain to support self-control. For example, regular meditators have more gray matter in the prefrontal cortex. And it doesn’t take a lifetime of practice — brain changes have been observed after eight weeks of brief daily meditation training.

Now, go find a blank wall. See you in 20 minutes.

Previously: Using meditation to train the brainHow meditation can influence gene activityAsk Stanford Med: Answers to your questions about willpower and tools to reach our goals and The science of willpower
Photo of Allyson Pfeifer by Ashley Turner

Complementary Medicine, Mental Health, Parenting, Pregnancy, Research, Women's Health

Ah…OM: Study shows prenatal yoga may relieve anxiety in pregnant women

Ah...OM: Study shows prenatal yoga may relieve anxiety in pregnant women

Desi_smallDuring a pre- and postnatal yoga module of my yoga teacher training, I was enchanted by instructor Desi Bartlett‘s reference to “pregnant goddesses” – our future students – as we learned how yoga could help them prepare for delivery day. (Think deep squats.) Methods to empower goddesses throughout and beyond pregnancy included modifications to traditional poses to stay fit while providing a safe “house” for the fetus, breathing and meditation to steady a busy mind, group activities to build community with other new parents and restorative poses to find calm during a period of change.

Now, a study (subscription required) has investigated how yoga can help relieve pregnancy-specific anxiety in mothers-to-be. Researchers at the University of Manchester and Newcastle University in the U.K. followed 59 women, each pregnant with her first child and receiving normal prenatal treatment during the late second to third trimester, and asked them to self-report their emotional states. A randomized group attended eight weekly prenatal Hatha yoga sessions, and researchers measured those participants’ saliva cortisol levels before and after the first and last classes of the intervention.

From a release:

A single session of yoga was found to reduce self-reported anxiety by one third and stress hormone levels by 14%. Encouragingly, similar findings were made at both the first and final session of the 8 week intervention.

“The results confirm what many who take part in yoga have suspected for a long time,” John Aplin, PhD, one of the senior investigators in Manchester and a yoga teacher, said in the release. “There is also evidence yoga can reduce the need for pain relief during birth and the likelihood for delivery by emergency caesarean section.”

The study was published in the Journal of Depression and Anxiety.

Previously: Toilets of the future, and the art of squattingA reminder that prenatal care is key to a healthy pregnancyPregnant and on the move: The importance of exercise for moms-to-be and Ask Stanford Med: Pain expert responds to questions on integrative medicine
Photo of Desi Bartlett by Natiya Guin

Complementary Medicine, In the News, Mental Health, Pediatrics, Stanford News, Videos

Stanford researchers use yoga to help underserved youth manage stress and gain focus

Stanford researchers use yoga to help underserved youth manage stress and gain focus

A segment on PBS NewsHour yesterday explored how Stanford researchers have brought yoga and mindfulness practices to students who experience post-traumatic stress disorder owing to difficult life circumstances. At Cesar Chavez Academy in East Palo Alto, Calif. – a low-income, high-crime area – a group of seventh-graders worked with Stanford’s Victor Carrion, MD, professor of psychiatry and behavioral sciences, and his team during a 10-week program introducing breathing and movement practices to help students manage their emotions and improve their concentration in school.

The researchers used imaging techniques to understand how children respond to daily stress. “With functional imaging, we actually can see what the brain is doing,” Carrion told PBS. “There is a deficit in the area of the middle frontal cortex in kids that have PTSD,” which, he noted, may discourage learning.

In the piece, seventh-grader Brayan Solorio describes how rolling out his yoga mat at home helps him keep his cool.

Previously: Med students awarded Schweitzer Fellowships lead health-care programs for underserved youthThe remarkable impact of yoga breathing for trauma, The promise of yoga-based treatments to help veterans with PTSD and Stanford and other medical schools to increase training and research for PTSD, combat injuries

Complementary Medicine, Mental Health

The remarkable impact of yoga breathing for trauma

The remarkable impact of yoga breathing for trauma

“Military guys doing yoga and meditation?” I’ve been asked in disbelief. It’s true that when they first arrived to participate in my study (a yoga-based breathing program offered by a small non-profit organization), the young, tattoo-covered, hard-drinking, motorcycle-driving all-American Midwestern men didn’t look like your typical yoga devotees. But their words after the study said it all: “Thank you for giving me my life back” and “I feel like I’ve been dead since I returned from Iraq and I feel like I’m alive again.” Our surprisingly positive findings revealed the power that lies in breath for providing relief from even the most deep-seated forms of anxiety.

As many of us know, there is an unspoken epidemic that is taking 22 lives a day in the U.S.

Who is impacted? Those who are willing to make the ultimate sacrifice in protection of others: Veterans.

How? Suicide.

Why? War trauma.

Average age? 25.

After a long deployment of holding their breath in combat, these men and women often return to civilian life no longer knowing how to breathe. Though the military trains service members for war, it doesn’t train them for peace. Ready to give up their life for others, service members embody the values of courage, integrity, selflessness, and a deep commitment to serving. They’ve trained under extreme conditions to do things most civilians don’t encounter: lose parts of their body, kill or injure another human being under orders or by mistake, get right back to work and keep fighting hours after seeing a friend killed, be separated from families and loved ones for months and even years, and live with the horrendous physical and emotional consequences thereof upon their return home.

The National Institutes of Health estimates that 20-30 percent of the over 2 million returning Iraq and Afghanistan war veterans have symptoms of post-traumatic stress disorder (PTSD). This anxiety disorder involves hyper-alertness that prevents sleep and severely interferes with daily life, triggers painful flashbacks during the day and nightmares at night, and causes emotional numbness that leads to social withdrawal and an inability to relate to others. Side effects of PTSD include rage, violence, insomnia, alienation, depression, anxiety, and substance abuse. PTSD symptoms are associated with higher risk of suicide, a fact that may explain the alarming rise in suicidal behavior amongst returning veterans.

While traditional treatments work for some, a large number of veterans are falling through the cracks. Dropout rates for therapy and drug treatments remain as high as 62 percent for veterans with PTSD. Symptoms can persist even for veterans who actually undergo an entire course of psychotherapeutic treatment and drug treatment results are mixed.

Our research at the University of Wisconsin-Madison and Stanford showed that the week-long Project Welcome Home Troops intervention was successful, with our analyses showing significant decreases in PTSD and anxiety. Improvements remained one month and one year later, suggesting long-term benefit. More telling even than the data are the veterans’ words; with a veteran of the war in Afghanistan writing:

A few weeks ago shooting, cars exploding, screaming, death, that was your world. Now back home, no one knows what it is like over there so no one knows how to help you get back your normalcy. They label you a victim of the war. I AM NOT A VICTIM… but how do I get back my normalcy? For most of us it is booze and Ambien. It works for a brief period then it takes over your life. Until this study, I could not find the right help for me, BREATH’ing like a champ!

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Aging, Complementary Medicine, Health and Fitness, NIH, Orthopedics, Research

Measuring the physical effects of yoga for seniors

Measuring the physical effects of yoga for seniors

LeslieAs my grandmother marched into her 80s, she would regularly eyeball pieces of furniture before sitting on them. “I’m afraid I won’t be able to get up,” she’d say, in the spirit of fun but with some underlying fear. Even though she and my grandfather stayed active by taking yoga classes at a senior center, and were a neighborhood hit riding their tandem tricycle in matching helmets and T-shirts, declining strength and range of motion with age just made certain everyday movements difficult.

I thought of my grandma while reading about an NIH-funded study from the University of Southern California and University of California, Los Angeles on yoga for seniors. Published in the journal BMC Complementary and Alternative Medicine, the study quantified the physical effects of seven poses in 20 ambulatory older adults whose average age was 70.7 years. Participants attended hour-long Hatha yoga classes twice a week for 32 weeks. The researchers used biomechanical methods joint moments of force (JMOF) and electromyographic analysis at the beginning and end of the study to measure each pose’s demands on select lower-extremity joints and muscles.

In a Research Spotlight, the National Center for Complementary and Alternative Medicine noted:

Findings from the study may be used to help design evidence-based yoga programs in which poses are chosen for the purpose of achieving a clinical goal (e.g., targeting specific joints or muscle groups or improving balance). The physical demands, efficacy, and safety of yoga for older adults have not been well studied, and older adults are at higher risk of developing musculoskeletal problems such as strains and sprains when doing yoga.

Study author Leslie Kazadi, a Los Angeles-based experienced yoga therapist, designed the yoga program with a geriatrician, exercise physiologist/biomechanist, and physical therapist from the research team and taught participants the poses. She told me that standing poses were chosen to target areas of the body that tend to become weak or limited in seniors. Hip stabilizers, for example, help with mobility and balance – and confidence in everyday situations, such as rising from a chair. “What you need to move around in the world is to be strong in your lower body,” Kazadi said. “If you don’t have stability downstairs, then you’re not going to get freedom upstairs no matter what.”

Previously: Exploring the use of yoga to improve the health and strength of bonesAsk Stanford Med: Pain expert responds to questions on integrative medicineExercise programs shown to decrease pain, improve health in group of older adults and Moderate physical activity not a risk factor for knee osteoarthritis, study shows
Photo by NCCAM/RaffertyWeiss Media

Aging, Complementary Medicine, NIH

NCCAM to host Twitter chat on research and complementary health approaches for Alzheimer’s

Save the date (it’s tomorrow) and tune in for a Twitter chat on Alzheimer’s research and complementary health approaches to preventing or managing the disease. Hosted by the National Center for Complementary and Alternative Medicine, the chat will feature experts from the NCCAM and the National Institute on Aging answering questions submitted using the hashtag #nccamchat.

Discussion topics will include dietary supplements such as ginkgo biloba that have been examined for possible effectiveness in slowing cognitive decline, and mind and body practices for caregivers. Check out the NCCAM’s current resources and Clinical Digest for more information.

Beginning at 1 PM Pacific time on Dec. 18, the conversation can also be followed at @NCCAM and @Alzheimers_NIH.

Previously: “Pruning synapses” and other strides in Alzheimer’s researchHow villainous substance starts wrecking synapses long before clumping into Alzheimer’s plaquesWhen brain’s trash collectors fall down on the job, neurodegeneration risk picks up and Ask Stanford Med: Pain expert responds to questions on integrative medicine

Complementary Medicine, Orthopedics, Research

Exploring the use of yoga to improve the health and strength of bones

Exploring the use of yoga to improve the health and strength of bones

yogaosteo I’ve written before about research studies on yoga, as well as components of my yoga teacher-training program. Delighted to find connections between the two worlds, I was interested recently to attend a workshop on yoga for osteoporosis and osteoarthritis with Loren Fishman, MD, an assistant clinical professor of rehabilitation and regenerative medicine at Columbia University Medical Center, and Annie Carpenter, founder of SmartFLOW® yoga.

Fishman is a physiatrist, dedicated yogi and proponent of yoga as a non-surgical, non-pharmaceutical approach to healing and preventive medicine. He’s published books on yoga for back pain, arthritis, and sciatica, among others, and he’s conducting a study of yoga in people who have osteoporosis.

Based on a 2009 pilot (.pdf) that showed improvement in bone density over a two-year period for the group of yoga practitioners versus a slight loss of bone in the control group, the current study prescribes a sequence of 12 yoga poses designed to place stress on the bones to generate cells and strengthen the bone’s dynamic support system. Participants track the poses they complete using an online scorecard, and their bone density is measured before and after practice is introduced. So far, he recently reported, in 65,000 hours of practice among 575 participants worldwide, no yoga-related fractures have been documented.

It’s essential for a patient to have a physician’s diagnosis of his condition before beginning yoga or any treatment program, Fishman and Carpenter emphasized in their workshop. And the most important job of a yoga teacher or therapist, Carpenter said, is being able to see the problems people are dealing with in their practice. She provided instruction on how to look at bodies in all three planes, find imbalances, examine the patterning in structure and movement and determine what to offer students as tools to improve their own well-being.

Previously: Ask Stanford Med: Pain expert responds to questions on integrative medicine, Exercise programs shown to decrease pain, improve health in group of older adults, Moderate physical activity not a risk factor for knee osteoarthritis, study shows, Treatments to reduce fractures for children with brittle-bone disease and New genetic regions associated with osteoporosis and bone fracture
Photo by Tiffany Caronia

Ask Stanford Med, Complementary Medicine, Nutrition, Pain

Ask Stanford Med: Pain expert responds to questions on integrative medicine

Ask Stanford Med: Pain expert responds to questions on integrative medicine

rolfing2Sometimes the best medicine is staying healthy. As more Americans look for ways to improve their health, prevent disease and manage pain, the subject of complementary practices may enter more conversations between patients and physicians. So for this installment of Ask Stanford Med, we asked Emily Ratner, MD, clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to questions on integrative medicine. Her answers appear below.

As a reminder, these answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

Mary says: Please speak about the efficacy of integrative medicine to alleviate multi-point pain from a variety of causes (ITP, OA, aging). A relative has doctor fatigue as well, and is not interested in anything else.

Integrative Medicine (IM) may be defined as the combination of conventional and nonconventional modalities chosen by a patient and physician in a patient-centered decision-making process in order to achieve the best outcome for an individual. Patients often seek nonconventional modalities when conventional medicine techniques are unable to achieve a particular goal, often pain relief or pain management. As a general rule, multi- and inter-disciplinary measures are often most helpful in relieving suffering from pain. These may include five general categories of nonconventional modalities, although there is overlap amongst the different types:

  • Mind-body medicine: meditation, hypnosis, biofeedback, guided imagery, yoga
  • Biologically based practices: uses substances found in nature – herbs, foods, vitamins, supplements
  • Manipulative/Body-based practices – massage, chiropractic/osteopathic manipulation
  • Whole medical systems: Traditional Chinese Medicine (includes acupuncture), Ayurveda, naturopathy
  • Energy Medicine – Reiki, Healing/Therapeutic touch, Qi Gong, acupuncture, yoga

Depending on patient preference, available resources in the community and other factors, a decision is made where to begin. I often recommend acupuncture as a place to start, closely followed by a mind-body medicine technique, as my experience is that stress plays a large role in either pain or the perception of pain. However, it largely depends on the individual’s needs and preferences.

Scope Editor asks: A recent study of herbal products found that most of those examined contained contaminants, substitutions and unlisted fillers among their ingredients. What are the implications of these findings, and how can consumers protect themselves when buying supplements?

This is a significant issue that highlights the need for increased supplement regulation, although the study to which you refer has been criticized for some of its conclusions. While FDA regulations for supplements are a bit stricter than for foods, the regulations are far less comprehensive than those for pharmaceutical agents.

That being said, product contamination with heavy metals, undisclosed pharmaceutical agents (especially in products from outside the U.S.), and inaccurate product ingredient amounts plague this field.

Until improved regulatory procedures are instituted, I suggest looking at a reputable database that independently tests these products, such as ConsumerLab.com. This and other independent organizations add their seal of approval to product labels that have tested either the products or the manufacturing practice involved in production of the substance. Look for the Consumer Lab seal or other seals: cGMP (current Good Manufacturing Practice), USP (United States Pharmacopeia), or NSF (another independent lab).

Some experts note that specific stores have strict quality control for their products – like Sam’s Club, Costco, Whole Foods – but I typically look up each individual product on a database (I use consumerlab.com) prior to recommending it.

Another option is to consult with a trained Integrative Medicine practitioner who has access to these databases and is knowledgeable about these products.

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Ask Stanford Med, Complementary Medicine

Ask Stanford Med: Pain expert taking questions on integrative medicine

organic produce and Whole FoodsIntegrative medicine – the combination of traditional Western medicine with evidence-based, complementary approaches to health improvement, symptom management and disease prevention – encompasses many disciplines. The National Center for Complementary and Alternative Medicine (NCCAM), one of the 27 members of the National Institutes of Health, oversees scientific research and informs decision-making in the area. NCCAM’s mission “to define, through rigorous scientific investigation, the usefulness and safety of complementary and alternative medicine interventions and their roles in improving health and health care” is upheld by a number of academic medical centers, including Stanford’s Center for Integrative Medicine.

If you’ve downed a spoonful of fish oil, taken vitamins or probiotics, visited a chiropractor, or engaged in deep breathing to manage pain, you’ve experienced a practice of integrative medicine. But for many, there’s a shroud of mystery around the subject, and while peer-reviewed research studies have been conducted on some aspects of the discipline, other practices require further study.

So for this edition of Ask Stanford Med, we’ve asked Emily Ratner, MD, a clinical professor of anesthesiology, perioperative and pain medicine and co-director of medical acupuncture and the resident wellness program at Stanford, to respond to your questions on integrative medicine.

Ratner’s research interests include the use of acupuncture to manage medical conditions and to address pain and side effects from surgery and cancer. She also studies physician and trainee burnout and resilience.

Questions can be submitted to Ratner by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Sunday, November 10 at 5 p.m.

When submitting questions, please abide by the following ground rules:

  • Stay on topic
  • Be respectful to the person answering your questions
  • Be respectful to one another in submitting questions
  • Do not monopolize the conversation or post the same question repeatedly
  • Kindly ignore disrespectful or off topic comments
  • Know that Twitter handles and/or names may be used in the responses
  • Ratner will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disordersStudy shows complementary medicine use high among children with chronic health conditions,Ask Stanford Med: David Spiegel answers your questions on holiday stress and depressionReport highlights how integrative medicine is used in the U.S. and Americans’ use of complementary medicine on the rise
Photo by ASSOCIATED PRESS

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