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December 22, 2009
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Low Back Pain: Healing your aching back
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Get your copy of Low Back Pain: Healing your aching back

Low back pain treatment has undergone a sea change over the past 15 or so years. This report describes the different types of back problems and the tailored treatments that are more likely to help specific conditions. A special section is dedicated to the self-care steps you can take to mend your back, and features information on different types of exercise and complementary therapies.

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Lower back pain? Yoga therapy can help.

Yoga has become a familiar part of the health and fitness scene in the United States. Nearly 16 million Americans currently practice yoga. Another nine million say they plan to try it within the year. Although many people turn to yoga to ease stress and improve overall health, a growing number have specific medical aims and are following the recommendations of their doctors.

According to a study in the journal Spine (Sept. 1, 2009), yoga therapy can reduce pain and improve function in people with chronic low back pain. Chronic low back pain—defined as pain that lasts more than three months—is notoriously difficult to treat. Not surprisingly, it drives many sufferers to turn to alternative and complementary therapies in search of relief. The Spine study is the second of two randomized trials to test a specific form of yoga called Iyengar (pronounced eye-en-gar) yoga, which is based on the teachings of B.K.S. Iyengar, one of the world's most well-known living yoga teachers.

Iyengar yoga vs. classic hatha yoga

Most yoga taught and practiced in this country is hatha yoga, which combines: classic poses (asanas), controlled breathing, and deep relaxation or meditation. Iyengar is a type of hatha yoga that uses props such as blankets, blocks, benches, and belts to help people perform the poses to the fullest extent possible even if they lack experience or have physical limitations. The emphasis is on precise physical alignment, with trained teachers adjusting everything from the position of the shoulders to the angle of the toes.

Iyengar adjustments to classic yoga poses

Iyengar yoga poses 

Iyengar yoga uses blocks, belts, and other props to help students perform classic yoga poses such as those shown in the grey insets above: parivrtta trikonasana, or the revolved triangle pose (A), and ardha uttanasana, or the standing half forward bend (B). Instructions are individualized, with adjustments made for age, experience, body type, physical condition, and medical problems.

What the research revealed

With funding from the National Institutes of Health’s National Center for Complementary and Alternative Medicine, researchers at West Virginia University enrolled 90 adults to participate in a yearlong trial comparing the effects of Iyengar yoga therapy with those of standard medical care. Participants ranged in age from 23 to 66, and all were suffering chronic low back pain. About half of them were assigned to 24 weeks of a twice-weekly, 90-minute regimen approved by B.K.S. Iyengar and taught by a certified Iyengar yoga instructor and two assistants with experience in teaching yoga therapy to people with chronic low back pain. On days when they didn’t have a yoga class, they were instructed to practice at home for 30 minutes using a DVD, props, and an instruction manual. The rest of the participants (the control group) continued with usual medical care and were followed with monthly telephone calls to gather information about their medications or other therapies.

All subjects reported on functional disability, pain intensity, depression, and medication use at the start of the study, midway through (12 weeks), immediately afterward (24 weeks), and at a follow-up six months later. Compared with the control group, the Iyengar group experienced a 29% reduction in functional disability, a 42% reduction in pain, and a 46% reduction in depressive symptoms at 24 weeks. There was also a greater trend toward lower medication use in the yoga group. There were no reports of adverse effects.

Six months after the trial ended, 68% of the yoga group was still practicing yoga — on average, three days a week for at least 30 minutes. Their levels of functional disability, pain, and depression had increased slightly but were still lower than those of the control group.

The study had limitations — a small number of participants, as well as reliance on the participants’ own reports of symptoms and disability. Also, the control group, on average, had been suffering back pain longer than the yoga group. Still, the results are consistent with findings from other studies of yoga for low back pain.


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What to do about High Cholesterol
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Get your copy of What to do about High Cholesterol

Why do people on cholesterol-lowering drugs still have heart attacks? What role does cholesterol really play? How can you lower your risk of heart disease and stroke? What to Do about High Cholesterol answers these questions and explains why lowering your LDLs (the bad cholesterol) is even more important than previously thought.

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Is vinegar good for the arteries?

Q. I’ve heard that apple cider vinegar can clean out the arteries. Is there any truth to that?

A. If you believe the stories written about apple cider vinegar, it is a miracle cure for just about anything that ails you, from curbing the appetite to detoxifying the body, boosting the immune system, treating arthritis, and improving circulation. That’s a tall order for a brew made from fermented apples. But there’s no evidence to back up most of these claims. So far, the only decent studies in humans suggest that daily doses of apple cider vinegar may help people with type 2 diabetes control their blood sugar.

Acetic acid is the substance that gives vinegar its distinctive smell and sour taste. A synthetic cousin of acetic acid, called ethylenediamine-tetraacetic acid (EDTA), attracts some dissolved metals. It is used in cases of lead, mercury, or iron poisoning to pull these metals out of the bloodstream. A dubious practice called chelation therapy involves repeated administration of EDTA. Chelation therapy is hyped as a way to clean out the arteries by dissolving cholesterol-filled plaque. This is based on wishful thinking, not science.

Apple cider vinegar is a terrific ingredient in foods, sauces, and dressings. It isn’t medicine. Taking too much can lower blood potassium levels and may not be good for your bones. If you choose to take a tablespoon or so a day, rinse out your mouth afterward — straight apple cider vinegar can erode the enamel on your teeth.

— Richard Lee, M.D.
Associate Editor, Harvard Heart Letter