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How to Fight Insomnia without Medication

2012-04-09T11:02:46-07:00

In a groundbreaking study released in February, Scripps researchers revealed a statistical link between sleep medications and increased risk of premature death from such causes as cancer and other ailments.

“Obese patients appear particularly vulnerable, perhaps through interaction with sleep apnea,” says study co-author Daniel Kripke, MD, a psychiatrist with Scripps Clinic’s Viterbi Family Sleep Center in San Diego, noting that sleeping pills were previously associated with more and longer pauses in breathing in people with sleep apnea. Additionally, among patients who received sleep medications, men were about twice as likely to die as women, after accounting for other factors.

The study’s conclusions were widely reported in national media, leaving many patients who have difficulty sleeping to wonder how they can get a safer night’s sleep.

Simple steps to better rest

Dr. Kripke suggests several non-pharmaceutical ways to achieve restful, restorative sleep without resorting to common sleep medications, by working with natural circadian rhythms that regulate sleep and wake cycles.

Reduce time in bed. “Many adults don’t actually need eight hours of sleep per night,” says Dr. Kripke. In fact, studies at the sleep center show most adults are only really asleep between six and seven hours per night. If you find you can sleep between five and seven hours per night and feel rested, don’t try to sleep more than that. Make the most of those extra hours of healthy wakefulness instead.
Keep a consistent sleep schedule. Once you discover your optimal amount of sleep, do your best to go to bed and get up at the same time every day, and don’t try to make up for “lost” sleep by staying in bed later on weekends. That tends to throw off the body’s natural clock, making it harder to get to sleep later that night.
Only go to bed when you are sleepy. Lying awake trying to fall asleep when you aren’t tired can create a counterproductive self-reinforcing loop, creating frustration that makes it harder to get to sleep. If you aren’t tired at your normal bedtime, try structured relaxation (a few techniques are outlined below). And if you wake up fully in the middle of the night, get out of bed and don’t return until you are tired again.

If these don’t help, consult a sleep specialist. Some problems, like restless leg syndrome and sleep apnea, require medical diagnosis and treatment for their core causes. In these cases, sleeping pills only mask the underlying conditions.

Setting the stage for restful sleep

Sometimes the environment can affect how easy (or difficult) it is to fall asleep. Light, sound and other factors can help.

If you’re a night owl, try melatonin. This supplement is a hormone that may help re-set circadian rhythms that are “off,” making it easier for people whose natural cycle is to go to bed late at night and get up late in the morning. Talk to you doctor about an appropriate low dose to try at bedtime to help you get to sleep earlier.
Keep the light out. Room-darkening draperies not only insulate your room from the cold or heat outside, they also dampen sound and light, creating a more restful space.
Drown out distracting noises. If traffic, voices, neighbors, barking dogs or other outside noises are making it difficult for you to drop off, try white noise. There are dedicated machines that create soothing background sounds, apps for your smartphone, and even such simple interventions as running a fan or humidifier to mask sudden bursts of annoying outside noise that could otherwise startle you awake.
Meditate or pray. Evidence suggests that mindfulness practices like prayer and meditation can help get rid of unwanted thoughts and set the stage for a good night’s sleep.
Learn progressive muscle relaxation or self-hypnosis. Structured exercises like these can be beneficial in the first few minutes after you go to bed.

Learn more about sleep medicine

If you’re looking for a doctor to help you get better sleep, contact Scripps Clinic’s Viterbi Family Sleep Center. Call 1-800-SCRIPPS (1-800-727-4777) to get a physician referral from a member of our call center.

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Is Your Diet Giving You a Headache?

2012-03-06T17:57:33-08:00

Nearly everyone experiences headache pain over a lifetime. It’s a common reason people visit their doctors—and a serious public health problem. According to a study published in The Journal of the American Medical Association in 2003, headaches are one of the most common causes of pain and they result in a significant loss of productive time in the United States workforce.

“There’s no question that headache pain diminishes the quality of life for millions of people, but it’s not because there aren’t effective treatments available,” says Robert Bonakdar, MD, a physician at Scripps Center for Integrative Medicine in San Diego, California.

Those treatments include acupuncture, biofeedback, medication and psychotherapy. Yet even with these options, many headache sufferers don’t seek help, because they think the pain is only a minor problem. In other instances, headaches are not being properly diagnosed.

Dietary changes to help stop a headache before it starts

“What we have found is that most headache sufferers report some sort of trigger, often in their diets,” Dr. Bonakdar explains. “When this is the case, the solution may be as simple as identifying and avoiding these triggers.”

While many foods can cause headaches, some are more common than others. Dr. Bonakdar tells his patients to avoid the following whenever possible:

Allergenic foods
These are foods that can cause an allergic reaction. Some of the most common are peanuts and foods made with gluten, a protein found in wheat, rye and barley.
Additives
Pre-packaged and processed foods often contain additives to preserve their flavor, color and texture.
Artificial ingredients
These ingredients are common in a lot of diet foods to reduce the calorie content or serve as a preservative. Artificial sweeteners such as aspartame and sucralose are common headache triggers.
Aged foods
The aging process can create some naturally occurring compounds such as tyramine and tannins, both of which could be a headache trigger. These foods include wine, cheese, sauerkraut and cured meats.

“People should keep in mind that diet is just one component of headache management,” says Dr. Bonakdar. “It’s important to look at the whole person to develop a treatment plan that includes a healthy lifestyle, integrative therapies—and when appropriate—medication.”

Find help for your headache

If you’re looking for a doctor to help you alleviate headache pain, contact Scripps Center for Integrative Medicine or the Headache Center at Scripps Clinic. Call 1-800-SCRIPPS (1-800-727-4777) to get a physician referral from a member of our call center.

Get a regular dose of health news and information from Scripps

Sign up to have health-related information from Scripps delivered to your inbox, including our monthly email newsletter. Designed to help you and your family get healthy and stay well, the publication contains timely and relevant consumer health news along with notices about classes, events and exclusive offers.

4 Surprising Things to Help Keep You Healthy

2012-02-07T09:34:17-08:00

Health recommendations are constantly changing. As scientists investigate new therapies and practices, the body of evidence supporting the use of complementary and alternative approaches to achieve optimal health and well-being is growing.

Mimi Guarneri, MD, a cardiologist and medical director of Scripps Center for Integrative Medicine, incorporates the latest findings in her heart care practice. Her prescriptions include interventions intended not only to heal the body, but also to mend the mind and soul. Here are four surprising things in her tool kit that you can easily incorporate in your healthy lifestyle plan.

Farmed and Wild Salmon
While seafood of any sort contains omega-3 oils that can benefit your heart, it turns out that not all fish are created equal. According to a study published in the Journal of Nutrition, your choice of wild vs. farmed salmon should be guided by your individual health concerns. Farmed salmon contains more heart-protective omega-3 oils, but it is also far more likely to be contaminated with concentrated environmental toxins. A middle-aged man with a high risk for heart disease will benefit more from farmed salmon, while young children, women of child-bearing age who are planning to conceive, and pregnant women are advised to reduce their exposure to contaminants by choosing wild salmon or other sources of fatty acids.
Meditation and Prayer
There is a growing body of evidence that mental and spiritual practices, including Judeo-Christian prayer, yoga, Zen, transcendental meditation and other relaxation techniques, are associated with quantifiable physical benefits including lower blood pressure, better blood lipid profiles, improved immune function, fewer stress hormones and better overall health outcomes. Research published in the journal American Psychologist looked at a wide variety of previously published studies on such practices and concluded that many were methodologically sound and presented evidence of efficacy. So whether you’re a believer or a skeptic, any regular activity that focuses and calms the mind may also help your body thrive.
Biofeedback
Dr. Guarneri has personally investigated and published papers on the effects of biofeedback on heart patients. In this technique, a therapist teaches you to control such measurements as blood pressure, heart rate, breathing, muscle tension, the skin’s temperature and ability to conduct electricity. While the mechanisms of biofeedback on health improvements are not fully understood, people who use this technique report symptom improvement from conditions such as anxiety, insomnia, tension and migraine headaches and urinary incontinence
Genetic Testing
One of the newest innovations in preventive medicine, genetic testing can reveal your inherited risk for a wide range of diseases and disorders like Alzheimer’s disease and obesity, as well as whether you process a dozen commonly used drugs differently than other people. Armed with individualized information, people who know they have an elevated risk for diabetes, for example, may be able to make proactive lifestyle choices that delay or even prevent the onset of the disease.

Learn more about integrative approaches to health

At the Scripps Center for Integrative Medicine, you can explore the latest evidence-based complementary and alternative therapies and practices for optimal health and well-being, including exercise, cooking classes and body-mind practices.

Get a regular dose of health news and information from Scripps

Get Fit and Stay Trim

2012-02-13T12:41:45-08:00

If you’re determined to make this your year for better health and fitness, Scripps Health can make it easier, providing tips and tools to help you create a plan and get started on the road to success.

“Don’t center your fitness goals on a number on the scale,” says Lisa Carpenter, fitness manager, Scripps Center for Integrative Medicine. “Instead of focusing on weight loss, focus on healthy living. If you do, weight loss will come.”

For more fitness success

Set personal goals
“We recommend SMART goals (see below), which are specific, measurable, achievable and timely,” says Carpenter. For example, set a goal that 6 weeks from now, you’ll be able to swim 10 laps without stopping.

Focus on fun
Concentrate on activities you like or something new you’d like to try. Carpenter calls these “exciting” goals. If you like to hike, aim to hike a certain mountain or distance. “If you enjoy it, you’ll be successful,” she says. “Success breeds more success.”

Find a workout partner and get family and friends involved
“When you find like-minded people and incorporate a social component, you’re more committed,” Carpenter points out.

Schedule fitness like any other appointment
“Put it on your calendar, work your schedule around it and ask others to respect that,” she says.

Keep a fitness diary
Recording progress can be especially helpful when starting a new fitness plan and it discourages you from making excuses.

Start a fitness plan and get guidance to reach your goals

Download (PDF, 713.6 KB) our SMART goals worksheet, fitness diary and sample fitness calendar.

To find a fitness professional who can help you set personal fitness goals and create safe workouts, call 1-800-SCRIPPS (1-800-727-4777).

How a Food Diary Could Help You Lose Weight

2012-02-13T12:43:59-08:00

Did you know that people who keep food journals lose more weight and keep more weight off in the long run? A food diary helps you confront the truth about how much, when and why you eat. Once armed with that information, you can start setting goals and making changes.

Cathy Garvey, registered dietitian at Scripps Center for Integrative Medicine, says this “bite it and write it” strategy can also be helpful to:

Control overeating
You are less likely to go for that second helping if you know you have to write it down.

Track progress
It can be motivating to look back and see that you are eating better today than you did weeks or months ago.

Connect eating to emotions
Certain feelings may trigger eating when you’re not even hungry. Only once you identify the causes can you start to do something about them.

Point out nutrition imbalances
Seeing food choices in black and white helps to uncover food and nutrient gaps you may have been neglecting.

Monitor eating patterns
Keeping tabs on your meals and snacks helps reveal things like that seven-hour gap between lunch and dinner, or the fact that you’re hungry only one hour after eating breakfast.

Garvey uses food diaries less as a calorie counter and more as a tool to help her clients work healthier foods into their meal plans.

Her mantra? “Once you are eating better, the weight loss (and health benefits) will follow.”

Start a food diary and get guidance

Download (PDF, 656.9 KB) our food diary worksheets.

Call 1-800-SCRIPPS (1-800-727-4777) to find a dietitian.

How to Lower Your Cholesterol Without a Prescription

2012-01-11T11:27:46-08:00

In November of 2011, Lipitor, the best selling drug in the history of pharmaceuticals went off patent, allowing a cheaper, generic version of the cholesterol-lowering drug to enter the market. The move made a popular medication more affordable for many Americans – but still not tolerable for some.

“We see quite a few patients who experience side effects from statins,” says Mimi Guarneri, MD, MD, cardiologist and medical director of Scripps Center for Integrative Medicine. “They are often looking for ways to reduce their dosage or get off the medication entirely.”

Statins can produce liver and muscle inflammation in some patients, which can result in abdominal distress, cramps, fatigue and achiness. Despite the discomfort of those side effects and others caused by the medication, the benefits of taking stains outweigh the risks for many patients. The drugs block a substance the body needs to make cholesterol. They may also help to reabsorb cholesterol that has accumulated in plaques on your artery walls, helping prevent further blockage in your blood vessels.

“The drugs can do a great job at lowering cholesterol, no doubt. But keep in mind, high cholesterol is only one of a number of risk factors for heart attack and stroke,” says Dr, Guarneri. “Cardiovascular disease is the end result of multiple factors. A pill alone won’t fix the problem.”

According to Dr. Guarneri, lifestyle changes are required to reduce your risk of heart disease, whether you take a statin or not. As the first line of intervention to lower “bad” cholesterol and improve heart health, she recommends the following dietary changes:

Cut the saturated fat
“Reduce your intake of butter, cheese, red meat and dark poultry. Those products are loaded with saturated fat, which raises cholesterol,” says Dr. Guarneri.
Eat more produce
“The closer you can get to being a vegetarian, the better,” she asserts. Eating fruits and vegetables won’t just help you keep your appetite in check. They have a protective effect against coronary heart disease.
Consume soluble fiber
Soluble fiber can help to remove artery-clogging LDL cholesterol from the body. Oat bran is a great source. Prunes, beans, barley, citrus fruits, apples, Brussels sprouts, apricots and broccoli all contain ample amounts too. “If you can’t fit those foods into your diet, you can also take soluble fiber in a pill or powder,” says Dr. Guarneri. “Just make sure you are incorporating it in some way.”
Add fatty fish to the menu
Certain types of fish are chock-full of omega-3 fatty acids, which can lower cholesterol and reduce blood pressure. High levels are found in salmon and sardines. “Aim to incorporate fish high in omega-3 fats into your diet two times a week,” she says. “Just be mindful about how you prepare it. Be sure to skip rich sauces that could be full of saturated fat.”

In addition to recommending changes to the menu, Dr. Guarneri often uses other evidence-based approaches to help her patients lower their cholesterol, including dietary supplements such as plant stanols, artichoke extract, niacin and red yeast rice. She also encourages her patients to exercise on a regular basis, and explore ways to reduce the amount of stress in their life.

“Chronic stress exposes your body to persistently elevated levels of stress hormones like cortisol, which can increase inflammation in the body and indirectly raise blood cholesterol levels,” says Dr, Guarneri. “To truly adopt a comprehensive program to reduce your risk of heart disease, it’s imperative that you find healthy ways to cope with stress.”

Next steps

If you have high cholesterol, have a thoughtful conversation with a doctor about your overall risk for cardiovascular disease. Develop a comprehensive heart disease prevention program that includes lifestyle changes.
To help make those changes stick, check out course offerings at Scripps Center for Integrative Medicine. From vegetarian cooking and yoga to meditation and music therapy, you’ll find classes and programs to help you heal mind, body and spirit.

Get a regular dose of health news and information from Scripps

How Yoga Helps Back Pain

2011-12-08T12:15:28-08:00

Low back pain is one of the most common reasons people visit the doctor – for obvious reasons. For some, the discomfort can be disabling, making it difficult to sleep or perform simple activities, like putting on shoes or picking up kids. It can also affect a career. In fact, low back pain is among the most frequent reasons for job-related disability and a leading contributor to missed work.

Historically, chronic lower back pain, which lasts more than three months, has been very difficult to treat. Now, a growing body of research is providing evidence that the condition can be alleviated using yoga.

The bottom line: stretching works

According to study findings published in the October issue of the Archives of Internal Medicine, weekly yoga or deep stretching classes were effective in reducing pain and improving mobility – yielding better results than simply following an at-home care plan. In addition to experiencing fewer symptoms and pain after following the exercise program, many people who attended the classes reported that they scaled back their medication usage.

“At the core of this study is the principle that individually-tailored exercise can be helpful. In many ways yoga has this built in, as it is done in a monitored setting where participants work to find positions that best address their needs,” says Robert Bonakdar, MD, director of pain management at Scripps Center for Integrative Medicine in La Jolla, California. “Additionally, yoga provides variable levels of attention to breath and relaxation, which is critical. Research has shown that low back pain can be associated with dysfunctional breathing patterns and/or stress-related muscle tension.”

Participants in the study experienced persistent, moderate back pain that was not the result of a specific medical condition. They attended weekly 75-minute exercise classes over a 12-week period, and supplemented the classes with 20-minute practice sessions at home, aided by CDs, DVDs or handouts. The classes emphasized basic postures and exercises that strengthened and stretched the low back and leg muscles.

“Basic yoga postures enhance hip flexibility, core strength and active spine rotation, all of which can be beneficial to a person with chronic back pain,” says Kathleen Blechertas, a physical therapist at Scripps Health in San Diego, California. After completing physical therapy, she and her colleagues typically recommend at-home and community exercise programs to patients.

Tips to keep in mind

Before embarking on an exercise program, patients should talk to their doctor or therapist about whether it is appropriate. Blechertas also recommends patients choose a class that starts with gentle stretches, and listen to their body for signs of increased pain and soreness.

Dr. Bonakdar stresses the importance of finding a good instructor. “When provided by a qualified teacher with appropriate attention to the participants’ movement needs, breath and relaxation, yoga can provide significant benefit for the pain with minimal downside,” he says.

Stay motivated

Regular stretching and strengthening of the back and leg muscles can alleviate chronic low back pain symptoms. However, you have to be persistent about following the exercise regimen. Here are a few tips to help you stay on track:

Find a class to attend on a regular basis.
Having something booked on your calendar increase the chances that you’ll go.
Find a partner to go with you.
Accountability is key. Find a friend to do the classes and exercises with you. Yoga and stretching are beneficial for most people.
Keep an exercise log.
Keep track of how often you attend class and practice at home, which exercises you do, and other details. A log will provide you an extra measure of accountability. You’ll also be able to see your progress, which is motivating.

Find help for low back pain

If you’re looking for a doctor, physical therapy or exercise class for low back pain, call 1-800-SCRIPPS (1-800-727-4777) to speak to a member of our call center.

Get a regular dose of health news and information from Scripps

Decoding Nutrition Labels

2011-12-08T12:20:21-08:00

Did you check the nutrition label on that can of soup before you tossed it into your grocery cart? A recent study conducted by researchers at the University of Minnesota suggests that even if you glance at the nutrition facts before you buy, you may still be missing key information.

The study asked consumers to participate in a simulated shopping experience, using a computer to track their eye movements. Only 1 percent of participants looked at the total fat, trans fat, sugar and serving size on nearly all the labels – even though 31 percent of participants claimed to do so.

Checking the nutrition facts on food labels before you buy can help you make smarter decisions about your diet. However, with so many elements to consider, it may feel like you need a road map to navigate the labels. That’s why Danielle Lipparelli, a registered dietitian at Scripps Health in San Diego, California, suggests starting with what’s most important to you.

“Dieters often count calories and check out the amount of fat,” says Lipparelli. “Patients with heart disease look for lower salt and lower fat foods because that is what’s important to them. Take your special health needs and goals into consideration and start there.”

Serving size vs. portion size

Once you know what type of nutrients you want to limit or get enough of, check the serving size to be sure you know just how much of each item on the label you’re actually eating if you consume the entire container.

“The entire food label quantifies one serving size,” says Lipparelli. “Right below that, it says how many servings are in the package. That piece of information is critical. If there are three servings in a package, eating the entire package would result in tripling all the nutrition information.”

For some packaged items, a serving size is not the same as the portion size you would normally eat. By checking the serving size, the amount of nutrients can be put into context.

Finding the right balance

Once you know the serving size, Lipparelli suggests looking for balanced foods that keep carbohydrates (carbs) and fats in moderation.

“A lot of our daily calories now come from eating excess carbs and sugar. A typical portion size for carbohydrates is only 15 grams,” says Lipparelli. “When you sit down for a snack, try to only have one portion. It puts some perspective on how much you’re eating.”

It’s also important to note the fat ratio. Whether you’re trying to lose weight, prevent heart disease or just stay healthy, look for items that have 3 grams of fat or less for every 7-8 grams of protein; or one carbohydrate portion (15 grams) for every 3 grams of fat. This technique can help you remember that the fat content of any item should no more than a third of what you’re eating.

If you find you’re still hungry, try adding foods that are higher in protein.

“Protein promotes satiety,” notes Lipparelli. “It also helps maintain energy for all of your daily activities.”

Download our easy-to-read nutrition label chart for your next grocery shopping trip. (PDF, 822.4 KB)

Take action

Want to learn more about eating healthy? Call 1-800-SCRIPPS (1-800-727-4777) to register for a healthy cooking class or find a nutritionist.

Get a regular dose of health news and information from Scripps

Dr. Mimi Guarneri of Scripps Receives 2011 Bravewell Physician Leadership Award for Pioneering Achievements in Integrative Medicine

2011-11-11T11:21:30-08:00

Dr. Mimi Guarneri, founder and medical director of the Scripps Center for Integrative Medicine, has received the 2011 Bravewell Physician Leadership Award. She accepted the $100,000 award Nov. 10 at a special reception in New York City.

Established by the Bravewell Collaborative in 2003, the award recognizes a physician leader who has made a significant contribution to the transformation of the United States’ health care system through the use of integrative medicine.

As an attending physician in Scripps Clinic’s interventional cardiology program, Dr. Guarneri placed thousands of coronary stents during the mid-1990s. Recognizing the need for a more comprehensive and holistic approach to cardiovascular disease, she founded the Scripps Center for Integrative Medicine in 1999. The center offers state-of-the-art imaging technology, education, clinical research and lifestyle change programs to aggressively diagnose, prevent and treat a wide range of diseases.

“Integrative medicine is emerging nationwide as a vital force within hospitals, clinics and even the military,” Dr. Guarneri said. “Through practicing integrative medicine I have been able to address the full range of influences that affect my patients’ health, including physical, emotional, mental, social, spiritual and environmental.”

Research shows that integrative medicine interventions can reduce costs and improve health, particularly for those dealing with chronic illnesses such as coronary artery disease, diabetes and persistent pain. Integrative medicine personalizes evidence-based care to best address each individual’s unique conditions and circumstances.

Dr. Guarneri was recently elected president of the American Board of Integrative and Holistic Medicine. She is also a fellow member of the American College of Cardiology, the Alpha Omega Alpha honor medical society and the American Medical Women’s Association. Dr. Guarneri is the author of “The Heart Speaks,” a collection of poignant stories from heart patients who have benefited from integrative medicine approaches.

Dr. Guarneri received her medical degree from State University of New York (SUNY) Medical Center, where she graduated first in her class. She completed her internship and residency at Cornell Medical Center, where she became chief medical resident.

Scripps Center for Integrative medicine blends evidence-based complementary and alternative therapies with conventional Western medicine, in a “best of both worlds” approach to treating disease, healing and improving health. The center cares for people with chronic conditions such as heart disease, cancer, diabetes, stress, pain, weight management and other health issues.

About Scripps Health

Learn more about Scripps Health, a nonprofit integrated health system based in San Diego, Calif.

Founder and Medical Director of Scripps Center for Integrative Medicine Named 2011 Inner IDEA Inspiration Award Recipient

2011-10-12T16:18:02-07:00

On Oct. 7, Dr. Mimi Guarneri,, medical director and founder of the Scripps Center for Integrative Medicine, was honored with the Inner IDEA Inspiration Award at the 2011 Inner IDEA Conference in La Jolla. The Inner IDEA Conference brings together a community of the most dedicated and visionary presenters, instructors and practitioners in the mind-body-spirit health arena.

Dr. Guarneri, a conventionally trained cardiologist, came to recognize that cardiovascular disease — the number one killer in America — needed a more comprehensive and holistic approach. Since 1999, the Scripps Center for Integrative Medicine has offered integrative medicine: a blend of conventional and evidence-based complementary therapies.

She is also the author of The Heart Speaks, a poignant collection of stories from heart patients who have benefited from an integrative medicine approach. The Heart Speaks and her clinical work have been featured on NBC Today and PBS’s To the Contrary and Full Focus. Dr Guarneri’s work was also featured in a two-part PBS documentary, The New Medicine.

Most recently, Dr. Guarneri was elected president of the American Board of Integrative and Holistic Medicine.

The Inner IDEA Conference features more than 100 sessions on the hottest topics and programs in Pilates, yoga, and wellness areas such as tai chi and qigong, Nia®, GYROTONIC® exercise, mindfulness and meditation, nutrition, research, preventive medicine, and wellness business and career development.