Yoga for Healthy Eating: An Overview

by Nina

Both Baxter and I have already written a number of posts exploring the topic of Yoga for Healthy Eating. But seeing that it’s the beginning of a new year—when people often make resolutions regarding their health—I thought now would be a good time to provide an overview of the topic. Basically, between the two of us, we’ve come up with a four-pronged approach to support healthy eating:

• Understand your digestive system

• Practice stress management
• Cultivate mindfulness
• Strengthen Will Power

1. Understanding Your Digestive System

Baxter has recorded a short audio tour of the digestive system (see Audio Tracks) that you can use to learn about how your digestive system works and what happens to your food as and after you eat it. It’s especially helpful for you to learn about how your digestive system interacts with your Autonomic Nervous System and higher brain function. When you’re in a state of stress (see Stress, Your Health and Yoga), your nervous system diverts your body’s resources away from your digestive system (you don’t need to be eating or digesting your food when you’re running away from that tiger or that car that looks like it’s not going to be stopping before the crosswalk!). So chronic stress can cause digestive problems. In addition, even thinking about stressful situation can have a potential negative impact on digestion!

2. Practicing Stress Management

Chronic stress may not only cause digestive problems as I mentioned above, but the cortisol that is released can cause weight gain by stimulating your appetite (Yoga, Stress and Weight Management). So one of the most important things you can do to improve digestion and move toward healthy eating is to use your yoga practice to reduce your stress levels. See The Relaxation Response and Yoga for basic information on using yoga to switch your nervous system from the Fight or Flight response (stress mode) to the Rest and Digest response (relaxation mode). It’s not called the Rest and Digest mode for nothing!

3. Cultivating Mindfulness

Many poor eating habits are just that—habits! Practicing yoga asana with mindfulness and meditating will help you tune into your body, and not to ignore it. And as you tune into your body, you may learn about foods you are currently eating that are compromising your health (see Got Mindfulness?) or notice poor eating habits, such as eating beyond satiety (see Meditation and Healthy Eating). Cultivating mindfulness can teach you to recognize:

• which foods are good for you and which are not (not just junk food, but maybe food intolerances or allergies)
• when you are full and don’t need to eat more
• when you are thirsty instead of hungry
• when you are eating for stress, not for hunger

See Yoga for Healthy Eating for more information.

Mindfulness will also help you start to recognize habitual thoughts that are getting in the way of healthy eating. You can then work on changing your perspective (see Cultivating the Opposite).


4. Strengthening Will Power

Once you’ve identified your habits or have decide to eliminate or cut back certain foods, it takes will power to change! According the Dr. Kelly McGonigal, being in a state of stress can increase impulsive behavior and decrease will power. So practicing stress management as we describe above will help with your will power (see Healthy Eating, Stress and Self Control). However, you can also use a meditation practice to intentionally strengthen your will power.  Meditation teaches you to return to your object of meditation (your focus) and tune out distractions (temptations):

“Neuroscientists have discovered that when you ask the brain to meditate, it gets better not just at meditating, but at a wide range of self-control skills, including attention, focus, stress management, impulse control, and self awareness. People who meditate regularly aren’t just better at these things. Over time, their brains become finely tuned willpower machines. Regular meditators have more gray matter in the prefrontal cortex, as well as regions of the brain that support self-awareness." —Dr. Kelly McGonigal

See Meditation and Healthy Eating for more information.

Tune in tomorrow to hear from Baxter on the same topic! He’ll discuss stress eating and recommend some specific yoga practices for you to support your goals for healthy eating.

I Like Swiss Cheese…But Not in My Work

I remember being a 22-year old in Italy and not worldly-wise. I was trying to buy “Swiss cheese” and was asking a friend to help me find it in a supermarket and translated it literally. My friend pointed out to me that Switzerland was known for its cheeses and there were many kinds of “Swiss cheese.” I explained to him that it was the one “with the holes in it,” and he then told me that the cheese was called Emmental.  

Many years later, when I was learning about safety, human error, and complex systems, I got introduced to the “Swiss Cheese Model of Error,” the work of Professor James Reason of Manchester University, in England. Professor Reason created the model to help his students understand the relationship between the thoughts and actions of humans in a complex system and how these thoughts and actions can either contribute to the creation of bad outcomes and in some cases, catastrophes, or help prevent them.

Reason knew that humans understand at some level that they are fallible, so that they build protective walls to “block” errors from resulting in bad outcomes. An example of this is in the system for protecting patients from medication ordering errors.  Physicians can and do occasionally make errors of ordering the wrong drug, the wrong dose, or the wrong route. The first wall of defense to block one of these errors is called pharmacist verification. Every time a doctor orders a medication on a patient in the hospital, the pharmacist checks it to make sure that it is safe for the patient. But pharmacists also occasionally make mistakes. So the pharmacy verification wall has holes in it, too. The next wall of defense is called nurse check. Nurses also make mistakes so this wall is also imperfect. If you line up all of the walls what does it look like? You guessed it…Swiss cheese.

                                                                                                                                                                   
Reason calls the holes in the cheese latent failures. Latent means hidden or present in an unexpressed form. These latent failures can be grouped into a number of categories. One of the categories is failures at the managerial level. This occurs when a manager knows that a design is not being followed that could cause a bad outcome but the manager allows the design to not be followed. An example would be if a manager knew that the doctors and nurses were not doing the timeout correctly before a procedure but let the procedure go on anyway.

A second type of latent failure is called a psychological precursor. Psychological precursors can be thought of as beliefs held by those involved in a complex system that lead to people not following the design. An example of this would be if doctors and nurses did not do the timeout properly because they believed the timeout was “stupid” and “not necessary and a waste of time.” A psychological precursor that is rampant in healthcare is: “I do it whatever way I have to, to get whatever my patient needs.” This psychological precursor is the end result of clinicians working in broken systems. They come to believe that they don’t have to do it the way it is designed because the design never works anyway. This psychological precursor is the opposite of what people in other high risk industries like commercial aviation or nuclear power believe: “I follow the design because it is not safe to do otherwise.”

Other holes in the walls may be due to less pervasive problems or one- time events. These latent errors are called: local triggers, intrinsic defects, or atypical conditions. An example of an atypical condition is when a clinician is dealing with a patient that does not speak his or her language. We know that the opportunity for error increases when our patients can’t participate fully in their care or in protecting themselves from harm.

Bad outcomes may start with an unsafe act where an individual does not follow a procedure as designed or does not follow the standard work.  

Let me tell a story about an employee injury at GBMC using the Swiss cheese model. 

Our colleague falls and injures her arm.
An employee took an office grade bag of trash that had a lot of liquid in it out of a break room garbage can. The employee placed it on the floor in the hallway where it leaked onto the floor. (The designed procedure is to place the bag immediately in a cart.) The employee then realized that the bag had leaked, and retrieved a mop and cleaned it up. The employee did not put a wet floor sign down and a nurse turned the corner and slipped, falling to the floor and injuring her wrist.

So applying the model we see that one latent error in our system is that we use trash bags that are not designed for liquid in trash cans that may receive liquid. Although it is not absolutely clear it appears that at least someone may have the psychological precursor of “any trash bag will do” in using the bag that is not designed for liquid.  A second psychological precursor may have been, “I don’t need to follow the rule, it won’t leak, I’ll just put it on the floor.” The actual unsafe act was putting the bag on the floor. A last unsafe act was not putting the wet floor sign up.

Notice that if any one of these latent errors had been “fixed,” the hole would have been blocked and our colleague would not have been injured. If the correct bag was used, or if the person emptying the trash had put it directly in a cart or if he or she had put up the wet floor sign, our colleague would not have been injured. But, if only one had been fixed, the other latent errors would still have been present waiting to align for the next bad outcome or catastrophe.

We cannot wait until the holes in the Swiss cheese align to create a catastrophe; we must fix the holes when we find them. This is what our near miss (Quantros) reporting system helps us to do.

What latent errors have you found and are working to fix in our healthcare system?