Stealth Health: Get Healthy Without Really Trying

Living healthier doesn't have to be complicated or time-consuming, experts say

By Colette Bouchez
WebMD Weight Loss Clinic - Feature

Reviewed By Brunilda Nazario, MD

How much do you know about what makes up a healthy lifestyle? Here's a pop quiz.

1. How do you define working out?

a. Going to the gym.
b. Turning the jump-rope for the neighbor's kid.
c. Playing Frisbee with your dog.

2. How do you define good nutrition?

a. Eating a vegetable at every meal.
b. Eating two vegetables at every meal.
c. Drinking a fruit smoothie for breakfast.

3. Which of these is a healthy activity?

a. Push-ups, sit-ups, or running the track.
b. Walking the dog after dinner.
c. Spending Saturday afternoon snoozing on the sofa.

Believe it or not, the correct answer to every question is A, B, and C -- even that Saturday afternoon snooze! According to the growing "Stealth Health" movement, sneaking healthy habits into our daily living is easier than we think.

"You can infuse your life with the power of prevention incrementally and fairly painlessly, and yes, doing something, no matter how small, is infinitely better for you than doing nothing," says David Katz, MD, MPH, director of Yale University's Prevention Research Center and of the Yale Preventive Medicine Center. Katz is also co-author of the book Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying.

From your morning shower to the evening news, from your work commute to your household chores, Katz says, there are at least 2,400 ways to sneak healthy activities into daily living.

"If you let yourself make small changes, they will add up to meaningful changes in the quality of your diet, your physical activity pattern, your capacity to deal with stress, and in your sleep quality -- and those four things comprise an enormously powerful health promotion that can change your life," says Katz.

And yes, he says, a nap on the couch can be a health-giving opportunity -- particularly if you aren't getting enough sleep at night.

Nutritionist and diabetes educator Fran Grossman, RD, CDE, agrees. "You don't have to belong to a gym or live on wheat grass just to be healthy," says Grossman, a nutrition counselor at the Mt. Sinai School of Medicine in New York. "There are dozens of small things you can do every day that make a difference, and you don't always have to do a lot to gain a lot."

Do a Little, Get a Lot

The notion that good health can come in small tidbits is not really new. Research showing that making small changes can add up to a big difference has been quietly accumulating for a while.

For example, a study published in the Archives of Internal Medicine in 2004 found that adding just 30 minutes of walking per day was enough to prevent weight gain and encourage moderate weight loss.

And if 30 minutes is still too big a bite? Another study, published in Medicine & Science in Sports & Exercise, found that three brisk 10-minute walks per day were as effective as a daily 30-minute walk in decreasing risk factors for heart disease.

"Just the act of going from sedentary to moderately active gives you the greatest reduction in your risks," says Helene Glassberg, MD, director of the Preventive Cardiology and Lipid Center at the Temple University School of Medicine in Philadelphia.

But it's not only in fitness where small changes can make a difference. The same principles apply at the kitchen table (and the office snack bar).

"Reducing fat intake, cutting down on sugar, eating a piece of fruit instead of a candy bar -- over time, these things can make a difference," says Grossman.

As long as the changes are moving you toward your goal -- be it weight loss, a reduction in cholesterol or blood pressure, or better blood sugar control -- you can get there by taking baby steps, she says.

Moreover, Grossman tells WebMD, making small changes can help give us the motivation to make bigger ones.

"A lot of bad eating habits are about not taking charge of your life, and that attitude is often reflected in other areas," says Grossman. On the other hand, she says, when you make small changes at the kitchen table, the rewards may show up in other areas of your life.

"It's the act of taking control that makes the difference in motivating you," says Grossman. "An inner confidence and power begins to develop that can be seen in other areas of life."

Tripping Over Baby Steps

Of course, not everyone is certain that baby steps can walk you all the way to good health. Marc Siegel, MD, a clinical associate professor at the NYU School of Medicine, says that while doing something is certainly better than doing nothing, making such small changes is like using a Band-aid to stop a hemorrhage.

"It's a small, gimmicky idea to target people with very unhealthy lifestyles, and for some it may be useful," says Siegel, author of False Alarm: the Truth about the Epidemic of Fear. But he fears that for most people, it's sending the wrong message.

"In some ways it's a resignation, an admission that things can't be changed -- and that's certainly not the long-term answer," Siegel tells WebMD.

Katz concedes that the Stealth Health approach may not be right for everybody.

"There is a trade-off because if you try to make the pursuit of health easier for people, you run the risk of leading them to believe they don't need to do very much -- and that would be the wrong message," he says.

At the same time, Katz believes that for those who find making health changes a daunting task, Stealth Health techniques can make a difference.

"If you want the really big gains, there has to be some pain," says Katz. "But there is a lot to be said for the idea that you can make some gains with little or no pain, and that's infinitely better than no gains."

Try the Stealth Health Approach

Tempted to give "Stealth Health" a try? Katz recommends picking any three of the following 12 changes and incorporating them into your life for four days. When you feel comfortable with those changes, pick three others. Once you've incorporate all dozen changes, you should start to feel a difference within a couple of weeks, he says.

To Improve Nutrition:

1. Buy whole foods -- whether canned, frozen, or fresh from the farm -- and use them in place of processed foods whenever possible.
2. Reject foods and drinks made with corn syrup, a calorie-dense, nutritionally empty sweetener that many believe is worse for the body than sugar, says Katz.
3. Start each dinner with a mixed green salad. Not only will it help reduce your appetite for more caloric foods, but it also will automatically add veggies to your meal.

To Improve Physical Fitness:

1. Do a squat every time you pick something up. Instead of bending over in the usual way, which stresses the lower back, bend your knees and squat. This forces you to use your leg muscles and will build strength.
2. Every time you stop at a traffic light (or the bus does), tighten your thighs and butt muscles and release as many times as you can. (Don't worry, no one will see it!) This will firm leg and buttock muscles, improve blood flow -- and keep you mildly amused!
3. Whenever you're standing on a line, lift one foot a half-inch off the ground. The extra stress on your opposite foot, ankle, calf and thigh, plus your buttocks, will help firm and tone muscles. Switch feet every few minutes.

To Improve Stress Control:

1. Give your partner a hug every day before work. Studies show this simple act can help you remain calm when chaos ensues during your day, Katz says.
2. Have a good cry. It can boost your immune system, reduce levels of stress hormones, eliminate depression, and help you think more clearly.
3. Twice a day, breathe deeply for three to five minutes

To Improve Sleep:

1. Sprinkle just-washed sheets and pillowcases with lavender water. The scent has been shown in studies to promote relaxation, which can lead to better sleep.
2. Buy a new pillow. Katz says that studies show that pillows with an indent in the center can enhance sleep quality and reduce neck pain. Also, try a "cool" pillow -- one containing either all-natural fibers or a combination of sodium sulfate and ceramic fibers that help keep your head cool.
3. Eat a handful of walnuts before bed. You'll be giving yourself a boost of fiber and essential fatty acids along with the amino acid tryptophan -- a natural sleep-inducer.

SOURCES: Archives of Internal Medicine. 2004; vol 164: pp 31-39. Medicine & Science in Sports & Exercise, September 2002. David Katz, MD, MPH, director, Prevention Research Center, Yale University; co-author, Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying. Fran Grossman, MS, RD, CDE, nutrition counselor, Mt. Sinai School of Medicine, New York. Helene Glassberg, MD, director, Preventive Cardiology and Lipid Center, Temple University School of Medicine, Philadelphia. Marc Siegel, MD, clinical associate professor, New York University School of Medicine; author, False Alarm, The Truth about the Epidemic of Fear.

INSTILLING QUALITY AND PATIENT SAFETY IN THE SURGICAL RESIDENCY TRAINING PROGRAM

by Alejandro C. Dizon, MD, FPCS, FACS

The publication in 1999 of the Institute of Medicine report: To Err is Human: Building a Safer Health System has brought a realization that more people die directly or indirectly due to medical errors in hospitals compared deaths from motor vehicle and airline accidents. As much as 100,000 die in US hospitals because of medical errors and 15,000,000 experience harm or adverse events in healthcare facilities. The World Health Organization deduces that in developing countries, these figures may proportionally be bigger. Contrary to the promise of the medical profession “To do no harm”, unfortunately the hospital can be one of the most dangerous place in the world.

For these reasons, the thrust in many developed countries and organizations is to enforce many safety processes, procedures and initiatives that address quality and patient safety. We are currently monitoring surgical success on the basis of morbidities and mortalities and sometimes, surgical site infection but we lack the instruments and mechanism to accurately validate this and miss the “contribution” of errors or events chance in lessening if not preventing future adverse events or outcomes to patients. This understanding and awareness should be brought to the consciousness of everyone in the healthcare industry, which includes the training of residents in the various training programs.

The old and current model for training still is based upon the “Read one–See one- Do one” model (a “See one – Do one- Read during, again or later” may sadly occasionally happen). This would be ideal if there is full and complete oversight and supervision by the attending consultant. But in reality, how often does this actually happen and we allow trainees to be “independently” doing surgical procedures in the context of “training”. How often will a trainee be doing a surgical procedure on an actual patient for the first time “independently”?

With the present lack of a more objective measure for compliance to the requirements of a training program, we still currently utilize primarily the number or volume of cases performed by a trainee. More credit is given to independently done procedures versus supervised ones. But are there measures of quality that will show that the surgical procedures performed had favorable outcomes? Were the patients properly and adequately assessed and prepared pre-operatively, intra-operatively and post-operatively? More importantly, were the patients informed and educated properly with regards to the diagnosis, planned procedure(s) and the expected outcome of the intervention? What is the degree of supervision in a surgical procedure that will be performed by a trainee who will be doing the procedure for the first time? What is the expertise or competence level of the surgeon supervising? We have all been guilty of somehow losing the “PATIENT” in a system that promulgates “good” training that fails to consistently provide even minimum safeguards against patient harm.

The other issue that has a big impact on surgical training programs is the current system and culture in our heath care systems and institutions. What dominates is the hierarchal system of practice and training that discourages lower ranked individuals to correct or question the superiors. Many of the “scut” or daily work is delegated to the newest member of the team. This may limit direct supervision of “senior” over “junior” house staff members and overwhelms the most junior member of the residency staff with the floor calls and work. These include assessment and management of most of the surgical patients in the wards or out patient clinics. This system and tradition likewise promotes a “Train and blame” culture that focuses on and even highlights the errors and faults of the individual but fails to approach and analyze the problem from a systems perspective. Even problems occurring with private patients during a resident’s duty can be easily blamed on the “incompetence” of the resident. In the Philippine setting, the work of a floor resident is even made more difficult by the high nursing turnover that transfers to the resident many of the tasks or decision making that could have been done by a more experienced nurse.

These issues should be addressed in the residency training programs in the interest of quality health care delivery and patient safety. We should review the design of the surgical curriculum and implementation of training programs in the context of safety for the patient. The first is the appropriate and competent teaching and supervision of trainees. The “Read one - See one- Do one” or Apprenticeship Model in teaching is still very effective if done properly. The teaching and supervision is the responsibility of the consultant training staff should be the most competent (if not the expert) in the field and cannot be delegated to anyone else. How often does it happen that supervision is delegated to fellow residents or even more concerning, no supervision at all? Even the manner of promotion is based on the number of years and the minimum (!) number of procedures performed. We should look more not into the minimum numbers but the success and quality of surgeries performed, not determined by numbers. The basis for promotion may differ from person to person as every learner is different. (e.g one resident may require 2 cases while another resident –slow learner or less skillful- may require 10 cases before promoting). This may be a logistical nightmare in terms of maintaining the structure of a program but shouldn’t our patients deserve no less before we certify a surgeon from a training program as competent and qualified?

The trend now in developed countries is to utilize Simulators or Virtual Reality (VR) Training systems. This is a model currently used in the airline industry that require pilots to successfully complete hours in a flight simulator and training planes before they are certified to fly commercial flights. Programs who have adapted this require a minimum number of hours of exposure and successful outcomes in these medical simulator systems before the trainees are allowed to perform surgery on “real” patients. These training platforms may not come cheap but one can actually innovate to achieve similar outcomes of teaching procedures and developing surgical judgment.

Next is breaking down the traditional hierarchy in the surgical training programs. The teamwork concept should be put in place to include not only the resident staff but also all members of the healthcare team (interns, nurses, technicians and even consultants). We should likewise veer away from the traditional “train and blame” or culture of blame to what quality advocates term as a “culture of safety”. The culture of blame tends to pinpoint mistakes and errors to an individual and in turn leads individuals to hide or “bury” mistakes in the process, for fear of reprimands. A culture of safety likewise investigates mistakes and errors from a systems perspective by looking more as to defects in the process or systems that “allowed” a person to commit the mistake. Systems solutions provide a wider and broader scope in preventing the same errors from recurring.

Lastly we should incorporate the basic principles of quality and safety in the training programs. We currently look closely at outcomes and complications and often retrospectively, providing more of technical solutions. We have to teach the importance of proper and complete, documented assessments, care coordination with the other specialties, respecting patient and family rights, providing patient education and proper post-operative care monitoring and follow-up. We should also implement and emphasize importance of the “time-out” or universal protocol to ensure that a complete pre-operative assessment, pre-procedure briefing with the surgical team, determination of correct procedure/patient/operative site and post-operative debriefing is performed in all surgeries. Clinical quality and safety monitors should be done to measure compliance and guide improvement processes.

We have gone a long ways in teaching the science and skills necessary for good surgery. Now we have to revisit the basics of patient safety, specifically surgical safety, to ensure the delivery of quality healthcare, healthcare that is not only safe and effective, but also timely and patient-centered. This is our responsibility not only to our patients but also to our profession. We should remember that we have to teach our young surgeons well because the students and trainees of today will be those that will take care of US in the future.

WHITE OIL THAT HEALS

Docs provide the science on VCO


DURING the decades-long campaign of the American soybean industry against tropical oils, Filipinos were made to believe that the coconut—oil and cream abundant in the Philippine diet—was bad for one's health. Only when American biochemists began uncovering the dangers of transfats in commercially processed soybean, corn and canola oils did consumers all over the world take a second look at the once disparaged tropical oil.

With the dangers posed by deadly viruses like HIV, SARS and H5N1, the Philippines has emerged as one of the countries least affected in the region. To this, HIV clinical study author Dr. Conrado Dayrit puts forward the question, “Could it be the coconut diet?”

Thus began the return of coconut oil to the dining table. Filipinos went further by going back to their forefathers' traditional manner of extracting food oil naturally from fresh coconuts to produce white edible oil and relabeled it virgin coconut oil or VCO.

Amid the hype, are Filipinos swallowing the truth about coconut oil? But that is not for oil producers to tell consumers. In a medical forum organized last month by the nongovernment group VCO Philippines, at least four noted Filipino doctors—a pediatrician, a dermatologist, a cardiologist-pharmacologist and a nutrition support specialist—have come out to exhort the once moribund industry, “You produce the right oil, we provide the science.”

Dr. Arturo C. Ludan
Pediatrician-gastroenterologist

VIRGIN COCONUT OIL (VCO) is immunoprotective in children, superior to Vitamin C.

The fatty acids that make up coconut oil so effective against germs are the same ones nature has put into mother's milk to protect infants.

Clinical studies show VCO's significant role in pediatrics as a source of energy, an immune system booster, a local antiseptic and an anti-inflammatory.

Dr. E. Gabriel Martinez conducted a triple-blind, randomized-controlled trial on premature infants who showed a trend toward higher weight gain per day, shorter duration of intervention and fewer adverse events among the treatment group supplemented with 0.5 ml of VCO per ounce of body weight.

Another study by Dr. Daisy E. Davila to determine the effect of VCO on recurrent respiratory infection among pediatric patients in Pasay General Hospital ages 1-5 years showed that VCO supplementation reduces the incidence by 67 percent and the duration by 62 percent.

In my clinical practice, I applied the studies of Doctors Conrado Dayrit, Vermen Rowell and C. E. Isaacs in prescribing VCO as a local antiseptic to keep a nursing mother's nipple relatively sterile against microbes, and to treat viral infections in children such as herpes simplex (which can cause infections of the mouth, eyes, female genital tract and brain) and Epstein-Barr as cause of infectious mononucleosis, influenza A and measles virus.

But what the pediatrician would like to explore about VCO is its anti-inflammatory potential in treating allergic disorders like asthma and rhinitis.

Dr. Vermen Verallo-Rowell
Dermatologist-medical researcher

VCO IS AN AFFORDABLE, medically acceptable alternative for those who cannot afford conventional antibiotics.
Medium-chain triglycerides of mainly lauric acid becomes active antiseptics when it breaks down into lauric acid monoglycerides or monolaurin in coconut milk (as well as in mother's milk).

With molecules small enough to be directly absorbed through the intestinal wall into the bloodstream, monolaurin travels around the body to act as an antiseptic.

Results from my clinical studies tally with those of Dr. Conrado Dayrit's HIV study. While Dayrit identifies monolaurin as having brought down the HIV viral counts in the study, there are more monoglycerides from the VCO's other medium-chain fatty acids that are anti-infective.

A study shows monolaurin (in gel) is comparable to alcohol. It can kill common disease-causing bacteria and fungi cultured from the hands of nurses after duty. But unlike alcohol, monolaurin is gentle to the skin and can be taken internally. When taken internally, it does not kill off the desirable intestinal bacteria but acts only on potentially disease-forming microorganisms.

In yet another study, monolaurin proved as effective as the most popular antibiotics in killing bacteria from already infected skin. In one case, it treated and prevented the recurrence of a drug-resistant herpes simplex.

Based on my clinical practice at Makati Medical Center, nutritional supplements of VCO lower the severity of psoriasis secondary infection and atopic dermatitis cases.

Dr. Conrado Dayrit
Cardiologist-professor emeritus

VCO PREVENTS HEART DI-sease. Coconut oil, like other vegetable oils, has no cholesterol.

In fact, VCO intake in substantial amounts keeps cholesterol low, between 170 and 200 milligrams per deciliter, by promoting the conversion of cholesterol into pregnenolone to be utilized in the production of adrenal and sex hormones. VCO's cholesterol-lowering effect is a regulatory action since it can also beneficially raise cholesterol when it is too low for the body's needs, thus maintaining the healthy ratio between low density lipoprotein-cholesterol and high density lipoprotein-cholesterol (HDL-C).

On the other hand, the lowering of total cholesterol by the omega-6 oils (corn and soybean oils) is not beneficial since it also lowers the good HDL-C, subsequently depositing the lost oxidized cholesterol in the arterial plaque, which could clog the arteries.

While statins block cholesterol synthesis, this does not address the inflammatory nature of atherosclerosis. VCO does, having the ability to kill major types of atherogenic bacteria and viruses in the blood while exhibiting anti-inflammatory action in synergy with omega-3 fatty acids.

The saturated fats-heart scare is a big fat lie because it covers up the fact that polyunsaturated oils are the sources of inflammatory prostaglandins, allergic leuko-trienes, and blood clot-inducing thromboxane. And when partially hydrogenated, polyunsaturated oils are converted into trans fatty acids that are even more atherogenic.

For more information, read his book “The Truth About Coconut Oil” (available at National Book Stores).

Dr. Eliza Perez Francisco
Family physician-nutrition support

IN MY CLINICAL PRACTICE AT ST. Luke's Medical Center, I use VCO for the elderly in relation to physiologic changes that occur with aging.

VCO can address sensory losses, tooth and gum problems, changes in the intestinal tract, changes in the immune system, changes in body composition, and changes that come with menopause and andropause.

With age, the intestinal wall loses strength and elasticity, thus slowing down motility. Two tablespoons or 30 ml of VCO at bedtime ought to regulate constipation. VCO also has a soothing effect on the sore anal area of hemorrhoids.

For arthritis, VCO used as massage oil or taken orally can relieve aches and joint pains.

Bedridden patients who require tube feeding could use nutrition support by blending VCO with tube feed or with commercial milk formulas in consultation with a dietitian.

A combination of old age and malnutrition makes older people vulnerable to pneumonia, UTI and bedsores. VCO can help fight infection in the early stages.

Take the case of a 76-year-old who developed painful herpes zoster on his trunk. The antibiotic cream given to him only lasted for one application because the area affected was so wide. But when VCO was applied all over the skin for a week, the patient reported relief from itch and the lesions dried up.

An 83-year-old patient who complained of loss of strength and lack of energy was able to walk and take a jeep to her favorite mall only after a week of taking two tablespoons of VCO every morning.

Published on page A12 of the September 17, 2006 issue of the Philippine Daily Inquirer