Physical wellbeing

It is important to look after our physical wellbeing through appropriate nutrition, sleep and exercise to reduce the risks of physical and mental ill-health.

If we go back to the days where we experienced stress when under threat from a predator it was typically a short-lived stress response with a sharp increase in cortisol to aid immediate survival that would quickly decline and usually have no long lasting effects on our bodies. Our bodies would then return to a state of equilibrium.

Modern day life is full of stressors and many of us are in a chronic state of stress. The issue we now face is that a stress response is triggered by the demands of a job, poor sleep and/or poor nutrition which can be sustained and lead to negative effects on our bodies and minds.

A prolonged stress response can lead to the following:

• Poor memory
• Low mood
• A reduction in our ability to resist stress
• Undesired weight gain
• Loss of lean muscle mass
• A weakened immune system

As we, in the veterinary profession experience long term demanding roles, often with sleep deprivation due to out-of-hours or shift work and potentially poor nutrition, due to having to eat on-the-go and having less time to consider and prepare what we are eating.

The priority of physical self-care is to consider our sleep, nutrition and exercise. We will discuss these separately, but for physical self-care to be successful in the longer-term, these 3 factors should be considered synergistically, i.e. improving each factor sequentially before looking to make further improvements.

• Though everyone’s optimal sleep patterns may differ, studies have shown that 3 consecutive nights of less than 6 hours of sleep can triple our cortisol levels, making us more prone to stress, lower mood and have reduced memory.
• We know that lack of sleep is associated with obesity and type 2 diabetes. During normal sleep we regulate certain hormones. When we experience a lack of sleep it can result in increased hunger and increased blood glucose levels.
• Lack of sleep has been associated with increased risk of heart disease and stroke.
• Inadequate sleep reduces cognitive performance, e.g. concentration, creativity and learning ability. It is useful to note for shift workers and those with extensive out-of-hours, that driving skills after being awake for 24 hours are equivalent to a blood alcohol concentration level of 0.10%.

NB The following tips to achieve optimal sleep are useful self-care guidelines, but if you are experiencing insomnia “persistent sleeping difficulties including falling asleep, staying asleep and maintaining quality sleep that impacts daily functioning,” then you may also need to seek medical support from your GP. The good news is that insomnia is CURABLE, so please do not live with it. CBT is the recommended treatment for insomnia and www.sleepio.com is a free online NHS therapy programme.

Lifestyle:

• Train your brain that sleep is imminent through routine and ritual:
  • Treat your bedtime routine as a bit of a ritual, be intentional in the things you do before you get into bed, this can be as mundane as brushing your teeth and getting into pajamas, but do it intentionally and in the same order.
  • Keep the same bedtime and wake-up time each day, even on weekends or days off.
    •  For those of you on shift or with out-of-hours this can be hard to achieve, but see our NIGHT SHIFT SLEEP TIPS section for more advice.
• Feel calm and clear your mind of worries.
  • Easier said than done, often at this time of day. When we wind down recurring or stressful thoughts can seem at their loudest (see the MENTAL WELLBEING pillar for advice on how to manage this).
  • Turning off electronic devices, or putting them on slumber mode so you disconnect from the outside world. Looking at emails or news feeds can be triggering for your thoughts before you sleep.
  • Some people find using electronic devices can distract them from more pressing thoughts and may be useful if used carefully.
    • This includes reading books or listening to audiotapes/ sleep app content such as sounds, music and meditations.

Environmental:

• Reduce room temperature to 15-19°C to promote the natural reduction in body temperature that happens when we first fall asleep. This helps signal to the body that sleep is coming.
• Blackout curtains or sleep masks create a dark environment that can help with sleep.
• Treat your bedroom as a “sleep sanctuary,” free from work-related distractions:
  • If you are sleeping on-site at work, using a face-mask, a pillow spray to bring the smell of home and bringing your own bed linen may help recreate this.

• Avoid drinking alcohol or caffeine. They both interfere with sleep. While alcohol can initially promote sleepiness, it inhibits the deep stages of sleep. The half-life of caffeine ranges from 1.5 to 9.5 hours, so the intake of caffeine-containing drinks in the early evening and afternoon interferes with sleep.
• Avoid large meals later in the evening, as digesting them is counterproductive for restful sleep.
• After 15 minutes of being awake in bed, get up and walk around, move to a chair or a different room before returning to bed to sleep. If you stay awake in bed regularly for long periods it can habituate the problem.

• Pre shift:
  • Get extra sleep before the first shift in the cycle, including taking a 2 hour afternoon nap before coming on shift.
• During shift:
  •  If it is possible during a night shift, take 20-45 minute naps to counteract fatigue.
  • Eat proper meals throughout the night (see NUTRITION section).
• Post shift:
  • Only if safe to do so, wear sunglasses on your way home to minimise exposure to sunlight that will make your brain feel awake.
  • Start your sleep ritual as soon as you get home.
  • Develop a daytime sleep routine, make the room cool, dark and quiet.

• A useful, NHS endorsed 6 week online therapy programme: www.sleepio.com

Inside our large intestine (also known as the “gut microbiome”) is our gut microbiota. Our microbiota is made up mainly of bacteria but also fungi and viruses and the combination is unique to each individual.

Research into this is developing rapidly and we now know that this microbiota supports our overall health.

To maintain a healthy gut microbiota we should follow the Eatwell guidelines, eat a varied, plant-based diet and stay hydrated.

We can also consume probiotics (e.g. yoghurt and fermented milk drinks like kefir or supplements) and prebiotics (e.g. fibrous foods like coconut, kiwi, walnuts, bulgar wheat, chia seeds, beans and lentils). Probiotics may be beneficial if you are experiencing depression.

1. By aiding digestion of fibrous foods through the process of fermentation.
2. Fermentation produces beneficial substances to keep our gut healthy.
3. Three quarters of our immune system is in the gut. By keeping the gut healthy the microbiota supports our immune system.
4. There is a gut-brain pathway, and research suggests a healthy microbiota can support a positive mood and may protect against anxiety and depression.
5. An unbalanced microbiota may increase our risk of type 2 diabetes, obesity, heart disease, some cancers, liver disease, dementia and bowel diseases.

Simply put, an ultra processed food is one that has ingredients that you would not expect to find in a regular home kitchen and that are designed for high palatability and shelf-life. Very often they are mostly or entirely lacking whole foods and fibre and are often high in fat, sugar and salt.

Not only do they have little to no nutritional value, but they are also highly addictive, and will encourage us to eat a larger amount, increasing the risk of obesity.

We should try to eliminate these from our diet or only consume them sparingly.

Some examples of ultra-processed foods include:
Cereals, chocolate, flavoured yoghurts, crisps, fizzy drinks, ready meals, mass produced/ packaged bread, cereal bars.

Ultra-processed foods are directly linked with increased risk of Type 2 diabetes, heart disease, strokes and cancers.

• A balanced diet is important for everyone, and for those of us experiencing chronic stress, doing shift work or chronic sleep deprivation, a healthy diet is even more so. Chronic stress makes us more susceptible to increased hunger and weight gain as well as disease.● Try adding vegetables like grated carrot to your porridge and/ or add different combinations of banana, berries (frozen is a cost effective way of doing this) and dried fruit.
• Experiment with high fibre grains (e.g. whole wheat products, barley, quinoa and brown rice).
• Add avocado to your toast, spinach to your omelette or tomatoes and lettuce to your bacon sandwich.
• Snacking is ok. Just pick a healthy option. Chopped vegetables and hummus, unsalted nuts and seeds are a great option.
• N.B. Frozen and canned fruit and vegetables (as long as not in syrup) are just as nutritious as fresh!
• Switch out meat for lentils and beans.
• Try new grains in place of pasta and noodles like bulgar wheat, quinoa, freekah and buckwheat.

• The British Nutrition Foundation has up to date information on healthy diets, gut health, ultra-processed foods and more.
• For information about a balanced healthy diet that has been reported to be environmentally sustainable, see The Eatwell Guide
• The British Association for Nutrition and Lifestyle Medicine (BANT) has useful infobites about specific nutrition topics on their website.

In combination with good sleep and nutrition, exercise can reduce our risk of physical illnesses such as stroke, heart disease and type 2 diabetes, as well as mental health conditions, including depression.

Humans are evolved for endurance, capable of maintaining a slow, steady pace over extended periods. Our bodies naturally respond better to programs that maximize endurance.

“But I only have a few hours a week to exercise, shouldn’t I make the most of it?”

Research shows the 80/20 training principle remains effective even with less than 4 hours of weekly exercise. Even when exercising only 30-45 minutes daily, the best strategy is to undertake low-intensity aerobic activities 80% of the time. The guidelines for this include maintaining a heart rate below 60%-65% of maximum, where in simpler terms conversation during exercise remains effortless.

The remaining 20% can be more challenging but in small doses at a time.

If you are experiencing depression or anxiety exercise can feel like a big challenge. The good news is that even small bursts of exercise can make a difference. Remember it doesn’t have to be formal exercise like going to the gym or running, it could be doing some gardening, walking up the stairs instead of the escalator/ lift, dancing in your kitchen or going for a brisk walk with a friend.

To keep at it, it can be useful to do the following:

• Set realistic goals, start with small expectations on yourself and pick something you enjoy.
• Listen to your body, and some days that will mean doing less.
• Celebrate the wins, take note of the effort and improvements you make, however small!
• Have an accountability partner, a friend or family member who is doing the exercise alongside you, so that you can check in and motivate each other to keep going.
• Group exercise is recommended by the National Institute of Care Excellence (NICE) and in some regions of the UK it is possible to get “exercise on prescription,” through your GP, which is a financial contribution towards a course of group exercise classes.

• NHS: Physical activity guidelines for adults aged 19 to 64
• Try this podcast: How to exercise with less effort and get fitter.