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Health and Wellness Guide

Looking to improve your health? Understanding how your lifestyle impacts your overall wellbeing gives you the power to make changes and improve. 

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Reviewed by Dr Sam Rodgers

6th December 2019

Contents

Taking control of your health and wellness.

Chapter 1

Taking control of your health and wellness.

6 reasons for having a health check

Chapter 2

6 reasons for having a health check

How can your diet affect your health?

Chapter 3

How can your diet affect your health?

Inflammation diet

Chapter 4

Inflammation diet

Stress and wellbeing

Chapter 5

Stress and wellbeing

5 reasons you could be tired all the time

Chapter 6

5 reasons you could be tired all the time

Sleep – the foundation of good health

Chapter 7

Sleep – the foundation of good health

Taking control of your health and wellness.

Chapter 1

Taking control of your health and wellness.

We look at the changing trends in health and wellness and how blood testing can provide additional information to help make you happier and healthier.

As a nation, we are increasingly focussed on our health and wellbeing – in fact, the value of the health and wellness market in the UK reached almost £20 billion in 2018[1]. We invest time and money in the gym, on tracking devices, vitamins, yoga and power leggings – and are focused more than ever before on being as healthy as we can be. In one recent survey, 74% of respondents considered themselves to be health conscious and those results were across all age groups[2].

We are now living longer and the population is ageing. As the post-war baby boomer generation enters old age, over 24% of the UK population is projected be over 65 by 2041 (up from 18% in 2016)[3]. This generation’s expectations of ageing are also changing, with increasing focus on remaining happy and active for as long as possible. This means being proactive about health and delaying the onset of chronic conditions which can harm the enjoyment of life in later years. Across all age groups we are encouraged to be more proactive and take more personal ownership of our own health.

Leading healthier lives is not just a focus for the elderly – a new generation of younger people is coming of age where healthy living is embedded into everyday life. Witness the growth of teetotalism amongst 16 to 24-year olds – a recent report showed that 29% never drink alcohol[4]. Younger generations are smoking less too – declining smoking rates are greatest in the 18-24 age group in the UK with an 8% fall between 2011 and 2017[5].

Individuals are also making wider lifestyle choices that benefit their health. The exponential growth in veganism looks set to continue – 42% of UK vegans made the change in 2018[6] and vegans and vegetarians are predicted to make up a quarter of the British population by 2025[7]. Those who identify as flexitarian (mostly vegetarian but who eat meat or fish occasionally) are forecast to represent half of the population by 2025[7].

The rise of the internet and digital health tools give everyone easier access to health information and advice at a time when it is increasingly difficult to get a GP appointment or even get through to the surgery on the phone. According to Google, around 1 in 20 online searches is health-related. This can be a double-edged sword – people are becoming better informed, but this is often accompanied by a rise in health anxiety. Now that we can see a doctor online in minutes, or take a blood test in the comfort of our own homes, people have access to services which can alleviate anxiety and provide the reassurance they need.

Your blood via biomarkers (yes, we talk a lot about them!) – can give you a unique insight into your health. Everyone is familiar with blood tests in the diagnostic process, but they can offer so much more – providing insight into potential chronic health conditions before physical symptoms appear and identifying nutrition and dietary issues which can be resolved by lifestyle changes.

[1] https://www.statista.com/statistics/491348/health-and-wellness-united-kingdom-uk-market-value/

[2] Attest – 2019 Health & Wellness Consumer Trends Report https://www.askattest.com/original-research/2019-health-and-wellness-consumer-trends-report

[3] Population estimates, Principal population projections, 2016-based, Office for National Statistics - https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerhowourpopulationischangingandwhyitmatters/2018-08-13

[4] Linda Ng Fat, Nicola Shelton and Norkio Cable. Investigating the growing trend of non-drinking among young people; analysis of repeated cross- sectional surveys in England 2005-2015 https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5995-3

[5] NHS – Statistics on smoking in England 2019 https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2019/part-3-smoking-patterns-in-adults-copy

[6] https://www.vegantradejournal.com/almost-half-of-uk-vegans-made-the-change-in-the-last-year-according-to-new-data/

[7] https://www.about.sainsburys.co.uk/~/media/Files/S/Sainsburys/pdf-downloads/future-of-food-08.pdf

6 reasons for having a health check

Chapter 2

6 reasons for having a health check

Should a health check be just for people who are sick or experiencing symptoms? Find out why we donʼt think so.

There are many stages of life which pose new challenges and it’s easy to overlook our health if we don’t have any symptoms. However, there may be times when we could benefit from a health check – to provide us with key insights into our health, to give us peace of mind or just to ensure we feel at our best. Here are 6 reasons why we think it is important to have a health check:

1. Establish your baseline

Many people associate health checks with getting older, but there are good reasons to have a health check when you are in your 20s and 30s. Knowing “what is normal for you” means that you can monitor your health over time and identify when something changes which can be the trigger to take action.

Key tests – cholesterol, diabetes

2. Optimising your performance

You don’t have to be a professional athlete to benefit from an all-round health check. By measuring key biomarkers in your blood and tracking them over time you can fine-tune your nutrition, training and recovery to get you to your new personal best.

Key tests – full blood count, hormones, inflammation (CRP), testosterone, ferritin, vitamin D

3. Reaching new milestones

The biggest risk factor for most diseases that affect us as we age is age itself. Once you reach your 40s and 50s it is important to check your status for diabetes, cholesterol, liver health and other markers that can be improved through lifestyle changes before they become irreversible.

Key tests – liver health, diabetes, heart disease risk, hormones

4. Lost your “get up and go"

We all go through phases when we just don’t feel our best. Sometimes that can simply be because we are doing too much or not getting enough sleep. But sometimes the answer can be found in a simple health check. Low levels of certain vitamins and minerals and conditions such as diabetes and thyroid disorders are all associated with tiredness and fatigue so if you feel more lethargic than usual it may be time for a health check.

Key tests – iron status, vitamin B12 and folate, diabetes, thyroid function, vitamin D

5. Investigate a family history

Although many conditions can be caused by unhealthy lifestyles or our environment, family history can also play a part. Knowing where you stand on issues that could affect you later in life is an important step in managing your health and will give you the knowledge you need to make important changes early.

Key tests – cholesterol, full blood count, thyroid function, diabetes

6. Peace of mind

You don’t have to be ill to benefit from a comprehensive health check. Nothing puts a spring in your step more than a clean bill of health. And if something is amiss? Rest assured that most of the conditions we test for can be reversed through lifestyle changes or medication if caught early enough.

Key tests – heart disease risk, liver health, kidney function, hormones

How can your diet affect your health?

Chapter 3

How can your diet affect your health?

Is the traditional balanced diet a thing of the past? Find out what you need to look out for if you follow a restricted diet. 

Vegan, vegetarian, flexi, paleo, gluten-free, ketogenic, Atkins, 5:2, alkaline, low GI, clean, raw… There’s a diet for everyone and, at the moment, it seems just about everyone is on one.

What is different about diets today is that rather than just cutting down on calories to get a beach-ready body, they are more about a food philosophy, with motives ranging from health, to animal welfare, to the environment and sustainability. Modern diet trends are also about elimination and it is not uncommon for people to eliminate whole food groups from their diets – from vegans spurning animal products to body-builders forgoing carbs to cut their fat to competition levels. Some want to live as our ancestors did on grass-fed meats and vegetables and those who are time-poor may live entirely on ready-meals and processed foods. It seems the traditional “balanced” diet is a thing of the past.

But what are the consequences of missing out on whole food groups? Sometimes eliminating foods from your diet, or eating a restricted diet, can have unintended consequences. We’ve identified the main ones so that you can make sure that your body is coping with your food philosophy and that you are getting all the nutrients you need.

Kidney function – eating too much animal protein such as red meat, poultry, eggs and seafood increases the level of uric acid and can lead to kidney stones. It also reduces levels of citrate, the chemical in urine that helps prevent kidney stones from forming. Vegetable eaters are also at risk from kidney stones from another source[1] – the oxalates found in dark green leafy vegetables. So, if you are starting every day with a raw spinach smoothie, you may want to swap it for a low oxalate alternative.

Liver function – as well as excessive alcohol consumption, a diet high in processed food, sugar and fat can damage the liver. Non-alcoholic fatty liver disease (NAFLD) is a build-up of fat in the liver, usually seen in people who are overweight and obese. It is estimated that 1 in 3 people in the UK could already have early stage NAFLD where fat is beginning to accumulate in their liver[2]. Those especially at risk are people who carry excess weight around their middle.

Calcium – restricting or cutting out dairy can significantly reduce the amount of calcium in the diet, especially if your diet is also low in green, leafy vegetables. This is particularly important for teenage girls as they need enough calcium to store for later life when levels may be low, such as during menopause. It is difficult to diagnose low calcium as your body does an excellent job of making sure that calcium levels in the blood remain stable[3]. However, if you don’t eat enough dietary calcium, your body will maintain calcium balance by taking it from your bones, leading to an increased risk of osteoporosis later in life.

Iron – meat is a rich source of iron but if you cut meat out of your diet there is a chance of developing iron-deficiency anaemia. The iron in meat is called heme iron and this is the most easily absorbable source of iron in the diet[4]. While there is iron in plants, and fortified foods, it is non-heme which means that the body has more difficulty absorbing it. Good plant sources of iron include lentils, chickpeas, tofu, nuts and seeds. It is especially important for menstruating girls and women to get enough iron in their diets as monthly blood loss depletes the iron in their bodies.

Diabetes – diabetes is caused by excessive glucose or sugar remaining in the blood rather than getting into the cells for energy. Diabetes is strongly associated with obesity, sedentary behaviour and a poor diet. People who eat a diet high in refined carbohydrates and sugar are more at risk of developing diabetes. Diabetes UK recommends a diet low in saturated fat and high glycaemic index carbohydrates (refined starches) and high in wholegrains, fruit, vegetables and healthy oils to improve blood sugar control[5].

Cholesterol – certain foods such as eggs contain cholesterol, however eating them may not affect a person’s blood cholesterol. While much of your cholesterol is formed in the liver, diet can also play a part. Cutting back on saturated fat and increasing exercise is still the recommended strategy to reduce cholesterol levels[6].

Vitamin B12 – this is an essential vitamin that is only found in significant amounts in animal products. Vitamin B12 comes from microorganisms that are found in soil which animals ingest and convert to B12 in their guts; even then, most animal feed is fortified with vitamin B12 as well. People who cut out animal products from their diet are at risk of B12 deficiency unless they take supplements or eat foods fortified with B12.

Folate – eating an unhealthy diet high in junk foods and low in fruits and vegetables can result in folate deficiency. Folate is crucial for the function of the body’s metabolism and for the growth and repair of cells. Folate is particularly important for women who are intending to start a family as low folate can cause neural tube defects (e.g. spina bifida) in babies[7].

Vitamin D – vitamin D is often referred to as the ‘sunshine vitamin’ because we make it in our bodies from the action of sunlight on our skin. There are also some food sources of vitamin D – such as fish, egg and mushrooms which have been grown in the sun, but these sources are not usually sufficient for anyone who lives in northern climes, or for people who rarely get out into the sun. Most people in the UK will need to take a vitamin D supplement in the winter to maintain healthy levels of vitamin D.

Essential Fatty Acids – many people’s omega 6 is too high as a result of consuming too much fat and processed food and not enough oily fish which is rich in omega 3. Cutting meat and fish from the diet may result in low omega 3 as there aren’t many sources found in vegetables. Plant-based sources include flaxseed, nuts and seeds.

Whatever type of diet you are on, it is possible to live healthily provided you identify where the shortfalls are and are prepared to compensate through supplements and lifestyle changes.

(1) https://www.kidney.org/atoz/content/what-are-oxalate-kidney-stones

(2) https://www.nhs.uk/conditions/non-alcoholic-fatty-liver-disease/

(3) https://americanbonehealth.org/nutrition/how-the-body-maintains-calcium-levels/

(4) https://www.gpnotebook.co.uk/simplepage.cfm?ID=x20110720105313880069

(5) https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/eating-with-diabetes/what-is-a-healthy-balanced-diet

(6) https://www.nhs.uk/live-well/healthy-body/lower-your-cholesterol/

(7) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3799525/

Inflammation diet

Chapter 4

Inflammation diet

Can what we eat help control inflammation? Learn more about which foods to include and which foods to leave out.

What is inflammation?

When something harmful or aggravating affects a part of our body, there is a biological response to try to remove it. This response occurs in the form of inflammation and is the defence mechanism our immune system uses to begin the healing process.

There are two main types of inflammation – acute and chronic.

Acute inflammation is one that starts rapidly and can be present for just a few days but may persist for weeks in some cases. Acute bronchitis, a sore throat, a scratch or cut, high-intensity exercise and tonsillitis are some examples of diseases, conditions and situations that can result in acute inflammation.

Chronic inflammation is long-term inflammation that can last for several months and in some cases years. Chronic inflammation can result from a failure to remove the cause of acute inflammation, an autoimmune disorder that attacks normal healthy tissue or exposure to a low-level irritant over an extended period of time. Although inflammation is a necessary self-defence mechanism the body needs to begin the healing process, chronic inflammation is a key risk factor in a number of diseases and conditions such as rheumatoid arthritis and atherosclerosis (the hardening and narrowing of the arteries).

What is the inflammation diet?

While medication and other treatments are important in the improvement and management of inflammatory conditions, following a diet that focuses on anti-inflammatory foods can help further decrease the occurrence of flare-ups and pain. We aren’t saying that an anti-inflammatory diet will cure your condition, however, it can help to make it more manageable and improve other health markers.

The anti-inflammatory diet focuses on replacing sugary, refined foods with fruits, vegetables, lean protein, plant-based protein, nuts, seeds, healthy fats and herbs and spices. By following these principles, the anti-inflammatory diet also increases antioxidants in the body that aid in the reduction of free radicals (molecules that may damage cells and increase the risk of certain diseases).

What to eat

Fruit & vegetables

By including a wide variety of fruits and vegetables in your diet, you are not only increasing your daily fibre intake, shown to prevent diseases such as diabetes, heart disease and bowel cancer, but also your antioxidant levels. Examples of these foods include berries, apples, avocados, dark leafy vegetables, sweet potatoes, and broccoli.

Whole grains

Oatmeal, brown rice, whole-wheat bread and other unrefined grains are high in fibre and can help to reduce inflammation. Similarly, beans and lentils are very high in fibre and contain the same health benefits as whole grains.

Nuts

Nuts such as walnuts, pistachios, pine nuts, pecans and almonds will help to reduce inflammation due to the healthy fats they contain. However, it is important to be aware that nuts are a low-volume, high-calorie food group meaning that just a small handful can add up to at least 300 calories. Keep an eye on your intake to ensure you are eating within a healthy range of calories and fat for your goals.

Fish

Salmon, tuna, mackerel and sardines all have plenty of omega-3 fatty acids, which will help to fight inflammation. Include these oily fish at least once or twice a week to see the associated health benefits.

Herbs and spices

Herbs and spices are a great and easy way to add antioxidants and flavour to your food. Turmeric, found in curry powder, has a strong substance called curcumin whose anti-inflammatory properties can support joints, increased mobility and pain relief. In addition, this natural herb is a powerful antioxidant and has also been shown to aid heart health, brain function and promote overall wellness and anti-ageing.

What not to eat

The main foods that people with inflammatory conditions should avoid are processed foods (in particular processed meat and snacks), sugary drinks, desserts, excess alcohol, trans fats and fried foods, butter, whole milk, cheese and refined carbohydrates such as white bread. Some people find that foods in the nightshade family (tomatoes, aubergines, peppers, and potatoes) can trigger flares in some inflammatory diseases. Despite limited and at times contradictory evidence surrounding the nightshade foods and their effects on inflammation, cutting nightshades from the diet for 2–3 weeks and assessing symptoms may help some people with inflammatory conditions.

Anti-inflammatory diets may be a big adjustment for people who tend to eat different kinds of food so we have highlighted several tips you can do to make the transition to an anti-inflammatory diet easier:

  • eat a variety of fruit and vegetables including dark leafy greens in particular
  • reduce the amount of processed foods in your diet
  • remove all soda and sugary beverages, whilst also cutting back on alcohol intake
  • write a shopping list ahead of time
  • supplement with omega-3 and possibly turmeric
  • stay within your daily calorie requirements, exercise regularly and get an adequate amount of sleep

While these dietary solutions alone do not hold the key to controlling inflammation, they can help prime the immune system to react in a measured way. An anti-inflammatory diet will help to reduce the occurrence of flare-ups and pain that an individual with an inflammatory condition experiences. It may also help the person avoid some of the potential health problems that chronic inflammation can cause as well as decrease the need for medication.

Stress and wellbeing

Chapter 5

Stress and wellbeing

What happens to your body when stress levels stay high? Understand how stress affects your wellbeing and what steps you can take to control it.

Let me ask you this – how do your conversations start with your colleagues or friends? Probably with a greeting, then by asking how the other person is doing – which is usually answered with something along the lines of “yes I’m good, stressed as always but that’s life!”. Does this sound familiar?

You are not alone because a study conducted last year revealed that 85% of UK adults experience stress regularly with the most common cause of this stress being money, followed by work, health concerns, failure to get enough sleep and household chores[1].

Whilst it may seem like there is no way out, especially with the unforgiving stress and strain of modern life, it is really important that we start to find activities and techniques that help us manage, reduce and ultimately alleviate our stress.

Let us explore the differences and consequences of chronic and acute stress, and exactly what effect stress has on our health, all with the aim of attacking the root causes of your stress, instead of attempting to improve only what we can see on the surface.

What does stress do the body?

To begin with, it is vital to recognise that stress isn’t necessarily a bad thing, despite the surrounding myths! Stress is a set of physical adaptations to a change in your environment that requires your body to adjust and react in response. It is what allowed us as human beings to evolve.

The onset of stress is the internal alert that elicits action, otherwise known as the ‘fight or flight’ mode. Stress signals to your body to release a series of hormones and chemicals including adrenaline, cortisol and norepinephrine that prepare your body for physical activity. These changes also lead to a diversion of blood to the muscles, an increase in respiratory and heart rate as well as the shutting down of unnecessary bodily functions (at least in the short term), including the digestive and immune systems.

We can see from this that the body goes through a lot when faced with a stressful situation, which isn’t a problem when experienced in acute, short-term scenarios. However, when we put our bodies through these physiological responses frequently and over a long period of time, otherwise known as chronic stress, it can be detrimental to our health.

Cortisol is a steroid hormone produced by the adrenal glands during times of stress. It plays an important role in many bodily processes including regulating blood sugar levels, metabolism, blood pressure and inflammation. Prolonged stress can cause health problems including heart disease, digestive problems, headaches and insomnia.

Chronic stress negatively affects our overall health and wellbeing and has the potential to contribute to a variety of conditions including high blood pressure, heart disease, insomnia, obesity and diabetes[2]. With this permanent state of stress, cortisol levels become excessively elevated which leads to suppressed immune function, increased appetite[3], abdominal weight gain and obesity[4].

All these symptoms have been linked back to evidence showing that chronic stress causes neuroendocrine/immune imbalances that lead to low-grade inflammation[6], a precursor for illness and disease. Aside from the physical symptoms of chronic stress, mental wellbeing can suffer with evidence of increased irritability, anxiety and depression[4,5]. Chronic stress is also responsible for many changes in behaviour including alcohol and drug abuse, overeating or not eating enough and social withdrawal[7].

When stress begins to interfere with our daily lives for an extended period, there are inevitable consequences that can lead to long-term health conditions and the evidence certainly doesn’t look promising if we don’t do something about it straight away. Although a lot of us find ways to improve and manage our stress levels, including exercise, going for a walk or listening to music[1], it still may not be enough.

So, what can we do to reduce our stress levels? Well, perhaps the most useful thing we can do is to recognise our stress, what exactly it is that is making us feel stressed, identify the situations and emotions linked to the stress and understand the impact stress has on our daily lives. It will make it much easier to find a solution once we have identified the problem.

Top tips for overcoming stress:

1. Identify the cause

If you are feeling stressed, write down what you think the cause might be, how you are feeling and your general mood. Once you have begun to identify the cause you can start to develop a plan to combat the stress, whether that is setting more realistic expectations for yourself or asking for help from others.

2. Move regularly

I am sure that you were expecting a specific exercise prescription – however, when you are stressed, it has been shown that the likelihood and desire to exercise is significantly reduced[7]. So, although only 32% of the UK population has been reported to use exercise as a form of stress reliever[1], the key here is to focus on incorporating any form of physical movement. Going for a walk outside, doing some gardening or even just getting on top of some of the more physically-demanding household chores can provide you with the same endorphin boost as going to the gym. So, you’ll not only benefit from the stress-relieving benefits of exercise, but you’ll also be working up to the NHS physical activity and exercise recommendations[9].

3. Work on your sleep hygiene

No, sleep hygiene isn’t about how clean your bedroom is. Sleep hygiene is the unique routine surrounding your bedtime that ensures you get good night-time sleep and full daytime alertness. We will go more in-depth with this topic in chapter 7 below but getting enough good quality sleep is vital to resilience and stress relief. Stay tuned for our tips on how to get a good night's sleep.

4. Make time for self-care

Beyond the recommendations for exercise, a healthy diet, social interaction and getting good quality sleep, there is plentiful evidence to suggest incorporating activities such as mindfulness and other meditative practices such as yoga can have a positive impact on our ability to manage stress as well as other aspects of our mental health and well-being. Incorporating activities such as meditation and mindfulness has been shown to improve anxiety, depression and pain[10], as well as improve physiological markers of stress including cortisol, blood pressure and heart rate[11]. Although the concept may seem simple and a bit unusual for some, studies have shown that mindfulness meditation can reduce stress, alter brain structure and function, and have a positive effect on the immune system[12].

In conclusion, stress is a natural reaction to changes in our environment and it is perfectly natural to experience increases in these levels over short periods of time. However, when these physiological changes within the body stay on ‘high-alert’, those chemical reactions become more harmful than helpful. It is very important that we find ways to manage and reduce the stress we experience from everyday life otherwise our health will start to suffer.

If you feel that you live a stressful life, begin by implementing a couple of the tips we mention above. However, if you continue to feel overwhelmed consult with your healthcare professional who will be able to advise you on ways to help manage your stress.

[1] Forth (2018). Stress Statistics UK: Survey of 2000 British People on Cause of Stress and How They Relieve It. (https://www.forthwithlife.co.uk/blog/great-britain-and-stress/)

[2] Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057-1072.

[3] Vicennati, V., Pasqui, F., Cavazza, C., Pagotto, U. & Pasquali, R. (2009). Stress-related development of obesity and cortisol in women. Obesity (Silver Spring), 17(9), 1678-83.

[4] Spencer, S. J. & Tilbrook, A. (2011). The glucocorticoid contribution to obesity. Stress, 14(3), 233-46.

[5] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

[6] Blix, E., Perski, A., Berglund, H., & Savic, I. (2013). Long-term occupational stress is associated with regional reductions in brain tissue volumes. PLoS One, 8(6), 64-65.

[7] Mariotti, A. (2015). The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future Science OA, 1(3), 2056.

[8] American Psychological Association (2016). How stress affects your health. http://www.apa.org/helpcenter/stress.aspx.

[9] National Health Service (2011) Physical Activity Guidelines for Adults: Factsheet. (https://www.nhs.uk/Livewell/fitness/Documents/adults-19-64-years.pdf)

[10] Goyal, M., et al. (2014). Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Medicine, 174(3), 357-68.

[11] Pascoe, M. C., Thompson, D. R., Jenkins, Z. M., & Ski, C. F. (2017). Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. Journal of Psychiatric Research, 95, 156-178.

5 reasons you could be tired all the time

Chapter 6

5 reasons you could be tired all the time

Are your energy levels at an all time low? Here are 5 ways a blood test can help you find out why.

Feeling tired all the time is one of the most common reasons why people visit their doctor, but sometimes finding out the underlying cause of low energy levels can be a journey of trial and error. Not getting enough good quality sleep can be detrimental to our health and can cause a range of problems including fatigue, a weakened immune system, weight gain and cognitive impairment.

Not getting enough sleep is a common reason for low energy levels, but many people are left feeling exhausted even when they have had a good night's sleep. If this is the case, it can be difficult to know whether you are simply doing too much or if your low energy levels are a symptom of an underlying health condition.

Here are 5 common causes of fatigue.

1. Low iron

Iron is an element that we require for many different bodily processes such as creating new red blood cells, carrying oxygen around our body and strengthening our immune system. Low levels of iron can lead to a decrease in the amount of oxygen carried around the body, eventually causing iron-deficiency anaemia. Iron deficiency is one of the most common causes of anaemia. Symptoms can include fatigue, heart palpitations, dizziness and headaches. Iron-deficiency anaemia is thought to increase the risk of heart disease as the heart needs to pump more blood around the body to compensate for low oxygen levels. Increasing dietary intake of iron-rich foods including leafy greens and whole grains will improve iron levels in the body.

2. Diabetes

People who are prediabetic or have diabetes often experience fatigue because their blood sugar is too high or, if they are on medication, can fall too low[1]. Diabetes is a condition where insulin stops working to get the glucose (blood sugar) from your blood into your cells for energy which can lead to fatigue as well as a host of other health issues. When your sugar levels are too high it can cause problems with your sight and extremities as well as increasing the risk of heart attacks and strokes. Diabetes is currently one of the biggest health issues in the UK. Symptoms of diabetes include frequent urination, fatigue, extreme thirst and unexplained weight loss. For many, diabetes can go undetected for many years.

3. Thyroid disease

The thyroid is responsible for producing key hormones which affect almost every cell in the body. The two main thyroid hormones are thyroxine (T4) and triiodothyronine (T3). An underactive thyroid, also known as hypothyroidism, occurs when the gland does not produce enough of the thyroid hormones, ultimately slowing down the body’s metabolism. With an overactive thyroid, also known as hyperthyroidism, the thyroid makes too much T4 and T3. Elevated levels of thyroid hormones speed up metabolism in the body. Fatigue is a symptom of both hypothyroidism and hyperthyroidism.

4. Low vitamin B12

One of the most important nutrient groups to give you an energy boost is the B vitamins, as many are directly involved in creating energy at a cellular level. Vitamin B12 is a nutrient that is important for tissue and cell repair, energy and red blood cell production and the functioning of nerves and DNA. The body absorbs B12 from the foods we eat with the best sources including dairy products, meat and fish. Low levels of vitamin B12 can cause red blood cells to enlarge, which affects their oxygen-carrying capacity. Sometimes this will be due to the immune system attacking the parts of the bowel responsible for the absorption of vitamin B12 – called pernicious anaemia. Symptoms include fatigue, feeling faint and constant headaches.

5. Low vitamin D

Vitamin D, which is commonly referred to as the ‘sunshine vitamin’, is important in maintaining healthy teeth, muscles and bones. When we are exposed to the sun, our body creates vitamin D using nutrients obtained from certain foods including oily fish. Many of us in the UK are vitamin D deficient - with symptoms including fatigue, muscle weakness and mood swings. By implementing a few easy lifestyle changes such as getting out more in the sunshine, eating more oily fish and taking a vitamin D supplement, vitamin D levels can be improved.

(1) https://www.diabetes.co.uk/symptoms/extreme-tiredness.html

Sleep – the foundation of good health

Chapter 7

Sleep – the foundation of good health

Nutritionist and lifestyle coach Effie Parnell-Hopkinson explains how a good nightʼs sleep is crucial for good health and wellbeing.

Would you believe me, as a nutritionist, if I said I thought sleep was potentially just as important as diet and exercise? Well, here I am telling you exactly that. Despite the rise in information regarding the importance of sleep, a large majority of the population still experience poor sleep. Considering sleep quality and quantity is entirely within our control and has such a large impact on our physical and mental health, surely it is something that we should start to prioritise?

In the modern world, it is becoming increasingly difficult to get adequate quality sleep at the right times due to factors such as longer working days, increased stress levels, increased artificial light and blue light exposure and lack of sleep hygiene. It may seem impossible to get away from these external factors that are detrimental to your sleep but there are ways you can begin to improve your sleep straight away.

Before I go through my top tips, it is important to understand exactly why sleep is so crucial for your health, how much sleep you actually need, the negative effects of lack of sleep and how to improve your sleep.

Why is sleep important?

Getting enough sleep is vital and can help to protect your physical health, mental health, quality of life and safety. Our bodies need sleep to function during the waking hours – and we spend a third of our lives sleeping to enable us to do this.

Sleep is an active period where important processing, restoration, and strengthening occurs that is essential for our daytime alertness and functioning. During sleep, the body is working hard to support healthy brain function, to grow muscle, repair tissue and synthesize hormones. In children, getting adequate sleep is important as it also helps to support growth and development.

One of the vital roles of sleep is the consolidating and solidifying of facts, information and memories that occur throughout the course of the day. The process of moving this information from the short-term memory to the long-term memory is known as consolidation and research has shown that people who get better sleep after learning have higher memory and information retention[1].

On the other hand, sleep deprivation can cause brain function to diminish meaning decision-making, solving problems, controlling emotions and coping with change becomes far more difficult.

In terms of the physical benefits, getting enough sleep decreases the risk of developing heart disease, kidney disease, high blood pressure, diabetes and obesity[2]. So not only are you improving brain function, productivity and focus, you are also improving critical markers of health and therefore increasing your longevity and quality of life.

As mentioned above, prioritising sleep will do wonders for weight control and healthy hormone secretion and balance. Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin) and when you don't get enough sleep your level of ghrelin goes up and your level of leptin goes down[3]. This imbalance makes you feel hungrier than when you're well-rested[4], hence that well-known feeling of wanting to eat junk when you’ve had a bad night’s sleep.

So, how much sleep is enough?

The amount of sleep a person needs varies from person to person and changes between different age groups. For example, a child between the ages of 6 to 12 years old requires approximately 9 to 12 hours a day whereas adults aged 18 and over require 7 to 8 hours of sleep a day[5].

If you find that you are consistently losing sleep, this adds up and is known as sleep debt. You should aim to minimise your sleep debt by increasing your hours of sleep at night and not by occasional naps. Naps are a great way to top up your sleep and should be run in 90-minute cycles as this allows for both REM (rapid eye movement) and deep sleep. However, naps don’t provide the full benefits of a night-time sleep so, although they provide a short-term boost in alertness and creativity, they shouldn’t be relied on.

Sleeping when your body is ready to sleep is an important factor to take into consideration and is something that is being made more and more difficult in the modern world with the increase in external stimuli confusing our natural circadian rhythms.

Our bodies were designed to align with the sun (daytime) and moon (night-time), which is highlighted in the way melatonin rises and falls during these periods. When the body is exposed to blue light, the photoreceptors in the body respond and prepare the body for daytime. So when you are exposed to this blue light in the evenings, your melatonin secretion is suppressed, leaving your body awake and ready for the day… only it’s night-time. Not ideal!

To put it into context, for every hour spent near something that emits blue light (your phone, tablet, TV, fluorescent light) your melatonin production is suppressed by 30 minutes. This suggests you should employ a screen curfew at least 60 minutes before bedtime.

Additionally, just one night of sleep deprivation increases cortisol production and suppresses melatonin which consequently impacts the body’s ability to breakdown brown adipose tissue[6]. This finding was also shown in people who were on a calorie-restricted diet with one group getting enough sleep and the other sleep deprived (8.5 hours a day vs. 5.5 hours a day, respectively). Those who were well rested burned 55% more body fat compared to the sleep-deprived individuals[6].

So, there we have some of the benefits of getting good night-time sleep and what happens if you deprive yourself of sleep. From the evidence, we can clearly see that getting good quality sleep, for the right amount of time, at the right time is vital for optimal brain functioning and productivity, physical health, heart health and overall quality of life.

But how do we go about improving our sleep?

Here are examples of things you can start to implement to help improve the quality of your sleep:

1. Create bulletproof sleep hygiene

Sleep hygiene isn’t about how clean your bedroom is, it refers to the different practices and habits that you create that are necessary for you to have good night-time sleep quality and full daytime alertness. Whether that’s taking a warm bath, reading, stretching or all of the above. Finding a routine that works for you is key and ensuring you implement this consistently will send the signals to your body that you are preparing to go to sleep. Once you begin to turn these signals on in a consistent manner, your body will begin to recognise these signs quicker.

2. Maximise your sleep environment

Thermoregulation is a critical determinant of both falling asleep and staying asleep. A marked increase in blood vessel dilation, resulting in a decrease in body temperature, occurs as the body prepares for sleep and is one of the main signals for the onset of sleep. Any changes in ambient and body temperatures will affect the body’s circadian rhythms and interrupt the normal physiology of sleep[7]. So keeping your bedroom between 17-20°C (62-68°F) will stimulate these signals and help to promote sleep.

3. Stay away from stimulants (alcohol, caffeine, nicotine etc) before bed

Although alcohol is a relaxant and has been used for many years as a way of promoting sleep, research has shown alcohol negatively affects sleep quality, sleep duration and increases sleep disturbances, as well as higher reported daytime dysfunction[8]. Similarly, nicotine and caffeine are both stimulants and decrease the quality of sleep and sleep duration[9,10]. So maybe it’s time to ditch the nightcap and focus on improving your sleep hygiene to promote sleepiness.

4. Natural sunlight exposure

Sunlight exposure suppresses the production of melatonin, which is exactly what we need to get rid of the morning grogginess and start our day on the right foot. Light exposure also increases the production of cortisol which also helps with suppressing melatonin secretion, as they work in opposites. If you work in an office or indoors, take some time to go for a walk or eat your lunch outside. This exposure to the sunlight will also help increase the production of serotonin, which after 10 hours or so will be converted to melatonin, helping to promote sleep in the evening.

5. Limit evening blue light exposure:

Your body interprets the blue light from your devices and TV screens you use in the evening as ‘daytime’, confusing our circadian rhythm and consequently our hormone secretion. For every hour spent exposed to a device, melatonin production (remember the hormone that helps you sleep) is suppressed by 30 minutes. To promote the biological body clock and re-sync our circadian rhythms to the sunlight and moonlight, introduce a screen curfew at least an hour before bedtime.

So, there are a few tips that you can start to implement to ensure you achieve a good night-time sleep as well as full daytime alertness. Remember, sleep is the foundation of health and without it, our overall physical and mental health will start to deteriorate.

References

[1] Rasch, B., & Born, J. (2013). About sleep's role in memory. Physiological reviews, 93(2), 681-766.

[2] Cappuccio, F. P., Cooper, D., D'Elia, L., Strazzullo, P., & Miller, M. A. (2011). Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. European Heart Journal, 32(12), 1484-92.

[3] Taheri, S., Lin, L., Austin, D., Young, T., & Mignot, E. (2004). Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med, 1(3), e62.

[4] St-Onge, M. P., & Shechter, A. (2014). Sleep disturbances, body fat distribution, food intake and/or energy expenditure: pathophysiological aspects. Hormone Molecular Biology and Clinical Investigation, 17(1), 29-37.

[5] National Sleep Foundation. How Much Sleep Do We Really Need? (https://www.sleepfoundation.org/excessive-sleepiness/support/how-much-sleep-do-we-really-need)

[6] Nedeltcheva, A. V., Kilkus, J. M., Imperial, J., Schoeller, D. A., & Penev, P. D. (2010). Insufficient sleep undermines dietary efforts to reduce adiposity. Annals of internal medicine, 153(7), 435-41.

[7] Tsuzuki K., Okamoto-Mizuno K., & Mizuno K.(2004). Effects of humid heat exposure on sleep, thermoregulation, melatonin, and microclimate. Journal of Thermal Biology, 29, 31–36.

[8] Park, S. Y., Oh, M. K., Lee, B. S., Kim, H. G., Lee, W. J., Lee, J. H., Lim, J. T., … Kim, J. Y. (2015). The Effects of Alcohol on Quality of Sleep. Korean journal of family medicine, 36(6), 294-9.

[9] National Sleep Foundation. Caffeine and Sleep (https://www.sleepfoundation.org/articles/caffeine-and-sleep)

[10] Dugas, E. N., Sylvestre, M. P., O'Loughlin, E. K., Brunet, J., Kakinami, L., Constantin, E.& O'Loughlin, J. (2017). Nicotine dependence and sleep quality in young adults. Addict Behav, 65, 154-160.

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