Body & Mind

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WATERWORKS

Mike Hewitson MPharm FFRPS FRSPH IP MRPharmS, Pharmacist, The Abbey Pharmacy

As a pharmacist, I learned during my undergraduate studies that there were many different types of water. Well, at least there are many different grades of water when it comes to medicine; there’s potable (drinking) water which is used to reconstitute antibiotic powders into liquids; there’s water for irrigation which is used to cleanse wounds, and there’s super-water otherwise known as water for injections which is prepared to the highest standards of purity. Each one has its place. We all know that water is essential to life – the human body is composed of around 60% water and we cannot survive for longer than three days without it. But it is so much more than that, especially when it comes to maintaining your health.

What are the benefits of drinking water? Harvard University Medical School lists some of the benefits, including helping to maintain the health of your gut, blood pressure, heartbeat, protecting organs, maintaining body temperature and even cushioning joints. But most of all it helps to carry oxygen and vital nutrients to your cells. So essentially, it does everything! The kidneys are one of the two key organs which help our bodies to get rid of drugs by eliminating water-soluble drugs in the urine. Maintaining an adequate water intake helps us to flush those medicines through the kidneys. Some medicines can alter the balance of fluids in your body to make you retain more water (such as anti-inflammatory pain killers), while others have the opposite which we call diuretics, but patients often refer to these as their ‘water tablets’ and may include furosemide, bendroflumethiazide or indapamide. Also, it is important to say that caffeine has a diuretic effect, so drinking too much tea or coffee

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can actually make you dehydrated.

Too little water can cause a range of symptoms such as low mood, or even impair your memory. How do you know if you are dehydrated? There are a few ways you can tell; firstly, do you feel thirsty? Listen to what your body is telling you! Next, what does your urine look like? It should be clear or at worst a pale yellow colour, but certain medicines such as antibiotics can also affect it. Watch out for red which could indicate blood in the urine (or if you have been eating beetroot!), in which case you should see your GP. Should yours be an orange, or brown colour, then this means that you could be dehydrated. For healthy adults, you should be aiming to drink around four to six cups of water a day, but for patients with some health problems such as heart conditions, less may be advised by your healthcare team. Patients taking a medicine called lithium which is used to treat bipolar disorder need to be particularly careful about avoiding dehydration.

There are some health problems such as diabetes which can confuse the issue somewhat. Two of the symptoms of diabetes are that you are thirsty and you need to wee more, so for some patients, they might need to be aware that this is why they feel thirsty rather than because they are dehydrated. And it probably goes without saying that if you are taking a diuretic then you will go to the toilet more often – I would suggest not taking it too late in the day or you might find that you need to get up in the middle of the night. I sometimes speak to patients who skip their water tablets if they know they are going out or might find it difficult to get to the loo. The problem with this is that it can cause fluctuations in blood pressure control, but there is a balance to be struck between managing the problem and maintaining a normal lifestyle. I’d suggest being honest with your healthcare team if you don’t take them all the time.

Most of us simply don’t drink enough water, or we drink too many caffeinated beverages. There is no magic solution to encourage you to drink more water, but lots of new products are becoming available all the time, from fancy water bottles and flavourings to apps that help you to track your fluid intake. The bottom line is that it is a good idea to have water with you wherever you go because you don’t know when you might get thirsty, and you are more likely to use it regularly if you have it to hand. I carry 1 litre with me every day which I try and drink while I’m at work – I don’t always manage it, but I can at least monitor how much I have had. You can try decaffeinated tea/coffee as this will help reduce the amount of water you are losing with each cup. Adding ice is another good way of incorporating additional water into your drinks. So is adding more chilli to your food as this will naturally encourage you to drink more water.

For regular users of medicines, talk to your pharmacist if you are noticing your medicines having an impact on your urine output, be that more or less, or a change of colour or habit. Try drinking regularly throughout the day, avoid caffeine and keep track of how much you are drinking. However you do it, try and make sure the habits you create are sustainable i.e. that you will carry them on permanently.

WHY WAIT?

Early Intervention is Key Lucy Lewis, Assistant Psychologist and Dorset Mind Ambassador

Eating Disorders Awareness Week (EDAW), from the 28th February to 6th March, aims to increase understanding and reduce the stigma surrounding various eating disorders such as bulimia, anorexia, Eating Disorder Not Otherwise Specified (EDNOS) and binge eating disorder. This year the organisers are encouraging us to ask, ‘Why Wait?’ Early intervention is crucial to the successful treatment of eating disorders however, research findings suggest that many people wait to seek help. Here are our top reasons to seek help early followed by information about ‘Restored’, our eating disorder service at Dorset Mind.

Prevention Research suggests that in many cases eating disorders can be prevented. For example, many people just beginning to experience difficult thoughts around their eating habits or body image may be able to avoid developing an eating disorder if they receive help early on. This can involve lower-level interventions such as psychoeducation and online programmes, which some consider more accessible and less overwhelming.

A common barrier to seeking help is the thought that the person is not ‘severe enough’. For example, they may have a healthy or overweight BMI, or minimal physical health complications. However, these are not necessary criteria of eating disorders, and it is always vital to seek help at any stage. Even if you are concerned that you do not reach the criteria for an eating disorder, seeking help can provide the opportunity for screening and lower-intervention sign-posting. Additionally, many people who believe they do not meet the criteria for eating disorders are mistaken, so it is always important to seek expert advice.

Increasing treatment success A general consensus across eating disorder treatment literature is that those with eating disorders have much better outcomes when they receive help early. Seeking help early has been associated with quicker recovery, a greater reduction of treatment and lower relapse rates. Additionally, eating disorders have the highest mortality rate of any mental illness, mainly due to the associated physical health complications, such as organ failure and cancer. Therefore, seeking help as soon as possible can literally save lives.

How do I know when to seek help? If you are ever unsure, always be cautious and seek expert advice, as early intervention is imperative. Generally, it is advisable to seek help if thoughts around your eating habits or body image are negatively affecting your emotions and/or behaviours. You do not need to be ‘severely unwell’ to seek help.

Restored at Dorset Mind Restored Eating Disorder Service at Dorset Mind can support your journey towards recovery. Restored work with those over 16 who are experiencing anorexia, bulimia and binge eating disorder as well as other specified feeding or disordered eating. However, you do not have to have a diagnosed disorder to use our services as we fully endorse the ethos of early intervention. Our staff provide support to help people to overcome the effects of eating disorders and eatingrelated issues. We encourage people to talk openly about eating-related issues in our safe, accepting and non-judgemental environment. Our team consists of professionals who have experience of eating disorders, whether directly or indirectly. We provide two pathways to assist you in your recovery that includes 1-2-1 mentoring and our weekly peer support group. Our services are effective and relatable because they are facilitated by people that have experience of a recovery journey. To book your initial assessment with one of our team, please email us at restored@dorsetmind.uk.

dorsetmind.uk nationaleatingdisorders.org

Remember, why wait to seek life-changing support? If you are ever in a crisis, call 999 or The Samaritans at 116 123.

NAVIGATING THE MENOPAUSE RESTORE

Julia Witherspoon, Nutritional Therapist

Image: Barbara Leatham

Before I understood I was in the middle of perimenopause, I spent a couple of years not only wondering if I was going slowly mad, but also constantly feeling like I wanted to scream, and I didn’t know why. There wasn’t anything particularly stressful going on in my life, apart from feeling like I was losing myself and my sanity. I felt afraid, but could not rationalise these feelings of anxiety and overwhelm as I could barely think straight sometimes.

I now understand that these emotions were caused by erratic sex hormone fluctuation, which was directly affecting my mental health and mood. This, together with poor sleep, was putting me in a constantly stressed state. I was in fight/flight mode all the time yet wasn’t having to fight or flee from anything – except maybe myself.

We read a lot nowadays about being in a ‘fight or flight’ state vs ‘rest and digest’ but what does this actually mean and why is it so important that they are balanced?

There are two branches of our nervous system –

sympathetic (fight/flight) and parasympathetic (rest/ digest) and they work together to maintain the body’s equilibrium. We constantly switch states depending on what’s going on in our lives at any given moment. This is an ancestral survival mechanism from the time when early humans were running around the plains trying to avoid being eaten by wild animals. Activation of the fight/flight reflex was vital to their chances of survival and our bodies still today react in exactly the same way – by orchestrating a number of physiological changes in the body, initiated by the release of adrenaline and noradrenaline: •Breathing rate goes up and becomes more shallow •Heart rate and blood pressure go up •Glucose is rushed into large muscle cells to provide a surge of energy •Pupils dilate and senses heighten •Blood flow to the brain and muscles of the legs and arms increases •Muscles tense •Alertness is heightened •Digestion is slowed right down •Cortisol is released from the adrenal glands after the initial surge of adrenaline dies down, to keep the body on high alert until the threat is gone

This is an acute stress response and once the danger has passed, the body reverts back to a rest/digest state and everything calms down. Early man would have gone back to his cave happy he was still alive and perhaps with his dinner if he’d stayed to fight.

Fast forward thousands of years and most of us are no longer faced with imminent danger from wild animals, or anything else for that matter, so such an extreme stress response should not need to be activated very often. However, our modern, busy lives; work, children, parents, financial worries, social media pressures, not to mention Covid, mean many of us are operating in a stressed state all day, every day, and we rarely switch on our parasympathetic nervous system. This is chronic stress and cortisol is being constantly released from the adrenal glands, keeping our bodies on high alert and primed to fight or flee all the time, with the associated physiological changes above. This is extremely detrimental to our health. It causes inflammation throughout the body and puts us at greater risk of a number of chronic diseases.

It is vital that we try and take measures to actively and mindfully relax and factor downtime into our lives every day, so we activate rest/digest mode. For perimenopausal women, this is even more important for several reasons, not least because cortisol levels increase gradually anyway from our forties onwards.

The huge hormonal changes taking place during perimenopause affects the way we respond to stress, both emotionally and physically, and can make many symptoms worse. If we are feeling overwhelmed, worried or fearful, our body responds accordingly and will raise our heart rate and our blood pressure, and cause a slowing down of our digestive system.

During perimenopause, as ovarian oestrogen production starts falling, the adrenal glands step in to act as a backup and produce an oestrogen precursor, as well as some progesterone. If the adrenals are constantly having to pump out cortisol, the production of oestrogen and progesterone will play second fiddle just when we need that extra support the most. Progesterone is very calming and a great balancer of cortisol, so can cushion women from some of its effects. Declining levels during perimenopause means that buffer is lost. A further result of chronic stress is weight gain. Fat cells can also produce some oestrogen, so if the ovaries aren’t producing much any longer, and the support of the adrenal glands is also weakened, the body will keep hold of those oestrogen-producing fat cells, and also create more (often around the abdomen). This fat is difficult to lose.

There are many ways to activate rest and digest mode and dampen down the raging cortisol. The clue is in the title – rest! This can take whatever form you like but it should be time out from the rush of everyday life and it must be calming and peaceful. A few ideas: •Mindfulness or meditation •Reading •A walk in nature •Deep breathing •Pilates/yoga/tai chi •Jigsaw puzzle •Adult colouring •Sudoku/crosswords •Gardening

Aim for at least 30 minutes, at least once a day. Your body will thank you for it.

Next month: ‘Move’

DON’T FORGET TO BREATHE

Dawn Hart, YogaSherborne

That may be an obvious reminder but is something you hear regularly in many yoga classes. If you are concentrating on which left, right, leg or arm you should be moving, where to look while you do it and how long to hold… it’s no surprise you suddenly realise you’ve been holding your breath!

Good breathing in yoga means breathing fully and rhythmically, making the most of your lung capacity. Yoga breathing or pranayama teaches us how to recharge the body, drawing in more oxygen and more fully purging the lungs of carbon dioxide. Yoga tradition describes Prana as ‘life force’ – a topic requiring more depth than we have space for here. At the same time, these exercises can help control our mental or emotional states by calming the sympathetic nervous system, reducing anxiety and tension.

However, some of these breathing exercises can appear daunting. Often we need to get to know our own breathing a little better first. Our brains make sure we breathe without us having to think about it. Very

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useful indeed but in this busy world, it does mean that we have lost some awareness of our own breathing. Being able to slow and deepen the breath has become something we have to work at. By linking breathing to our movement we can restore some awareness. This is central to the style of hatha yoga that I teach and the following exercise can help you whether you are on a yoga mat or not. •To begin, sit either on the floor or on a chair with your feet flat on the floor. In both cases make sure your back is comfortably straight and your shoulders relaxed, opening up your chest. Rest your hands on your lap or at your side. •Now rest your attention on your breathing. If it is comfortable breathe in and out through your nose otherwise use your mouth. •Notice the inhalation and the exhalation to begin with. •Perhaps the air is cool when it enters and slightly warmer when it leaves. •Notice which parts of your body move when you breathe, maybe the chest or lower abdomen. •Now notice the sound. •Then notice there is a slight pause after the inhalation and another after the exhalation, just before you inhale again. •Don’t try and control it, just let your body breathe and be an observer. •Keep your attention here for 1 or 2 minutes – set a timer if that helps.

You can now experiment moving your arms in time with your breath. This is a simple exercise but can really help energise your body, helping you breathe more fully, as well as bonus tension relief for the shoulders.

If you experience any lightheadedness, discomfort or feel unwell, stop. Rest and return to observing your breathing again.

•Standing or sitting with good posture. Begin with your arms relaxed down by your side. •As you inhale, lift them out to the side and up, bringing the palms gently together above your head. •Your hands should meet just as you finish the inhalation. •Hold the breath in briefly as you turn your hands so the palms now face outwards. •As you exhale, lower your arms back down to your sides. Draw the fingers back as you do gently pushing through the wrists. You are aiming to get some tension through the arms without straining. •Your arms should reach your sides just as you finish the exhalation. •Repeat 3-4 times. Focus on making the movement and your breath line up. •Once you have found your rhythm, and if you are comfortable, you can practise for up to 1 minute.

To begin with, you may move quite fast so try slowing the movement and keep your breath in time with that movement. Notice how much deeper you can breathe as you slow down. Never slow so much that you feel uncomfortable.

At the start of every class, we ease out the neck and shoulders in time with our breathing like in the exercise here. We are warming up muscles helping to prevent injury when we begin to move more fully, but also preparing our minds. As you slow your breathing, tension eases. This makes it easier to focus your mind when you move into postures, either to hold them or move into a faster flow. If you can find this connection, even for part of a class, it can have a powerful effect on your physical strength and your stress levels.

My job is to give structure, a bit like a pacemaker. It is easier to notice if your movements are fast when you have someone calling out the rhythm. It doesn’t mean my pace is perfect for you but it gives you a base to work from. As you become familiar with postures and routines you are able to breathe and move together more naturally. You may still get your left and right mixed up but at least you stay relaxed when you do!

This also works off the mat. You may be able to bring it into your day as you walk, in the shower or stirring soup in the hob. It really doesn’t matter where or when, just see if you can become a little more aware of the connection and see where it takes you.

"In this busy world, it does mean that we have lost some awareness of our own breathing."

yogasherborne.co.uk yogasherborne

SIT AND STRENGTHEN

Craig Hardaker BSc (Hons), Communifit

Image: Stuart Brill

Communifit was formed four years ago this month and it feels like a good time at present to reflect on the reasons behind its creation.

Communifit was created on the back of our ever-popular Sit and Strengthen exercise class. My grandma lived in a nursing home in Yorkshire and living more than 250 miles away I was not able to visit her as often as I would have liked. As a result of this I was regrettably more easily able to notice any physical deterioration that had occurred between visits. This invariably concerned me, being caused I believe primarily by sitting for long periods of the day, not using many of her muscle groups. You will know from previous articles I have written that as we age we weaken, so by sitting for long periods of the day this would only speed up the weakening process.

When my grandma passed away the idea of a strengthening chair-based exercise class was taken forward and Communifit was formed. We now deliver our programme across all areas of Dorset and Somerset and have ongoing plans to expand further. But why is the class so beneficial, and what type of exercises are performed? Some people will think chair-based exercise is easy, and not for them – but this is not always the case.

If you look at a traditional gym floor layout, you will have cardio exercises such as the treadmill, bike, rower etc on one side of the gym. On the other will be the strengthening machines. Most, if not all would be chair-based. You take a seat, the machine puts your arms or legs in the correct position and then you perform the exercise. In our classes we do the same but instead of being machine-driven, it is our instructors who guide, correct and advise as needed. We have over 50 different exercises that we use within our Sit and Strengthen classes – here are the benefits of just two of them:

Knee-raise Our legs are actually incredibly heavy, and without strength, particularly in our hips, it can be difficult to pick them up off the floor when we walk. This can lead to the ‘shuffle walk’, where we shuffle our feet across the floor as opposed to picking them up. This shuffle causes extra friction that in fact makes it incredibly tiring to walk far whilst making it more likely to fall. The knee raise can help us with our walking, moving from sitting to standing, climbing stairs and improving balance.

Sit-ups There aren’t many activities within everyday life where we don’t need a strong core – our chair-based sit-ups target this exact area! Holding ourselves upright can be rather challenging. Building strong core muscles is proven to assist with balance, helping us walk, reducing back pain and making most activities that bit easier to achieve.

Our exercise programme is carefully planned to cover all major parts of the body from head to toe, working on not only strength but also mobility, flexibility and balance. Chair-based exercise is incredibly beneficial, challenging, targeted and a great way to stay strong and active. We hope to welcome you to a class soon!

THE POWER OF MEDICINE BALLS

Simon Partridge BSc (Sports Science) Personal Trainer SPFit

Mark Nazh/Shutterstock

Last month I wrote about the versatility of kettlebells and how to progress your training. As we are now in the throws of spring, let’s look at a piece of equipment you can find in most gyms, but is rarely used, to achieve increased ‘power’ – namely medicine balls.

Power and athletic training have always been high on my list of favourite training methods. I really enjoy moving quickly, challenging my brain and body. Whenever I have the chance to implement this form of training into my clients’ programmes the feedback is always fantastic. You can also use this form of training with a personal trainer or in small group training to increase the level of interaction and engagement with each other. This then builds a stronger team environment, either with clients and their trainer or within the class. I want everyone to understand that power training is not just for elite athletes but something we can all benefit from, no matter our age or fitness level. This article is therefore intended to help you train differently with medicine balls in the future.

There are three main types of ball to consider. First, is a ‘vertball’, a large, soft-feel medicine ball used for basic partner training drills and wall-based training options. These balls are not designed to be slammed. Second, is the ‘slamball’. Its name gives it away. Use this ball for vertical slams, horizontal throws and rotational throws. They have a dull bounce which means when you slam it into the floor, they won’t bounce back up at you. Thirdly, the standard medicine ball, is most commonly found in gyms; it is round, with a textured and often dimpled thick rubber surface to enhance your grip and can also sometimes have handles to make it easier to hold.

Now for the science bit. Power can be defined as the amount of work done per unit of time. Simply, power is the maximum amount of force the muscle or body can apply in one single explosive movement. You may ask why we should train powerfully. The answer again is simple. We move dynamically in our everyday life. Therefore when we train it’s important to move dynamically and use functional tools such as medicine balls rather than slow, fixed machines.

So what are these benefits? •Improved ability to load and absorb greater force •Reduced risk of injury through improved connective tissue elasticity •Reduced risk of injury through improved reaction time and proprioception •Improved explosive power •Improved coordination

The crossover benefits for those of you who play sport should also be clear. Most sports require us to move quickly, dynamically and with force. Thus, powerful movements with a medicine ball can be very beneficial for improving your speed and power.

Let March be the month you train to become more powerful. If we learn to move more dynamically, this will help us in our everyday life to move in different directions at greater speeds. But as always, have fun trying something new. Good luck.