Healthy Living Advice for the Whole Family.

Our health is our freedom to live a life that we have reason to value, and our ability to bounce back when our circumstances change and life kicks us in the teeth. Both of these elements of health are more likely to happen if we try to adopt daily habits that are fun, good for us and rewarding. One way to remember them is the acronym CLANGERS, which depicts 8 daily vitamins (and joys) of health.

Try to do your CLANGERS every day, as part of a regular routine 

• Connect
• Learn
• (be) Active
• Notice
• Give back
• Eat well
• Relax
• Sleep

In 2008, research by the New Economics Foundation and funded by the government, came up with five evidence-based steps we can all take to improve our mental wellbeing. Connect, Learn, be Active, Notice and Give back (CLANG). I built on this to come up with a plan for ‘whole-body wellbeing’ by adding Eat well, Relax and Sleep. These are the fundamentals of feeling good and, if you can do them at regular times to fit in with your body’s natural 24 hour rhythm (particularly eating, exercising and sleeping), it should improve how you feel and your energy levels.

CONNECT with the world around you. Human beings are social animals. We are leaves on a tree, needing to feel part of something bigger. Reach out to people, pets, plants, places and the planet.These connections are the cornerstones of our life. Take time and care to nurture them. Disconnection and loneliness may be as bad for us as smoking. And don’t forget to connect with yourself. Loving yourself may not always be easy, but are you happy in your skin? Do you enjoy your own company? Can you disappear inside your own head and not mind what you find there? People who like their own company like being on their own sometimes. You have space to think, reflect, explore and relax.

LEARN What do you want to do with your one wild and precious life? A purpose in life often stems from learning about what matters most to you, developing a passion for learning and keeping your curiosity alive. And there is good evidence that the more you learn, the better your health becomes. Try something new. Rediscover an old interest. Sign up for that course. Join a choir. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Develop new passions. Set a challenge you will enjoy achieving. Learning new things will make you more confident as well as being fun. And learning with others in your ‘circle’ often cements the skills and gives you confidence to use your new knowledge.

Be ACTIVE, in mind and body. Rediscover activities and passions you left behind, and have the courage to try new ones. Aim for five portions of fun a day, each different, at least one outdoors and one that involved getting pleasantly breathless. Being outdoors in the morning light wakes you up and helps you sleep well later. Gardening, dancing or singing in a choir are all excellent therapy. Physical activity is better for both mind and body than any drug, but keeps you awake if you do it too close to bed time. Choose activities that you enjoy, so you want to keep doing them. Park runs, dancing, singing, cycling and gardening are great examples. And let’s not forget the power of pets. They are usually happy to see you and . give you unconditional love when you are feeling at your lowest and least energized.

NOTICE, and be present in, the world around you. Try to be as still as you can be for fifteen minutes every day, preferably outside. Fill up your senses. Catch sight of the beautiful. Remark on the unusual. Enjoy the everyday. Savour the moment, and your place in it. Life is a balance and being and doing, and the older and wiser we get, we realise that most of the pleasure in life comes from just being. Notice how lovely your partner or children are without judging or diagnosing them. Simply slowing down and focusing on your breathing for ten minutes a day can pay huge dividends. Breathe in for 3, hold for 4 and out for 5. Feel those fabulous human air bags filling up to their fullest extent. Then slowly, slowly let it all out.

GIVE BACK. Helping and caring for friends, strangers and those less fortunate than ourselves is fundamental to good emotional health. It cements us as part of a community and develops more meaningful connections and insights. A friend of mine overheard a dad telling a waiter in the Glasgow hotel that is son was having chemotherapy in the nearby hospital, and that he was going to shave his head in solidarity so they would both be bald when they came down to breakfast in the morning. He wanted to warn the waiters so they didn’t feel uncomfortable. The head waiter said he would pass the message on. When the newly bald father walked into the restaurant with his son the following morning, they looked around and saw that every single waiter had shaved his head. The joy of being human is to be humane.

EAT WELL. Food is above all a pleasure. Learn what’s good and enjoyable to eat, and in what quantities. Learn how to grow it, where to buy it and how to prepare it. Set time aside to sit and eat with friends and family. Your gut is like a garden. It contains trillions of healthy bacteria that are as fundamental to your health as your DNA. Many people with chronic diseases have a fairly narrow range of bacteria in the gut. Healthier people seem to have a wider range of bacteria fed from a wide variety of different foods. Eat plenty of plants – vegetables and fruits of many different types and colours, nuts, seeds, whole grains and olive oil. Add in a little bit of what you fancy.  Sustainable fish, lean meat, dark chocolate and  the odd beer or glass of wine (note: alcohol can improve your chat but seriously disrupt your sleep). You can have the odd Pringle but you wouldn’t plant too many in your garden.  Cutting down on sugary snacks and drinks, processed food is a good starting point. Learn to love water as your ‘go to’ drink. And try to do all your eating in a 12 hour period (say 7am-7pm) to fit in with your body clock, give your gut a break and improve your sleep. It also keeps you at a healthy weight

RELAX. Take time to rest and reflect on the day you’ve had, reliving and re-savouring the happy memories and having gratitude for friends and family. Learn to meditate. Be kind to your mind and let it wind down and de-clutter. My Uncle Ron used to have a sitting room that was just for sitting. At the end of the day, he would really happy little things that have happened during the day, and be grateful for the love he had in his life. I used to think he was crazy, but I now know he was practising positive psychology. Our brains are neuro plastic, which means what we focus on is what grows. So if we learn to relive happy moments and have gratitude for the good things, it can actually make us happier. And this happy end of day wind down can really improve your sleep.

SLEEP Good sleep is one of life’s great joys. It’s also essential for mental and physical health, helping you prevent and recover from a whole range of illnesses and improving your energy levels, creativity and performance. The flip side is that sleep deprivation prevents you from recovering from many illnesses, and it’s the first and most important thing to concentrate on. Adults work best on a regular 8 hours sleep a night, adolescents need nine hours if possible and children need more. Half the population in the UK have poor quality sleep and feel more tired, more stressed, less energized and more anxious as a result. If you’d like to find out more about the importance of a normal sleep pattern,  I would recommend Why We Sleep by Matthew Walker or the The Four Pillar Plan by Dr Ranjan Chatterjee. Dr Chatterjee also hosts some excellent podcasts on health.

‘CLANGERS’ WHEN YOU’RE KNACKERED 

 The CLANGERS you can do when you’re ill will be very different from the CLANGERS you do when you’re well, but they are equally important

Severe fatigue often happens to previously very active people. As one of my patients put it; ‘It’s like I used to have Duracell batteries but now I have Poundland batteries.’ If you overdo your activity, you can boom, bust, crash and take days to recover, which is why you have to use your energy wisely, and switch to rewarding activities that are less exhausting.

One young man played football for Bristol City but got severe fatigue after glandular fever and had to stop, which was a crushing disappointment. His Dad encouraged him to take up the guitar – a much less energy-draining hobby – and he gradually taught himself to play, finding the strumming very therapeutic. He has now fully recovered, formed a band, played a gig at the Fleece and Firkin in Bristol and made an EP. He sent me a lovely letter saying how much he loved his music and if he’d never have had severe fatigue, he’d never have picked up the guitar in the first place. Sometimes doors close in life, but another door opens.

Severe fatigue can be caused by many things, such as sleep deprivation, stress, anxiety, low mood or just about any illness, including Chronic Fatigue Syndrome/ME, which is a physical illness that may be triggered by an infection, or repeated infections, or other stressful events. Sometimes there is no apparent trigger, and there may just be a strong genetic predisposition to fatigue. A nutritious diet is essential for all of us but with severe fatigue you may find little and often is easier than eating big meals. Try to do your eating in a 12 hour window, and not late at night. It’s also important to try to optimise your sleep. As a teenager, this means trying to get 8-9 hours good quality sleep at the same time every night, including weekends, and trying to avoid oversleeping (you get no extra benefit unless you are sleep deprived) and afternoon catnaps (which, beyond half an hour, can interfere with the quality of your later sleep). Adults  of all ages function best after 8 hours sleep

Teenagers have it tough because their body clock shifts to make their natural going to be time later (11 PM onwards) but school demands that they get up early (often 6.30 am or before). So many are sleep deprived and stressed-out for no fault of their own. Severe fatigue on top of early school wakening is a double whammy.  It is far more important for your health and recovery to fiercely protect the 8-9 hours sleep and aim to get to school at morning break at the earliest, until you have fully recovered

A high quality sleep routine that fits in with your natural body clock is absolutely vital to recovery. Below are 25 tips for better sleep, not all of which may work for you, but they may start your journey to recovery. A normal sleep pattern can improve memory, energy, pain and many other unpleasant symptoms.

25 TIPS TO TRY TO IMPROVE YOUR SLEEP

1. Try to go to bed at the same time and – most importantly – wake up at the same time each day, including weekends, even if you have had a bad night. This may not always be possible. Aim for a ‘non-negotiable’ 8 hours sleep every night as an adult, 9 hours as an adolescent. This isn’t easy, so decide which timing works best for you and your daily functioning. You will need to ensure 8.5-9.5 hours in bed to give you adequate nodding off time. Keep a sleep diary if this helps.
2. If this routine goes wrong, don’t beat yourself up. If you don’t get good, refreshing sleep you will build up a sleep debt that has to be paid off on days off. And if your red (high) energy allowance is set too high, you will sleep longer or more deeply to try to recover
3. If you are asleep all day and awake at night, treat this like jetlag and cut back your going to bed time and your waking up time by 1 hour each day. Day One: 6 am sleep 3 pm wake Day Two: 5 am sleep, 2 pm wake Day Three:4am sleep – 1 pm wake etc until you wake at the desired time.
4. Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least thirty minutes each day. If you aren’t sensitive to light wake up with the sun or use bright lights in the morning. If you have problems falling asleep, you should get an hour of exposure to morning sunlight and turn down the lights before bedtime.
5. Enforce a strict ‘no caffeine after noon’ rule. Coffee, colas, certain teas, and chocolate contain the stimulant caffeine, and its effects can take as long as twelve hours to wear off fully. Nicotine in cigarettes and e-cigarettes, and alcohol also severely disrupts your sleep, as can some medications. Check with your pharmacist.
6. Come off close-up screens and games 60-90 minutes before bed. The blue light and excitement they give off boosts cortisol and blocks melatonin release.
7. Set an alarm to tell you when it’s time for bed, and stick to it. Alarm clocks in the morning freak out your heart and are best avoided if possible.
8. Fit blackout blinds in your bedroom. The darker your room for sleep, the better. A black-out mask is a cheaper option
9. Remove ALL screens from your bedroom, so temptation is avoided.
10. Consider opening the bedroom window. The perfect temperature for sleeping is around 17ºC/ 65ºF. A cooler room is much better for sleeping than a hot one
11. Eat earlier in the day, before 7 pm if possible. Don’t snack at night.
12. Exercise earlier in the day, and outdoors when you can. Exercising 2 hours before sleep time raises your metabolic rate and temperature, and makes it hard to sleep
13. Socializing is important but don’t do it late at night except on special occasions.
14. Consider red lights for night-time illumination
15. Consider amber glasses to filter blue light from screens
16. Don’t use your phone as an alarm clock
17. Install f:lux on your e-devices, or switch on ‘night-time mode’ from 6pm
18. Don’t take catnaps after 3 pm and keep them short, ideally less than 30 minutes. And keep the curtains open. You are not trying to fall into deep sleep as this disrupts the next night’s sleep, but trying to have a quick refresh.
19. Relax before bed. Don’t overschedule your evening so that no time is left for unwinding. A relaxing activity, such as reading, listening to music, chatting through the day with friends or family or stroking a pet should be part of your bedtime ritual.
20. Take a hot bath before bed. The drop in body temperature after getting out of the bath may help you feel sleepy, and the bath can help you relax and slow down so you’re more ready to sleep.
21. If you can’t sleep, counting sheep isn’t as effective as repeating the same word over and over (the, the, the, the…) or filling your mind with peaceful music
22. Don’t lie in bed awake. If you find yourself still awake after staying in bed for more than twenty minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.
23. Keep trying to improve your sleep, little by little. It’s about quality as much as quantity
24. We all have bad runs of sleep, particularly in stressful times, but if we allow ourselves to get back in synch with our body clock, we may rediscover the joy of a good night’s sleep
25. Some drugs may appear to help you sleep but your sleep quality will be better if you can manage without them, so try these tips first, keep a sleep diary and ask your doctor or nurse to review your progress.

‘Why treat people and send them back to the conditions that make them sick?’
Michael Marmot

Universal healthcare in a society that is poor at prevention and in denial about death is like attempting to rescue a never ending stream of people from a river of illness. As science advances, we dive deeper and deeper into the river to pull out people who are sicker and sicker. The right to healthcare for all means that all too often, we treat the untreatable. Just because we can do something doesn’t mean it’s kind or wise to do so. A high-tech death can be very unkind. We spend so much time, effort and money pulling bodies to the riverbank, that we have no energy left to wander upstream and stop them falling in.

We live in a very unequal society, with huge disparities in both life expectancy and years lived in good health. Unless we can improve living and working conditions as well as lifestyle, with a strong emphasis on helping people to build resilience and stay mentally healthy, then no system of universal healthcare can cope, no matter how it is designed or funded. Those of us who are lucky enough to be healthy at present have a responsibility to try to remain so for as long as we can. The best hope for the NHS lies outside its structures. We must reduce poverty, promote healthy minds as well as bodies, lessen the burden of avoidable illness and permit choice in dying. There’s more than enough unavoidable illness to keep the NHS in business.

This burden of avoidable illness could be further reduced by being honest about medical harm and the limits of medicine, and restricting over-medicalisation. Too many serious errors have been covered up and repeated in healthcare systems primed to protect professional, institutional, corporate and political reputations. Too many tests and treatments of marginal benefit turn healthy people into anxious patients. Enough people fall into the river of illness without being sucked in by the health industry.

There simply isn’t a sound evidence base for the mass medication of the elderly, many of whom are either unable or unwilling to take so many drugs as prescribed. Waste due to ineffective treatments, non- attendance and non-adherence is significant. When patients are given the time and opportunity to fully understand and participate in decisions about their care, taking in the likely long-term risks and benefits in absolute as well as relative terms, they often choose less medicine, not more. Universal healthcare must also be prudent healthcare, using the minimal effective intervention wherever possible. Sound evidence based on real life data, as well as compassion, must inform health policy and provision.

Above all we must see healthcare in the context of all care. The boundaries between self, health and social care are entirely superficial, and we must extend our circles of collaboration and compassion as widely as possible and consider the environmental impact of what we do. Indigenous populations have a better understanding of how to live on this planet without taking so much as to threaten the health of future generations, and how to die. We only die once, and a gentle death for as many people as possible is the kindest service society can offer. As the Australian Aboriginal elder Dr Noel Nannup explains: ‘Human beings are the carers of everything.’ But to care for everything, we must first care for ourselves and build our own resilience. The NHS has had enough top down ‘re-disorganisations’. It’s time for a bidet revolution. From the bottom up.

Healthcare begins with self-care

‘Tell me, what is it you plan to do with your one wild and precious life?’
Mary Oliver

Self-care requires time to reflect and to do some ‘self- work’. What are our goals, values, passions and purpose? Can we get near them without burning out? How can we be kind to our minds? How will we cope with pressure, failure, and adversity? Is our current lifestyle making avoidable disease more likely or even inevitable? Physical health stems from mental health, and learning how to be happy, how to self-care and how to cope under pressure should be taught and revisited at every stage of our lives. And we need to build happy and resilient cities, communities and organizations that promote mental health and allow individuals to flourish.

And yet as a society, we aren’t great at talking about what matters most (mental health, sexual health, how we want to die). Self-care needs the self-knowledge that comes from these difficult conversations, and also self- love. Can you disappear inside your mind and like what you find there? Enjoying our own company is key to happiness and resilience. Accepting responsibility for self-care is also fundamental to the sustainability of universal healthcare. Every day we don’t need to use the NHS, someone who does benefits.

The CLANGERS self-care model

Universal healthcare must embrace the continuum of self-care to intensive care, and I would restructure it around the CLANGERS model. The Clangers of the children’s television series were, and probably still are, a community of mauve mice who spoke in whistles and ate sensible portions of soup, made by a dragon, and blue-string pudding, none of which was processed. They lived a simple yet serene life built around friendship, collaboration and enjoying the little things. Very seldom, if ever, did they need to go to hospital or indeed die, because they were so good at self-care and pleasuring themselves in a safe and sustainable way.

The Clangers’ habit for a satisfying and meaningful life can be learned by anyone, at any age:

• Connect with the world around you. Reach out to people, pets, plants and places. We like to feel as if we belong, as part of something bigger. These connections are the cornerstones of your life. Take time and care to nurture them. And don’t forget to connect with yourself.

• Learn. A purpose in life often stems from learning what matters most to you, developing a passion for learning and keeping your curiosity alive. Why do you get out of bed in the morning?

• be Active, in mind and body. Rediscover activities and passions you left behind, and have the courage to try new ones. Aim for five portions of fun a day, each different, at least one outdoors and one that involves getting pleasantly breathless.

• Notice, and be present in, the world around you. Fill up your senses. Catch sight of the beautiful. Remark on the unusual. Enjoy the everyday. Savour the moment, and your place in it.

• Give back. Helping and caring for friends, strangers and those less fortunate than ourselves is fundamental to good emotional health. It cements us as part of a community and develops more meaningful connections and insights. The joy of being human is to be humane.

• Eat well. Learn what’s good and enjoyable to eat, and in what quantities. Learn how to grow it, where to buy it and how to prepare it. Set time aside to sit and eat with friends and family. Eating well on a budget isn’t easy. For excellent help try Cooking on a Bootstrap by Jack Munroe

• Relax. Take time to rest and reflect on the day you’ve had, reliving and re-savouring the happy memories and having gratitude for friends and family. Learn to meditate. Be kind to your mind and let it wind down and de-clutter.

• Sleep. Don’t cheat on your sleep. It’s vital recovery time for mind and body, and boosts your energy, creativity and productivity. You eat better and exercise more when you’re well rested. Relaxing and winding down beforehand is key. Learning to housekeep your mind and deal with stress is vital. If you doubt the power of sleep, read Why We Sleep by Mathew Walker

Some lucky people will do all eight steps intuitively, partly out of habit. Others will struggle through sickness and circumstance but with support and time, can continuously improve and slowly raise their own bar – hopefully without the stress of comparing themselves to others. If you need more detailed help with your CLANGERS, I recommend the book The 4 Pillar Plan – Eat, Sleep, Relax, Move – by Dr Rangan Chatterjee. He is one of the few lifestyle medicine gurus who isn’t trying to sell you a fad diet or his own brand of nutritional supplements, and his enthusiasm is infectious. You can also check out his podcasts here.

Your Clangers may be very different to my Clangers, the only rule is that we should try not to harm ourselves or others. The ‘clang’ in CLANGERS comes from the government-funded Foresight report, ‘Mental capital and wellbeing: making the most of ourselves in the 21st century’. It gathered the evidence on simple ways to a fulfilling life that just about anyone can do, irrespective of wealth or health. I added the ‘ers’ because they’re also fundamental to living well and slowing down the rust.

CLANGERS works not just as a model for living well, but also as a way of coping in adversity. When I interviewed patients and carers for a book about how to get the best from the NHS, it was striking how it fitted in with a successful model of patient engagement.

• Connect with the team treating you, and get to know them if you can. Know their names and something about them. It’s easier to ask questions when you know someone.

• Learn as much as you can about your illness, the treatment options, what you are entitled to, the standards of care you should be getting, what you can do to improve your odds and who to speak to if you have concerns.

• Be Active, both in the management of your illness and preventing further illness, be your own advocate when you can, have others to act for you when you can’t. The five portions of fun a day may be different to the ones you might enjoy when you’re well, but still try to have the energy for joy, warmth and purpose each day.

• Notice the good and bad in your care, and speak up if you have any questions or concerns. Notice the little acts of kindness that make illness bearable, and be thankful for them.

• Give back to the NHS and your carers by providing thanks and constructive feedback. Share vital information with other patients and carers. Get involved in research, service improvement and design and volunteering for your local NHS and charities.

• Eat well, Relax, Sleep – even more important when you’re ill.

The CLANGERS model equally applies to staff engagement and wellbeing. Health systems will always be high pressure places to work and so need to comprise of resilient organisations that support the mental health of the staff, encourage learning, are free from fear, bullying and blame and encourage everyone – patients, carers and staff alike – to speak up, feedback and continuously improve.

Ultimately, patients and carers must be handed as much control and responsibility as they want, and supported to live lives governed by their own goals and values, not the mass-produced end points of clinical trials. The best population evidence has to be combined with empathy for the individual. There is no single structure for healthcare provision that works in any context, and to continually seek the perfect structure in the NHS has proven to be hugely disruptive and disastrous for morale. Different models and structures will work in different parts of the country, but they must be built around common values and understanding of the needs of the individual. If each person can go about their daily CLANGERS, united by compassion, candour, competence and collaboration, then we can rediscover a values based service that is also effective and affordable.

Conclusion: competent, compassionate, cost-effective collaboration

In the 34 years since I first set foot on an NHS ward, I’ve lived through a dozen major structural reforms, more ideological than evidence-based, seldom embedded long enough to prove their worth before being uprooted by the next political vanity project. So I’m loathe to suggest any structural miracle pill for universal healthcare. Continuous evidence-based improvement is far more likely to work, raising the quality bar a little at a time, as resources allow. Consultations – or rather meetings between experts – must be long enough to be safe, effective, enjoyable and meaningful. Transparency and accountability must embrace innovation and learning from failure. The spirit of competent and compassionate collaboration must triumph over competition.

Patients and carers must have as much choice and control over their illnesses as they – and a fair system – can manage. Anyone must feel free to speak up and challenge, knowing their concerns will be acted on. Pure knowledge, like pure water, must be available to all who need it. Communities must promote health and meaningful work for all, and we should all be taught the skills of resilience from a young age. The healthy must accept responsibility for trying to remain so, and society must support them. Artificial divisions must melt away (self-care, healthcare and social care are all care). And all of this care must be prudent, and mindful of the cost for the planet and the payer. The minimum necessary intervention is usually the kindest and the least obstructive. We have but one wild and precious life, and we want healthcare to improve us, not imprison us. Release the joy of your inner CLANGERS.

Above all, we need Collaboration to solve the complex problems facing us. It was defined brilliantly by Margaret Heffernan in her book ‘A Bigger Prize‘

‘Innovative organizations thrive not because they breed superstars but because they cherish, nurture and support the vast range of talents, personalities and skills that true creativity requires. Collaboration is a habit of mind, solidified by routine and prepared on openness, generosity, rigour and patience. It requires precise and fearless communication, without status, awe or intimidation. Everyone must bring their best. And failure is part of the deal, an inevitable part of the process to be greeted with support, encouragement and faith. The safest hospitals are those where it’s easiest to acknowledge an error. The biggest prizes grow as they are shared.’

I believe politics would lead to much more progress if we adopted this constructive, collaborative scientific approach to all the great challenges of our time – Brexit, improving public health, reducing poverty, funding public services and pensions, caring for an older population, Global warming etc. I also believe we need experts rather than politicians overseeing their fields of expertise (education, pensions, health etc). The issues facing us are far too complex for politicians with little or no experience and damaging tribal loyalties to flit in and out of every few months. Time to put some grown-ups in charge.