Implementing key strategies such as nutrition and exercise into your self care regime supports your current and future well-being as a veterinary practitioner, and diminishes your susceptibility to “dis-ease”.

As veterinary practitioners, we are well-versed in the importance of good nutrition, sufficient rest, exercise and lifestyle for our veterinary patients. But in regards of self care, do we walk our talk by taking as much care of ourselves? Sometimes we’re so busy looking after others that we don’t make the time or effort to do the same for ourselves. This article looks at current research that tells us what we already know intuitively, but probably don’t pay enough attention to in our busy, sometimes hectic, daily lives as veterinary practitioners. Self care is important. Let’s take some time to holistically assess our own health, and look at some efficient practices to improve our own well-being.

Reality Check

First, rate yourself subjectively on a scale of 1 to 10 (10 being the best). Remember, no one sees this but you!

Is there room for improvement – and what should we take notice?

Avoiding death, disability, dementia and cognitive dysfunction are high priorities as we age. Evidence is mounting that these conditions are associated with impaired glycemic control,¹ and that a healthy dietary pattern reduces the risk of common diseases such as cardiovascular disease, diabetes and dementia.² Maintaining your physical health is an important part of self care.

Self care and the importance of body condition

Increased BMI (see image below) and body fat content, especially central obesity, have been associated with endothelial dysfunction.³ The endothelium is a complex organ with endocrine functions, and endothelial dysfunction is considered a key process in atherogenesis, a risk factor for heart disease, and is also linked to Alzheimer’s disease.⁴ Endothelial dysfunction has also been shown to be directly involved in peripheral vascular disease, stroke, diabetes, insulin resistance, chronic kidney failure, tumor growth, metastasis, venous thrombosis, and severe viral infectious diseases.⁵ Dysfunction of the vascular endothelium is thus a hallmark of human diseases, including chronic inflammation. The pathogenesis is still not completely understood but is linked to tumor necrosis factor (and reduced nitric oxide production), oxidative stress, dyslipidemia (and insulin resistance) and autoantibodies.⁶

Dyslipidemia is additionally associated with excess visceral fat, the metabolically most active adipose tissue that causes increased insulin resistance, high triglyceride concentrations, changes in the size of low-density lipoprotein (LDL) particles, and low concentrations of high-density lipoproteins.⁶

Skeletal muscle comprises approximately 40% of total body mass and is the primary tissue contributing to insulin-mediated glucose uptake and fatty acid oxidation. Mounting evidence suggests that skeletal muscle is also an endocrine organ capable of secreting a variety of factors that act on peripheral tissues to alter metabolic function. Myokines are skeletal muscle specific-secreted factors able to exert humoral effects in vivo and may underlie the health benefits associated with daily physical exercise.

Assessing your cardiorespiratory fitness through peak oxygen uptake

Many studies suggest that cardiorespiratory fitness, measured as peak oxygen uptake (VO2 peak), may be the single best predictor of future health, cardiovascular morbidity, and premature cardiovascular mortality. Recently, a cross-sectional study of over 4,600 men and women (20 to 90 years old) showed that even in people considered to be fit, VO2 — the maximal oxygen uptake (fitness) — was clearly associated with cardiovascular risk factors.⁷

The same study proposed a model that can provide a rough tool for assessment of cardiovascular fitness.8 The researchers observed that the mean maximal oxygen uptake in women and men were 35 and 44 mL/kg/min, respectively. The material suggested a ~7% decline in maximal oxygen uptake with every ten-year age increase in both genders. Women and men below the gender-specific mean were four to eight times more likely to have a combination of more than three conventional cardiovascular risk factors (i.e. metabolic syndrome) compared to the most fit quartile of subjects. The researchers also observed that maximal oxygen uptake may represent a continuum from health to disease, and that a general 5 mL/kg/min lower maximal oxygen consumption was associated with ~56% higher odds of having metabolic syndrome. The study indicates that cardiovascular fitness may be even more important for cardiac health than previously thought.

You can use an online fitness calculator (ntnu.edu/cerg/vo2max) that asks a series of questions to calculate your VO2 and expected fitness level, as well as your actual fitness level or fitness age.

VO2 max =15.3 x HR Max / HR Rest (or see Table 2)

Your HR Rest is your pulse at rest ________

Your HR Max = 205.8 – (0.685 x age) (Run or cycle as fast as you can for three minutes, take a rest for two minutes and repeat. Your heart rate will peak during the second burst — it’s best not to do this if you haven’t been exercising!)

Your HR max = ________ Your VO2 max = ________

Data from the study mentioned above helps you gauge your fitness by age. Middle age (defined as 35 to 58 years old) is associated with a loss of aerobic capacity, as evidenced by a decline in VO2 max of approximately 8% per decade and an associated functional decline of 15% between young and middle age. The loss of skeletal muscle performance/skeletal muscle endurance capacity is associated with a loss of mitochondrial enzyme activity and impaired mitochondrial protein synthesis at rest. Further, there’s a loss of insulin sensitivity of 8% per decade in both males and females. Together, the loss of skeletal muscle performance is associated with an increased risk of lifestyle diseases such as Type 2 diabetes (T2D) and cardiovascular disease during middle age.⁹

After your self-assessment, now what?

What holistic self care options do you have to improve your cardiovascular fitness and reduce BMI?

1. High Intensity Interval Training (HIIT)

You could start running one hour per day, three to four times per week, join a gym, or even walk daily for 30 minutes. The belief is that that the more time you spend exercising, the better. You will be pleased to know that High Intensity Interval Training is another option. HIIT has caused a stir because studies over the last decade demonstrate that a few minutes of intense exercise a day can make a significant difference to your metabolism and VO2; it can get you fitter faster than standard exercise, improve your insulin sensitivity, build muscle tone, and reduce fat in the most time-efficient manner. There is evidence that just 40 seconds of intense activity can make a difference. Researchers have recently reported improved insulin sensitivity in young men following six weeks of HIIT training involving three sessions per week of two 20-second sprints against 7.5% of bodyweight — a total of ten minutes exercise over six weeks.¹⁰ A study also demonstrated the benefits of HIIT in untrained middle-aged adults, three males and 11 females. Over eight weeks, with twice-weekly training consisting of ten six-second sprints with one minute of recovery between each, there was significant improvement in aerobic capacity (8% increase in VO2 peak), physical function (11% to 27%), and a 6% reduction in blood glucose.⁹

Another study showed that three minutes of intense intermittent exercise each week, with a total time commitment of 30 minutes, including warm-up and cool-down, increased skeletal muscle oxidative capacity and markers of health status in overweight/obese but otherwise healthy men and women. Each session began with a two-minute warm-up, followed by three 20-second all-out sprints interspersed with two minutes of recovery followed by a three-minute cool-down. Peak oxygen uptake increased by 12% after training (32.6 ± 4.5 vs. 29.1 ± 4.2 ml/kg/min), and resting mean arterial pressure decreased by 7%.¹¹

So even implementing just two short 11-minute sessions per week into your self care routine can make a significant difference, and have the potential to improve and maintain physical function and reduce the risk of disease. While time is a major barrier for all of us, can you afford not to invest 11 minutes twice a week for your health? Alternatives to sprinting include hurtling on a stationary bike with resistance, squatting, rowing, lunging, planks, skipping, pushups, step-ups, boxing, or anything that makes you open-mouth breathe and raises your heart rate! If you can’t engage in HIIT, then consider aerobic and/or resistance training.

2. Nutrition

Nutrition is a key pillar to self care. We all know what good nutrition is, but do we eat well to optimize health and well-being? Metabolic syndrome, dysglycemia and insulin resistance are insidious and silent. Between 32% and 34% of all adults (31% to 34% of men and 33% to 35% of women) in the United States have metabolic syndrome. Over 50% of people with hypertension have dysglycemia,¹²and both are components of metabolic syndrome. Although only more recently defined and investigated, metabolic syndrome epitomizes the integrative nature of modern chronic disease, given its endocrine, metabolic and cardiovascular underpinnings.

The most important causes of insulin resistance are a high-fat refined-carbohydrate diet and physical inactivity.¹³ In 2006, the Harvard School of Nutrition hosted a conference called Metabolic Syndrome and the Onset of Cancer, during which several papers were presented showing that hyper-insulinemia was related to breast, prostate and colon cancers. It has been known for over a decade that adipose tissue dysfunction is a central underpinning link to obesity in the pathogenesis of metabolic syndrome and Type 2 diabetes, and we now know that adipose tissue is a dynamic, metabolic endocrine organ, secreting various cytokines, chemokines and adipokines.

Table sugar (sucrose) is a disaccharide composed of two monosaccharides: glucose and fructose. Sucrose is a common ingredient in industrially-processed foods, but not as common as high-fructose corn syrup (HFCS). Whereas sucrose is equal parts fructose and glucose, HFCS has more fructose (usually 55%) than glucose (the remaining 45%) and is the most frequently-used sweetener in processed foods, particularly in fruit drinks and sodas. Feeding sucrose to rats stimulates the sympathetic nervous system (SNS), and increases heart rate, renin secretion, renal sodium retention and vascular resistance. These interact to elevate blood pressure; sucrose-fed rats have increased blood pressure. Sucrose feeding also induces insulin resistance, as part of a broader metabolic dysfunction. People who consume 10% to 24.9% of their calories from added sugars have a 30% increased risk of mortality from cardiovascular disease compared to those who consume less than 10% of their calories from added sugars. Worse, those who consume 25% or more calories from added sugars have an almost threefold increased risk.¹⁴

It’s time to take a stock of sugar consumption in the foods you eat on a regular basis. Around 300 years ago, humans consumed a few pounds of sugar per year — now, Americans consume anywhere from 77 to 152 pounds of sugar per year, with 13% consuming at least 25% of their total caloric intake as added sugars. This equates to an intake of added sugars of 24 to 47 teaspoons (about 100 g to 200 g) per day, with an average daily fructose consumption of 83.1 g (about 16 teaspoons)!

Spend some time analysing your own diet using nutritiondata.com(also a useful tool for looking at animal diets).

We all know that the cornerstones of self care and good health — good nutrition, exercise, and taking care of our emotional health — apply to ourselves as well as our animal patients. We must commit to walking our talk and practicing what we preach, so we may achieve the vibrant health and well-being we strive for so diligently in our patients.

References

¹Cukierman-Yaffe T, Anderson C, Teo K. “Dysglycemia & cognitive dysfunction & ill-health in people with high CV risk: results from the ONTARGET/TRANSCEND studies Unsuccessful Aging & Dysglycemia”. Am Soc Clin Oncol Educ Book. 2015;35:e66-73.

² Harvie M, Howell A, Evans DG. “Can diet and lifestyle prevent breast cancer: what is the evidence?” BMC Geriatr. 2015; 14: 36. Mar 21.

³ Sundell J, Laine H, Luotolahti M et al. “Obesity affects myocardial vasoreactivity and coronary flow response to insulin”. Obes Res. 2002; 10:617-24.

⁴ Lathe R, Sapronova A, Kotelevtsev Y. “Atherosclerosis and Alzheimer – diseases with a common cause? Inflammation, oxysterols, vasculature”. BMC Geriatr. 2014 Mar 21;14:36.

⁵ Rajendran P, Rengarajan T, Thangavel J. “The Vascular Endothelium and Human Diseases”. Int J Biol Sci. 2013; 9(10): 1057–1069.

⁶ Steyers C, Miller F. “Endothelial Dysfunction in Chronic Inflammatory Diseases”. Int J Mol Sci. 2014 Jul; 15(7): 11324–11349.

⁷ Aspenes S, Nilsen T, Skaug E et al. “Peak oxygen uptake and cardiovascular risk factors in 4,631 healthy women and men”. Med Sci Sports Exerc. 2011 Aug;43(8):1465-73.

⁸ Nes B, Janszky I, Vatten L et al. “Estimating VO2 peak from a non-exercise prediction model: the HUNT Study”. Norway Med Sci Sports Exerc. 2011 Nov;43(11):2024-30.

⁹ Adamson S, Lorimer R, Cobley J. “High Intensity Training Improves Health and Physical Function in Middle Aged Adults” Biology (Basel). 2014 Jun; 3(2): 333–344.

¹⁰ Metcalfe RS, Babraj JA, Fawkner SG, Vollaard NBJ. “Towards the minimal amount of exercise for improving metabolic health: Beneficial effects of reduced exertion high intensity interval training”. Eur. J. Appl. Physiol. 2012;112:2767–2775.

¹¹ Gillen J, Percival M, Skelly L et al. “Three Minutes of All-Out Intermittent Exercise per Week Increases Skeletal Muscle Oxidative Capacity and Improves Cardiometabolic Health”. PLoS One. 2014; 9(11): e111489.

¹² Cheung B, Wat N, Tso A et al. “Association Between Raised Blood Pressure and Dysglycemia in Hong Kong”. Chinese Diabetes Care. 2008 Sep; 31(9): 1889–1891.

¹³ Roberts C, Hevener A, Barnard J. “Metabolic Syndrome and Insulin Resistance: Underlying Causes and Modification by Exercise Training Compr Physiol”. 2013 Jan; 3(1): 1–58.

¹⁴ DiNicolantonio J, Lucan S. “The wrong white crystals: not salt but sugar as aetiological in hypertension and cardiometabolic disease” Open Heart. 2014; 1(1): e000167.