Stressing (a) need for a healthy breakfast?

It doesn’t take much to amuse me these days. During the recent wet, grey and autumnal afternoons, I have sometimes switched the TV on to watch an episode or two of ‘Four in a Bed’. It’s a simple concept for a TV show. It’s a competition. Four couples each stay at each other’s bed and breakfast accommodation and score their stay against a variety of different criteria. One of which is the breakfast. Not only is the food judged, the quality of sausages, eggs and so on, but also the service of the hosting couple. It’s the comments and the expressed expectations that I find amusing.

Like me, many of the show’s participants are often disappointed with the breakfast they are served. I’m not sure why after many years of eating breakfast in a range of hotels, that my optimism always triumphs over experience. There are two things that contribute to my disappointment – lukewarm food and the lack of vegetarian options. Stranger still, is that, at home, I never eat breakfast.

Whether we eat breakfast, and what we might eat for breakfast, featured in the news media last week. These stories felt like a welcome relief from the utterly depressing daily diet of unpalatable global news and/or the meaningless celebrity stories. Actually, reading the newspapers these days is enough to put me off my breakfast altogether.

I don’t normally feel hungry in the morning, and so don’t feel the need for breakfast. Which again, might be strange. I’ve been told from a very young age that breakfast is the most important meal of the day. I’m the eldest of seven children. As children we would start the day with a bowl of porridge, often laced with chocolate and/or sultanas. Family breakfast on Sunday was always a cooked meal, not quite a full English, but close.

Missing breakfast is not my attempt to lose weight. If I feel I need to lose weight, I simply stop drinking alcohol. In almost what feels like counter intuitive research, the evidence suggests we should try and eat 20% - 30% of our energy at breakfast time if we want to lose weight.

Likewise, I almost never drink coffee, and never in the morning. A cup of coffee in the morning can mask hunger, and of course caffeine doesn’t provide our bodies with energy. What it does is stimulate the adrenal glands to provide a ‘false’ boost of energy. Whilst eating your breakfast before 09.00 is said to help reduce the risk of depression, not eating breakfast at all can also have a negative impact on your mental health.

One of the reasons we shouldn’t drink coffee until after eating breakfast is that doing so helps our bodies regulate the flow of adrenaline and cortisol. The hormone cortisol is sometimes referred to as the stress hormone. Whilst we need cortisol, as it provides our ‘get up and go’ stimulus, too much can be very unhealthy. If like me, you do wake up in the morning and you’re not hungry, it could indicate your body is ‘running’ on cortisol.

High levels of cortisol in the body can indicate chronic stress. High stress levels have been linked to higher risk of heart disease, stroke and anxiety. Now I wouldn’t describe myself as being particularly stressed. I think I’m genuinely just not a breakfast person. That said, it doesn’t explain why I readily look forward to a breakfast when on holiday or staying overnight in a hotel! I’m a morning person. I wake up early, never use an alarm clock, and almost inevitably want to get up and make a start on the day. It’s not that I don’t have time for breakfast, it just doesn’t seem relevant.

One of the other stories I read last week focused upon working mums and how they manage to eat (or not) breakfast each morning. You can read the story here. It was simply exhausting. The story did make me think about a seemingly unrelated story about an essay our future Queen, Kate, published last week.

Kate talked about how children today are possibly ‘the most connected generation of all time’, yet at the same time were ‘often more isolated, lonely and less equipped to form warm, meaningful relationships’. She was citing from the world’s longest-running study into adult development undertaken by the Harvard University. This showed that the best predictor of a mentally healthy life was the quality of an individual’s connections with others. It brought to mind those childhood breakfasts, sitting together around the family table, each of us with a bowl of porridge in front of us. Maybe I am missing something in missing breakfast?

Touching hands, and hearts

Last Tuesday I was at my GP practice. I was there to see someone who was described in the text they sent me, as a ‘First Contact’. It was a new role on me. Now Jane is an expert internet navigator. She is my go-to Google interrogator. If there is information in the virtual-sphere, she can find it. Using this undoubted skill, Jane was able to discover that the ‘First Contact’ I was going to see was a nurse. She was also a nurse with an extensive background and experience in orthopaedic care.  This was fortunate, as I was going to see her about my painful hands.

My appointment was made using PATCHS. It seemed incredible that I would be matched with a practitioner, who was best placed to help me, rather than a more generic health care practitioner. Yet it seemed I was. As I noted in a previous blog, my GP practice is quite extraordinary. I know that digital technology and AI developments are beginning to make all kinds of new ways of working possible, but of course, it could just have been serendipitous.

What wasn’t serendipitous was the care and compassion I experienced during my consultation. More of which later. First, I need to just briefly back track some 45 years, when I was foolish enough to do my own tree surgery. On one occasion, the ladder I was standing on, while working in a tree, slipped. I was thrown off the ladder, landing on the ground, and hurting my hands in the process. Over the years that followed, I started to suffer with painful hands, particularly at night. To this day, I don’t know if it was that fall from the ladder, or the many years of milking goats by hand that was the cause of my painful hands.

About 10 years ago, I underwent some investigations on my hands. One hand showed a small bony growth, that was probably causing some of the pain. However, both hands were showing signs of arthritis, and in both cases the arthritis was more acute and centred around the base of each thumb. Sometimes the pain was so bad that I felt I could no longer trust myself to grip or hold things safely. In most aspects of my life, this was simply an irritation. I found many ways to compensate. However, I loved climbing.

As a younger me, I was a sports climber. It was the only sport I was good at. Whilst feet and legs are important in climbing – that’s where the power to move comes from, not the arms - being able to use one’s hands for balance and grip is equally important. I have a healthy fear of heights, and becoming less confident about being able to use my hands without pain, I eventually, and very reluctantly, gave up climbing. More recently, the pain at night was waking me up every few hours. I don’t sleep for long periods anyway, and the increasing number of disruptive nights was taking their toll on my wellbeing.

Having put off going to see the doctor for many a year, Jane persuaded me that I needed to make an appointment and go and seek some help. Of course, when I say persuaded, what I actually mean is that she used my phone to fill in the PATCHS referral request and secured an appointment for a couple of days later with the ‘First Contact’. The consultation started with the usual history taking. Then there was a physical examination.

My hands were held in hers with such tenderness that the act felt almost therapeutic. There was no mistaking the crunching of bones against bone, or the pain, which was fairly intense. I have never subscribed to the notion of ‘therapeutic touch’ as an intervention, but I do know that touch and touching, and the use of hands to do so, can be a powerful diagnostic tool.  Indeed, there is much evidence to support the notion that touch can benefit both physical and mental wellbeing. Touch can have a positive effect whether it is in the health care context or in everyday experiences - a hug from a friend or a colleague for example. Indeed, our local church offers a monthly ‘healing hands’ service.

My visit to the GP surgery didn’t result in a cure. I was offered painkillers, steroid injections and even surgery to shave the bones in my hand. None of these appealed. It was Jane who found a solution, albeit it might be a temporary one. She interrogated the internet once more and found wrist brace's, developed by clinicians at Addenbrookes. She bought one, and it’s a game changer. I have now enjoyed a number of pain free nights. My heart, as well as my hands, felt touched by the gift.

The bad news is that nothing lasts for ever; the good news is that nothing lasts forever

Some regular readers of this blog will know I have long had a thing about all things ‘chicken’. Due to my interest, I have my social media search engines set to pick up on stories about chickens. Last week, I was alerted to the horror incident of a lorry fire, down in Essex. The lorry was carrying live chickens. It was probably a story that passed you by. It’s a busy world out there, and of course last week there was a lot going on in the world.

I saw the story on Facebook. The reports didn’t say how many chickens were being transported, but a similar lorry fire last year in Ireland involving a similar-sized lorry, was carrying 8,000 birds. None of the reports made any mention of the number of birds that would have died, although the report did state the fire and rescue services’ concern for the birds’ welfare as being paramount.   

Scrolling through the comments on the article, I was appalled and saddened at the callous and offensive dark humour of many of those commenting. It felt to me that some of these folk had become so inured from dreadful events that they felt able to make fun of such a tragic incident. It made me stop and think about how much ‘negative news’ we are bombarded with each day. We have seen a rapid rise in the live communication and sharing of tragic and awful events, as these are occurring, almost from anywhere in the world. I wondered about the impact such exposure might have on our children and young people in particular. 

Last week saw the celebration of the annual World Mental Health Day. First celebrated in 1993, this year’s theme felt both timely and so prescient: it is ‘access to service – mental health in catastrophes and emergencies’. The focus highlights the importance of people being able to effectively safeguard their mental health in times of international insecurity and instability. I think the world has never felt so unstable, leaving many people feeling anxious and vulnerable at best and totally overwhelmed at worse.

The Mental Health Foundation has some great advice on how to deal with feeling overwhelmed. Being overwhelmed is not a good place for anyone to find themselves in. It will have a lasting and negative impact on anyone’s mental health and wellbeing. I worry more about the longer-term impact it might have on children and young people over time. I struggle at times to make sense of what I watch on TV, read in the papers or see on social media. Some of the behaviours, decisions and actions I see played out in the news feel to me to be almost inexplicable, inexcusable and at times very frightening. Just consider what is being currently reported on what is happening on the streets of many US cities?

So, if at times, and despite my experience, knowledge and age, I find the unremitting negative news difficult, goodness knows how younger people and children deal with news. Jane and I no longer have young children living in the house. However, experience tells me that often children, trying to make some kind of sense of what they are seeing, hearing or worse still witnessing, can give rise to all kinds of emotions and misunderstandings. The news stories, complete with horrifying images of conflict in place such as Ukraine or Gaza can be terrifying. Likewise, the recent dreadful events at the Heaton Park Synagogue, which was featured over and over again on the news and on social media will, I’m sure, have given rise to much anxiety.

Families separating or divorcing is another example of the difficulties children can have in making sense of what is happening to their worlds. In 2024, there were 2.5 million separated families in the UK. Over 4 million children lived in these separated families. Many of children will blame themselves for the break-up of their family. Of course many don’t necessarily, but the evidence shows most children will suffer behavioural and emotional disturbances, as a consequence of their family separating.

Often children dealing with any trauma will have difficulty in expressing how they feel. The NSPCC website has an excellent guide for talking about difficult issues with children. For children, and for all of us trying to make sense of the world, it’s always important to remember that the emotions they feel, we feel, (and I feel) will be normal and understandable. There can be many ways to deal with these emotions. Connections with others are always important, and finding ways to keep talking, equally so. For me, mindfulness works well, particularly when I’m able to be outside and able to slow down, think and make sense of the world I’m part of. And let’s remember the importance of sharing some kindness.  Kindness matters, always.    

Visiting my GP: boiled sweets and swimming pools.

Whenever I became ill as a child, my parents would try ‘over the counter’ remedies and draw upon their many years of family experience to try and make me well again. This was a time before Dr Google. If all else failed, then it was a trip to our local doctor. His practice was but a few streets away, situated in an ordinary semi-detached house. It was a single GP practice, and the doctor was a lovely man whose name I have long since forgotten.

What I haven’t forgotten however is how each visit was conducted. Back then there wasn’t an appointment system. If you needed to see the doctor, you turned up at the surgery, entered through the side door and sat and waited for your turn to see him. The chairs were dining room chairs, set around the walls of the room. There was a gas fire, lit in winter, and a small table with a range of magazines on it. It was always stifling hot.

In terms of medical memories, I once went there and was diagnosed as having a ‘burst appendix’ and was swiftly walked to the local hospital to have it removed. My other enduring memory was when I developed a huge abscess on my back. After days of unsuccessful home treatment, I was taken to the doctors, only to be sent straight to the aforementioned hospital to have it lanced, drained, and sewn up, followed by two weeks of ultra sun lamp treatment! However, each visit to the doctor meant you got a boiled sweet from one of those old-fashioned tall glass jars he kept on his desk.

Now the more astute of you will have made this blog’s connection to the news last week that as of the first of October, all GP practices must offer online appointments. The appointments must be available from 08.00-18.30. Many GP practices already offer such a system. Our GP practice has been offering this service for over 18 months now. I can contact our surgery through my NHS App, Patient Access and Patchs. That said, it has taken me a while to be able to navigate my way through the Patchs system. Unlike Jane.

Over the last month Jane has used Patchs to access her health care, and has done so very successfully. She has been offered appointments to see GPs, and an Advanced Practitioner, had call backs, blood tests and other investigations, and all arranged remotely. Jane’s biggest problem is actually physically getting to the surgery. Since her brain injury earlier in the year, she has not been allowed to drive. The folk at DVLA keep saying the computer says no. Very frustrating.

Our GP practice has two branch surgeries. Our regular one is a five-minute walk away and comes complete with a swimming pool, library, café, gym, kiddies’ play area and a therapy garden. It would blow my childhood GP’s mind. The branch surgery is a 20-minute drive away and requires two buses to get to it. It was at this practice that Jane was receiving her recent health care, and thankfully, I was able to ferry her to and from her appointments.

Understandably, a lack of transport is going to be a problem for some people; fortunately, it was just a minor issue for us. The problem would have still been a problem had we tried to access our GP using the more traditional 8am telephone call. I have to say I’m a big advocate for using new technology to make it easier to access the health care I need, when I need it. I’m not alone. Currently one in five GP appointments are made online, and that’s equates to about 72 million appointments a year.

Whilst I understand that not everyone will have access to a smart phone or computer or be digitally literate, my greater concern is the number of folk, who struggle with health literacy. Last week, NHS Providers, in partnership with NHS England, published a report on improving health literacy across the NHS. It makes for a sobering read.

The report contains a number of case studies. One of these focuses on my local hospital. It details the steps that they are taking to improve health literacy across a population with high levels of deprivation. Not all health care policy make sense. Mandating online appointments in primary care certainly does. However, it’s clear from the NHS Providers’ report that there is a need to also address some more basic and fundamental issues around how people could best access health care services. I’m sure it is unlikely any such approaches will involve boiled sweets.