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Introduction

I have always been so grateful and have admired first responders for their bravery and daily selfless acts of heroism! I started thinking about this article as I was reflecting on the events of 9/11 this year. It always reminds me how courageous you are and how fortunate we are to have you.

Your job takes a toll on your physical and mental health like no other. From environmental extremes to long hours, recognizing your unique potential health stressors can help you identify and make the changes necessary to make your own health a priority. This can then help you continue your mission with the strength and vitality you need to help endure the rigorous schedule.

Reprioritizing your own health and nutrition will help you gain the strength and focus you need to continue performing selfless acts of heroism. By recognizing what issues are placing your health at risk is a good place to start.

First Responders Have Increased Health Risks Due To

• Disrupted sleep cycle.
• Disrupted circadian biological clock which can alter digestion and metabolism and negatively affect food choices.
• Long work hours.
• Difficult to change to new habits when scheduling extra shifts for long hours.
• Fatigue and difficulty to stay focused during long work hours.
• Stress. Emotional stress. Physical stress.
• Sudden adrenaline surge.
• Finding the time and energy to make healthy meals.
• Being on the road during mealtime. Food access and availability.
• Eating regardless of hunger and fullness cues due to time constraints, emergency calls during meals, feeling rushed.

These situations can lead to stress which can lead to systemic inflammation in our body. Stress and inflammation are a recipe for chronic disease such as heart disease and diabetes and can contribute to depression and anxiety. Some diseases may be exacerbated or partially caused by workplace environments and schedules (shift work, long hours, job strain). 

First responders have the added stress of both physiological (increased adrenaline, cortisol, sleep disruption, poor eating habits) and emotional stress which can also contribute to inflammation in your body and brain.

It has been reported that more than 

• Seventy percent of the US firefighters are overweight or obese, exceeding the national average for adults. 
• Forty percent suffer from sleep disorders.

The combination of poor nutrition habits and increased stress can drive poor health outcomes for first responders. 

First Responder Nutrition: How Food Affects Your Brain

What we eat is also important to physical and mental health. Like a car, your brain functions best on premium fuel to protect it from oxidative stress. Consuming sugar, fast food, and junk foods can impair your brain function. 

Serotonin is a neurotransmitter that regulates sleep, appetite, and mood. Ninety-five percent of this neurotransmitter is produced in the gastrointestinal tract and is influenced by the beneficial bacteria that make up the microbiome. Beneficial bacteria influence what your gut digests and absorbs and affects the degree of inflammation throughout your body.

Your brain works best when it is supplied with proper fuel. What you eat can directly affect the structure and function of your brain and your ability to focus and concentrate. 

Eating processed foods and refined sugars can impair your brain function and worsen symptoms of mood disorders, cause brain fog and lead to energy crashes. Addiction can accompany an unhealthy relationship with food.

Healthy diet is important for mental and physical health. Many mental conditions are correlated with brain inflammation which begins in the gut. A Mediterranean eating style has been linked with improved cognition and cognitive thinking skills. A Mediterranean type of diet has been linked with less incidence of depression and stress and improved overall well-being. For more information see  Mediterranean Diet Pros and Cons – Waistline Dietitian and Good Mood Food: Fact or Fiction – The Mental Wellness Dietitian (angelalagonutrition.com).

First Responder and Shift Work Nutrition

Shift workers can encompass many essential fields including medicine, security, military, and first responders. Shift workers have been shown to have a higher risk of health consequences including cardiovascular disease, diabetes, and cancer, digestive issues, and depression, stress, and fatigue. 

Why does shift working take a toll on your health? First, working the night shift can disrupt your circadian rhythm or normal sleep, wake cycle. Your body has a 24-hour cycle or body clock. This clock helps regulate many bodily functions necessary including digestion. It is essential for activating certain hormones, alters body temperature, and regulates your metabolism.

Your body metabolizes food differently at night and heavy eating may decrease your alertness and productivity. When working at night when your body clock is disrupted, you may experience fatigue, sleep problems, poor concentration, difficulty metabolizing food.

Shift work also can negatively affect your daily habits and routines making healthy choices more difficult. Routines can help keep us on track. Meal planning and exercise routines are essential for health. Scheduling and being a part of social activities are important for mental health.

Night Shift Eating Schedule: Tips for Shift Work Meal Timing

Eating when your body can digest food well and provide you with proper energy is essential to your energy and stamina. The best schedule is one that works for your unique schedule. 

Try to eat meals at “normal” times.

Eat breakfast when you get home from a shift (or in the morning). 

Eat lunch when you wake up (or in afternoon).

Eat dinner before your shift ( or in the evening).

Eat light snacks and stay well hydrated to help reduce fatigue during the nights you are working.

Caffeine: If you feel you need caffeine to wake up or stay alert, have a maximum of 200 milligrams 30-60 minutes before your shift and then every 3 to 4 hours. But stop caffeine 8 hours before sleep time. Keep daily doses less than 400milligrams a day. *See more about caffeine below.

These are tips but do what makes your body feel the best. 

Healthy Meals and Snacks for Night Shift

Plan meals and snacks ahead. Start your day with a balanced meal. Focus on healthy proteins and fiber rich carbohydrates to maintain blood sugar and energy long term. Try to eat your main meal earlier in the evening. Fueling your body ahead of time will help you manage your hunger and energy throughout your shift. 

Pack healthy snacks and beverages. Planning and having the right foods with you will help your success. Bring snacks ready to eat. Focus on protein, healthy snacks and minimal carbohydrates for best easily digested snacks at night. *See healthy snack ideas below.

Stay hydrated. Reporting to work well hydrated is a good place to start and it is important to stay hydrated throughout your shift to stay alert. It is important to not rely on thirst alone. You will know if you are drinking enough fluids if you rarely feel thirsty and your urine is colorless or light yellow.

Pre-hydrate before work and throughout your shift and after. Aim for 64-130 ounces of fluid a day. * Optimally try to consume half of your body weight in ounces. For example, if you weigh 200 pounds, you would drink 100-ounces of fluid daily. Drink 12-32 ounces before work. Any liquids count but water is best. 

Avoid caffeine 8 hours before your planned sleep time. Avoid beverages that contain sugar. Water is best. Try adding sliced lemon, limes, or other fruit for a flavor change.

Proper hydration is essential to

• Maintain energy
• Prevent fatigue
• Keep body temperature cool

Dehydration can

• Reduce muscle strength
• Reduce ability to concentrate
• Reduce alertness
• Cause fatigue
• Cause headaches

First Responder Nutrition: Staying Hydrated

Being adequately hydrated is essential for optimal performance. Getting into the good habit of staying hydrated should be prioritized. 

Incorporate good hydration habits into your daily routine. Find what works for you to find a successful hydrating routine.

Fluid needs vary from person to person. Your fluid needs will depend on your activity, body weight, temperature. The more you sweat during an activity the more fluids you need to replace. 

Under normal circumstances we lose about 2 to 2.5 liters of fluid a day through body waste, sweat and breathing. With strenuous work in protective clothing and in hotter climates you could lose up to one to 2 liters of bodily fluid an hour! 

• Pre-hydrate before work and throughout your shift and after.
• Aim for 64-130 ounces of fluid a day. * Optimally try to consume half of your body weight in ounces. For example, if you weigh 200 pounds, you would drink 100-ounce of fluid daily.
• Drink 12-32 ounces before work. Any liquids count but water is best. 
• Additional 8-16 ounces per hour with exercise under AC or 50-70 ounces per hour with work in extreme heat one quart of fluid each hour during fire suppression activity. (*Fire suppression, follow your squads’ recommendations*) drink 16 ounces of water before. Drink 8-10 ounces every 15 minutes. If activity lasts longer than an hour, consider electrolyte replacements in addition to water/fluid.
• Monitor urine color. Clear urine is an indicator that you are well hydrated. Light yellow or straw colored indicates hydration. Dark yellow indicated early dehydration.
• Get into the habit of taking in fluids throughout the day. Smaller quantities at frequent intervals can help.
• Thirst always underestimates fluid needs,
• Symptoms of dehydration are weakness, fatigue, dizziness, low urine volume, or dark color.
• Symptoms of hyponatremia (low content of sodium in your blood due to losses from sweat and drinking too much plain water without eating food containing sodium) include being tired, bloated, nauseated, headache, swollen hands and feet, confusion, disorientation, seizures, coma, and even death.
• Energy drinks contain stimulant drugs such as caffeine, taurine, ginseng, yerba, green tea extract and guarana and are discouraged. Consuming high levels of caffeine and energy drinks without proper water consumption may exacerbate dehydration.
• Alcohol slows reaction time and impairs coordination. It also impairs your ability to control body temperature.
• Carbonated beverages may hamper your fluid intake due to bloating.

First Responder Nutrition: Meal Planning

MyPlate is an Effortless Way to Build a Healthy Meal

Check out https://www.myplate.gov/ to help you build a healthy plate. Your portions will depend on your age, weight, sex and activity level.

Meal Planning for Sustained Energy and Improved Cognition

• Meals should include a balance of protein, fruits and vegetables and whole grains.
• The exact amount of food you need depends on your age, gender, height, weight, and physical activity.
• Carbohydrates provide fuel for our brains and muscles. Fiber rich carbohydrates provide a feeling of fullness that can help satisfy your hunger. They also supply vitamins and minerals. Protein helps provide a feeling of fullness and helps normalize blood sugar and improves mood. Fat provides essential nutrients, helps your body absorb vitamins, strengthens hair, skin, and nails and boosts immunity, decreases inflammation and strengthens bones.
• Half of your meal should be fruits and vegetables. A quarter of the plate is complex carbohydrate (whole wheat grains, pasta, rice, beans, lentils, quinoa, barley). And a quarter of the plate should be lean proteins (fish, skinless poultry, lean red meat). Healthy fats provide energy and essential nutrients (Avocado, olive oil, nuts, and nut butters)
• When building your meals, try to include carbohydrates with fiber, Protein, and healthy fats with each meal to make it more satisfying.
• Use snacks to get in more fruits and vegetables, protein or healthy fats. Try to combine at least 2 food groups per snack to make it more satisfying.
• If you are rushed and sitting down to a meal is not possible, try planning smaller meals or well-balanced snacks. Or divide your meal and eat half at a time.

Shopping Tips for First Responder Nutrition

• Shop for foods that are in season. Fruits and vegetables that are in season are usually less expensive.
• Buy just what you need so they do not go bad before you use them. Also have frozen vegetables and fruits on hand and buy them whenever they are on sale.
• Focus on the nutritious lower cost foods such as beans, peas, and lentils, eggs, peanut butter, sweet or white potatoes, canned salmon, tuna, or crabmeat. 
• Grains such as oats, brown rice, barley, or quinoa. Frozen and canned fruits and vegetables.
• Plan all meals and snacks a week in advance.
• Write out meals. Write a shopping list and organize per section of the supermarket. 
• Review sale ads, coupons etc. 
• Do not shop hungry.
• Go when stores are not busy, or use pick up.
• Bring your glasses so you can read the labels!
• Take advantage of foods in season.
• Meal prep for the week. Wash and cut produce so it is ready to eat. Cook raw meat that you will be using over the next few days for meal prep.
• Cook any meals ahead and freeze in single serving containers. 

Ideas for Grocery List (* your grocery list will depend on the menus and recipes you decide on)

• Frozen, fresh, unsalted canned vegetables.
• Frozen, fresh canned with natural syrup fruits.
• Low fat yogurt, low fat milk, unsweet almond, or soy milk, cottage cheese, cheese.
• Unsalted almonds, cashews, walnuts, flaxseeds, pumpkin seeds, sunflower seeds, avocado, chia seeds.
• Natural nut butters.
• Olive oil, avocado oil.
• Beans, lentils, chickpeas, hummus. (Canned beans, rinse and drain)
• Whole wheat pasta, whole wheat breads, pita, whole grain crackers.
• Barley, brown rice or wild rice, quinoa
• Oatmeal
• Potatoes, sweet potatoes.
• Eggs and egg substitute.
• Skinless poultry.
• Fish, lean red meat.
• Green tea, black tea.
• Herbs and spices. Vinegar, cayenne, cinnamon, curcumin, garlic, ginger, turmeric.
• Non-stick cooking spray, olive oil, avocado oil.

Eating Out on the Run: First Responder Nutrition

Healthy Eating at a Restaurant

• Review menu options. If you are frequently going to the same place for meals, review the menu. Plan your order ahead of time. Check the nutrition facts for any chain restaurant to help you choose the healthiest choices.
• Drink water before meal and during.
• Choose grilled, steamed, roasted, poached cooking methods.
• Add healthy sides: vegetables, salads, soup. Skip bread.
• Ask for sauce, gravy, dressings on the side.
• Choose tomato over cream sauce.
• Use mustard, relish, salsa, ketchup, vinegar.
• Go light on cheese, mayonnaise, sour cream.
• There will be times when eating out is your only option. In this case, slow down and eat mindfully. Enjoy your company. Enjoy your food one bite at a time. Savor the flavors.
• Ask for extra vegetables.
• If you do not love cooking seafood at home, this is your chance to eat them.
• Try vegetarian dishes.
• If ordering a meat entrée, cut the portion in half and either share or take the other half home to eat another day.

Healthy Gas Station Snacks and Meals

• If your shift was just extended or if you did not pack snacks, the following are some ideas for healthier snacks you can pick up at a convenience store or gas station while you are on the road.
• Water bottle, unsweet tea.
• Beef Jerky, Almonds, Trail mix with nuts, Sunflower seeds, Air popped popcorn.
• Fruit.
• In Cooler: Salads, Yogurt, Sandwiches, Hard boiled eggs
• Protein Bars: What to look for in a protein bar
• 200-300 calories,
• More than 8 grams protein and 3 grams of fiber.
• Less than 13 grams of sugar and 3 grams of saturated fat.
• Ideas: Rx Bars, Epic Bars, KIND Bars, Lara Bars.

Eating on the Run Fast Food Suggestions

Life is busy and hectic, and planning ahead may not always be possible. If you find yourself relying on fast food from time to time, you can still choose “healthier” options. Knowledge is power. Check out the nutrition facts for the menu items ahead of time and preplan your order to help with your success.

You can look ahead at Fast Food Restaurants Nutrition Facts (fastfoodnutrition.org) . 

This can help you make healthier menu choices when you are needing to rely on fast food.

Examples of Fast Food Calorie and Fat Saving Swaps:

Healthy Snack Ideas for Night Shift Work

• Almonds and Grapes
• Apple or Banana slices with peanut butter
• Apple slices with string cheese
• Apple slices and Edamame
• Air-popped popcorn with nutritional yeast
• Beef jerky with nuts or fruit
• Berries and cottage cheese or Greek yogurt
• Celery sticks with peanut butter
• Cutie oranges and turkey jerky
• Hummus packs with vegetable slices
• Fresh fruit 
• Grapes and walnuts
• Granola with Greek yogurt
• Tuna with whole grain crackers
• Oatmeal with chopped nuts or peanut butter
• Hard-boiled egg and carrots
• Popcorn with parmesan cheese
• Pretzels with chocolate milk
• Peanut butter and jelly on whole grain bread or crackers
• Protein bar and fruit
• Kale chips and pistachios
• Trail mix with whole wheat cereal, nuts, dried fruit

Caffeine: How Much is Safe?

Caffeine, a mild stimulant to the central nervous system can quickly boost alertness and energy. It is a drug, and you can become dependent on it and build up tolerance.

Caffeine is absorbed within 45 minutes after consumption and peaks in the blood from 15 minutes to 2 hours. Drinking caffeine on an empty stomach may give you a quicker boost because food can delay its peak. Caffeine is broken down in the liver and can remain in the blood for 1.5 to 9.5 hours.

Good goal is to limit caffeine to

• 400mg (milligrams) a day for adults.
• 200mg a day for pregnant women (ask your doctor as some doctors recommend less)
• 2.5mg caffeine maximum per kilogram body weight for adolescents.
• Children under 12 years should avoid it.
• Limit caffeine if you have high blood pressure or atrial fibrillation. (Less than 200mg/day)

People vary in their tolerance to caffeine. Too much caffeine can cause gastrointestinal problems, nervousness, jitteriness, anxiety, irregular heartbeat, excess urination, heartburn, insomnia. Caffeine intake may be linked to other unhealthy behaviors such as smoking and consumption of sweets. As much as ten grams of caffeine a day can cause convulsions and vomiting.

How to Reduce the Caffeine Safely

Withdrawal symptoms of caffeine include headaches, irritability, depressed mood, flu like symptoms, difficulty concentrating, agitation.

Tapering the amount gradually will help reduce negative side effects.

Tips for cutting back caffeine. First, evaluate how much caffeine you are consuming in a day. It is found in a variety of foods and beverages. Second, reduce caffeine consumption gradually by about one hundred milligrams per week. And lastly, have a plan when you start craving something with caffeine. 

Caffeine Content of Popular Foods: (amounts are approximate)

See Caffeine Chart | Center for Science in the Public Interest (cspinet.org) to look up your favorite food.

• Starbucks, coffee, Blonde Roast Grande 16 ounce =360mg caffeine
• Starbucks, coffee, dark roast, Grande, 16ounces=260mg caffeine
• Dunkin, Coffee, Large 20ounces=270mg caffeine
• High Brew Nitro Black cold brew 10 ounces =200mg caffeine
• Death Wish instant coffee 1 packet 8 ounces= 300mg caffeine
• Folgers Classic Roast 2 tbs, makes 12 ounces= 120-160mg caffeine
• Keurig k-cup, 1 pod, makes 8 ounces =75-150mg caffeine
• Lipton Black Tea, 1 bag, brewed=55mg caffeine
• Snapple Lemon Tea 16 ounces= 37mg caffeine
• Lipton Lemon Iced tea 16.9ounces=21mg caffeine
• Pepsi Zero Sugar 12 ounces =69mg caffeine
• Mountain Dew diet or regular 12 ounces= 54 mg caffeine
• Dr Pepper diet or regular 12 ounces=41mg caffeine
• Fanta Orange 12 ounces= 0 mg caffeine
• Adrenaline shoc energy drink 16 ounce= 300mg caffeine
• 5-hour Energy Extra Strength=1.9 ounces =230mg caffeine
• Monster Energy 16 ounces= 160mg caffeine
• Mio Energy ½ tsp squeeze= 60mg caffeine
• Ben & Jerrys Brewed to Matter Ice Cream 2/3 cup= 66 mg caffeine
• Hershey’s Special Dark Chocolate Bar 1 bar 1.4ounces=20 mg caffeine
• Jelly Belly Extreme Sport Beans 1 ounces=50 mg caffeine
• NoDoz 1 caplet= 200mg caffeine
• Excedrin Migraine= 2 caplets= 130mg caffeine

Keeping Alert Without Caffeine

• First eat balanced meals with protein and complex carbohydrate to aim for a balanced blood sugar.
• Keep your mind stimulated. Change up your tasks. Team up. Try social connections and interacting with people to give you a mood boost.
• Sunlight exposure releases serotonin and boosts mood. Early morning sun can help reset your biological clock and help you focus during the day and sleep at night.
• Deep breathing improves circulation. Breathe deeply through your nose and let your belly expand. Then breathe out through your mouth with your lips pursed (like you are whistling)
• Chew gum. Try chewing gum to increase circulation and improve concentration.
• Stay hydrated. Dehydration can trigger feelings of fatigue and reduce your concentration. Staying hydrated can help your blood sugar transfer oxygen and other nutrients to your cells to keep you energized.
• Take a short break and listen to your favorite music. 
• Take a power walk and move your arms and legs briskly. Take the stairs. Take a walk around the perimeter of your property.
• Move in your seat if you are stuck in the car. To keep blood flowing point and flex toes and feet. Do ankle circles. Roll your shoulders. Pull your knees up to your body. Stretching can keep your blood flowing.
• Splash water on your face. Brush your teeth.
• Strong scents: Sniff Rosemary, peppermint, coffee. Strong scents can help you keep alert and increase your cognitive ability.

Healthy Eating at the Firehouse

• Your job places your body under many physical and mental demands. You have many potential outside stressors that can lead to poor health. Self-care is essential for recovery and to help you stay in the best possible shape to maintain the stamina your grueling job takes.
• Fueling your body with unhealthy foods can lead to reduced body recovery, reduced reaction time, reduced cognition, and reduced energy.
• A healthy balanced diet with adequate nutrients will help your body recover after a stressful event. A healthy diet also puts less stress on your body.
• Aim for an anti-inflammatory diet rich in antioxidants: Fruits, vegetables, healthy fats, minimally processed plant, and animal proteins. For more specific information adopting an anti-inflammatory diet see How To Adopt A Mediterranean Diet – Waistline Dietitian
• Eating healthy at the firehouse is possible. Making positive changes gradually at a cultural level with the cooperation and input from staff. The goal is to make sustainable lifestyle changes that are enjoyable. Encourage nutrition awareness and foster inclusion of ideas and suggestions. Focus on working together as a team to feel good and to help improve performance.
• Important self-care rituals include working on coping skills for stress, exercise, sleep patterns, healthy eating, mindfulness activities. We can’t avoid stressors in our lives, but we can learn to make changes that will enhance our body’s ability to recover from stressful events.

Firehouse Nutrition

• Start where you are. Discuss the benefits of healthy nutrition and lifestyle changes and why it will help overall health, mood, strength, recovery, performance. It is important for employees to know the why first.
• Get employee input for suggestions. Some staff may have excellent ideas for what has worked for them. Favorite recipes at home that could be adapted for a larger group.  Work together as a team. 
• Keeping it simple is best. Make changes gradually. Plan.
• Keep healthy snacks in plain sight and in a ready to eat form.
• Make slight changes and allow employees to decide what they want.
• Have healthy food stocked in the pantry and readily available to eat. 
• Portion control. This may be the first thing you implement. Start by balancing the meals to 50 percent vegetables, 25 percent lean protein and 25 percent healthy higher fiber carbohydrates. 
• Plan simple, easy meals with vegetables, lean protein, and complex carbohydrates. 
• Plan days when you are going to have “popular meals” that you know are not as “healthy”. Limit indulgent meals to 1-2x week. Keep in mind the 80:20 Rule. Aim to have healthy choices 80% of the time.
• Eating patterns. Eat slower. Chew. Mindful eating. Take 20-minutes to eat your meal. Stop when 80% full. Yes, this may be very difficult if you are used to eating on the run. Start with paying attention to your meal. Being in the present moment when eating. This really can help your overall digestion and improve how you feel after eating.
• Drink mostly water, unsweet beverages.
• Limit caffeine to less than 400mg a day. Limit caffeine if you have high blood pressure and acid reflux.

Ideas for Healthy Firehouse Recipes

FRF-HEALTHY-FIREHOUSE-RECIPES.pdf (firerescuefitness.com)

5 healthy firehouse recipes for every firefighter (firerescue1.com)

5 Healthy Firehouse Meals – Firefighter Furnace

Fit-Fire-Fighter-Meals-Recipe-Book.pdf (draeger.com)

Firehouse Healthy Recipe Swaps

Try gradually substituting healthier food options in the recipes you are already using.

Instead of …	Try…
Butter stick margarine solid shortening	Healthier fats: Olive oil, extra virgin, olive oil ,avocado, avocado oil, chia seeds, flaxseeds, pumpkin seeds, sunflower seeds, walnuts, low fat light margarine, low fat or light mayonnaise, nonfat cooking spray
Beef, pork, poultry with skin	Substitute more fish, seafood, salmon, skinless poultry breast, more meatless meals with legumes, beans, peas, lentils
Chips, crackers, snack foods	*See healthy snack list for lots of ideas! Raw or unsalted nuts and seeds. Homemade trail mix Natural nut butters and fruit. Hummus with vegetables or whole grain breads. Avocado on whole grain toast. Popcorn.
Whole milk, whole fat cheese and yogurt	Choose 1% or skim, milk, low-fat cheese, low-fat yogurt without added sugar unsweetened soy, or almond milk
White bread, rolls, biscuits, waffles, sweet breads, doughnuts, pastries made with refined ingredients, refined pasta, white rice	Whole grain breads, cereal, pastas. Brown or wild rice, cauliflower rice, vegetable pasta (chickpea, lentil), Quinoa, Barley, Couscous, Oats, High fiber cereal
Sweetened drinks, including sweet coffee, tea, soda, energy, or sports drinks with sugar	Water, Flavored water with fruit slices, Coconut water, Unsweet coffee* watch caffeine intake, Unsweet tea, Herbal tea, Fruit smoothies made with frozen or fresh fruit and unsweetened nut milk or yogurt (low-fat)
Salt, condiments with salt or sodium in the word such as “garlic salt”.	Use herbs, garlic, onion, peppers, lemon or lime juice and spices. Include Cayenne, Cinnamon, Cocoa, Curcumin, ginger, turmeric
	Eat more Fresh Fruits and Vegetables to meals and snacks

Conclusion

Although there are many unique challenges in the First Responders schedule that can make healthy habits challenging, it is crucial for your strength and stamina to put yourself first. A few healthy changes to your daily routine can greatly improve your overall performance and health.

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