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General health

Depression affects around 264 million people worldwide.  Recent UK figures  show that almost 1 in 5 adults (19.2%) experienced depression during the coronavirus crisis in 2020 — a figure that almost doubled from around 1 in 10 (9.7%) before the pandemic. People most affected included younger adults aged 16-39 years, women, those with financial worries and people with disabilities.  

‘There are many factors  that may contribute to depression,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry. ‘But social isolation, lockdowns, money and health worries during the pandemic are further factors, causing more people to feel depressed.’

There are some simple, daily practices that science has shown may positively affect your mood, if you practice them regularly. Here’s a toolkit to get you started.

## 1. Find time to head outside every day

‘Lack of sunlight can cause seasonal affective disorder (SAD) in some people,’ says Gauffin. ‘This is a type of recurring depression with a seasonal pattern.’ It’s not certain what causes SAD, but some theories suggest a lack of light in winter may affect mood-regulating chemicals in the brain. Typical symptoms include persistent low mood, irritability, feelings of despair, lack of energy, sleeping for longer than normal, craving carbohydrates and weight loss or gain.   

__Tools to use daily__ 

- Get as much daylight as possible.  Even a short daily walk can be beneficial. Natural light is the most important cue for maintaining circadian rhythms (the body’s natural sleep/wake cycle).  A lack of sunlight can throw this internal body clock out of sync and by affecting sleep and appetite, make symptoms worse
- Spend time in nature. One study showed that just 10 minutes spent sitting or walking in a natural environment can have a positive impact on mental wellbeing  

## 2. Get moving (and your heart pumping)

Exercise can support your mood if you have depression and is especially useful for people with mild to moderate depression. 

This doesn’t have to mean sweating for hours. It could be as little as a daily 20-minute walk. According to a recent meta-analysis, exercising for a total of 150 minutes each week can reduce the risk of depression by a third.

‘Exercise is important if you’re feeling depressed,’ says Gauffin. ‘Moving physically has an energising effect,’ she explains. ‘The less you move, the more lethargic you feel. Try and do some exercise that gets you out of breath every day such as dancing, stretching, walking or running. If you find it hard to motivate yourself, arrange to meet a friend for a socially distanced walk.’  

__NHS recommends...__
- Each week, aim to do 150 minutes of moderate activity (like brisk walking, gardening, rollerblading) or 
- 75 minutes of intense activity (including jogging, aerobics, walking up the stairs) weekly or
- A combination each week — to maintain your health

## 3. Connect with friends and family as often as you can

‘One of the reasons people are finding it hard to cope during the coronavirus crisis is because they can’t spend time with friends and family in the same way as they did before,’ says Gauffin.  

A US study found that confiding in friends and social connection generally has a protective effect against depression (it also found that reducing time watching TV and napping in the day also help to lower depressive symptoms).

__Tools to use daily__

- Talk to friends regularly on the phone or Zoom
- If you don’t feel like talking, check in with friends over text
- Join an online art, book or music club. Or, find a local mental health support group
- See friends in person where possible, depending on the restrictions in your area

## 4. Avoid processed foods and sugar

‘If you’re feeling low or depressed, you’re less likely to cook healthy meals,’ says Gauffin. ‘And, if you eat a lot of processed foods, sugar and carbohydrates, you may feel worse.’ One of the reasons for this is that processed and sugary foods can lead to blood sugar highs and lows, which many people find affects their mood. 

A recent review of the scientific literature on food and depression  reported that the most beneficial diet to reduce depression contained plenty of vegetables, fruit, fibre, fish, wholegrains and legumes and was low in processed foods and sugar. 

__Tools to use daily__

- Make sure you eat a wide variety of whole foods
- Aim to get enough of the micronutrients magnesium (like green leafy vegetables, low-fat dairy, nuts and seeds), folate (including legumes, asparagus and beetroot) and B vitamins (such as eggs, seafood, dairy products and leafy greens) as these were found to be associated with lower rates of depression 
- Try to avoid cutting out entire food groups, unless advised to do so by a doctor or dietitian. This was associated with higher rates of depression. It’s not possible to prove causality but cutting out food groups can affect your health in other ways too, so it isn’t a good idea to do so before discussing it with a medical professional 

## 5. Consider Cognitive Behavioural Therapy (CBT)

CBT is a talking therapy that can help you to change the habitual thought patterns that might be playing a part in your depression.  

‘CBT can be very helpful in treating depression,’ says Gauffin. In fact, a large body of scientific evidence has shown that CBT is effective in treating low mood.  In one recent meta-analysis  of 91 studies, it was shown that CBT interventions showed a larger short-term decrease in depression compared with other treatments. 

‘When you start CBT, you write down your thoughts, feelings and behaviours and then look for connections between these and your depression,’ says Gauffin. ‘This helps you to become more aware of your thoughts and actions.’

__Tools to use daily__

- A GP can refer you for CBT on the NHS. This can teach you the behaviours and practices you can use every day to help stop the thought patterns that may be affecting your mood. These include challenging thinking patterns, breathing techniques and journaling

## 6. Explore the art of mindfulness  

Mindfulness is about paying attention to the present moment. It involves observing your breath, thoughts and emotions, without any judgement. 

By focusing on your breath and bodily sensations, even if a negative thought creeps in, you can let it go. ‘You can apply mindfulness to any situation, including making a cup of tea and washing the dishes, right through to meditation,’ says Gauffin.

‘Mindfulness can help with depression,’ says Gauffin. ‘But it requires consistency, consciousness and commitment. To be effective you need to commit to practicing it daily. Even 10 minutes every day will make a difference but it may take a couple of weeks to notice improvements.’

__Tools to use daily__

- Practice daily mindfulness of breathing meditation — even if it’s only for 10 minutes a day. This will help you observe your thoughts and emotions and, in time, see that they will pass and cannot hurt you 
- A mindful pause and deep, belly breath is available to you at any time of the day. This can help you stop and observe your emotions when you’re feeling overwhelmed by them
- Try to be more mindful in everyday life by focusing on one task at a time, be that washing the dishes or finishing a report for work. This helps you become more grounded in the present moment. That in turn may help reduce the catastrophising and ‘what ifs?’ that can lead to depressive thoughts

Read more about how to [deal with a panic attack](/your-health/6-causes-of-panic-attacks-and-expert-tools-for-how-to-cope/)

## 7. Practice yoga 

Yoga’s psychological benefits have been proven to help increase mental energy and improve mood.  In one study, it was shown that doing yoga for 60 minutes three times a week increased  levels of gamma-aminobutyric acid or GABA, a chemical in the brain that helps regulate nerve activity and mood.

__Tools to use daily__

- Start with a little and often approach if you’re just beginning yoga, such as a few sun salutations each day. A recent study showed that when participants practised the Sun Salutations (12 physical postures done as a flowing sequence) every day for just 20 minutes, they felt mentally calmer, more relaxed, well rested, refreshed and joyful after 14 days 

## Should you see a doctor about your mood?

Sometimes, all the lifestyle changes in the world won’t impact the way you’re feeling — and that’s okay. Don’t beat yourself up, there is help available so seek it sooner, rather than later.

See a doctor if you experience symptoms of depression for most of the day, every day, for more than 2 weeks.  

Symptoms of depression  include:
- Continuous low mood or sadness
- Feeling hopeless and helpless
- Feeling tearful
- Feeling irritable, guilty and intolerant of others
- Having no motivation or interest in things
- Difficulty making decisions
- Moving and speaking more slowly
- Changes in appetite and weight
- Sleep disturbances
- Lack of energy 
- Low sex drive
- Unexplained aches and pains
- Feeling suicidal – if you feel like this, you must always seek help

If you think you have depression, a Kry doctor can assess your symptoms and suggest a plan of action to help you feel better.

__This article has been approved by Dr Rhianna McClymont, Lead GP at Kry and Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Kry.__


Kry.co.uk > Your health > Help for depression — 7 daily tools to improve your mood

original (17)

If the pandemic or winter’s dark days have affected your mood, these simple tools have been shown to help day-to-day mental health

Help for depression — 7 daily tools to improve your mood

General health and seasonal

## Quick facts
- Fat around the middle, known as visceral fat, fuels inflammation in the body
- A high waist-to-hip ratio (WHR) may indicate higher risk
- The WHO says that women should have a WHR of 0.85 or less, and for men it should be 0.9 or lower
- You can calculate your WHR by dividing your waist measurement by your hip measurement

It’s no secret that being overweight or obese is not good for your health. Not only can excess weight increase your odds of developing diabetes, heart disease and many other serious health problems, it can also add to your chances of complications from Covid-19.

## Why does where you carry your weight matter?

There’s now a body of evidence which shows that being an ‘apple shape’ and having additional fat around your belly is more dangerous than being a ‘pear shape’ and carrying excess fat on your buttocks and thighs.

This is because it’s now known that fat produces healthy — and unhealthy — body chemicals. This cocktail of body chemicals varies, depending on where you tend to deposit your body fat.

The most dangerous is abdominal or ‘visceral’ fat. It’s sometimes called intra-abdominal fat, because most of it is hidden away in the abdominal cavity. This fat also builds up in an apron-like flap of tissue called the omentum, located under the diaphragm, which blankets and protects the intestines and other organs. 

‘Visceral fat is important as it increases the risk of health problems such as type 2 diabetes and heart disease,’ Dr Rhianna McClymont, Lead GP at Kry explains. 

It also produces inflammatory chemicals called [cytokines](/your-health/what-is-cytokine-storm/). These are associated with severe illness from Covid-19, as well as with increased blood pressure and pushing up levels of free fatty acids in the blood and organs, which may contribute to heart disease risk. 

## Why your waist-to-hip ratio is important

The most obvious clue that you have too much visceral fat is having an ‘apple’ body shape, in which your waist seems wider than your thigh area. That’s why measuring waist to hip ratio (WHR) can be a useful tool for assessing your weight-related health risks. This is often done in addition to calculating your [body mass index (BMI)](/your-health/5-simple-tips-for-a-healthy-bmi/), which doesn’t account for where excess weight is distributed on the body. 

To calculate your WHR, divide your waist measurement by your hip measurement. If your waist is 80cm and your hips are 90cm, your ratio is 0.89. The World Health Organization (WHO) says that women should have a WHR of 0.85 or less and for men it should be 0.9 or lower.

## How do you know if your measurements put you at risk?

If calculating WHR is confusing, you can simply measure your waistline (around the belly button).

The NHS and Sweden’s Karolinska Institutet advise losing weight if your waist is more than 94cm (37in) for men, or 80cm (31.5in) for women. 

Men with a waist measurement of more than 102cm (40in) and women measuring 88cm (34.5in) or more are at high risk of health problems and should speak to a doctor.

## Do age, genes and stress play a part?

Lots of factors beyond your control will influence your tendency to store visceral fat. These include your genes, getting older and hormones. Visceral fat for example, may increase after menopause. 

But stress also plays a key role. ‘Studies have also shown that stress can play a role in obesity through the increase in a hormone called cortisol,’ says Dr McClymont. ‘This is released in response to periods of chronic stress. Cortisol causes increased deposits of visceral fat and has been shown to increase appetite and a preference for energy-dense foods.’

## Why shifting belly fat isn’t as hard as you might think

The good news is that it’s easier to reduce visceral fat with diet and exercise than it is to shift fat from the hips and thighs.

Exercises like sit-ups will tighten abdominal muscles but won’t target visceral fat. The best ways to shift it are through a combination of healthy diet and increased exercise. 

The NHS recommends 150 minutes of moderate physical activity like walking, swimming or gardening or 75 minutes of vigorous activity like aerobics, rowing, strength training or jogging each week. 

‘[Reducing alcohol intake](/your-health/6-health-benefits-of-drinking-less/) can also be a good way of reducing waist size,’ adds Dr McClymont. ‘[Getting plenty of sleep](/your-health/4-ways-to-sleep-better-during-the-pandemic/) and reducing stress levels can also help,’ she says.

## How Kry can help

‘Certain people who are very obese and have not managed to reduce their weight with diet and exercise may benefit from a medication to help with weight loss, or a referral to a bariatric clinic to discuss weight-loss surgery,’ says Dr McClymont. If you’re concerned about your waist size or impact of visceral fat, speak to a doctor for medical advice.

__This article has been medically approved by Dr Rhianna McClymont, Lead GP, Kry.__


Kry.co.uk > Your health > Is your waist size putting your health at risk?

Is your waist size putting your health at risk?

Excess fat around your middle can raise your risk of type 2 diabetes and heart disease. We explain why, and how shifting abdominal fat may not be as hard as you might think

## Quick facts
- Stress depletes your self-control, so managing it is key
- Setting short and long-term rewards as you complete the steps toward your goal can help maintain motivation
- Willpower can be built up like a muscle, say researchers 

Life is uncertain at the best of times. But right now, there’s little certainty about anything. We can’t plan our lives like we used to, so it’s perfectly understandable if you’re feeling lost and unmotivated. 

Yet, while this next year may be extra challenging in the wake of Covid-19, especially if you’re looking to motivate yourself to reach new wellness, health or personal goals, it’s important not to lose sight of your hopes and dreams. 

That’s why we’re bringing you some of the science on motivation, with easy ways to work it into your 2021 plans. 

Take it slow and work only what you can into your routine — after the year that’s just passed, being easy on yourself is most important.  

## What influences motivation? 

Motivation is the reason behind why we do things. It’s the energising behaviour we adopt in pursuit of a goal.  

Your environment, how you were brought up and your experiences all play a part in what motivates you.   

But there are also two main types of motivation — knowing the difference between the two can help you reach your goals.  

Extrinsic motivation comes from external factors, like a reward or punishment. For example, when you’re driven to complete a work project, because you want to get paid, or because you don’t want to attract criticism, lose out on an opportunity or feel like you’ve failed. 

Intrinsic motivation on the other hand, comes from internal factors. It’s about doing something for the sheer satisfaction or enjoyment it brings you. This is not contingent on any external pressure or reward. 

If you’re looking to get motivated to make some health and wellness, or personal goals in the new year, here are 5 ways to do it based on scientific research. 

## Motivating secret #1 — Learn to manage your stress

Stress may induce changes in your brain that can lower motivation. In a recent study  it was shown that increasing stress levels can affect prefrontal cortical activity (this is the area of the brain that governs the integration of emotion, motivation and cognition) and decrease the motivation to pursue reward.  

In fact, learning to manage stress is one of the most important things you can do to improve your motivation and willpower, say researchers into these areas. 

Being under stress puts you into the fight or flight response and encourages you to focus on short term goals and outcomes. But self-control requires you to keep the big picture in mind. 

So, if you want to stay motivated, incorporate tools to help manage stress into your daily routine. Even if it’s just going for a daily walk, [spending time in nature](https://www.livi.co.uk/your-health/5-health-benefits-of-being-in-nature/), doing some yoga stretches, breathing exercises or doing a daily 10-minute meditation. 

## Motivating secret #2 — Prioritise sleep — especially if you want to maintain a healthy weight 

If one of your goals is to get food cravings under control or to [maintain a healthy weight](https://www.livi.co.uk/your-health/5-simple-tips-for-a-healthy-bmi/), not sleeping enough could sabotage your motivation. 

A recent study  shows that a reduction in sleep of 33% led to increased hunger and food cravings the next day in study participants. The researchers suggested that sleep deprivation activates food-related reward regions in the brain, leading to more hunger. 

In another study  it was found that not sleeping enough could suppress activity in the dorsolateral prefrontal cortex (this is the part of the brain to do with self-control). 

Lack of sleep can also cause an increase in the production of the hunger hormone ghrelin and a decrease in the appetite-suppressing hormone, leptin.  

Read more about simple [lifestyle changes to help you sleep](https://www.livi.co.uk/your-health/4-ways-to-sleep-better-during-the-pandemic/).

## Motivating secret #3 — Connect with your intrinsic motivation

Intrinsic motivation is when you’re motivated to do something you enjoy. When you’re intrinsically motivated you engage in an activity because you find it interesting and inherently satisfying.   

Here are some ways to increase your intrinsic motivation:
- Workout to your favourite music. That way it won’t feel like such hard work
- Listen to your heart and choose goals that resonate with what you love doing. Journaling can help you figure this out. If you’re not sure, think back to when you were small. Was there something you loved to do that you gave up as you got older?
- Do sports you enjoy, not only those you think you should be doing. Then, set goals around them. For example, if you love running, set a goal to complete a virtual 10km by Easter 
- Make a list of activities you love, then figure out ways of working them into your goals. For example, if you love cooking but also want to get healthy, set up an online cooking group with friends you know already have a healthy lifestyle and steal their recipes

## Motivating secret #4 — Create a reward system

Staying motivated is always much easier in the initial stages than it is a few months down the line. One way to keep up the momentum beyond January is to plan a reward system you can use over time, as you move closer to achieving your goals.

For example, if you aim to exercise three times a week, make a plan for what specific exercise you will be doing and how you’ll be doing it. Then, every fortnight that you have managed your goal, reward yourself with a massage. Once you have continued for three months, reward yourself with a new pair of sunglasses (just in time for summer).

Rewards are important in the short-term too though. If your goal is going for a walk five times a week or completing a work project, planning in immediate rewards after you have completed each step toward that goal (for example, after each walk or when you complete a presentation) will motivate you. 

In fact, a recent study  found that immediate rewards you give yourself (especially in the first stages of changing your behaviour while it’s becoming a habit) can boost intrinsic motivation more than delayed rewards. In the study, when people were asked to complete a task, there was a 20% increase in motivation amongst those participants who received an immediate bonus compared to those who received nothing.

## Motivating secret #5 — Build up your willpower muscle

Willpower is the ability to delay gratification and resist temptations to reach a goal.  

When faced with something tempting, the two parts of your prefrontal cortex (remember, that’s the part to do with regulating behaviour) are in competition. 

The right part of the PFC (the dorsolateral prefrontal cortex) is to do with analysing thoughts and self-control and the left (the orbitofrontal cortex) is associated with making decisions based on emotional information.   

But willpower is like a muscle — you can train it to help you make choices that come from the right part, and get you closer to your goals more often. The more you use your willpower, the more your brain will follow healthy cues. 

Here are some simple ways to build up your willpower muscle:
- Reduce stress. If you’re in fight or flight mode, this activates the more primitive, emotional side of your brain so you’re less likely to have self-control
- Break your goals into smaller ones to begin with and add to these gradually. For example, after a month of those daily walks, extend them from 30 to 45 minutes. After another month, switch to an hour
- If you’re trying to improve your diet, don’t keep comfort foods in the house. That way your emotional brain won’t be tempted
- Focus on one or two goals, rather than trying to change your life overnight
- Try the 80/20 approach as this won’t make you feel deprived. 80% of the time, follow through with your goal or healthy choice. For the rest of the time, allow yourself a little leeway
- Spin your goals into something positive. For example, instead of thinking ‘I can’t have chocolate’, focus on how much more energised and alive you feel after eating something healthy

Remember though, to take small steps. Don’t put any more undue pressure on your mind and body than feels right. Now in particular is a time for [self-compassion](https://www.livi.co.uk/your-health/what-is-self-compassion-and-why-does-it-matter/), not just goal-setting.


Livi.co.uk > Your health > 5 motivation secrets to use all year (backed by science)

5 motivation secrets to use all year (backed by science)

If pandemic stress has left you feeling unmotivated, you may need good advice to make your health goals stick. Here’s the science on how to stay motivated

Kry.co.uk > Your health > 5 motivation secrets to use all year (backed by science)

## Quick facts
- Indigestion and heartburn are widespread — 40% of adults experience it
- Spicy, fatty foods as well as coffee and alcohol are common triggers
- Being overweight and obese, as well as smoking and stress, are also key causes

Most people suffer from indigestion occasionally and some are more prone to it than others.  

Indulging in rich food and alcohol can overload our digestive systems and leave us with uncomfortable feelings – like heartburn and gas – after eating.

Here we answer your questions, with advice from Dr Rhianna McClymont, Lead GP, Kry.

## What’s the difference between heartburn, acid reflux and indigestion? 

Indigestion can be felt as discomfort or pain in the upper abdomen, also known as dyspepsia. It’s incredibly common with around 40% of adults experiencing it each year. 

One of the main symptoms of indigestion is heartburn and acid reflux (these are the same thing, by the way).  Heartburn is felt as a burning sensation behind your breastbone or in your throat. It happens when acid from your stomach comes up your oesophagus and into your throat, which is called acid reflux. Most people only have occasional episodes, but when this keeps happening, it’s called gastro-oesophageal reflux disease (GORD). 

Dyspepsia and heartburn may occur together or on their own and symptoms usually appear soon after eating or drinking.  

## What causes indigestion?

As well as heartburn, belching or flatulence, bringing food back up from your stomach into your throat, nausea, and feeling uncomfortably full are also symptoms of indigestion. They’re caused by stomach acid irritating the protective lining of the digestive system. 

Indigestion can also be due to the lining in your digestive system being overly sensitive to stomach acid, or it may be stretched  as a result of eating too much.

‘Heartburn is most commonly caused by a laxity in the lower oesophageal sphincter,’ says Dr Rhianna McClymont. This sphincter forms a tight ring between the top of the stomach and bottom of the oesophagus (the food pipe). It opens to let food pass from the oesophagus and into the stomach, and then closes again to prevent stomach acid and food travelling the wrong way back into the oesophagus. ‘With acid reflux, this sphincter is more relaxed than it should be, allowing acid to pass out of the stomach and cause painful symptoms,’ Dr McClymont explains.

## What triggers heartburn and indigestion?

Coffee and alcohol, as well as spicy and fatty foods — including chocolate and tomatoes, according to the NHS  — can be common triggers for indigestion. 

If you’re overweight or obese, you may be more likely to suffer with indigestion. 

Some medicines, like anti-inflammatory painkillers, can cause it too. ‘Medications like ibuprofen are a particularly common trigger for heartburn, so make sure you’re not taking these regularly, unless you have been directed to by your own GP,’ says Dr McClymont.

Stress can also make indigestion worse  — as can smoking. 

Indigestion is particularly common in pregnant women, usually from 27 weeks onwards, with up to 45% of pregnant women suffering from it at some point.  This can be caused by hormonal changes and the growing baby pressing against the stomach.  

## How can I prevent indigestion? 

There are many things you can do to prevent an episode of indigestion. Start by avoiding foods that you know trigger episodes. Cutting back on alcohol and stopping smoking can also help.

If you’re overweight or obese, research suggests that losing weight can be helpful in alleviating symptoms.  

Try to avoid overeating by opting for smaller, more frequent meals. If you can, make your evening meal 3-4 hours before bedtime, as lying down can cause symptoms.

In fact, if you find that you suffer from indigestion mostly when you’re lying down in bed, try raising the top of your bed by 10-20cm with some pillows. Ideally, your chest and head should be above the level of your waist so your stomach acid doesn’t travel up towards your throat. Avoid tight clothes that put pressure on your stomach area too. 

If stress triggers your indigestion, a course of Cognitive Behavioural Therapy (CBT) can help you better deal with pressures and stressors in your life.

## What’s the best over-the-counter medicine?

‘Different preparations work better for different individuals,’ says Dr McClymont. Pharmacies will usually stock a range of over-the-counter medicines such as antacids and proton pump inhibitor (PPI) drugs as well as H2 blockers, she explains. 

‘For mild, occasional, heartburn symptoms, an antacid is generally all that’s needed,’ says Dr McClymont. ‘There are numerous brands available and a pharmacist would be able to talk you through the different options.’

Antacids work by neutralising the acid made by your stomach. Widely available from pharmacies, they’re the medication that most people turn to when they first start suffering from heartburn or indigestion — and most people don’t develop any side-effects.

H2 blockers reduce the amount of acid your stomach makes and are usually taken as tablets, soluble tablets or a drink, with or without food.

PPIs work on the cells that line the stomach to reduce the acid your stomach makes.  However, if you need to use a PPI for more than 4 weeks you should talk to your doctor. 

## I always seem to have indigestion after eating, what should I do?

‘If you have constant indigestion that hasn’t improved with lifestyle changes, talk to a doctor,’ says Dr McClymont. ‘They can discuss your individual symptoms, lifestyle and medication history, and make a plan on whether you need further treatment or investigations.’ A Kry doctor can help take you through this.

## What are the signs I need to see a doctor?

‘If you’ve tried to treat indigestion yourself with lifestyle adaptations or over-the-counter medications and are still experiencing symptoms, then it is best to see your doctor,’ says Dr McClymont. 

Talk to a doctor or Kry GP if your indigestion persists, or you experience any of the following alongside it:
- Severe pain
- Sudden weight loss without meaning to
- You’re 55 or older
- Have difficulty swallowing
- Keep being sick
- Have iron deficiency anaemia
- Feel like you have a lump in your stomach
- Have blood vomit or poo

## Could indigestion be a sign of something more serious?

‘Indigestion is common and will usually resolve quickly with lifestyle changes or over-the-counter medications,’ says Dr McClymont. 

‘Occasionally, it can be something more serious. If you’re worried, your indigestion has become persistent or it’s occurring with other symptoms then you should speak to a GP.’

Rarely, it’s a sign of something more serious for example, hiatus hernia, an infection, stomach ulcer or in rare cases, cancer. There’s probably no reason to worry, but it’s always worth discussing with a doctor if your indigestion is persistent and unresponsive to lifestyle changes. 

## How Kry can help

If lifestyle changes and medication don’t help, your doctor may refer you for an endoscopy, for further investigation. An endoscope is a long, thin, flexible tube that has a light and camera at one end so images of the inside of your body can be seen on a screen. It’s not usually painful but may be a little uncomfortable and usually takes 15-45 minutes.  This procedure can help a specialist determine any deeper causes of your indigestion and identify a course of suitable treatment.

__This article has been medically approved by Dr Rhianna McClymont, Kry Lead GP__


Kry.co.uk > Your health > Heartburn and indigestion — your questions answered

Heartburn and indigestion — your questions answered

It’s the season for eating, and that can come with feelings of a burning in the chest, gas and other signs of heartburn and indigestion. A GP gives her tips

Since the start of the coronavirus, with its limitations on mixing and face-to-face contact, naturally, more people report feeling lonelier and disconnected from one another.

But even before the pandemic, loneliness was a global issue affecting millions of people.

Around nine million people in the UK said they felt lonely, in a report by The Campaign to End Loneliness.

Now as the uncertainty of the current times continues, compounded by the darker days of winter, many people are facing more emotionally challenging times, including deeper loneliness and isolation. 

‘During difficult times, it’s natural to want to pull together and support each other’, says Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Kry. 

There are lots of situations where most people would turn to friends and family for support, like after job loss or bereavement, Gauffin points out. ‘But current social restrictions are forcing people to fall back more on their own resources and not everyone is equipped for this. 

‘If you’re feeling lonely and isolated, it can be easy to get things out of proportion, so fears and anxieties get even bigger,’ says Gauffin.

‘Most people feel lonely at times, but there are also certain life stages when you may be more likely to feel lonely, like after a divorce or moving to a new area,’ says Gauffin. 

## Loneliness and solitude — the key difference

For some people, not having to deal with social situations can be a relief. ‘Feeling lonely is not the same as being alone,’ says Gauffin. ‘You can be alone and feel perfectly content in solitude.’ 

Loneliness is the feeling that your needs for social connection aren’t being met. And it can happen not only to those who feel the lack of other people in their lives, but also to some people in relationships and communities where they don’t feel accepted and supported.

Research shows that social isolation and loneliness increase the risk of developing a variety of physical and mental health conditions. These include high blood pressure, heart disease, obesity, anxiety, depression, cognitive decline, addiction and a weakened immune system. 

Here are some expert recommendations for dealing with increased loneliness during a more restricted festive season this year.

### 1.  Meet up online

‘While there are some people who never want to attend another Zoom meeting again, if you can’t see friends or family in real life, it helps to make the effort to keep in touch with people in any way you can,’ says Gauffin.  

Making a list of the people in your life can also help you to see more opportunities to connect with others, Gauffin suggests. 

‘You can consider starting new networks, too, like an online book club. Or, arrange to have dinner with friends or family over the internet.’  

### 2.  Keep walking

A recent study has shown that even going for a walk on your own for at least 20 minutes a day can help to reduce feelings of loneliness. ‘When you’re outdoors, your world opens up,’ says Gauffin. 

‘You see nature and other people, and this is a good distraction away from your own thoughts. If you can’t see people indoors, going for a walk or a hike with a friend is a good way to connect.’ Find out more about [the benefits of walking.](/your-health/the-power-of-walking-for-your-health/)

### 3.  Maintain a healthy daily routine

Create a daily routine,’ says Gauffin. ‘Get up at the same time, have breakfast, do some work, have lunch, go for a walk and schedule in meetings and phone calls. 

‘This will stop you from falling out of sync with your natural circadian rhythms. If you’ve got things to do and look forward to, it will help you to feel less lonely.’

### 4.  Focus on things that make you feel better 

‘Ask yourself — “What do I need right now? What do I need to take care of myself better?”’ says Gauffin. 

‘Even if you’re on your own, there’s no reason why you can’t prepare a lovely meal for yourself, or do an hour of yoga or meditation. Remind yourself that you’re not the only one feeling lonely.’

### 5.  Get professional help

If you’re stressed, anxious or you’ve had a low mood for longer than 2 weeks, or nothing you do seems to be helping, a Kry GP can help.

‘Your doctor can refer you to a psychologist or psychotherapist,’ says Gauffin. ‘It could be that lockdown is bringing up issues related to experiences in your past. Also, don’t hesitate to call a helpline if you feel lonely.’

To contact the Samaritans, visit: [www.samaritans.org](https://www.samaritans.org) or call 116 123.

__This article has been approved by Madeleine Gauffin, Licensed Psychologist and Licensed Psychotherapist at Kry.__


Kry.co.uk > Your health > 5 ways to cope with loneliness this winter

5 ways to cope with loneliness this winter

It’s normal to be feeling lonely as the dark days of winter set in. Here are some healthy ways to cope

As the uncertainty in all of our lives continues, it’s understandable to sometimes feel overwhelmed, stressed and anxious. 

But there’s something a growing number of people are turning to that can help — the practice of self-compassion.

At its core, this is simply about treating yourself with the same kindness and compassion that you would show a close friend. And it comes with benefits not only to your emotional wellbeing, but also to your physical health.

### 1.	Self-kindness
Being warm, understanding and kind towards yourself when you’re suffering, feeling inadequate or as though you’ve failed 

### 2.  Common humanity
Recognising that you’re not alone and that suffering is part of the shared human experience

### 3.	Mindfulness
Observing and ‘sitting with’ your feelings as they are (see below), without trying to suppress, judge or deny them

## Do you need to be more self-compassionate?

Here are some signs that it might be good for you:
- You beat yourself up emotionally with negative self-talk
- You find it hard to care for yourself, for example by eating healthily and exercising regularly 
- You have little or no work-life balance
- You suppress and ignore your emotions
- You’re critical and unforgiving of what you perceive to be your faults, mistakes and weaknesses
- You always feel anxious and tense
- You live in the past and the future — not the present
- You drink, overeat, or smoke too much as a way to numb your feelings
- You replay conversations and situations in your head, wishing you’d done things differently
- You’re always comparing yourself to others in a negative way

## What’s the point in being more self-compassionate?

### 1.	It lowers anxiety and stress
Giving and receiving care to others is part of the human survival instinct, that helps us feel safe and connected to family and friends. 

Showing this same care to ourselves also activates this system through self-soothing activities, like touch and kind self-talk. This triggers the release of the love or bonding hormone oxytocin, which can help reduce anxiety, stress and fear. Oxytocin is produced when we touch ourselves and others, hug and have sex. It’s also produced by new mothers when they caress their baby, and also during breastfeeding.

### 2.	It can improve physical health
Oxytocin reduces levels of stress hormones like cortisol and adrenalin. Chronically raised levels of stress hormones can be harmful to the body, contributing to problems with your digestive, reproductive and circulatory systems. 

### 3.	It might support immunity
When stress hormones are elevated for long periods, the immune system can become weakened too. Being kinder to yourself calms the heart rate, toning down the body’s fight-or-flight stress response – helping reduce stress hormone levels.

### 4.	It could help you cope with pain
Research shows that self-compassion helped women cope better with difficulties relating to chronic pain. It also helped them engage more in activities they enjoyed — despite the pain — which helped decrease depressive symptoms.  

### 5.	It might help you reach your goals
Being more accepting and compassionate toward yourself — and less critical — makes you better able to deal with failure. That means you’re more likely to take the calculated risks needed to reach your goals. 

A recent study shows that people who were low in self-compassion were more likely to experience psychological distress when they had a setback. This often caused them to disengage and give up. 

On the other hand, the more self-compassionate people were less likely to show negative emotional reactions. Self-compassion can help you perceive setbacks as a normal part of life. That means you’re more able to regulate your emotions when things don’t go to plan (which is often!)

## How to be more self-compassionate, every day

Self-compassion is a skill that takes practice. These tools can help:

### Use self-soothing phrases
Learn some phrases that resonate with you that you can repeat silently whenever you feel anxious, overwhelmed or distressed. Kristin Neff suggests these:
- May I be kind to myself in this moment
- May I give myself the compassion I need
- May I learn to accept myself as I am
- May I forgive myself
- May I be strong
- May I be patient

### Rate your behaviour, not yourself
This means reframing your inner critic in a friendly, positive way. For example, rather than feeling bad and disgusted with yourself for overeating, instead tell yourself: ‘I know you ate all the chocolate/biscuits, but that’s okay. You’re feeling sad and you thought it would help. But it’s made you feel even worse. Why not go for a long walk so you feel better instead?’  

### Keep a self-compassion journal
Try this for a week or so. Every evening, write down the day’s events that have made you feel bad about yourself. Maybe you were rude to someone or didn’t call a friend when you said you would.  

Rather than berating yourself, write down how you feel — for example, you’re disappointed in yourself. Then think about what led you to behave that way: were you frustrated? Tired? Or feeling overworked? 

Write down some words of kindness and comfort toward yourself. Forgive yourself and accept that you messed up — maybe you can do it differently next time.

### Take a moment to listen to yourself
You might be a good listener for others, but self-compassion is about becoming a good listener for yourself too. Try this whenever you feel anxious, overwhelmed or self-critical:  
- Take a moment to sit quietly and focus on your breathing
- Notice and name your emotional experience — for example ‘I’m feeling anxious’
- Become aware of where you feel it in your body. It may be a tightness in your chest or throat. Emotions are commonly felt somewhere in the body as physical sensations
- Remind yourself that you’re not alone, that everyone feels like this at times and that it’s only a feeling; it will pass. And it can’t hurt you
- Soothe yourself with kind words or gestures — what would you say to or do for a friend feeling like this? 
- Place your hand where you feel the emotion most intensely in your body (this is commonly the heart, throat or abdomen but may be somewhere else for you) and gently breathe. Focus on the warmth of your hand and allow yourself to feel more soothed, accepted and loved. 

__Reviewed By: Dr Rhianna McClymont, Lead GP, Kry__


Livi.co.uk > article page > What is self-compassion — and why does it matter > call out

Kry.co.uk > Your health > What is self-compassion — and why does it matter?

What is self-compassion — and why does it matter?

Learning to show yourself kindness and compassion can benefit your health — both physically and mentally

Want to know the answer to the question: how much should I weigh? It’s probably not surprising that there’s no one-size-fits-all answer. Calculating your overall health is complicated, but there’s one simple method many people use – and that’s BMI. 

BMI stands for body mass index. It takes your age, height and weight into account, and gives you a score on a chart ranging from underweight to extremely obese. The healthiest weight is somewhere in between. 

BMI has its limitations – like not considering your distribution of fat and muscle – but it’s a good way to understand whether you’re at a generally healthy weight.

## Benefits of a healthy BMI

- Reduced risk of Covid-19 complications
- Reduced risk of type 2 diabetes
- Reduced risk of [cardiovascular disease](https://www.livi.co.uk/medical-advice/cardiovascular-disease/) and [heart attacks](https://www.livi.co.uk/medical-advice/cardiovascular-diseases/heart-attack/)
- Fewer joint and muscle problems
- Improved fertility
- Better mobility and self-confidence

## How to lower your BMI

The best way to lower you BMI is to make simple changes towards a healthier lifestyle. Here are some things you can do to help.

### 1.  Don’t bother with crash diets

Ever put yourself on a serious diet to lose weight quickly before an event? Or tried to keep up with so many diet trends that you flick from one to the next? It happens.

But these ‘quick fix’ diets do not work for the longer term, and are certainly not the best way to lower your BMI. You’re likely to lose weight fast because of the dramatic change, but it’s not sustainable to adapt your eating habits this way indefinitely.

A balanced, calorie-controlled diet is the ticket to a healthy BMI – the safe way. By making simple [healthier food swaps](https://www.livi.co.uk/your-health/8-ways-to-make-healthier-food-choices-every-day/), reducing portion sizes and cutting down on high-calorie food and drink, you’re more likely to reach a healthy BMI steadily, and keep the extra weight off.

### 2.  Look out for hidden sugar

The government recommends that adults should have no more than 30g of sugar a day (roughly equivalent to 7 sugar cubes), children aged 7 to 10 should have no more than 24g of free sugars a day (6 sugar cubes), and children aged 4 to 6 should have no more than 19g of free sugars a day (5 sugar cubes). 

Consuming more than the recommended amount of sugar can be a real hindrance to achieving, or maintaining, a healthy BMI. When trying to lose weight, many of us make the decision to cut down on sweet treats and fizzy drinks – but unfortunately, sugar often creeps into a lot of unexpected foods. Examples include:
- Pasta sauces
- Granola and cereal bars
- Salad dressings
- Tinned fruit in syrup
- Coleslaw
- Ketchup
- Shop-bought soups

If you’re trying to reduce your sugar intake, think about the surprising sources of hidden sugars, as well as the obvious ones, like cake and chocolate. Take your time when doing the food shop and check pre-packages products for their sugar content. 

### 3.  Get your heart pumping

It’s no secret that the more you exercise, the more you can lower your BMI, healthily. NHS recommends doing at least 150 minutes of moderate intensity exercise a week (for example a [brisk walk](https://www.livi.co.uk/your-health/the-power-of-walking-for-your-health/), hiking or cycling), or 75 minutes’ vigorous intensity. You should mix up cardio and strength training to strengthen key muscles and achieve better weight loss results.

Vigorous intensity activities include:
- Running or jogging
- Fast swimming
- Cycling fast or uphill
- Gymnastics
- Using a skipping rope
- Martial arts
- Playing sports like football, rugby and netball

And don’t worry about the cold weather approaching. There are still plenty of [benefits of exercising outside in winter](https://www.livi.co.uk/your-health/5-reasons-to-keep-exercising-outside/) – like better immunity and a boosted metabolism – so you don’t need a gym membership if you don’t want one. 

### 4.  Simply move more

Sometimes it’s hard to find the time for a proper workout – work and family commitments might get in the way. If you’re looking to add more exercise to your daily life, but can’t commit to a strict gym routine, simply get moving throughout the day to burn calories. 

Walk or cycle to work if you can, and choose stairs over the lift. These are not only healthy changes towards a healthier BMI, they’re also very suitable with social distancing guidelines in place.

Using a step tracker on your phone is a good way to see how much you’re really moving day-to-day. If you can’t get to the gym, try to walk 10,000 steps a day, even if just running errands. It can help more than you may think. 

Ready to make the effort to maintain a healthy BMI? Try using the [NHS BMI calculator](https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/) to see where you fall on the scale, and get suggestions for managing your weight. 

### 5.  Get the right support

When working towards a healthy BMI, many people find it easier spending time with others who have the same goal. You could try a group weight loss programme, gym support groups and classes, or even just a social media community with like-minded people.

Even just the right encouragement from friends and family can make a huge difference to your success. If you have a friend in the obese or overweight range, go on a health journey together and check in with each other regularly. If you live with your partner or have a family, cook vibrant, tasty meals with plenty of goodness they’ll enjoy. By making these few simple lifestyle tweaks, you can be well on your way to a healthier BMI.

Want to make your lifestyle changes permanent? Try these tips to help make your new [healthy habits stick](https://www.livi.co.uk/your-health/5-habits-for-living-a-healthier-lifestyle/). 
__Reviewed By: Dr Rhianna McClymont, Lead GP, Livi__

kry.co.uk >article page > CTA

See a GP about your BMI

Livi.co.uk > Your health > 5 simple tips for a healthy BMI

5 simple tips for a healthy BMI

As we become more aware of the risks of obesity, it’s important to keep to a healthy body mass index (BMI). Follow these 5 simple tips for success.

Kry.co.uk > Your health > 5 simple tips for a healthy BMI

5 simple tips for a healthy BMI | How to lower your BMI | Kry UK

## Quick facts
- Cytokine storm increases the risk of serious complications from Covid-19
- It happens when the immune system attacks the body’s healthy tissue
- Doctors are now starting to spot the early signs
- Medications can be used to reduce the risk of cytokine storm

We often see advice about ‘boosting’ the immune system. But an effective immune response is a balancing act that involves releasing the right chemical messengers and defenders, in the right amounts, at the right time.

If that goes wrong, all sorts of things can happen. Reactions like allergic asthma and hay fever, and auto-immune conditions like rheumatoid arthritis, multiple sclerosis and psoriasis are all examples of the body triggering an immune response when it should not. 

Cytokine storm is an example of one such auto-immune malfunction. This is how it works.

## How your immune system fights disease

Immune responses are driven by a family of chemical messengers known collectively as cytokines, that are released by the immune system to help fight illness. 

When the body perceives a threat, or tissues are damaged by an injury, bacteria, or virus, this triggers the release of pro-inflammatory cytokines. These quickly go to work recruiting and activating immune cells to fix the problem.

These inflammatory cytokines increase blood flow and instruct blood vessels to leak fluid into surrounding tissues. This leads to swelling, designed to trap foreign substances and stop them coming into contact with healthy tissue. It’s all part of the healing process.

These chemical messengers also step up production of T-cells and other ‘defender cells’. These seek out and destroy invaders such as viruses and bacteria.

In the short term, this flurry of activity by the immune system protects healthy tissue and promotes healing. 

But in the long term it’s not sustainable. So, our immune system also has a collection of anti-inflammatory cytokines, which put the brakes on these inflammatory responses. This should happen when the job of healing is done and you’re getting better.

## Cytokine storm — an immune system in overdrive

If this does not happen, the immune system continues its fighting process but then starts to damage healthy tissue. This happens with auto-immune conditions like multiple sclerosis and rheumatoid arthritis. It also happens to some Covid-19 patients — known as cytokine storm.

When these anti-inflammatory cytokines cannot switch off, they cause more inflammation. That leads to more cells damaged, and more pro-inflammatory cytokines flooding the body. 

As a result, blood vessels can become so leaky that the lungs fill with fluid, and blood pressure drops – which reduces oxygen levels throughout the body. Blood begins to clot, which further reduces blood flow to vital organs. As organs begin to fail, patients can go into shock and face permanent organ damage, or in the worst case, death.

## How spotting the early signs of cytokine storm is saving lives from Covid-19

Unsurprisingly, cytokine storm dramatically increases the risk of becoming seriously ill with Covid-19, and it is thought to be a factor in most Covid-related deaths.

But the good news is that this knowledge is already saving lives and improving outcomes.

It’s early days but by spotting the signs of cytokine storm, doctors are beginning to find ways of taking steps to help prevent it from making a patient seriously ill. 

These signs include raised blood levels of certain inflammatory biomarkers. By checking for these markers, doctors are starting to identify patients most at risk and treat them before cytokine storm takes hold.

Steroid medication can be used to damp down inflammation and minimize tissue damage, especially in the lungs, while blood-thinning drugs can be administered to prevent potentially life-threatening blood clots. ‘The use of steroids and blood-thinning drugs were 2 major milestones in the standard of care at the intensive care units during spring to help prevent life-threatening serious complications for Covid-19 patients’. 

However, there’s still a lot that doctors don’t know about cytokine storm, and the different chemical messengers that switch inflammation on and off. There are no simple answers. 

Genetics, individual immune memory, and any number of other factors such as our general health and nutrition, are all likely to influence our immune system responses. 

What’s needed now is more research to work out how, and when, to accelerate our immune responses to Covid-19: and how, and when to put the brakes on before they can spiral out of control.

__This article has been medically approved by Dr Annette Alaeus, Head of Infectious Diseases at Livi.__


Livi.co.uk > Your health > What is cytokine storm?

Header-GettyImages-1220126596

People with Covid-19 can experience an extreme immune system response known as cytokine storm. Dr Alaeus, Head of Infectious Diseases at Kry, explains

Kry.co.uk > Your health > What is cytokine storm?

What is cytokine storm?

kry.co.uk > General health and seasonal > Articles 

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