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General health

__Wash your hands frequently.__  Especially whenever you leave or enter a building, before or after cooking and eating, or after touching surfaces or objects outside your house. Use soap and warm water and wash well for at least 20 seconds. Use hand sanitiser gel if soap and water are not available.

__Clean other objects and your surroundings frequently.__ Objects, especially objects outside the house or things that get touched often – like computers, door knobs, pens and phones – can spread infection. Keep them clean with antibacterial spray.

__Avoid touching your face and eyes.__ Do not touch your eyes, nose or mouth if your hands are not clean. This will be difficult because as humans we’re hardwired to touch our faces a lot. So when you aren’t able to easily wash your hands, make sure you are applying hand sanitiser regularly while you’re outside your home.

__Cough and sneeze into a tissue.__ Then throw it away. If you don’t have one, use a handkerchief and wash it, or use your armpit or elbow. Wash your hands afterwards!

__Put used tissues in the bin immediately.__ Then wash your hands again! Don’t leave them lying around or in your pocket.

Of course the best way to reduce catching or spreading infection is to stay at home as much as possible and avoid contact with others - especially elderly people. Remember whenever you need a GP and can’t leave home, you can usually get an [appointment with a Kry GP](/gp-appointments-online/) in minutes.

__Reviewed by:__ Hemal Shah, Lead GP Kry


kry.co.uk > Your health > How good hygiene can protect yourself and others from coronavirus

COVID-19 spreads primarily through close contact with someone who is infected, but it can also spread if you touch contaminated objects and surfaces. So good hygiene is critical to protect yourself and others from the virus.

How good hygiene can protect yourself and others from coronavirus

kry.co.uk > Your health > How good hygiene can protect yourself and others from coronavirus 

General health and seasonal

5 ways that good hygiene can reduce the spread of infection

There’s plenty written about salt, but sometimes the advice can be confusing. We’re warned not to eat too much and then we watch TV chefs and bakers throw handfuls of salt into their recipes. So we’ve put together a no-nonsense guide to how to manage salt in your diet.

## How much salt are we supposed to have? 

Adults (and children aged 11 and over) should have no more than 6g per day. That’s just a level teaspoonful. Children under 11 should have half that. And babies should have none at all.

## Is salt really bad?

Salt in itself is actually critical to life – but only in tiny amounts. It’s also vital in bringing flavour to food. So it’s not about cutting out salt altogether – just making sure you don’t regularly have too much – or too little. 

The main problem with salt is that sodium can cause high blood pressure which is a leading cause of strokes and a major risk factor for coronary heart disease.

One analysis of 13 other studies found that an extra 5g of salt per day produced a 17% greater risk of total cardiovascular disease and a 23% greater risk of stroke.*

But studies have also shown that having less than 3g a day can produce worse health outcomes in people than those who had 4-5g! 

So as ever, it’s about balance and sticking to the recommended amount - unless you have a particular condition and have been given specific advice by your GP.

## How to reduce your salt intake.

If everything you eat was home-cooked, avoiding excessive salt would be easy – you’d simply be careful regarding how much you added to your food. There are plenty of ways to add additional flavour without using lots of salt – like garlic, herbs and more adventurous spices, or even just a low-sodium salt.

But for most people, 75% of the salt we eat comes from the processed food in our diets. So that means we need to stay aware of foods we eat often without realising their salt content. 

## So where is the hidden salt? 
Here are some processed foods to watch out for.

### The familiar enemies 
There are a bunch of foods that tend to be naturally salty and taste salty - so they’re easier to spot and avoid. These include: bacon and other cured meats, hard cheese, yeast extract, soy sauce, stock cubes, salted nuts and crisps.

### The old offenders.
Many of the traditional offenders such as breakfast cereals, biscuits and meat sausages have reacted to negative coverage of their high salt content and reduced salt – often by as much as 50%. But it’s always important to check the label – especially with foods you eat regularly.

### The new dangers 
Things like ready-meals and processed ‘snack’ foods remain the biggest offenders. 

- __Vegetarian foods__ 
As vegetarianism and veganism become more popular, the market for meat-free products is booming. However many of these products try to pack in more flavour with dangerous levels of salt. Some examples include Quorn sausages which have 1.1g of salt per sausage, and certain vegan sausage rolls. 

- __‘Healthy’ snack foods__
Other seemingly ‘healthy foods’ like houmous, falafels and olives. Some of the olives in past tests had 5g of salt per 100g – double the amount of seawater itself.**

- __Meat replacements.__
[A recent study](http://www.actiononsalt.org.uk/salt-surveys/2018/meat-alternatives-survey/) by Action on Salt focussed on 157 meat replacement supermarket products. Some of the results were startling. Tofurky's Deli Slices Hickory Smoked had 3.5g of salt per 100g and Tesco Meat Free Bacon Style Rashers, 3.2g of salt per 100g. 

As well as finding that many of these products had more salt than the meaty versions they replaced, it was clear that the salt content varies dramatically between the same food from different brands or supermarkets. Meat-free mince had huge variations in salt content of up to 83%  across supermarkets.

### How to be sure of your salt intake. 

When it comes to salt content in processed food, there’s only one way to be sure of what you’re eating and that’s to check the label! Even if you’ve eaten the same food by a different brand previously, or you think it’s healthy, check first. Then, wherever possible, keep processed foods to a minimum. Combine that with plenty of home-cooked food and a balanced diet, and your salt intake should be nothing to worry about at all. 

__Reviewed by:__ Dr. Asimah Hanif
March 4 2020

    *
[https://www.bmj.com/content/339/bmj.b4567](https://www.bmj.com/content/339/bmj.b4567)

    **
[https://www.theguardian.com/society/2019/aug/15/salt-levels-in-picnic-foods-dangerously-high-health-group-warns](https://www.theguardian.com/society/2019/aug/15/salt-levels-in-picnic-foods-dangerously-high-health-group-warns)


kry.co.uk > Your health > the hidden dangers of salt

The hidden dangers of salt

Excess salt can often be found in surprising places. Find out where, and discover how much salt we should be eating.

kry.co.uk > Your health > the hidden dangers of salt >metainfo

Sleeplessness is on the rise. A recent study found that 67% of UK adults suffer from disrupted sleep, with 23% getting no more than 5 hours a night.* And although some people can manage on less, most of us need between 7 and 9 hours sleep to function effectively – with children and teenagers needing even more. 

There are many different reasons for this increase in sleeplessness as insomnia reflects a wide range of issues – from depression to certain physical conditions, shift work through to stress. Because of this, it’s important to explore the particular reasons for your own insomnia - especially if it lasts more than a couple of months.

*“Sleep helps prevent heart disease, diabetes and depression, boosts your immunity and can even increase fertility and sex drive. So it’s worth taking seriously. If it was a medicine, our GPs would prescribe it to everyone!”*
__Dr Asimah Hanif, Lead GP Kry.__

## Do you suffer from occasional or short-term sleeplessness?
For most people, sleeplessness happens from time to time and although it’s frustrating and tiring, it’s not long-lasting. In fact it’s perfectly normal and worrying about it can actually make things worse. 

If it happens more regularly, it’s worth thinking carefully about the things that might be causing the problem – it could be something that’s worrying you or a change to your usual sleep routine. Try keeping a sleep diary and make a note when you sleep badly and when you sleep well. This diary will also be useful if you need to discuss it with a GP at any point.

Some of these simple sleep tips may also help - but remember different things work for different people, so it’s worth trying different things. 

- Exercise during the day (but just not before bed).
- Avoid alcohol,  heavy meals and caffeinated drinks before bed.
- Go to bed and get up at the same each day.
- Try a warm (not hot) bath an hour before you go to bed.
- Get a comfortable bed, mattress and pillows – you spend a third of your life in bed!
- Don’t use your mobile or computer in bed (or at least an hour before bed). 
- Try listening to calming music or reading a book.
- Make sure your bedroom is dark and quiet – use thick curtains, blinds, an eye mask or ear plugs.

You may want to __see a pharmacist__ for sleep aids. However these can make you drowsy the next day.

## When lack of sleep becomes a long-term problem
If you’ve tried the techniques described above, your insomnia has lasted a few months or more, or it’s making it hard to cope with your daily life, do talk to a GP. In severe cases our GPs may be able to refer you to psychology services such as CBT (Cognitive Behavioural Therapy) to help uncover the underlying reasons you can’t sleep. However, only in rare circumstances will they prescribe medication. They can also refer you to a range of NHS approved sleep apps which use different techniques to help you beat insomnia. 

If it’s less severe, the GP will be able to help identify and advise on the possible causes of your insomnia and give guidance on good sleep hygiene.

*Aviva: Sleepless cities revealed that one in three adults suffer from insomnia. 

*__Reviewed by: Asimah Hanif, Lead GP, Kry__*

kry.co.uk > Your health > Sleep special

How to sleep better. 

The health benefits of sleep are extensive. So how can you beat insomnia and get a better night’s sleep?

How to sleep better

Struggling with sleep? You're not the only one. The good news is there are now lots of apps to help you sleep, but here are three of the best NHS sleep apps that won't break the bank.

Although there are many other apps available, these have been more rigorously assessed by doctors or had clinical trials. 

## Sleepio
Sleepio is described as an online sleep improvement programme based upon the principles of Cognitive Behavioural Therapy or CBT. Because it’s been clinically proven to work, it can be prescribed for free on the NHS by your GP. But of course that doesn’t mean it will work for everyone. The programme focuses on resetting your sleep patterns naturally over time, via a series of 20-30 minute ‘meetings’ with a virtual sleep expert. It’s available on their [website](https://www.sleepio.com/) or as an app and is available by referral from [GPs in certain areas](https://www.bighealth.com/NHS) and via certain NHS psychology services. 
## Sleep Station
One of the highly-recommend apps to help you sleep, this 6-week online course starts with you completing a 7-day sleep diary. It then provides personalised advice to help you start sleeping better, with regular reviews and a support team to help. It covers both the quality and the length of your sleep and tracks your progress to make sure the recommendations are working. Courses start at £95. 
## Pzizz
Pzizz is an NHS-recommended sleep app that focuses on calming the mind, to reduce the anxiety or ‘racing thoughts’ that can sometimes cause insomnia. It mixes music, voice and sound effects to help you sleep during the night and take effective naps during the day. Using headphones (or your phone speaker) at night, Pzizz can help manage your sleep automatically throughout the night and wake you up gently with your own personal alarm call. The app is free, but does feature some in-app purchases.

For more information on the above apps to help you sleep, and how they are chosen and assessed, visit the NHS sleep apps page. 

*__Reviewed by: Asimah Hanif, Lead GP, Kry__*

kry.co.uk > Your health > Sleep apps

NHS-recommended apps to help improve your sleep.

With the rise in ‘sleep tech’, we take a look at three apps that the NHS recommends to help you sleep better. Although there are many other apps available, these have been more rigorously assessed by doctors or had clinical trials. 

kry.co.uk > Your Health > Sleep apps > Meta info

Apps to Help You Sleep - NHS Recommended Sleep Apps (Free & Paid)

NHS recommended apps to help improve your sleep

If you’re off work sick, you don’t need the added worry of working out when you need a fit note – or having to explain yourself to your boss. So here’s a quick guide on what to do when you’re not well enough to work.

## What is a fit note? 
Although most people still know them as [sick notes](/gp-appointments-online/sick-notes/), the official name when a GP signs you off work is a fit note! Confusingly you only need one when you are sick! They’re also sometimes called doctor’s notes or medical statements. 

## When do I need a fit note?
If you’ve been ill for less than 7 days your employer shouldn’t ask for a fit note. Instead, you can self-certify by completing a form that your employer should supply.

If you’ve been ill for 7 days or more consecutively you do need a fit note. Don’t forget that every day counts towards that 7 days – including weekends or bank holidays. 

## Seeing a GP for your fit note assessment.
When you see the GP, they will do an assessment of your health. They may decide you aren’t fit for work, or that you are fit for work – but only under certain circumstances. They might suggest that you can’t do certain tasks, need to limit your hours or require more help to do your job. However this still counts as unfit for work if your employer can’t or won’t accept those limitations. 

## Do schools need fit notes for children? 
Schools should not request fit notes for children and it’s not a GP’s job to supply them. But a GP may be able to advise the school in relation to long-term health conditions. 

*Reviewed by: Asimah Hanif, Lead GP, Kry*

kry.co.uk > your health > fit notes

How do fit notes work? 

Fit notes, sick notes, doctor’s notes… what they are and when you need one if you’re off ill. Here’s a quick guide on what to do when you’re not well enough to work.

kry.co.uk > your health > fit notes > metinfo

What is a Fit Note & How Do They Work?

How do fit notes work?

For millions of people, the arrival of a new year feels like a good time to make a fresh start. However evidence suggests that our natural inclination to eat and sleep more in winter can make it a tough time to start a new health regime. So if you’re planning to set yourself a health-based New Year's resolution, here are a few tips to help make it a success.

1. __Start small.__
Having a small goal that you succeed in will motivate you to continue or extend it. Try setting yourself a more achievable goal, or a series of developing goals. For example - try eating more grains, fruit and vegetables for just one day a week – and add more days as you get used to it. 

2. __Focus on one thing.__
It’s easy to find lots of things we’d like to improve about ourselves. Aim to choose one thing that you haven’t tried before and that you know will have the most health benefits. 

3. __Try something different.__
The classic New Year’s resolutions – losing weight, running a 5km race, giving up alcohol - are all very well, but finding something that really works for you is more motivating. If you want to be more active - set yourself a time to be active and try different things – a walk, a class or a swim. 

4. __Do it for yourself.__
Try not to set a resolution with someone else. It may seem like a nice idea to have a running partner for example, but if they give up it’ll make it harder for you to continue. Instead, find people who already pursue that activity like a parkrun or campaign like Dry January to encourage you if you flag.  

5. __Be patient.__
Studies show that developing a new habit – the key to making successful health changes – takes at least two months - and often more. So stick with any changes you make – the more you do them, the easier they’ll get. 

Above all remember that nobody’s perfect – so don’t put too much pressure on yourself and if you slip up, just start again – don’t give up. You won’t regret it. 

*Reviewed by: Asimah Hanif, Lead GP, Kry*

kry.co.uk > Your health > New year resolution

How to succeed at New Year’s resolutions.

Finding the right resolution for you – and the right mindset – is crucial to succeed in making a positive change.  If you’re planning to set yourself a health-based New Year resolution, here are a few tips to help make it a success.

kry.co.uk > Your health > New years resolution > metinfo

How to succeed at New Year’s resolutions

Look in your kitchen or bathroom cupboard and the chances are there’s a half-used jar or two of vitamins in there. Most of us know that vitamins are medically important for our health – but which do doctors actually recommend we take regularly as supplements? 

## A balanced approach to vitamins
For most people, most of the time, a well-balanced diet combined with sensible exposure to sunlight will produce all the vitamins they need naturally. Vitamins can’t truly replace a balanced diet. So apart from those mentioned below, most GPs only recommend vitamin supplements on a case-by-case basis – for example those with restricted diets or certain medical conditions. 

## But be careful with fizzy vitamins – they often contain salt
Effervescent vitamin supplements can contain large amounts of salt – sometimes as much salt as in 2 bags of crisps! That’s because of the sodium bicarbonate which enables them to fizz and dissolve. Always check the label and consider changing to a normal tablet - especially if your salt intake is already high. 

## The vitamins GPs recommend taking
### Vitamin D.
__Who?__ Everyone aged 1 and over.  
__When?__ Daily – in Autumn and Winter.

It’s now clear that the amount and strength of the sun in the winter months is not enough to produce all the vitamin D we need. It’s also very hard to get it from diet alone. So the advice is that everyone takes at least 10 mcg daily. 

__Who else?__ Those with a higher risk of Vitamin D deficiency.
__When?__  Daily – all year round.

The following people should consider taking Vitamin D all-year-round: People with dark skin. People who cover all their face and skin when outside. People who get less exposure to the sun due to their age or physical condition. 

### Vitamins A, C and D. 
Who? ALL Children aged from 6 months to 5 years
When? Daily – all year round. 

Essentially a precaution, this is to make sure that growing children – especially those who are fussy eaters or don’t get a varied diet – receive all the vitamins they need. 

__Folic Acid.__
Who? Pregnant women.
When? Daily – from conception to 12 weeks of their pregnancy.

All women thinking of having a baby should take Folic Acid up to week 12 of the pregnancy.

*Reviewed by: Asimah Hanif, Lead GP, Kry*

kry.co.uk > Your health > Vitamins

Vitamins

The vitamins that doctors recommend taking

While many people don’t enjoy the Winter months, for some the shorter days can have more serious effects. This is because around 2 million adults in the UK experience Seasonal Affective Disorder or SAD, which is a type of depression triggered by the darker days in Winter.

## What causes SAD? 
The exact cause is not known, but the lack of sunlight appears  to be important. This is probably due to its effects on brain chemicals such as serotonin and the hormone melatonin which helps to regulate our mood.

## How do I know if I have SAD?
Many of the symptoms of SAD are similar to those of depression: a persistent low mood; a loss of interest in everyday activities; and feelings of despair or worthlessness. These are often combined with lethargy, sleeping for a long time and finding it hard to get up, as well as craving carbohydrates and putting on weight. 

Some people may only experience SAD for the first time between the ages of 20 and 30 and __SAD affects four times as many women as men__. 

__Can vitamin D help?__
In short, no. Despite research, there is no proven effect of increased does of vitamin D on SAD. 

__When Livi can help.__ 
You should speak to your GP if you have most, or all of these symptoms and they are really starting to impact on your day-to-day activities and you’re struggling to cope. Your GP can help you identify the causes, point you to support, resources and initiate treatment if indicated.

If SAD is diagnosed, some lifestyle measures such as exercising more in daylight, using a light-box, eating nutritious food and sleeping properly may work for some people. For others, talking therapies and, in severe cases, antidepressants may be necessary.

*Reviewed by: Asimah Hanif, Lead GP, Livi*

livi.co.uk > Your health > SAD

SAD –  Seasonal Affective Disorder 

kry.co.uk > Your health > SAD > Metainfo

When Winter gets you down.

When Winter gets you down

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

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