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General health

Why and how we choose to lose weight or maintain a healthy weight is very much down to the individual. Our weight can be affected by medical, mental and emotional factors, and it’s also common for our weight to fluctuate throughout the day or at different points of the menstrual cycle. 

‘Our relationship with food and drink, and what, how and why we eat, is fundamental to how we manage our weight,’ says Dr Menon. ‘We’re learning more and more about the negative effects of being overweight.’ 

Being overweight or obese can increase the risk of chronic conditions like heart disease, while [new studies](https://www.medrxiv.org/content/10.1101/2020.04.23.20076042v1.full.pdf)  have shown it can also increase the risk of becoming seriously ill from Covid-19. 

Don't believe all the [weight loss myths](/your-health/5-weight-loss-myths-exploded/) out there, the key is to keep a healthy mindset. Here, Dr Menon shares 5 key things to remember when thinking about sustainable weight loss or maintaining a healthy weight. 

## 1. There’s no set ‘healthy weight’, but there are measures to help guide you 

The body mass index (BMI) tool will give you a rough idea of a healthy weight for you. ‘It’s a guide, not a rule, and there may be reasons for being overweight despite being healthy,’ says Dr Menon. That said, it’s currently the measure favoured by the medical community.

Your [BMI](/your-health/5-simple-tips-for-a-healthy-bmi/) is calculated by dividing your weight in kilograms by the square of your height in metres and can help identify if a person is overweight or obese. Obesity is classified as a chronic illness and can be treated in different ways, while you can usually manage being overweight with lifestyle changes.

‘Another useful measure is waist circumference,’ adds Dr Menon, explaining that [carrying extra weight around your waist](/your-health/is-your-waste-size-putting-your-health-at-risk/) increases your risk of developing type 2 diabetes.

__In summary:__ 
- Monitoring your BMI and waist circumference can help you understand what’s a healthy weight for you.

## 2. For sustainable weight loss, small healthy changes are best 

‘There are no tricks or shortcuts,’ says Dr Menon. ‘A well-balanced diet and exercise are the cornerstones. Find out what works for you and build in new habits incrementally, as you’re more likely to stay on track when times are difficult if you take it slow and make it fun. Explore new foods and more active ways of getting around, like [walking](/your-health/the-power-of-walking-for-your-health/) or cycling.’

If the weighing scales are triggering for you, simply manage your goals and healthy habits instead, and perhaps keep an eye on your waist size. Your healthy habits will likely pay off in obvious ways, and you’ll feel better in the long run.

__In summary:__ 
- You’re more likely to stick with simple lifestyle changes built into your daily routine than with drastic, restrictive rules.
- Develop new healthier habits that work for you.

## 3. Maintaining a healthy weight or losing just a small percentage of your weight comes with big health gains

There are countless benefits of maintaining a healthy weight, including the significantly lowered risks of heart disease, type 2 diabetes, muscle and joint problems, and some cancers. There’s even [significant evidence  ](https://www.bmj.com/content/359/bmj.j4849.long)that maintaining a healthy weight reduces mortality.

Losing weight can also improve your fertility and quality of sleep, and for some, it can be a self-esteem boost.

Losing as little as a few kilograms can have meaningful positive impacts. ‘There’s strong evidence that weight loss lowers the blood pressure of people who are overweight,’ says Dr Menon. ‘Given that high blood pressure is a huge risk factor for heart disease and [stroke](/your-health/spotting-the-signs-of-a-stroke-a-doctors-guide/), there are great health-saving opportunities to be had from losing just a little.’

__In summary:__
-	The benefits of maintaining a healthy weight – or losing a small percentage of your bodyweight if you’re overweight – are dramatic and wide-ranging.

## 4. Keep it simple with what you eat and avoid restrictive fad diets

Dr Menon advises against fad diets – they’re often unsustainable and sometimes based on flawed science. 

There’s [evidence to suggest that diets low in carbohydrates](https://www.bmj.com/content/363/bmj.k4583.long)  are more effective for lasting, sustainable weight loss and management. This is because carbs impact our blood glucose levels, which affect our blood sugar and insulin levels, as well as the way we store fat. 

A more straightforward approach to weight loss is to aim to eat fewer calories than you use up. 

‘We start to lose weight when we’re in a negative energy balance: when the energy we use is greater than what we consume,’ Dr Menon explains. ‘It may seem obvious, but this can be difficult to remember in a world where we’re constantly bombarded with exercise plans, diet menus and foods we should avoid. 

‘Eat a little less, and eat mainly plants – this is the only unshakeable truth.’

__In summary:__
-	For most people, sustainable weight loss or management is simply about continuously eating a little less while keeping active.
-	There’s evidence to show the benefits of replacing some carbohydrates with vegetables and other plant-based foods.

## 5. Steady and sustainable weight loss is better than losing weight quickly

‘Restricting certain foods for an extended period can lead to nutritional deficiencies, when our body doesn’t get the necessary amount of nutrients. If we deprive ourselves of the food our bodies need, we’re risking our health considerably, particularly as we start to eat again,’ Dr Menon explains. 

‘I’d recommend making small, steady adjustments that allow your body’s appetite regulation and energy use and storage to sync. When we rush weight loss, our bodies often become out of sync and we’re more likely to rebound,’ says Dr Menon. In fact, drastically reducing your calorie intake actually triggers [a hormone response that makes you hungrier](https://journals.physiology.org/doi/full/10.1152/ajpregu.00755.2010).  

__In summary:__
-	Losing weight quickly doesn’t give our body enough time to adapt, and we can do more damage than good. 
-	Be patient, and your small changes will pay off.

__This article has been medically approved by Kry Lead GP Dr Samuel Menon.__


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Speak to a GP about healthy weight loss

Kry.co.uk > Your health > 5 things to know about sustainable and healthy weight loss – according to a doctor

5 things you need to know about sustainable and healthy weight loss – according to a doctor

How can I lose weight healthily, and what’s the most sustainable way to do it? Lead GP at Kry, Dr Samuel Menon, shares the key things to know

Kry.co.uk > Your health >5 things you need to know about sustainable and healthy weight loss – according to a doctor

Sustainable and healthy weight loss – doctor’s guide | Kry UK

General health and seasonal

It’s not only the sun that comes out in summer. Hot weather also brings with it stinging insects and animals. The good news is that you can follow these simple steps to lower your risk, and here’s what to do if you get bitten or stung to reduce the discomfort.

## How to prepare against bites and stings

Make sure you cover up with loose clothing and use a repellent when you’re outdoors – particularly around water, long grass and woodland. If you’re in grassy, shady areas, be mindful of [ticks](/your-health/tick-bites-what-you-need-to-know/). Insect repellents containing 50% DEET provide up to 12 hours’ protection.

If you prefer a more natural insect repellent, some evidence has found that lemon eucalyptus, citronella and linalool oil may have proven repellent properties.

## What to do if you do get bitten or stung

Most discomfort and itching from bites and stings is short-lived and won’t require medical treatment. A cold compress, ice pack or bag of frozen peas should provide sufficient relief.

Discourage children from scratching bites as it increases the risk of infection.

For persistent itching, adults and children over 10 years can use a mild hydrocortisone cream, which is available from most pharmacies. 

For painful bites, try paracetamol syrups for infants aged from 2 months, and tablets or syrups to children aged above 6 years. Alternatively, you can give ibuprofen to babies from 3 months. However, ibuprofen isn’t recommended for anyone with [asthma](/medical-advice/respiratory-conditions/asthma/).

For swelling and [allergic reactions](/medical-advice/allergies/), you’ll need oral or topical antihistamines.

Seek medical advice if:
- Symptoms worsen or don’t improve after a few days
- You develop any new symptoms after a few days
- An area of 10cm or more around the bite becomes red and swollen
- There is pus around the bite
- You develop swollen glands, breathing difficulties or flu-like symptoms

If you have a severe allergic reaction, a doctor may suggest carrying an auto-injecting adrenaline pen (also known as an EpiPen).

## Mosquitoes

Mosquitoes suck blood through their bite. It doesn’t hurt, but it does itch. 

Follow the steps above to reduce your risk and treat bites. If you feel worse after a few days of being bitten, get medical advice.

## Midges

There are more than 150 species of biting midges. They are common throughout Scotland, Scandinavia and northern Europe and are often found around water.

Midge bites aren’t dangerous, but can be intensely itchy. They sometimes swell and develop into fluid-filled blisters. Follow the steps above if bitten – especially trying not to scratch.

## Horseflies

Horseflies are bigger than houseflies and have larger, multi-coloured eyes and a painful bite.

Be careful if you’re running or doing anything strenuous, as there’s evidence that horseflies are attracted by exhaled carbon-dioxide.

Ease any pain with a cool compress or local anesthetic spray, and follow the steps above.

## Bees, wasps and hornets

All these insects are attracted to sugary drinks, so when you’re outdoors, avoid drinking from cans and other containers that bees and wasps can fly into. Close unfinished bottled drinks as soon as you can.  

If you do get stung, then removing the sting quickly is the key to reducing pain. Scrape it out with a credit card, or squeeze it out with your fingers. For these particular stings, avoid using tweezers as you can spread the venom.

Wash and, if possible, elevate the area to reduce swelling. Pressing something cold against the bite can also help reduce the swelling.

A small proportion of us are allergic to bee and wasp stings. Get immediate medical advice from a doctor in the event of breathing difficulties, fast heartbeat, confusion, clammy skin or light-headedness.

## Caterpillars

From late May to early June, oak processionary moth caterpillars – which are found throughout Europe – are covered in toxic hairs that, if touched, cause an itchy rash. They can also be carried in the wind, leading to sore throats, eye irritation and asthma.

Rinse the area with water and apply an antihistamine (for children aged above 2). Anyone who suffers from asthma should carry an inhaler, and oral antihistamines will help to ease throat and eye irritation.

## Jellyfish

Several species of jellyfish are found in the English Channel, the North Sea and the Baltic Sea. The most venomous is the Lion’s Mane, which grows up to 2m, and has been found off the coasts of France, Germany, Ireland, Sweden and the UK.

Avoid swimming in water where you know there are jellyfish. If you’re stung, rinse the area with seawater – not fresh – and remove any spines using tweezers. Soak the area in water as hot as can be tolerated for at least 30 minutes – or apply hot flannels or towels. Take paracetamol or ibuprofen for the pain.

If you’re stung by a jellyfish, it’s best not to:
- Use vinegar
- Urinate on it
- Apply ice or a cold pack
- Cover the wound

See a doctor if you experience severe pain that doesn’t improve after an hour or so, or if the face or genitals have been stung.

## Snakes

The European adder can be found throughout the UK and Europe. It grows up to 90cm, ranges from light to dark brown, and most have a zigzag pattern down their back.

Most bites aren’t serious but they do require medical attention, so speak to a doctor as soon as you can. 

It’s especially important to get medical assistance quickly in the event of breathing difficulties, chest pain, seizures, severe swelling, vomiting or light-headedness.


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Speak to a GP about bites and stings

kry.co.uk > Your health > Summer bites and stings – a guide to prevention and treatment 

Summer bites and stings – a doctor’s guide to prevention and treatment 

Summer means embracing the great outdoors, but it also comes with the increased chance of bites and stings. Here’s a guide to stings treatment and more

kry.co.uk > Your health >Summer bites and stings – a guide to prevention and treatment 

 Summer bites and stings treatment & prevention – guide | Kry UK

kry.co.uk > medical reviewer

IMG 20200730 224911 865[33] (1)

Dr Rhianna McClymont

Lead GP at Kry

Maintaining a healthy blood pressure is an essential part of looking after your body. High blood pressure, also called hypertension, increases your risk of serious conditions like a heart attack, heart failure, stroke and kidney damage. 

Approximately 1.13 billion people worldwide have high blood pressure and it’s a major cause of premature death globally, but [fewer than 1 in 5 of those who suffer with it have the issue under control.  ](https://www.who.int/news-room/fact-sheets/detail/hypertension)

‘Monitoring your blood pressure levels – and taking action if they rise too high – is important for reducing your risk of complications and staying healthier for longer,’ says Dr Rhianna McClymont, Lead GP at Kry. 

## What is blood pressure?

Blood pressure is a measure of the force of blood in the arteries as it’s pumped around the body by the heart. Blood pressure and heart rate are two separate measurements. ‘Your heart rate measures how quickly your heart is beating to pump blood, while your blood pressure measures the pressure within your arteries,’ says Dr McClymont.

Your blood pressure will naturally fluctuate throughout the day and night. It becomes more of a concern when your overall blood pressure is consistently high, even while resting. 

## What is normal blood pressure?

As a general guide, according to Dr McClymont:

- Optimal blood pressure is considered to be between 90/60mmHg and 120/80mmHg
- High blood pressure is considered to be 140/90mmHg or higher. For people over 80, this threshold rises to 150/90mmHg or higher 
- Low blood pressure, known as hypotension, is considered to be 90/60mmHg or lower 

## What causes high blood pressure?

If you suffer from hypertension, it means your heart is having to work harder to pump blood around your body. For most people, there isn’t always one particular cause of high blood pressure, but there are several key risk factors, including: 

- Drinking too much alcohol or caffeine
- Being overweight
- Eating an unhealthy diet
- Not exercising enough 
- Smoking
- Having a family history of hypertension 

Sometimes high blood pressure is the consequence of another underlying medical condition. This is known as secondary hypertension. For example, an excessive production of hormones from the adrenal glands can cause high blood pressure. Conditions that cause secondary hypertension include:

- Diabetes 
- Kidney disease
- Obstructive sleep apnoea
- Pregnancy

## What are the signs of high blood pressure to look out for?

‘Usually, high blood pressure doesn’t have any symptoms, which is why it’s important to measure it frequently,’ explains Dr McClymont. ‘Some people may experience headaches, nosebleeds, blurred vision, chest pain, shortness of breath or dizziness.’

## What are the long-term effects of high blood pressure?

‘If high blood pressure isn’t controlled long term, it can increase the risk of cardiovascular problems, such as heart failure, peripheral arterial disease, strokes and heart attacks, as well as issues like kidney disease and certain types of dementia,’ Dr McClymont says. 

This is because [high blood pressure puts an extra strain on your heart](https://www.cdc.gov/bloodpressure/about.htm), blood vessels and other organs, including the brain, eyes and kidneys.  

## Managing high blood pressure 

These simple lifestyle changes can help lower your blood pressure levels: 

__1. Maintain a healthy weight__
As your weight increases, your blood pressure tends to rise too, so maintaining a healthy weight can help with managing healthy blood pressure levels. A high waist-to-hip ratio (WHR) may also indicate a higher risk. 

__2. Eat more fruit, vegetables and wholegrains__
Studies show that the [DASH](https://pubmed.ncbi.nlm.nih.gov/29771736/) (Dietary Approaches to Stop Hypertension and[ Mediterranean diets](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4366416/) can help manage blood pressure as well as cholesterol and lower your risk of heart disease.  Both diets are rich in fruit, vegetables and wholegrains, and low in saturated fat and red meat.

__3. Reduce your salt intake__
Too much salt can raise your blood pressure. You should be eating no more than 6g (around 1 tsp) a day.

__4. Fit more exercise into your day__
Regular exercise is important because it keeps your blood vessels and heart healthy. Activities that are good for your blood pressure include cycling, swimming, dancing, gardening, tennis and jogging. [There’s strong evidence](https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.118.12373) that a 30-minute walk each morning may be as effective at lowering blood pressure as taking medication. 

__5. Cut down on alcohol__ 
The recommended healthy limit of alcohol per week is less than 14 units. [One review](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30003-8/fulltext) found that high blood pressure was rapidly reversed when heavy drinkers reduced their intake by about 50%. 

__6. Give up smoking__
Like high blood pressure, smoking causes your arteries to narrow, which dramatically increases your risk of [heart attack ](/medical-advice/cardiovascular-diseases/heart-attack/)or stroke. By giving up, you’ll lower your risk of disease. 

## What about low blood pressure? 

‘Low blood pressure can cause symptoms such as light-headedness, blurred vision and feeling faint, sick or weak. It’s common to have lower blood pressure in pregnancy, and some people also develop it as a side effect to certain medications or other medical conditions,’ says Dr McClymont. 

Low blood pressure doesn’t always cause symptoms, and treatment depends on the cause. Certain things can help ease symptoms, including:

- Wearing support stockings to increase blood pressure and improve circulation
- Increasing the amount of water you drink, because when you’re dehydrated your blood pressure drops
- Eating small meals frequently, as larger meals are associated with a drop in blood pressure

‘Low blood pressure is more common in younger people, but it can sometimes develop in older people too,’ Dr McClymont says. 

## How is blood pressure measured? 

Blood pressure is measured with a device called a sphygmomanometer (pronounced ‘svig-mo-man-ometer’) through a cuff, which is wrapped around your upper arm. ‘This cuff is inflated – either manually with a handheld device by a doctor or automatically via an electronic machine,’ explains Dr McClymont.  

The test should ideally be taken sitting down, with your arm relaxed and resting on a table at the same level as your heart. ‘It’s best to sit quietly for a few minutes before taking the blood pressure reading to get the most accurate result,’ Dr McClymont says. 

## Understanding your blood pressure reading 

Your blood pressure is measured with two numbers in millimetres of mercury (mmHg). ‘The top number is called the “systolic” – this measures the force with which blood is pumped around your body,’ explains Dr McClymont. ‘The bottom number is known as the “diastolic” – this number represents the resistance to this blood flow within the blood vessels.’ 

For example, if you’re told that your blood pressure is 120 over 80 (written as 120/80), it shows you have a systolic pressure of 120mmHg and a diastolic pressure of 80mmHg. 

After taking a test, you can use a blood pressure chart to see what your readings mean. You can also enter your readings into this [NHS calculator ](https://www.nhs.uk/conditions/blood-pressure-test/)to find out what they mean.

## Where can you get blood pressure checked? 

You can get your blood pressure checked at several places, including GP surgeries, some pharmacies or at home with an automatic blood pressure machine.

Your blood pressure may rise due to the anxiety of being in a healthcare setting, a problem known as ‘white coat hypertension’. ‘If you suffer from this, it’s best to take the test at home to get a more accurate reading,’ recommends Dr McClymont.


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Kry.co.uk > Your health > Are my blood pressure levels healthy? A doctor’s guide

Are my blood pressure levels healthy? A doctor’s guide

Maintaining a healthy blood pressure is essential for avoiding conditions like heart attack, stroke and kidney damage. Read this doctor’s guide to blood pressure.

Are my blood pressure levels healthy? A doctor’s guide | Kry UK

[People of all ages experience heart palpitations](https://bestpractice.bmj.com/topics/en-us/572),  described as an awareness of your heart beating in your chest. ‘Some people describe feeling their heart racing, beating very strongly or pounding, or skipping a beat. Others describe a fluttering sensation in their chest. Sometimes this experience lasts for only a few seconds or it may go on for hours,’ says Lead GP at Kry, Dr Rhianna McClymont. 

Palpitations are non-specific, meaning they can be a symptom or a diagnosis. ‘There are a variety of causes of heart palpitations,’ Dr McClymont explains. ‘Many causes are harmless, and most palpitations aren’t a sign of anything sinister.’

## What causes heart palpitations?

There are a number of different causes of palpitations, including:

- Lifestyle triggers, like strenuous exercise and alcohol consumption
- [Anxiety](/medical-advice/mental-health/anxiety/), panic attacks and other psychological triggers
- Heart rhythm problems and heart conditions, like atrial fibrillation
- Hormonal changes, like menopause and pregnancy
- Medications, including certain antihistamines and antidepressants
- Medical conditions, like [hyperthyroidism](/your-health/thyroid-symptoms-overactive-underactive/) 

Lifestyle factors are a common trigger. Some people notice palpitations after drinking alcohol. 

Caffeine and nicotine can also cause palpitations, particularly when used excessively, as can other recreational drugs, explains Dr McClymont. If you experience heart palpitations after eating, it might be a result of eating very sugary foods, drinking energy drinks or overeating.

While exercise can trigger palpitations as a result of the heart needing to pump faster to send oxygenated blood to the muscles, Dr McClymont stresses that regular exercise is important for a healthy heart. 

## What’s the link between stress and heart palpitations?

‘We can experience palpitations if we’re under significant stress or experiencing a strong emotion,’ says Dr McClymont, adding that anxiety disorders and panic attacks in particular are also linked to heart palpitations. In fact, studies have shown  anxiety and other psychosomatic triggers are responsible for around a third of all cases of heart palpitations.

## Why do I have heart palpitations when I’m resting?

Most causes of palpitations actually have nothing to do with your activity levels. It’s not uncommon to notice palpitations more at night when you’re trying to sleep, says Dr McClymont. ‘It’s a time when it’s quiet and your mind isn’t as distracted by other tasks. 

‘Lying down on your left side may make palpitations more noticeable, as in this position your heart is right next to your chest wall.’

## Are heart palpitations linked to long Covid? 

Heart palpitations are one of the common [symptoms of long Covid](/your-health/what-is-long-covid/), and several studies have confirmed that the Covid-19 virus gains access to the heart and can cause abnormal structural changes as well as inflammation.  

‘A number of people suffering from long Covid have reported palpitations,’ says Dr McClymont. ‘It’s known that many people who were hospitalised with severe Covid symptoms suffered damage and inflammation to the heart muscle, but it’s also clear that people who had relatively mild symptoms of Covid-19 have developed a range of symptoms afterwards, collectively known as long Covid.

‘There’s so much that we still don’t know about long Covid in terms of prognosis, severity and duration of symptoms, but research is ongoing.’

## Can heart palpitations be a symptom of another medical condition?

‘Thyroid problems – particularly an over-active thyroid – are a common cause of heart palpitations,’ says Dr McClymont. ‘Other associated conditions include anaemia, low blood pressure, dehydration and sepsis.’

Anaemia, she explains, causes increased work for the heart as there are fewer red blood cells in the body and these carry the oxygen. ‘This means the heart has to pump more quickly to push the existing red blood cells around the body faster to deliver enough oxygen,’ says Dr McClymont. ‘This extra work on the heart can lead to palpitations.

‘Conditions affecting the heart – such as heart failure, valve disorders, cardiomyopathy and problems with the electrical conduction in the heart – could also be the cause.’ 

Very occasionally, heart palpitations can be a symptom of a serious heart condition, including certain types of structural heart disease.  If there’s no obvious explanation for your symptoms and the palpitations don’t go away, you should make an [appointment](/gp-appointments-online/) to see a doctor.

## Is it normal to experience heart palpitations during pregnancy?

‘Being pregnant means that your heart needs to pump more blood around your body to supply the growing baby and placenta. This causes your heart rate to increase – which, in some cases, can lead to palpitations,’ Dr McClymont confirms.

[Palpitations are quite common during pregnancy](https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/tog.12599) and usually not a sign of anything serious. However, if it does turn out that the palpitations are a symptom of heart rhythm disturbances that need to be managed, most treatments are perfectly safe in pregnancy.

## What can I do to reduce my heart palpitations?

‘If you drink alcohol or caffeine regularly, cutting back can often reduce the frequency of palpitations or stop them altogether,’ Dr McClymont recommends. ‘It’s recommended that we drink no more than 14 units of alcohol per week, and it’s best to space out these drinks throughout the week. Binge-drinking is more likely to lead to palpitations.’

Think about your stress or anxiety triggers, too. If you suffer from anxiety, your heart rate can go up as a result of what’s known as ‘fight or flight’ mode, which can trigger palpitations. Talk to a doctor if you’re struggling, as there are things you can do to cope and manage your symptoms.

## When to worry about heart palpitations

‘If you have heart palpitations accompanied by chest pain, dizziness or severe shortness of breath or you faint or collapse, you should seek emergency help from your nearest A&E department as it could be a sign of a serious problem with your heart,’ says Dr McClymont.

‘If you have recurrent palpitations that have been going on for a while and haven’t improved with simple lifestyle changes, speak to a doctor, who can arrange further tests.’


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See a GP about heart palpitations

kry.co.uk > Your health > Why is my heart racing when I’m resting? The facts about heart palpitations

Why is my heart racing when I’m resting? The facts about heart palpitations

Dr Rhianna McClymont, Lead GP at Kry, explains what causes heart palpitations, what you can do to minimise them, and when they can be a cause for concern

What causes heart palpitations? A doctor explains | Kry

Feeling anxious or fearful can be distressing. Your heart starts racing and you may also feel light-headed, shaky, short of breath, and slightly nauseous. ‘We all have things that make us feel uneasy or fearful but for anyone who suffers from a phobia, these fears are much more extreme,’ says Madeleine Gauffin, Licensed Psychologist and Psychotherapist at Kry. 

## What exactly is a phobia?

‘A phobia is an intense fear of something, for example, an object, situation, place, feeling or animal. It’s a type of anxiety disorder that can be extremely debilitating.’

There are many different types of phobias and these can range from mild to severe. ‘A phobia can occur for all sorts of reasons,’ Gauffin continues. ‘It may be triggered by an incident or trauma in your past or you may be genetically predisposed to feeling more anxious.’ The good news is, it’s usually possible to overcome phobias of all kinds without drugs. A recent meta-analysis  (based on 33 studies) shows that cognitive behavioural therapy (CBT) used independently, or as an adjunct to other therapies, is a highly effective treatment. 

Phobias fall into two categories:

__1.__	__Specific, or simple phobias__, include certain animals, situations, or activities (for example, fear of heights, germs or flying).  Specific phobias affect around 7.4% of people worldwide – [4.9% of the male population and 9.8% of the female](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674525/#:).   

__2.__	__Complex phobias__ on the other hand, are associated with more deep-rooted but general fears about a behaviour or circumstance, for example agoraphobia  or social phobia.  Agoraphobia affects around 1.3% of people,  and social phobia, one of the most common anxiety disorders, [is estimated to affect around 12%. ](https://www.nice.org.uk/guidance/cg159/documents/social-anxiety-disorder-final-scope2)  

## What is cognitive behavioural therapy?

‘CBT is a talking therapy that looks at how your thoughts, beliefs, and attitudes affect your feelings and behaviour,’ says Gauffin. ‘It’s based on the idea that how you think influences the way you feel and behave. A therapist helps you to identify negative thinking patterns and shows you what you can do to change them.’ 

There are a variety of techniques used in CBT, for example, keeping a record of your thoughts and also relaxation and breathing exercises. CBT helps you become more aware of the triggers that exacerbate your anxieties and fears. It is a short-term therapy that can be done face-to-face or online, usually once a week, for anything from five to twenty sessions.’

## 5 phobias that CBT helps

### __1.	Dental phobia__
For people with dental phobia, even the smells, sights, and sounds of a dental surgery can trigger an anxiety attack.  Many will avoid seeing a dentist and this can have serious implications on dental health. For most, therapy may be needed to help a patient overcome their fears – this is where CBT can be extremely useful.

In a [small 2018 study  on children and adolescents](https://pubmed.ncbi.nlm.nih.gov/29358158/), internet-based cognitive behavioural therapy (ICBT) was shown to significantly decrease dental anxiety. In a one-year follow-up, over half the participants were still phobia-free. According to an older systematic review of the evidence, it was concluded that behavioural interventions like CBT could significantly improve dental anxiety in adults. 

### __2. Social phobia__
Social anxiety, also called social phobia, is a long-term and overwhelming fear of social situations.  It can have a huge impact on friendships, work and social life. For some, everyday activities like meeting people, starting conversations, talking on the phone, working, or being in groups can trigger [anxiety symptoms](/your-health/need-help-for-anxiety-here-are-your-questions-answered/). Social anxiety can lead to increased isolation and depression. [In a recent study](https://www.nature.com/articles/s41398-019-0668-2), CBT was shown to significantly reduce social anxiety.  

### __3. Agoraphobia__
Most people think agoraphobia is a fear of open spaces. But it’s much more complex than that, encompassing a fear of being in places or situations where escape may be difficult or impossible.  Agoraphobia initially starts off as a panic disorder, where you regularly experience panic attacks in certain situations and then avoid them more and more, until a phobia develops.

The standard treatment for agoraphobia, recommended by NICE, is CBT.  Now, a recent study  has shown that using a CBT- based mobile phone app can help to significantly reduce symptoms, which may be useful for people who are hard to reach, or for whom travel is a problem.

### __4.  Acrophobia (fear of heights)__
A fear of heights is one of the most common phobias in the world.  As well as bringing on a panic attack, it may also be accompanied by symptoms of vertigo. Sufferers usually try to manage their phobia by avoiding high places which can make life difficult when simply going into a lift can cause anxiety. 

Traditional CBT can be helpful for the treatment of the fear of heights. Plus, a recent [Dutch study ](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2728184) has found that using a self-guided virtual reality CBT based app (VR CBT) could also help reduce symptoms in sufferers after 3 weeks of treatment.

### __5. Emetophobia (fear of vomiting)__
An estimated 6-7 % of women and 1.7-3.1% of men are affected by an intense fear of vomiting.  People who have this phobia have a fear of losing control and vomiting in public. So they try to avoid situations where they might be sick. This may include avoiding eating out in a restaurant, having dinner at a friend’s house, trying new food, or leaving the house if there’s a tummy bug going around. A study (the first to evaluate CBT for a specific phobia of vomiting) showed that 58% of sufferers experienced an improvement in symptoms after a course of therapy.

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


kry.co.uk > Your health > Did you know that CBT can help these 5 phobias?

Cognitive behavioural therapy CBT for phobias

Scared of heights, the dentist or social interaction? CBT helps you change the thoughts, beliefs and attitudes behind a phobia. A psychologist shares how

kry.co.uk > Your health >Did you know that CBT can help these 5 phobias?

5 phobias CBT can help with | Kry

Did you know that CBT can help these 5 phobias?

Stress is a natural, essential part of our body’s response system. It stems from an innate survival instinct that we share with many other animals. When we experience something frightening or dangerous, stress is what drives us to react quickly, triggering our ‘fight or flight’ impulse. 

But chronic stress is completely different. While short-term stress can help us achieve important goals, long-term stress can actually cause serious health problems. Symptoms of stress include nagging feelings of worry, sleeplessness, [anxiety](https://www.livi.co.uk/medical-advice/mental-health/anxiety/), [depression](https://www.livi.co.uk/medical-advice/mental-health/depression/) and even physical illness. 

‘Long-term stress can cause a multitude of physical symptoms – such as headaches, muscle tension and digestive problems’, says Dr McClymont, Lead GP at Livi. ‘In turn, these symptoms often make us feel anxious, worried, and even more stressed! Recognising signs of stress, and taking action to reduce it, is important for breaking this negative cycle.’ 

## How your body responds to stress

When you’re under stress, your brain releases a ‘stress response’. This sends signals via the pituitary gland to the adrenal glands, to release the hormones cortisol, adrenaline and noradrenaline.

These hormones raise your blood pressure and give your body a dose of glucose that goes straight to your muscles. The idea is to get you ready and give you a boost of energy to respond to an immediate stressor.

Stress hormones are energising. They give you the motivation and focus to complete difficult tasks, solve problems, and reach your immediate goals. That’s why stress is good for you in small doses.

After the stressful situation has passed, your body can return to a normal, relaxed state. But ongoing, long-term stress – the kind that can’t easily be solved with a short burst of energy and focus – can cause serious physical signs of stress.

## Where might I spot the physical signs of stress?

__The immune system__ 
Stress initially inhibits the immune system – the chemicals our body releases to deal with immediate threat aren’t designed to keep us healthy long-term. People affected by chronic stress can find their immune system affected, making them susceptible to [colds](https://www.livi.co.uk/medical-advice/infections/common-cold/), flu and other infections.  

__The liver__
Our liver gives us a boost of glucose when we’re stressed, enabling us to physically respond to stressors. Long-term, this constant release increases our risk of developing type 2 diabetes, and can make it hard for us to maintain a healthy weight. 

__Digestion__
Our guts are surprisingly sensitive organs, and respond to hormone imbalances, stress, and many physical and mental health conditions with pain, bloating, and sometimes changes in bowel habit.

__Nervous system__
[Chronic stress affects dopamine levels](https://elifesciences.org/articles/46797), which is one of the reasons long-term stress makes us more vulnerable to mental illness. It can particularly make us seek short-term rewards like sugary, fatty or salty foods, affecting our weight and overall health.

__Through weight gain or loss__
Increased cortisol levels stop our bodies from breaking down fat, so it can make it hard for us to lose weight or keep weight off. It can even influence our shape, with research suggesting it can lead to [more abdominal fat](https://pubmed.ncbi.nlm.nih.gov/14618117/). Chronic stress can also make us look for immediate comfort in foods. 
On the other hand, some people find that they have a decreased appetite when stressed, as adrenaline levels – and sometimes the depression that can go hand-in-hand with chronic stress – affects appetite.

__Skin__
Even our skin responds to stress, with inflammation and worsening of skin conditions like [acne](https://www.livi.co.uk/medical-advice/skin-conditions/acne/), eczema and [psoriasis](https://www.livi.co.uk/medical-advice/skin-conditions/psoriasis/). 

__Headaches__
The release of stress hormones can cause changes in the blood vessels around the brain, causing [tension headaches and migraines](https://www.livi.co.uk/your-health/9-types-of-headache-and-what-you-can-do/).

__Hormonal imbalance__
Long-term stress can impact hormonal balance and reproductive cycles and - especially for women – can disrupt periods and make us more affected by the mood and emotional changes throughout the cycle. Stress and related conditions can also affect [sex drive](https://www.livi.co.uk/your-health/8-causes-of-low-libido-a-doctors-guide/) and even fertility. 

## Stress and mental health

Chronic stress is incredibly closely linked with our risk of serious mental health conditions, and chronic stress, anxiety, and depression are closely related. Over time, chronic stress can make you more susceptible to mental and emotional illness. Some people find coping strategies that can actually make us more unwell – smoking and drinking alcohol are common ways people try to handle stress. 

‘Finding healthy coping strategies for stress isn’t always easy, but it’s really important,’ says Dr McClymont. ‘Exercise, mindfulness and talking therapies are excellent ways of dealing with stress. If you find yourself turning to unhealthy coping mechanisms like alcohol or smoking, then be open about this with a doctor.’ 

## How to reduce stress levels

Some of the stressors in our lives are things that we can take some practical control over – some of them are not. When we can’t take away the thing that’s causing us stress, we need to find ways of responding to that stress without becoming unwell. Some good ways to reduce stress can include: 

__Sleep well__
Getting enough sleep and sticking to regular hours can make a huge difference to how well we cope with everyday stress. Remember that stimulants like late-night screen time, alcohol, big meals and nicotine can stop us getting to sleep. Caffeine can still affect us around 6 hours after drinking it, so cut out the coffee early in the afternoon.

__Stay in touch__
Even when you don’t feel like it, trying to maintain your social life is important. It might even help to talk to friends and family about what’s going on in your life, but if you’re not comfortable with that, just socialising with them can help you feel more positive.

__Eat well__
One of the best things we can do for our physical and mental health is to [eat a healthy diet](https://www.livi.co.uk/your-health/6-tips-for-healthy-cooking-at-home/). This means lots of fruit and vegetables, wholegrains, and lean proteins. 

__Meditate__
[Breathing exercises](https://www.livi.co.uk/your-health/3-breathing-exercises-a-psychologist-recommends/) and mindfulness techniques have become popular stress-management strategies over the last few years, and they’re supported by good clinical evidence. 

__Get outside__
Even a little bit of time outdoors can energise us, help us maintain a good sleep pattern, and improve our mental and physical health. Exercise is particularly good for stress relief. 

__Professional help__
Stress and related conditions are incredibly common, and there’s a lot of experienced professional advice available. Getting support from a GP can be the first step towards reducing stress. 

‘Stress and its physical symptoms are a common reason people speak to their GP. If you’re struggling with stress there are options available for support, and it’s always okay to ask for help.’

If you’re concerned about your stress levels and the effect stress is having on your health, book a meeting with a Livi doctor.


livi.co.uk > Your health > How does stress affect the body

7 ways stress affects the body image

Long-term stress can cause health problems. Discover how stress affects the body physically, and how to reduce stress levels

kry.co.uk > Your health > How does stress affect the body

How does stress affect the body? | Physical signs of stress | Kry

How does stress affect the body? 

On average, most people go for a pee around 6 or 7 times a day, though everyone’s a bit different. If you find that you’re going to the toilet much more than this, you might have problems with urinary frequency.

Feeling like you need to pee all the time can interfere with your life. It can mean planning your day around access to a toilet, it can affect your quality of sleep, and can lead to feelings of [anxiety](/medical-advice/mental-health/anxiety/). Urinary frequency can affect anyone, but we’re more likely to get it as we age.

‘Urinary frequency is a problem we see quite often as GPs, most commonly in women and people who have given birth,‘ says Dr Rhianna McClymont, Lead GP at Kry. ‘A few simple measures or lifestyle changes can often make a big difference to your symptoms. But if you’re worried, or these changes are not helping you, then it’s definitely a good idea to chat to a doctor.’

Here are some reasons you might have a constant need to pee, and how to help keep it under control.

## 7 causes of urinary frequency and what you can do

 ### 1. Drinking lots of fluids

The most common cause for needing to pee all the time is also the most simple. Drinking more fluids than usual will mean you need to go to the toilet more often. Forgetting to drink all day then getting thirsty in the evening might also lead to needing the toilet more during the night – this is known as nocturia.

We’re often encouraged to drink more liquids, but if you think you have problems with urinary frequency, try monitoring your intake over the course of a few days. See if there are any patterns that might be causing you to pee more, like the times you tend to drink, and see if it helps to change things up.

### 2. Choosing the wrong drinks

Some drinks in particular can give you a strong, frequent urge to pee – caffeinated drinks like coffee, tea, energy drinks, and even cola can make you need to go more often. [Alcohol](/your-health/6-health-benefits-of-drinking-less/) is a particular culprit for a constant need to pee.

### 3. UTIs

[Urinary tract infections (UTIs)](/your-health/utis-your-questions-answered/) commonly cause symptoms of urinary frequency, as well as urgency (not getting much notice when you need to go) and sometimes a burning sensation when you pee. If this happens a lot, lasts more than a couple of days, if your urine is cloudy, blood-stained or smells bad, or if you feel generally unwell with UTI symptoms, you should see a GP. 

### 4. Diabetes

Having high blood sugar can make you feel very thirsty, needing to drink more and, in turn, pee more. 

### 5. Pregnancy

Carrying a baby can put tremendous pressure on the bladder, and cause the muscles of the pelvic floor to relax a little, meaning that urinary frequency and urgency are common. Doing exercises to strengthen pelvic floor muscles can be helpful for everyone, not just women – these are called Kegels, and there are apps that can help with this.

### 6. Constipation

A very full bowel can put pressure on the bladder and can even squeeze the urethra, meaning your bladder might not empty properly when you do go to the toilet. 

Usually a [good diet](/your-health/8-ways-to-make-healthier-food-choices-every-day/), plenty of healthy fluids and exercise is enough to keep bowels healthy and regular. Pharmacists are a good source of advice on over-the-counter remedies, but if constipation is frequent or difficult to manage, you should speak to a GP. 

### 7. An overactive bladder

Sometimes there’s no obvious underlying cause, and the constant urge to pee might just be described as an ‘overactive bladder’, or a ‘sensitive bladder’. This could be the muscles that control the bladder becoming weaker, especially as we age, or sometimes after childbirth.

It’s important to know that getting into the habit of going to the toilet as soon as you get the urge can actually make things worse, as the bladder never fully fills and it loses its tone. But you can retrain your bladder by holding on a little longer before going for a pee. It takes several months, but can be an effective way of getting your bladder used to holding larger volumes of pee for longer periods of time. A Kry GP can provide more guidance to help with bladder retraining. 

## When should I get help for urinary frequency? 

There are several conditions that can cause a frequent urge to pee, and they all have different treatments, so it’s important to get properly assessed by a doctor if taking simple steps at home hasn’t helped. 

‘If you’re struggling to identify a simple cause of urinary frequency that can be managed at home, it’s best to discuss the problem with a GP. In your appointment, the cause may become clear from your medical history and associated symptoms, or you may need to have further tests to investigate,’ says Dr McClymont.

Some people might already know they have a condition that affects how much they pee, like reduced kidney or heart function. If you take medications for such conditions – particularly diuretics for chronic heart conditions – you must not stop taking them without advice from a doctor, even if you’re struggling with a constant need to pee. 

‘Many chronic health conditions, like diabetes, kidney failure or prostate problems, can affect how frequently you need to pass urine. Many of the medications we use can also affect this frequency. Everyone needs support to manage complex conditions, so always check in with a doctor’ says Dr McClymont.

If you’re struggling with incontinence – not knowing when you’re passing urine, never quite managing to get to the toilet on time, or leaking as soon as you feel the urge to go, that’s a slightly different issue, and might need a different approach. If incontinence is a problem, a GP can refer you to a continence service with specialists in helping people with bladder or bowel control. 


kry.co.uk > Your health > Urinary frequency: what a constant need to pee could mean

Urinary frequency: what a constant need to pee could mean

A nearly constant need to pee – known as ‘urinary frequency’ – can be uncomfortable and annoying. Discover the causes and what you can do to help

Urinary frequency: what a constant need to pee could mean | Kry

Dr Bryony Henderson

## Quick facts

- Most types of back pain have non-specific causes, like poor posture
- Taking quick movement breaks once every hour is helpful for back health
- Exercise like pilates can prevent back pain by strengthening the muscles that support your spine

Back pain can have a major impact on your life, making it harder to sleep, do the things you enjoy and for some, even sit down and stand up again. But it’s incredibly common, affecting an estimated 540 million people worldwide.  And now, with more people confined to their homes, working remotely, and being increasingly sedentary, this figure may rise. 

But back pain is not inevitable and there are many things you can do to not only help to prevent it, but also to alleviate it when it happens. Read our guide based on the best clinical evidence on how to cope with lower back pain.

Most types of lower back pain have no obvious cause (known as non-specific or NSLBP), or they’re mechanical, where the pain originates from the joints, bones, or soft tissues around the spine.    

This type of pain...
- May be the result of poor posture, or lifting something awkwardly
- Can develop suddenly or come on gradually
- Usually gets better within a few weeks — 50% of sufferers recover within 2 weeks without treatment 
- Often feels worse when you move, for example getting up from a chair
- May hurt more in certain positions and feel better if you’re sitting or lying down
- May be caused by a minor injury like a sprain (pulled ligament) or strain (pulled muscle) 
- May feel worse if you’re feeling stressed or run down. ‘Stress may make back pain worse,’ says Dr Rhianna McClymont, Kry Lead GP ‘Particularly, if stress causes you to tense your muscles, hunch, adopt poor posture, or forgo activities that would normally improve back pain, like regular exercise’

Less frequently, lower back pain may be caused by an underlying medical condition like a slipped disc or sciatica (characterised by pain that runs from the lower back to the feet)  but you will usually also have other symptoms, like numbness, weakness or tingling. In these cases, your doctor will refer you for specialist treatment.

## What’s the best way to treat lower back pain when it strikes?

For non-specific pain, taking non-steroidal anti-inflammatory (NSAIDS) medication (like ibuprofen) can help to ease pain, but these should be taken for the shortest period of time.  Always check the label, as NSAIDS may not be suitable for everyone. Paracetamol on its own is not recommended for back pain, but is usually taken in combination with a stronger painkiller like codeine. A doctor can also prescribe muscle relaxants for painful muscle spasms.

## Should I use ice or heat?

Both heat and ice can help in different circumstances. Here’s a quick guide: 

- __Use ice if__ your pain occurs as a result of a direct injury, for example, after a fall, knock, sprain, or strain. Apply an ice pack for 10 minutes several times during the day. The cold lowers body temperature and helps to constrict blood vessels, reduce swelling, and inflammation.  Cold will also help to reduce muscle soreness. But don’t apply ice directly to the skin as this can cause an ice burn, instead always wrap in a cloth or towel
- __Use heat if__ your pain is more ongoing (and there’s no inflammation). Taking a hot bath or placing a hot water bottle on the affected area can often help 
- __Use a combination of ice and heat__ to help manage your pain.  For example, use heat to warm up stiff muscles in the morning or before you go to bed and apply an ice pack for pain, where there’s inflammation through exertion, during the day. The cold will help to reduce inflammation and the heat aids in tissue healing

## Is it better to move or stay as still as possible when I have an attack?

It may seem counterintuitive, but it’s important to keep moving and continue with normal activities as much as possible if you’ve got a bad back.   

A recent meta-analysis showed that if you’ve got non-specific lower back pain (NSLBP), long periods of inactivity can have an adverse effect on recovery.  The review showed that regular moderate aerobic exercise like walking and swimming, as well as strengthening and stretching exercises, can all reduce non-specific chronic lower back pain by over half.

But while it’s important to have some movement, it’s best to wait for any swelling to subside in acute cases before doing any exercise. 

## 6 changes to help with lower back pain

If you get recurrent bouts of lower back pain, these simple lifestyle recommendations can help you manage and prevent them in the longer-term.

### 1. Stay as active as you can each day
A recent study  shows that leading a largely sedentary lifestyle significantly raises the risk of lower back pain. Staying active can be as simple as doing some stretches or other gentle activity as often as you can throughout the day. For example, if you work at a desk, take a 10-15 minute activity break every 45 minutes.  ’Taking breaks from work to walk and stretch and getting plenty of regular exercise is important for back care,’ says Dr McClymont. 

### 2. Practice good posture
If you’re working from home, make sure you have an ergonomic workstation. ‘A suitably-sized desk and chair and correct keyboard position is important to help prevent back pain,’ says Dr McClymont. This includes sitting in a proper chair that supports your back, feet flat on the floor with your knees slightly lower than your hips and your shoulders relaxed. Your screen should be at eye level, with the monitor about an arm’s length away.  

### 3. Do regular back exercises and stretches
‘Strengthening exercises like yoga or pilates are particularly good for back pain,’ says Dr McClymont. In a recent review,  patients with chronic lower back pain showed significant improvement in pain relief after doing pilates 4 times a week for 6 weeks. One of the key principles of pilates is to work on strengthening your core muscles  which support the spine, as weak core muscles can make you more susceptible to lower back pain.  

### 4. Use correct lifting technique 
When lifting objects, avoiding bending your spine. Instead, slightly bend at the hips and knees, keeping your core muscles strong.  Hold the object close to your body and avoid twisting your back or leaning it sideways. Keep your shoulders level and facing the same direction as your hips. Try to move smoothly and know your limits.

### 5. Maintain a healthy weight
The more weight you carry, the more pressure on your back — two recent clinical research reviews showed that being overweight or obese increased the risk of developing lower back pain.  If you’re finding it a struggle to keep to a healthy weight, ask your doctor for advice and treatment options. 

### 6. Get enough sleep
Poor sleep can increase your perception of pain, while sleeping well can make pain seem less severe, a recent study showed.  If you’ve been having trouble sleeping for two weeks or more, talk to your doctor about treatment options available, like a course of Cognitive Behavioural Therapy (CBT). Read more about [how to sleep better in a pandemic](/your-health/4-ways-to-sleep-better-during-the-pandemic/).

## When should I see a doctor?

If you have any of the following, talk to a doctor:

- A new and persistent back pain that doesn’t start to improve within a few weeks
- Back pain that is getting consistently worse with time
- Severe pain that is limiting your daily activities

‘Your doctor will examine you and decide on further investigations,’ says Dr McClymont. ‘Depending on what your doctor suspects might be the underlying cause of your pain, this might include a referral to a physiotherapist, an X-ray of your back or a more detailed scan like an MRI. Your doctor can also prescribe the appropriate pain medication, if over-the-counter painkillers aren’t enough.’

## When to seek urgent medical attention

Occasionally, back pain can be a sign of something more serious and needs to be checked urgently. Get immediate medical advice at your nearest A&E department if your back pain is accompanied by any of the following symptoms:  

- A sudden change to your bowels or bladder (like urine or faecal incontinence)
- Numbness in your legs or around your genitals or buttocks
- Weakness in your legs

Also, get immediate advice from your GP, from 111, or from A&E if you have back pain accompanied by:

- Chest pain
- A high temperature
- A swelling or deformity in your back
- It does not improve with resting or is worse at night
- Pain started after a serious accident 
- Pain is so bad you’re having problems sleeping
- Pain gets worse when you sneeze, cough or open your bowels
- Pain is coming from the top of your back, between your shoulders, rather than your lower back


kry.co.uk > Your health > What can help my lower back pain? A doctor’s tips

Lower back pain

Over 80% of people  will experience back pain at some point in their lives. But simple changes to the way you move, sit, and sleep, as well as knowing what to do when your back pain arises, can help you prevent recurring bouts. Here’s a simple guide

What can help my lower back pain? A doctor’s tips

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

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