Self-Care Guide

To keep health risks from alcohol to a low level:

• both men and women are advised not to drink more than 14 units a week on a regular basis
• spread your drinking over 3 or more days if you regularly drink as much as 14 units a week
• to cut down, try to have several drink-free days each week

If you drink less than 14 units a week, this is considered low-risk drinking. It’s called “low risk” rather than “safe” because there’s no safe drinking level.

Fourteen units is equivalent to 6 pints of average-strength beer or 10 small (125ml) glasses of low-strength wine per week.

The type of illnesses you can develop after 10 to 20 years of regularly drinking more than 14 units a week include: 

• Liver disease – While alcohol affects almost all your body systems, your liver is most affected. This is because the liver is where most of the alcohol you drink is processed. When alcohol is broken down, toxic chemicals are produced, which can damage your liver. After a while these chemicals are converted into less toxic substances that leave your body. If you drink lots of alcohol or too quickly, these toxic chemicals can build up, and your liver must work harder to process them. Over time, regularly drinking too much alcohol can increase your risk of alcohol-related liver disease. Rates of alcohol-related liver disease have risen considerably over the last few decades. Alcohol misuse is now one of the most common causes of death in the UK, along with smoking and high blood pressure. The good news is: if you cut down or stop drinking in the early stages of liver disease, your liver may well recover.
• Heart and Circulation Problems – When you drink alcohol, your heart begins to beat faster. If you regularly drink too much alcohol, it will raise your blood pressure. Having high blood pressure puts strain on your heart and blood vessels and can increase your risk of heart disease or stroke. Your heart muscle can become damaged and drinking too much can also lead to an abnormal heart rhythm (arrhythmia) or enlargement of the heart.
• Cancer – Drinking alcohol increases your chances of developing certain cancers. This includes cancers of the mouth, throat, voice box (larynx), gullet (oesophagus), large bowel (intestine), liver and breast. Not everyone who drinks alcohol develops cancer, but we know that drinking even a small amount can increase your risk. The more you drink, the greater your risk.
• Digestive Problems – Alcohol irritates your stomach. It increases the amount of acid your stomach produces, causing the lining of your stomach to become inflamed. This is known as gastritis. It can cause reflux – when acid in your stomach travels up into your gullet, causing a burning sensation and nausea. Alcohol can also damage your pancreas. If you drink too much, it can lead to acute (short-lasting) or chronic (long-lasting) pancreatitis.
• Mental Health Issues – Drinking heavily over a long time can affect your mental health. If you drink regularly, it can create dependence and you might find that you experience cravings and find it difficult to go without a drink. Alcohol also alters the chemistry in your brain and can increase your risk of anxiety and depression. Drinking can also affect your judgement, your behaviour, your sleep, your mood. Research has found strong links between alcohol misuse and self-harm, including suicide.
• Nervous System Damage – Regularly drinking too much alcohol can damage nerves, which carry information between your body and brain, and between different parts of the brain. This can lead to problems with memory (dementia), balance and coordination, and how sensations, including pain, are felt around your body.
• Fertility Problems – Male and female fertility can be affected by drinking too much alcohol. For women, alcohol decreases the chance of conceiving and can also affect how well infertility treatments work. In men, excessive drinking can lead to a decrease in libido and can affect the ability to get an erection. Regularly drinking too much alcohol will affect sperm quality.
• Weight Management Challenges – Alcohol contains a lot of calories. Regularly drinking more than the NHS recommends can have a noticeable impact on your waistline.

Drinking too much can also affect your immune system, which can affect the body’s ability to fight infectious diseases.

Drinking too much too quickly on any single occasion increases your risk of:

• accidents resulting in injury or death
• misjudging risky situations
• losing self-control, like having unprotected sex or becoming involved in violence

To reduce your health risks on any single session:

• limit how much you drink
• drink more slowly
• drink with food
• alternate with water or non-alcoholic drinks

The effects of alcohol on your health will depend on how much you drink. The less you drink, the lower the health risks.

The number of units you are drinking depends on the size and strength of your drink.

Build healthy habits by swapping a pint of beer for a half pint of beer.

The Hidden Risks of ‘Social Drinking’

Many people who see themselves as “social drinkers” are at risk of developing long-term health conditions because of the amount they regularly drink. Many drinkers are unaware that regularly drinking more than 14 units a week can lead to a wide range of long-term health problems.

Some people think it’s natural to have a bottle of wine a night. They believe it is low risk because they are drinking with food and it’s not associated with any drunken behaviour or feeling drunk. But if this happens regularly, it is likely to cause problems. You don’t need to be an alcoholic to develop severe alcohol-related liver disease. 

Tips on Cutting Down

If you regularly drink more than 14 units of alcohol a week, try these tips to help you feel the benefits of cutting down:

• Make a plan – before you start drinking, set a limit on how much you’re going to drink.
• Set a budget – only take a fixed amount of money to spend on alcohol.
• Enlist the support of friends and family – if you let your friends and family know you’re cutting down and it’s important to you, they can act as support.
• Take it a day at a time – cut back a little each day. That way, every day you do is a success.
• Make the drink smaller – you can still enjoy a drink but go for smaller sizes. Try bottled beer instead of pints, swap a pint of beer for a half pint of beer or a small glass of wine instead of a large one.
• Have a lower-strength drink – cut down the alcohol by swapping strong beers or wines for ones with a lower strength (ABV in %). You’ll find this information on the bottle.
• Stay hydrated – have a glass of water before you have alcohol and alternate alcoholic drinks with water or other non-alcoholic drinks.
• Take a break – have several drink-free days each week.

Alcohol and Pregnancy

Experts are still unsure exactly how much – if any – alcohol is safe to drink during pregnancy. The Chief Medical Officers for the UK recommend that if you’re pregnant or planning to become pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby; the more you drink, the greater the risk.

Page last updated – August 2022

An allergy is the response of the body’s immune system to normally harmless substances, such as pollens, foods and house dust mite. Common symptoms can include sneezing, wheezing, coughing, shortness of breath, sinus pain, runny nose, rash, hives, swelling, itchy eyes, ears, lips throat and mouth and sickness, vomiting and diarrhoea. You may notice a worsening of asthma or eczema symptoms.

There are 3 key things to remember when managing your allergy:

1. Documenting where and when an allergy occurs
2. Reducing the risk of an allergic reaction by avoiding the allergen where possible
3. Medical treatments are available to reduce symptoms and include medications and immunotherapy.

The most common causes of allergic reaction are:

• pollen from trees and grasses (hay fever)
• dust mites
• moulds – small particles in the air
• foods – such as shellfish, peanuts, tree nuts, cow’s milk and eggs
• pets  – such as cats and dogs, and other furry or hairy animals such as horses, rabbits and guinea pigs
• insect bites and stings
• medicines which can include ibuprofen, aspirin and certain antibiotics
• latex – often used in disposable gloves and condoms
• household chemicals and hair dyes

Managing an allergy – In many cases, the most effective way of managing an allergy is to avoid the allergen that causes the reaction whenever possible.  Advice on dealing with some of the most common allergens is given below:

House dust mites – are one of the biggest causes of allergies. They are tiny insects found in household dust. There are several practical solutions to limit the number of mites in your home and to get maximum impact you should concentrate your efforts in the areas of your home where you spend the most time. Limit the number of mites found by:

• choosing wood or hard vinyl floor coverings instead of a carpet
• fitting roller blinds that can be easily wiped clean
• choosing leather, plastic or vinyl furniture instead of upholstered furniture
• cleaning cushions, soft toys, curtains and upholstered furniture regularly, either by washing (at a high temperature) or vacuuming
• using tested allergy-proof covers on mattresses, duvets and pillows
• using a vacuum cleaner fitted with a hepa (high efficiency particulate air) filter, as it can trap more dust mites than ordinary vacuum cleaners
• regularly wiping surfaces with a damp, clean cloth – avoid dry dusting, as this can spread dust into the air

Pets – A pet’s dead skin, saliva and dried urine will cause an allergic reaction. If you are unable to re-home a pet, you could try:

• keeping pets outside as much as possible, or limiting them to an area of the house, preferably an area without carpet
• not allowing pets in bedrooms
• washing pets at least once a week and grooming them regularly outside
• regularly washing all bedding and soft furnishings pets lie on
• increasing ventilation with fans or air conditioning, or by opening windows
• using an air filter in rooms where you spend most of your time
• If you’re visiting a friend or relative with a pet, ask them not to dust or vacuum on the day you’re visiting, as this will stir up the allergens into the air.

Taking an antihistamine medicine about an hour before entering a pet-inhabited house can also help reduce your symptoms.

Mould spores – are the tiny particles released by moulds can cause an allergic reaction in some people. You can help prevent this by:

• avoiding damp buildings, damp woods and rotten leaves, cut grass and compost heaps
• keeping your home dry and well ventilated, dealing with any damp and condensation found quickly
• not drying clothes indoors, not storing clothes in damp cupboards and avoiding packing clothes too tightly in wardrobes
• removing any indoor pot plants from your home or if you like to have plants indoors, use pea-shingle to cover the soil in the plant pot as this will stop the mould settling and forming

Food allergies – Make sure you carefully check food labelling for the list of ingredients and avoid any known allergens. If you are eating out, you need to consider:

• not relying on the menu description alone (remember, many sauces or dressings could contain allergens)
• avoiding places where there’s a chance that different types of food could come into contact with each other, such as buffets or bakeries
• letting restaurant staff know your dietary requirements, including how severe your food allergy or intolerance is, making sure to communicate clearly.
• always checking what allergens are in the dish, even if you have eaten it before, as recipes and ingredients can change
• remember that simple dishes are less likely to contain “hidden” ingredients. If you’re not sure about a dish, do not risk it.

Hay fever – is caused when trees and grasses release pollen into the air. Different plants pollinate at different times of the year, so the months you get hay fever will depend on what sort of pollen you’re allergic to (typically, trees in spring and grasses in summer).

To help keep your hay fever under control, you can:

• check weather reports for the pollen count and stay indoors when it’s high, if possible
• avoid drying clothes and bedding outside when the pollen count is high
• wear wraparound sunglasses to protect your eyes
• keep doors and windows shut when possible
• shower and change your clothes after being outside
• avoid grassy areas, such as parks and fields, particularly in the early morning, evening or night, when the pollen count is highest
• if you have a lawn, try asking someone else to cut the grass for you

Insect bites and stings – If you have ever suffered a bad reaction to an insect bite or sting, it’s important to take precautions to minimise your risk. When you’re outdoors, particularly in the summer, you could:

• cover exposed skin
• apply insect repellent
• avoid wearing strong perfumes or fragrances, as these can attract insects
• wear shoes

Preventing severe allergies (anaphylaxis) – If you’re at risk of experiencing a severe allergic reaction (anaphylaxis), make sure you carry 2 adrenaline auto-injectors with you everywhere. Wearing a MedicAlert or Medi-Tag medallion or bracelet can make others aware of your allergy in an emergency. Consider telling your teachers, work colleagues and friends so they can give you your adrenaline injection in an emergency while waiting for an ambulance.

Medicines available – there are several medicines available to help control symptoms of allergic reactions, including:

• antihistamines – these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen, to stop a reaction occurring
• decongestants – tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose
• lotions and creams, such as moisturising creams (emollients) – these can reduce skin redness and itchiness
• steroid medicines – sprays, drops, creams, inhalers and tablets that can help reduce redness and swelling caused by an allergic reaction

For some people with very severe allergies, a treatment called immunotherapy may be recommended. This involves being exposed to the allergen in a controlled way over several years, so your body gets used to it and does not react to it so severely. This would only be recommended in the most severe cases.

Page last updated – August 2022

Taking antibiotics when you don’t need them puts you and your family at risk as it can encourage harmful bacteria that live inside you to become resistant. That means that antibiotics may not work when you really do need them.

No one likes being sick and it is especially upsetting when your child is ill but remember if you’re feeling unwell, antibiotics aren’t always needed and don’t work for everything.

When Antibiotics Are Needed – Antibiotics are only needed for treating certain infections caused by bacteria. We rely on antibiotics to treat serious, life-threatening conditions such as pneumonia and sepsis, the body’s extreme response to an infection. Effective antibiotics are also needed for people who are at high risk for developing infections. Some of those at high risk for infections include patients undergoing surgery, patients with end-stage kidney disease or patients receiving cancer therapy (chemotherapy).

When Antibiotics Are NOT Needed – Antibiotics do not work on viruses, such as those that cause colds, flu, bronchitis, or runny noses, even if the mucus is thick, yellow, or green.

Antibiotics are only needed for treating infections caused by bacteria, but even some bacterial infections get better without antibiotics. Antibiotics aren’t needed for many sinus infections and some ear infections. Antibiotics save lives, and when a patient needs antibiotics, the benefits usually outweigh the risk of side effects and antibiotic resistance. When antibiotics aren’t needed, they won’t help you, and the side effects of taking the antibiotics could still cause harm. Common side effects of antibiotics include a rash, nausea, diarrhoea, and yeast infections. Rarely, more serious side effects may occur.

Antibiotic resistance and ‘superbugs’ – The overuse of antibiotics in recent years means they’re becoming less effective and has led to the emergence of “superbugs”. These are strains of bacteria that have developed resistance to many different types of antibiotics, including:

• MRSA (methicillin-resistant Staphylococcus aureus)
• Clostridium difficile (C. diff)
• the bacteria that cause multi-drug-resistant tuberculosis

These types of infections can be serious and challenging to treat and are becoming an increasing cause of disability and death across the world.

The biggest worry is that new strains of bacteria may emerge that cannot be treated by any existing antibiotics.

We can all do our bit to help, by not taking antibiotics when we do not need them, and by taking them as prescribed by a doctor, ensuring we complete the prescribed course.

Page last updated – August 2022

Arthritis is a common condition that causes pain and inflammation in the joints. The 2 most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis affects the smooth cartilage lining of the joint. It makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments must work harder. This can cause swelling and the formation of bony spurs called osteophytes. Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position. The most affected joints are those in the hands, spine, knees and hips.

Rheumatoid arthritis is the body’s immune system targeting affected joints, leading to pain and swelling. The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joint’s shape. This may cause the bone and cartilage to break down. People with rheumatoid arthritis can also develop problems with other tissues and organs in their body.

Managing your arthritis

Self-management is key to living with arthritis.

Self-management is about making positive and healthy lifestyle choices and addressing the physical and emotional effects of the disease. Having arthritis affects everyone differently, so it’s up to you to learn and practice what helps you to live well and thrive. Through self-management, you can make a big difference to how much arthritis affects your quality of life, so you can continue to say ‘Yes’ to the things that are important to you.

Habits that can help you successfully manage your disease are:

1. Stay active – Even though it might seem like the last thing you want to do when you’re in pain, exercise is beneficial for managing arthritis and your overall health. It can strengthen muscles that support your painful joints, preserve and increase joint range of motion, improve sleep quality, boost your mood and sense of well-being and help you lose excess pounds that add stress to joints. It’s important to avoid sitting in the same position for long periods of time, so take regular breaks and move around.
2. Balance activity with rest – Rest is important when your disease is active, and your joints feel painful, swollen or stiff. Lighten your schedule and obligations and ask for help when you need to. Pace yourself throughout your day and take breaks to conserve energy.
3. Take care of your joints – If you have arthritis, it’s important to look after your joints to avoid further damage. For example, try to reduce the stress on your joints while carrying out everyday tasks like moving and lifting. To help protect your joints you need to use larger, stronger joints as levers – for example, take the pressure of opening a heavy door on your shoulder rather than on your hand. Use several joints to spread the weight of an object, for example, use both hands to carry your shopping or distribute the weight evenly by using a rucksack. Don’t grip too tightly, grip as loosely as possible or use a padded handle to widen your grip.  Good footwear can provide support and comfort for your feet – important if you have arthritis.
4. Eat a healthy balanced diet – A healthy diet, when combined with exercise, can help you achieve and maintain a healthy weight. Also, adding foods with anti-inflammatory properties and that are rich in antioxidants can help control inflammation. If you are overweight, losing weight can really help you cope with arthritis. Too much weight places excess pressure on joints leading to increased pain and mobility problems.

Improve sleep – Poor sleep habits can worsen arthritis pain and fatigue, but there are things you can do to help you fall asleep and stay asleep. Make your bedroom dark, cool and quiet, avoid caffeine or strenuous exercise in the evening and wind down with a warm bath or practice relaxation techniques before bedtime. If you are still having trouble sleeping, talk to your doctor about a change in or timing of your medication or other ways that may improve your sleep.

Page last updated – August 2022

Asthma is a common lung condition that causes occasional breathing difficulties. It affects people of all ages and often starts in childhood, although it can also develop for the first time in adults. There’s currently no cure, but there are simple treatments that can help keep the symptoms under control so that the impact on your life is reduced.

MANAGING YOUR ASTHMA

Asthma symptoms include coughing,  a wheeze, chest tightness, and shortness of breath. Symptoms can be triggered by factors such as exercise, exposure to an irritant or allergen, changes in weather, and viral respiratory infections such as cold or flu. Symptoms may be able to resolve themselves or may require medication. Symptoms may sometimes be absent for weeks or months at a time.

Several other conditions can cause similar symptoms, so it’s important to get a proper diagnosis and the correct treatment if you have any of these symptoms.

Asthma is usually treated by using an inhaler, a small device that lets you breathe in medicines. The main types are:

• Reliever inhalers – used when needed to quickly relieve asthma symptoms for a short time
• Preventer inhalers – used every day to prevent asthma symptoms occurring

Some people also need to take tablets

Getting into a good routine and managing your asthma well means:

• You get no daytime symptoms
• You get no night-time waking due to asthma
• You don’t need to use reliever inhalers (usually blue)
• You don’t have any asthma attacks and don’t need emergency treatment
• Your lungs don’t suffer long-term damage
• Asthma doesn’t limit your daily life (including working and exercising).

The following steps will help you to manage your asthma well:

• Use an asthma action plan to stay on top of symptoms – This will mean you are better equipped to manage your symptoms, and so you’re less likely to end up in hospital with your asthma. An asthma action plan has all the information you need in one place. It reminds you how to look after your asthma every day and it tells you what to do if your asthma gets worse.
• Take your preventer inhaler every day even if you feel well – Your preventer medicine builds up protection over time. It stops your airways from getting inflamed, which means you’re less likely to react to your triggers. Sticking to a good routine of taking your preventer as prescribed will cut your risk of symptoms and an asthma attack. It could mean you stay symptom-free, so you can get on with what you want to do in life without asthma getting in the way.
• Carry your reliever inhaler with you everywhere – This will enable you to deal with unexpected symptoms quickly. Your action plan can help you spot any symptoms that show your asthma is getting worse. If you act quickly you can reduce the risk of an asthma attack. If you’re increasing the use of your reliever inhaler, this can be a sign that your asthma is getting worse, and you need to see your GP, pharmacist or asthma nurse.
• Check your inhaler technique – There are so many different types of inhaler out there it can be hard to know if you’re using yours in the right way. Good inhaler technique makes a big difference to how much medicine gets into your airways where it’s needed. If you get it right, you should notice fewer symptoms. Taking your inhaler in the right way also means you can help prevent side effects from the medicine staying in your mouth. Ask your pharmacist or asthma nurse to check your technique for you each time you go for your asthma review.
• Go for an annual asthma review – A once-a-year asthma review is a chance to update your asthma action plan and get your inhaler technique checked. You can make sure you’re taking the right medicines at the right doses to keep your symptoms under control. It’s worth going even if you’re feeling well with your asthma, so you can make sure you’re still doing all the right things to reduce the risk of an asthma attack.

Other things you can do to help manage your asthma

If you smoke, get support to quit. Smoking will make asthma symptoms worse and puts you at much higher risk of an asthma attack. It also means your asthma medicines won’t work as well.

If you know you’re overweight, losing some weight can make a real difference to your asthma and how well you can manage it.

Getting active is good for your asthma, improving stamina and helping your lungs work better. It’s also good for boosting your immune system, so you’ve got some defence against colds and viruses which are asthma triggers.

Even if you have mild asthma, flu can trigger asthma symptoms and put you at risk of an asthma attack. You can support your asthma management by getting the flu vaccine every autumn so you’re ready for flu season.

If you have been identified as clinically extremely vulnerable, you have severe asthma, or you are now eligible you should be invited to receive the Covid-19 vaccine.

Page last updated – August 2022

Exercise and continuing to work are key to recovery when you are dealing with chronic pain. Lying still for long periods can increase the pain you feel as your body will stiffen up and your muscles and bones will get weaker. This will affect your quality of sleep and could reduce contact with others which will in turn affect your mental wellbeing and could increase your levels of pain.

A good approach to reducing pain is a combination of:

• Exercise – Choose an exercise that won’t put too much strain on your body. Suitable options could include walking, swimming, using an exercise bike, dancing, yoga or Pilates. Activity and stretching should become part of your routine, so that you exercise little and often.
  
  Try to be active every day instead of only on the days when you’re not in so much pain. This may reduce the number of bad days you have and help you to feel more in control. It is a fine balance, as overdoing it too much on good days can mean an increase in the number of bad days.
• Staying at work – Research shows that people become less active and more depressed when they do not work so it is important to stay in work even though you are in pain. Often this will distract you from the pain and in most cases, won’t make your pain any worse.
  
  If you must stay off work for a while, try to get back as soon as possible with the help of your employer. Talk to your employer about the specific parts of your job that you can continue to do well, and those parts which may initially prove difficult to undertake, but stress that you want to be at work.
  
  If you have been off work for an extended period, plan with your doctor, therapist and employer how and when you can return. Gradually increasing the time you spend at work each week can be effective in managing chronic pain and getting back into the workplace.
  
  It may be possible to agree with your employer changes to your job or work pattern if it helps. Larger organisations have Occupational Health departments and Health and Safety Reps who will be able to assist you with any requests.
• Physical Therapy – A short course of physical therapy can help you to move better, relieve your pain and make daily tasks and activities easier. Physical therapy for persistent pain can involve manipulation, stretching exercises and pain-relief exercises.
  
  Physiotherapists can give you advice on the right type of exercise and activity. Occupational therapists can support you with environmental changes that help you to remain in work and function better at home.
• Painkillers – It’s safe to use over-the-counter painkillers to reduce your pain so you can be more active but it’s important to use painkillers carefully, as they have side effects. Paracetamol is the simplest and safest painkiller. You could also try anti-inflammatory tablets like ibuprofen as long as you don’t have a condition (such as a stomach ulcer) that prevents you using them.
  
  It’s important to take painkillers at the recommended dose and to take them regularly every 4 to 6 hours, preferably to overcome a flare-up of your pain or help get you through an impending activity. Don’t wait until your pain is severe before you start taking painkillers, as they won’t work as well.
  
  If a 2-week course of over-the-counter painkillers does not work, ask for help from your pharmacist or GP.

Page last updated – August 2022

Chronic obstructive pulmonary disease (COPD) is the name for a group of lung conditions that cause breathing difficulties and includes:

• emphysema – damage to the air sacs in the lungs
• chronic bronchitis – long-term inflammation of the airways

COPD is a common condition that mainly affects people who smoke. Many people do not realise they have it. The breathing problems which include increasing breathlessness, a persistent chesty cough with phlegm, frequent chest infections and persistent wheezing, tend to get gradually worse over time and can limit your normal activities, although treatment can help keep the condition under control.

The damage to the lungs caused by COPD is permanent, but treatment can slowdown the progression of the condition. The most important thing you can do is stopping smoking followed by inhalers and medicines designed to make breathing easier, pulmonary rehabilitation which is a specialised programme of exercise and education and in a small number of cases surgery or a lung transplant.

COPD can affect many aspects of your life. But there are some ways to help reduce its impact. It is important that you take good care of yourself if you have COPD. You need to consider the following:

• Stop smoking – If you smoke, stopping will slow down or prevent further damage to your lungs. It is never too late to stop smoking. Stopping smoking will improve the quality of your remaining years of life.
• Take your medicine – It’s important to take any prescribed medicine, including inhalers, as this can help prevent bad flare-ups. Make sure you read the information leaflet that comes with your medicine about possible interactions with other medicines or supplements. Check with your care team if you plan to take any over-the-counter remedies, such as painkillers or nutritional supplements. These can sometimes interfere with your medicine.
• Exercise regularly – Exercising regularly can help improve your symptoms and quality of life. The amount of exercise you can do will depend on your individual circumstances. Exercising until you’re a little breathless is not dangerous, but do not push yourself too far. It’s a good idea to speak to your nurse or GP for advice before starting a new exercise programme if your symptoms are severe or you have not exercised in a while. You may be advised to participate in a pulmonary rehabilitation programme, which will include a structured exercise plan tailored to your needs and ability.
• Maintain a healthy weight – Carrying extra weight can make breathlessness worse, so it’s a good idea to lose weight through a combination of regular exercise and a healthy diet if you’re overweight. Some people with COPD find that they unintentionally lose weight. Eating foods that are high in protein and taking in enough calories is important to maintain a healthy weight.
• Get vaccinated – COPD can put a significant strain on your body and mean you’re more vulnerable to infections. Everyone with COPD is encouraged to have the annual flu jab and the one-off pneumococcal vaccination. If you have been identified as clinically extremely vulnerable or are now eligible you should be invited to receive the Covid-19 vaccine.
• Check the weather – Cold spells and periods of hot weather and humidity can cause breathing problems if you have COPD. It’s a good idea to keep an eye on the weather forecast and make sure you have enough of your medicine to hand in case your symptoms get temporarily worse. 
  
  If you have COPD and you’re planning to fly, you may need a fitness-to-fly assessment, speak to your GP about this in advance of any planned travel.
• Watch what you breathe – There are certain things that should be avoided, if possible, to reduce COPD symptoms and the chances of a flare-up, including dusty places, fumes, such as car exhausts, smoke, air freshener sprays or plug-ins, strong-smelling cleaning products (unless there’s plenty of ventilation), hairspray and perfume.
• Regular reviews and monitoring – You’ll have regular contact with your care team to monitor your condition. These appointments may involve talking about your symptoms (such as whether they’re affecting your normal activities or are getting worse), talking about your medicine (including whether you think you might be experiencing any side effects), and tests to monitor your health.
• Breathing techniques – There are various breathing techniques that some people find helpful for breathlessness. These include breathing control, which involves breathing gently using the least effort, with the shoulders supported. This can help when feeling short of breath.
  
  Breathing techniques for people who are more active include:
  • relaxed, slow, deep breathing
  • breathing through pursed lips, as if whistling
  • breathing out hard when doing an activity that needs a big effort
  • paced breathing, using a rhythm in time with the activity, such as climbing stairs
• If you have a chesty cough that produces a lot of phlegm, you may be taught a specific technique to help you clear your airways called the active cycle breathing technique.
• Relationships – Having a long-term illness such as COPD can put a strain on any relationship. Difficulty breathing and coughing can make you feel tired and depressed. Your spouse, partner or carer may also have a lot of concerns about your health. It’s important to talk about your worries together. Being open about how you feel and what your family and friends can do to help may put them at ease. But do not feel shy about telling them that you need some time to yourself, if that’s what you want.
• Your sex life and COPD – As the condition progresses, the increasing breathlessness can make it difficult to take part in strenuous activities. The breathlessness may happen during sexual activity. Talk to your partner and stay open-minded. Explore what you both like sexually. Simply touching, being touched and being close to someone helps a person feel loved and special. Your doctor, nurse or physiotherapist may also be able to suggest ways to help manage breathlessness during sex.

Page last updated – August 2022

Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. Although dementia mainly affects older people, it is not a normal part of ageing and there are many things you can do to reduce the risk of developing dementia.

There are different causes and types of dementia and each person will experience dementia in their own unique way.

Symptoms of dementia may include:

• Memory problems – difficulty retaining new information, become increasingly forgetful, misplacing things regularly
• Difficulties processing information (cognitive ability) – difficulties with time and place, ability to reason and make decisions, movement, a sense of restlessness and difficulties with concentration. 
• Communication – repeating yourself often, having difficulty finding the right words, struggling with reading and writing
• Changes in personality and behaviour, mood swings, anxiety and depression. Losing interest in daily activities and seeing others socially, reduced self-confidence
• Seeing or hearing things that others do not

Reducing your risk of developing dementia

Getting older is undeniably the biggest risk factor for dementia. However, research suggests that you can delay or prevent dementia by making some modifications to your lifestyle. Everything that keeps your heart healthy, can also keep your brain healthy.

• Eat a balanced healthy diet and keep hydrated
• Don’t smoke
• Limit alcohol intake
• Keep your cholesterol and blood pressure under control
• If you have been diagnosed with Type 2 diabetes you will need to follow any advice you have been given to manage this effectively and ensure that your blood sugar levels remain under control
• Try to attend regular check-ups to monitor any conditions and check medication
• Keeping physically fit throughout your life
• Making sure you keep socially active; talk to people in group situations as well as one to one
• Taking part in hobbies like art, woodwork, learning a new language, knitting, puzzles and listening to music will stimulate different areas of the brain and help with attention and concentration

Talk to others about your dementia, this may help you stay independent for longer.

LIVING WITH DEMENTIA

Coping with memory loss and problems with thinking speed can be distressing. But there are things that can help:

• have a regular routine
• put a weekly timetable on the kitchen wall or fridge, and try to schedule activities for when you feel better (for example, in the mornings)
• put your keys in an obvious place, such as a large bowl in the hall
• keep a list of helpful numbers (including who to contact in an emergency) by the phone
• put regular bills on direct debits so you don’t forget to pay them
• use a pill organiser box to help you remember which medicines to take when (your pharmacist can help you get one)
• make sure your home is dementia-friendly and safe
• find out more about how technology can help at home e.g. telecare, daily living aids such as clocks showing the day and date as well as the time, smartphones and tablets and the range of apps and functions that these have.

LOOKING AFTER SOMEONE WITH DEMENTIA

Both you and the person with dementia will need support to cope with the symptoms and changes in behaviour. It’s a good idea to:

• make sure you’re registered as a carer with your GP
• apply for a carer’s assessment
• check if you’re eligible for benefits
• find out about local support groups

Helping someone with everyday tasks – as symptoms get worse, the person may feel anxious, stressed and scared at not being able to remember things, follow conversations or concentrate. It is important to support the person to maintain skills, abilities and an active social life. This can also help how they feel about themselves. You can help by including the person in everyday tasks such as shopping, laying the table, gardening and walking the dog. Memory aids can be used around the home to help the person remember where things are.

Helping with eating and drinking – Eating a healthy, well-balanced diet is an important part of a healthy lifestyle for everyone. People with dementia may not drink enough because they don’t realise they’re thirsty. This will put them at risk of urinary tract infections (UTIs), constipation and headaches which will lead to increased confusion and make the symptoms of dementia worse. Common food-related problems can include not recognising foods, forgetting what food and drink they like, refusing or spitting out food and asking for strange food combinations. These behaviours can be due to a range of reasons, such as confusion, pain in the mouth caused by sore gums or ill-fitting dentures, or difficulty swallowing. Try to remember that the person isn’t being deliberately awkward. Involve the person in preparing the meal if they’re able to. To make mealtimes less stressful make sure you set aside enough time for meals, offer food you know they like in smaller portions, be prepared for changes in food tastes – try stronger flavours or sweeter foods, provide finger foods if the person struggles with cutlery and offer fluids in a clear glass or coloured cup that’s easy to hold. Make sure the person you care for has regular dental check-ups to help treat any causes of discomfort or pain in the mouth.

Help with incontinence and using the toilet – People with dementia may often experience problems with going to the toilet. Sometimes the person with dementia may simply forget they need the toilet or where the toilet is. Both urinary incontinence and bowel incontinence can be difficult to deal with. It can also be very upsetting for the person you care for and for you. Although it may be hard, it’s important to be understanding about toilet problems. Try to retain a sense of humour, if appropriate, and remember it’s not the person’s fault. You may also want to put a sign on the toilet door – pictures and words work well, keep the toilet door open and keep a light on at night, or consider sensor lights, look for signs that the person may need the toilet, such as fidgeting or standing up or down, try to keep the person active – a daily walk helps with regular bowel movements and try to make going to the toilet part of a regular daily routine. Items such as waterproof bedding or incontinence pads are available if needed.

Help with washing and bathing – Some people with dementia can become anxious about personal hygiene and may need help with washing. They may worry about the bath water being too deep, a noisy rush of water from an overhead shower, a fear of falling and being embarrassed at getting undressed in front of someone else, even their partner. Washing is a personal, private activity, so try to be sensitive and respect the person’s dignity. Ask the person how they’d prefer to be helped, be reassuring, use a bath seat or handheld shower, use toiletries that the person likes and be prepared to stay with the person if they don’t want you to leave them alone.

Sleep problems – Sleep disturbance may be a stage of dementia that’ll settle over time. Put a dementia-friendly clock by the bed that shows whether it’s night or day, make sure the person has plenty of daylight and physical activity during the day, cut out caffeine and alcohol in the evenings, make sure the bedroom is comfortable and either have a night light or blackout blinds and if possible limit the number of daytime naps.

You need to make sure that you look after yourself. Caring for a partner, relative or close friend with dementia is demanding and can be stressful. It is important to remember that your needs as a carer are as important as the person you are caring for.

Family and friends can help in a variety of ways, from giving you a break, even if it’s for only an hour, to taking the person with dementia to an activity or memory café. Charities and voluntary organisations provide valuable support and advice on their websites and via their helplines. Sharing your experiences with other carers can be a great support as they understand what you’re going through. You can also share tips and advice. If it’s difficult for you to be able to attend regular carers groups, join an online forum.

Carers often find it difficult to talk about the stress involved with caring. If you feel like you’re not managing, don’t feel guilty. There’s help and support available. Taking regular breaks can help you to look after yourself and better support you in caring for someone with dementia.

Page last updated – August 2022

Diabetes is a serious condition where your blood glucose level is too high. There are two main types: Type 1 and Type 2.

When you’ve got Type 1 diabetes, you can’t make any insulin at all. If you’ve got Type 2 diabetes, the insulin you make either can’t work effectively, or you can’t produce enough of it.

In both types of diabetes, because glucose can’t get into your cells, it begins to build up in your blood, leading to diabetes symptoms.

The common symptoms of diabetes include:

• Going to the toilet a lot, especially at night
• Being very thirsty
• Feeling more tired than usual
• Losing weight without trying to
• Genital itching or thrush
• Cuts and wounds taking longer to heal
• Blurred vision

If you’re diagnosed with diabetes, you’ll need to eat healthily, take regular exercise and carry out regular blood tests to ensure your blood glucose levels stay balanced.

People diagnosed with type 1 diabetes also require regular insulin injections for the rest of their life.

As type 2 diabetes is a progressive condition, medicine may eventually be required, usually in the form of tablets. There are many types of medicine for type 2 diabetes. It can take time to find a medicine and dose that’s right for you. Usually Type 2 diabetes is controlled without insulin but sometimes insulin may also be required.

Type 1 Diabetes

Diabetes courses are encouraged for everyone with type 1 diabetes. It doesn’t matter how long you have had it. Evidence shows that people who have been on a course have more stable blood sugar levels and fewer complications.

There are various courses, including face-to-face courses like Dose Adjustment For Normal Eating (DAFNE), which focus on learning how to adjust your insulin. You will learn about:

• Insulin adjustment
• Carb counting
• Exercise
• Hypos
• Complications
• What to do if you’re ill

Attending a course will help you to feel more confident about managing your diabetes, allow you to get better control of your blood glucose levels and be more flexible with your food and drink.

Learning online means you can do it at your own pace and at a time that suits you. You can leave and come back at any time. This might be useful if you have just been diagnosed and there’s a lot to take in, or if you have already done a course but need a refresher.

Type 2 Diabetes

About 90% of people with diabetes have Type 2 diabetes.

• A major risk factor is being overweight. The more overweight you are, the more your risk increases, especially if you’re large around the middle
• Your risk tends to increase with age. You’re more at risk if you’re aged over 40 and white or aged over 25 and of African-Caribbean, Black African or South Asian descent
• You’re also more likely to get Type 2 diabetes if you have a parent, brother or sister with diabetes

Other factors that can affect your risk of developing Type 2 diabetes include:

• Sedentary lifestyle – it is important to keep moving and be physically active
• Disturbed sleep – Not getting enough sleep, or sleeping for too long have been associated with an increased risk
• Gestational diabetes – If you have gestational diabetes during pregnancy it is important to have your blood glucose levels tested regularly afterwards as you have an increased risk of developing Type 2 diabetes

A healthy diet and keeping active will help you to manage your blood sugar level.

There’s nothing you cannot eat if you have type 2 diabetes, but you’ll have to limit certain foods. You should:

• Make healthier choices more often, reduce your portion sizes
• Eat a wide range of foods – including fruit, vegetables and some starchy foods like pasta
• Keep sugar, fat and salt to a minimum
• Eat breakfast, lunch and dinner every day – do not skip meals

Physical exercise helps lower your blood sugar level. You should aim for 2.5 hours of activity a week. You can be active anywhere as long as what you’re doing gets you out of breath. Activity can be built into your day by walking faster, climbing stairs rather than taking the lift or doing more strenuous housework or gardening.

Losing weight (if you’re overweight) will make it easier for your body to lower your blood sugar level and can improve your blood pressure and cholesterol. If you need to lose weight, try to do it slowly over time. Aim for around 0.5 to 1kg a week. Find out about a structured education course in your area that will help you understand and manage your diabetes.

Page last updated – August 2022

Flu is a contagious respiratory illness caused by viruses that infect the nose, throat and sometimes the lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent flu is by getting a flu vaccination each year.

Antibiotics with not treat the flu.

It can be very unpleasant, but you will usually begin to feel better within about a week.

Flu symptoms come on very quickly and can include:

• a sudden fever – a temperature of 38C or above
• an aching body
• feeling tired or exhausted
• a dry cough
• a sore throat
• a headache
• difficulty sleeping
• loss of appetite
• diarrhoea or tummy pain
• feeling sick and being sick

The symptoms are similar for children, but they can also get pain in their ear and appear less active.

Could it be coronavirus (COVID-19)?

If you have a high temperature, a new, continuous cough or a loss or change to your sense of smell or taste, it could be COVID-19.

Get advice about symptoms of COVID-19 and what to do

Cold and flu symptoms are similar, but flu tends to be more severe. Flu will appear within a few hours, affect more than just the nose and throat and makes you feel exhausted and too unwell to carry on as normal whereas a cold will appear gradually, affect mainly your nose and throat and makes you feel unwell, but you are still ok to carry on as normal and for example, go to work.

To help you get better more quickly, you need to:

• rest and sleep
• keep warm
• take paracetamol or ibuprofen to lower your temperature and treat aches and pains. Be careful not to use flu remedies if you’re taking paracetamol and ibuprofen tablets as it’s easy to take more than the recommended dose.  A Pharmacist can give treatment advice and recommend flu remedies.
• drink plenty of water to avoid dehydration (your pee should be light yellow or clear)

Flu germs can spread even before symptoms appear, and you can infect others up to a week after you first become sick. By practicing a few simple rules at home, you can help keep your family healthy and prevent the flu from spreading:

• get vaccinated
• use a tissue to cover your mouth and nose when you cough or sneeze.
• avoid touching your eyes, nose, and mouth as flu germs can live on hands and surfaces for up to 24 hours
• wash your hands often
• limit contact with family members who are ill
• clean your home, including kitchen sponges, dishcloths, cutting boards, desks, floors, sinks and toilets
• practice a healthy lifestyle to boost your immune system. this includes getting plenty of sleep, eat a balanced diet, drink plenty of fluids, exercise regularly and manage your stress

Get advice from 111 now if:

• you’re worried about your baby’s or child’s symptoms
• you’re 65 or over
• you’re pregnant
• you have a long-term medical condition – for example, diabetes or a heart, lung, kidney or neurological disease
• you have a weakened immune system – for example, because of chemotherapy or HIV
• your symptoms do not improve after 7 days

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Immediate action required:

Call 999 or go to A&E if you:

• develop sudden chest pain
• have difficulty breathing
• start coughing up blood

Page last updated – August 2022

Headaches are one of the most common medical complaints; most people experience them at some point in their life. They can affect anyone regardless of age, race, and gender.

A headache can be a sign of stress or emotional distress, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. It can lead to other problems. People with chronic migraine headaches, for example, may find it hard to attend work or school regularly.

Headaches can radiate across the head from a central point or have a vice-like quality. They can be sharp, throbbing or dull, appear gradually or suddenly. They can last from less than an hour up to several days. The symptoms of a headache depend to some extent on what type of headache it is.

Tension headache – There may be general, mild to moderate pain that can feel like a band around the head. Tension headaches tend to affect both sides of the head.

Migraine headache – There is often a severe throbbing pain in one part of the head, often the front or the side. There may be nausea and vomiting, and the person may feel especially sensitive to light or noise and experience blurred vision.

Cluster headaches – These can cause intense pain, often around one eye. They usually happen around a particular time of year, possibly over a period of 1 to 2 months.

The most common causes of headaches are:

• having a cold or the flu
• stress
• drinking too much alcohol
• eyesight problems
• not eating regular meals
• not drinking enough fluids (dehydration)
• women having their period or menopause

Several steps can be taken to reduce the risk of headaches and to ease the pain if they do occur:

• apply a heat pack or ice pack to your head or neck, but avoid extreme temperatures
• avoid stressors, where possible, and develop healthy coping strategies for unavoidable stress
• eat regular meals, taking care to maintain stable blood sugar
• a hot shower can help, although in one rare condition hot water exposure can trigger headaches

Exercising regularly and getting enough rest and regular sleep contributes to overall health and stress reduction.

Get advice from 111 now if:

You have a severe headache and:

• your jaw hurts when eating
• blurred or double vision
• your scalp feels sore
• you get other symptoms – for example, your arms or legs feel numb or weak

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Immediate action required:

Call 999 or go to A&E if:

• you injured or hit your head badly – for example, from a fall or accident
• a headache came on suddenly and is extremely painful

You have an extremely painful headache and:

• sudden problems speaking or remembering things
• loss of vision
• you’re feeling drowsy or confused
• you have a very high temperature, feel hot and shivery, and have a stiff neck or a rash
• the white part of your eye is red

Page last updated – August 2022

Eating a healthy, balanced diet that has fibre, vitamins, minerals, protein, calcium and unsaturated fat in it, is an important part of maintaining good health and helping you to feel your best. This means choosing from a wide variety of foods and eating the right amount to achieve and maintain a healthy body weight.

A healthy diet contains:

• Fruits and Vegetables (eat more of these!) – Increasing our consumption of fruits and vegetables reduces the risk of heart disease, stroke, high blood pressure and some cancers. Fruit and vegetables contain fibre (roughage), as well as vitamins and minerals which are good for your overall health. Fibre helps you feel fuller for longer and slows down the speed at which sugar is absorbed into your blood stream. However, do not overdo fruit juices or smoothies as consuming fruit in this way disrupts the fibre and makes it easier for your body to absorb the sugar. 
• High Fibre Foods – Fibre is important for our digestive health and regular bowel movements. As well as helping you feel fuller, it can improve cholesterol and blood sugar levels and assist in preventing diseases such as diabetes, heart disease and bowel cancer. Dietary fibre can be found in cereals, oat bran, wheat bran, barley, nuts, seeds, beans, lentils, peas, whole grains, fruits (such as apples, bananas, oranges, strawberries, raspberries, mango) and vegetables (particularly dark coloured vegetables such as broccoli and spinach).
• Foods Low in Added Fat – You should try to eat whole, unprocessed foods that are naturally low in fat. Limit the amount of fatty meats, dairy and fried foods that you eat. If buying processed foods, you need to remember that products with reduced fat claims often have added sugar.
• Foods Low in Added Sugar – Eating foods high in added sugar can lead to obesity, type 2 diabetes, heart disease, cancer and tooth decay. While sugar is naturally found in foods like fruits and vegetables, this type has little effect on your blood sugar. The danger is from added sugars in processed foods and confectionery like chocolate, biscuits and cakes.
• Foods Low in Salt – A high salt intake can lead to raised blood pressure, which can increase your risk of heart disease and stroke. There are high levels of salt found in processed foods. Fruit and vegetables do not naturally contain salt. Some foods are almost always high in salt because of the way they are made, these include, anchovies, bacon, cheese, gravy granules, ham, olives, pickles, prawns, salami, salted and dry-roasted nuts, salt fish, smoked meat and fish, soy sauce, stock cubes and yeast extract. Other foods, such as bread and breakfast cereals, can also contribute a lot of salt to our diet. Whether you’re eating at home, cooking or eating out, don’t add salt to your food automatically but taste it first.
• More Plants, Less Meat – Certain meats are high in saturated fat and can raise blood cholesterol levels. If you eat a lot of red and processed meat, it is recommended that you cut down as there is likely to be a link between red and processed meat and bowel cancer. If eating meat, try to eat lean cuts, avoid eating the skin and cook healthily by grilling rather than frying. When cooking, try to use smaller quantities of meat and mix with vegetables, pulses and starchy foods in dishes such as stews, curries and casseroles.  Meats such as chicken, pork, lamb and beef are all rich in protein. A balanced diet can include protein from meat, but you can also obtain plenty of protein from non-animal sources such as beans and pulses.
• Regular Meals – It is better for our metabolism if we eat at regular intervals. If possible try to eat dinner at least two and a half hours before you go to bed to aid digestion and reduce weight gain.
• Plenty of Water – It is important to consume sufficient water, generally around 6-8 glasses a day. This will need to increase if you are exercising, or it is hot as you lose water through sweating. Drinking water with a meal can help you feel full and reduce calorie intake. Staying hydrated can improve memory and mood and reduce risk of headaches, constipation, bladder infections and kidney stones. Try to reduce or avoid drinks which are high in sugar and have water instead.

Page last updated – August 2022

Heart and circulatory diseases (also called cardiovascular diseases) are problems with your heart and blood vessels. They include:

• coronary heart disease (heart attack and angina)
• stroke
• vascular dementia
• diabetes
• peripheral vascular disease (e.g. narrowed arteries in the leg)

Problems with your heart and circulatory system typically occur when your arteries become narrowed or weakened. This is the result of a gradual build-up of fatty material (atheroma) within the blood vessel walls. In time, your arteries may become so blocked that they cannot deliver enough blood to your heart or brain. Also, a blood clot may form, triggering an acute event such as a heart attack or stroke.

The good news is most heart and circulatory diseases are caused by risk factors that can be controlled, treated or modified. These common risk factors include:

• smoking
• high cholesterol
• high blood pressure
• being overweight or obese
• having poorly managed diabetes
• drinking too much alcohol

Family History – If you have a family history of a heart or circulatory disease, you’re at higher risk of developing conditions like angina, heart attack or stroke.

Ethnicity – Your ethnicity can increase your risk of developing heart and circulatory diseases. If you’re South Asian, African, or African Caribbean in the UK, your risk of developing some heart and circulatory diseases is higher than for white Europeans.

Air pollution – Air pollution is harmful to your heart and circulation.

Stress and Mental health – Stress and poor mental health can affect your risk of developing heart and circulatory diseases and is linked to unhealthy habits that increase your risk.

TIPS FOR A HEALTHY HEART

The good news is that there are lots of positive things you can do to look after your heart:

• Stop Smoking – If you’re a smoker, quit. It’s the single best thing you can do for your heart health. Smoking is one of the main causes of coronary heart disease. Smokers are almost twice as likely to have a heart attack compared to people who have never smoked. A year after giving up, your risk of a heart attack falls to about half that of a smoker.
• Maintain a healthy weight – Being overweight can increase your risk of heart disease especially if you carry weight around your middle. Stick to a healthy, balanced diet low in fat and sugar, with plenty of fruit and vegetables, combined with regular physical activity. Ensure that you are eating the correct portion sizes.
• Get active – The heart is a muscle, and like any other muscle it needs physical activity to help it work properly. Getting and staying active can reduce your risk of developing heart disease. It can also be a great mood booster and stress buster. Do 150 minutes of moderate-intensity aerobic activity every week. One way to achieve this target is by doing 30 minutes of activity on 5 days a week. If this would be difficult for you at the moment, try starting at a level you can manage and increase the time and intensity of your activity as your fitness improves over time. Fit the activity in where you can, such as by cycling to work.
• Get your 5 A Day – Eat at least 5 portions of a variety of fruit and vegetables every day. They’re a good source of fibre, vitamins and minerals. There are lots of tasty ways to get your 5 A Day, like adding chopped fruit to cereal or including vegetables in your pasta sauces and curries.
• Cut down on saturated fat – Eating too many foods that are high in saturated fat can raise the level of cholesterol in your blood.  Foods high in saturated fat include fatty cuts of meat, lard, cream, cakes and biscuits. This increases your risk of heart disease. Choose leaner cuts of meat and lower fat dairy products like 1% fat milk over full-fat (or whole) milk.
• Cut down on salt – To maintain healthy blood pressure, avoid using salt at the table and try adding less to your cooking. Once you get used to the taste of food without added salt, you can cut it out completely. Watch out for high salt levels in ready-made foods. Most of the salt we eat is already in the foods we buy. Check the food labels as a food is high in salt if it has more than 1.5g salt (or 0.6g sodium) per 100g. Adults should eat less than 6g of salt a day in total which equates to about 1 teaspoon. Flavour can be added to food by using herbs and spices instead.
• Drink less alcohol – Do not forget that alcohol contains calories. Regularly drinking more than the NHS recommends can have a noticeable impact on your waistline. Excess alcohol intake can also raise blood pressure. Try to keep to the recommended daily alcohol limits to reduce the risk of serious problems with your health, including risks to your heart health.
• Eat Omega 3 fats – Fish such as pilchards, sardines and salmon are a source of omega-3 fats, which may help protect against heart disease. You should aim to eat fish at least twice a week, including a portion of oily fish. Pregnant or breastfeeding women should not have more than 2 portions of oily fish a week. If you are vegan or vegetarian you should eat flax seeds, which are small brown or yellow seeds. They are often ground, milled, or used to make oil. These seeds are by far the richest whole-food source of the omega-3 fat or alternatively Chia seeds which are tiny black seeds that are full of nutrients.

Page last updated – August 2022

Having good mental health helps us to relax more, achieve more and enjoy our lives more. Looking after our mental health is not something reserved for when we are struggling, or feeling low, anxious or stressed. It’s something we should think about all the time and really invest in, just like physical health.

There are simple things we can all do to look after our mental health and wellbeing.

Reframe unhelpful thoughts – The way we think, feel and behave are linked. Sometimes we develop patterns of thoughts or behaviours that are unhelpful, so recognising them and taking steps to think about things differently can improve your mental health and wellbeing.

Be in the present – If we take time to be aware of ourselves and be in the present moment, noticing our own thoughts and feelings, and the world around us, we can gain a better perspective. Sometimes this is known as being more mindful.

Get good sleep – Good-quality sleep makes a big difference to how we feel mentally and physically, so it’s important to get enough.

Connect with others – Spending quality time with friends or family, talking to someone about how we are feeling, or finding ways to help other people can all help stop you from feeling lonely, help give you a sense of purpose and improve your mental health and wellbeing.

Live a healthy life – Being active, enjoying the outdoors and having a healthy, balanced diet all impact on how we feel and our self-esteem. Also, binning bad habits like smoking, and cutting down on alcohol and caffeine can have a positive effect on our mood.

Do something for yourself – From enjoying your favourite hobby, learning something new or simply taking time to relax, it’s important to do things that make you happy.

ANXIETY

Anxiety is something everyone experiences at times and feeling anxious is a perfectly natural reaction to some situations. But sometimes feelings of anxiety can be constant, overwhelming or out of proportion to the situation and this can affect your daily life. To cope with anxiety, try the following:

• Understand your anxiety – Try keeping a diary of what you are doing and how you feel at different times to help identify what’s affecting you and what you need to act on.
• Challenge your anxious thoughts – Tackling unhelpful thoughts is one of the best things we can do to feel less anxious.
• Make time for worries – If your worry feels overwhelming and takes over your day, setting specific “worry time” to go through your concerns each day can help you to focus on other things.
• Shift your focus – Some people find relaxation, mindfulness or breathing exercises helpful. They reduce tension and focus our awareness on the present moment.
• Face the things you want to avoid – It’s easy to avoid situations, or rely on habits that make us feel safer, but these can keep anxiety going. By slowly building up time in worrying situations, anxious feelings will gradually reduce, and you will see these situations are OK.
• Get to grips with the problem – When you’re feeling stressed or anxious, it can help to use a problem-solving technique to identify some solutions. This can make the challenges you’re facing feel more manageable.

SLEEP

Sleep problems usually sort themselves out within about a month but longer stretches of bad sleep can start to affect our lives. Regular poor sleep puts you at risk of serious medical conditions, including obesity, heart disease and diabetes – it’s now clear that a solid night’s sleep is essential for a long and healthy life.

To get to sleep and sleep better try the following:

• Keep regular sleep hours – Going to bed when you feel tired and getting up at roughly the same time helps teach your body to sleep better. Try to avoid napping where possible.
• Confront sleeplessness – If you are lying awake unable to sleep, do not force it. Get up and do something relaxing for a bit and return to bed when you feel sleepier.
• Create a restful environment – Dark, quiet and cool environments generally make it easier to fall asleep and stay asleep.
• Write down your worries – If you often lie awake worrying about tomorrow, set aside time before bed to make a list for the next day. This can help put your mind at rest.
• Move more, sleep better – Being active can help you sleep better. A walk or yoga can help but avoid vigorous activity like running near bedtime if it affects your sleep.
• Put down the pick-me-ups – Caffeine and alcohol can stop you falling asleep and prevent deep sleep. Try to cut down on alcohol and avoid caffeine close to bedtime.

STRESS

Stress is the body’s reaction to feeling threatened or under pressure. It’s very common and can be motivating to help us achieve things in our daily life, and can help us meet the demands of home, work and family life. But too much stress can affect our mood, our body and our relationships – especially when it feels out of our control. It can make us feel anxious and irritable and affect our self-esteem. Top tips to deal with stress include:

• Split up big tasks – If a task seems overwhelming and difficult to start, try breaking it down into easier chunks, and give yourself credit for completing them.
• Allow yourself some positivity – Take time to think about the good things in your life. Each day consider what went well and try to list 3 things you’re thankful for.
• Challenge unhelpful thoughts – The way we think affects the way we feel.
• Be more active – Being active can help you to burn off nervous energy. It will not make your stress disappear, but it can make it less intense and help you sleep.
• Talk to someone – Trusted friends, family and colleagues, or contacting a helpline, can help us when we are struggling.
• Plan ahead – Planning out any upcoming stressful days or events – a to-do list, the journey you need to do, things you need to take – can really help.
• Try not to use alcohol, drugs, cigarettes or other things that can be unhealthy to relieve your stress – these things can contribute to poor mental health.

LOW MOOD

Everyone feels low or down from time to time. It does not always mean something is wrong. Feeling low is common after distressing events or major life changes, but sometimes periods of low mood happen for no obvious reason. You may feel tired, lacking confidence, frustrated, angry and worried. But a low mood will often pass after a couple of days or weeks – and there are some easy things you can try and small changes you can make that will usually help improve your mood.

• Increase helpful activity – Low mood can stop us doing important or enjoyable activities. Try listing these things and doing some each day. Start with easier ones and, as you progress, your mood should improve.
• Challenge unhelpful thoughts – The way we think affects the way we feel.
• Talk to someone – Trusted friends, family and colleagues, or contacting a helpline, can help us when we are struggling.
• Get better sleep – Low moods can make us feel tired. Tiredness can also have a bad impact on our mood.
• Be kind to yourself – Try to break big tasks down into manageable chunks, and do not try to do everything at once. Give yourself credit when you complete each bit
• Healthy living – Being active, cutting back on alcohol and making sure you have a healthy balanced diet can help boost your mood.

If you’re still feeling down or no longer find pleasure from things for most of each day and this lasts for several weeks, you may be experiencing depression. It’s important to seek help from a GP if you think you may be depressed. Many people wait a long time before seeking help for depression but it’s best not to delay. The sooner you see a doctor, the sooner you can be on the way to recovery.

Page last updated – August 2022

Having a healthy lifestyle is especially important if you are pregnant, or planning to be pregnant, as your baby will rely on you to provide them with the best start in life.

ANTENATAL APPOINTMENTS

Regular antenatal appointments are important to:

• Keep an eye on how your baby is growing
• Pick up some conditions such as pre-eclampsia and urinary tract infections – these might not have any early symptoms that you would notice but routine blood-pressure checks and urine tests can pick up on them, even if you feel fine
• Check the health of your baby through blood tests and ultrasound scans

If you can’t go to an antenatal appointment, let your midwife or the hospital know so you can make another one.

HEALTHY EATING

Eating a healthy, nutritious diet is especially important if you’re pregnant, or planning a pregnancy. Your baby relies on you to provide the right balance of nutrients to help them grow and develop properly (even after they’re born). You don’t need to spend lots of money or go on a special diet – you just need a balance of the right types of food. These include:

• Fruit and vegetables – aiming to eat at least 5 portions of fruit and veg a day.
• Starchy foods (carbohydrates) – these types of food are an important source of energy, certain vitamins and fibre.
• Protein – provides the building blocks for your baby to grow. Eggs produced under the British Lion Code of Practice (stamped with the red lion) are considered very low risk for salmonella and safe for pregnant women to eat.
• Dairy products – these contain calcium and other essential nutrients.

Eating for two is a myth. Being pregnant, you’ll obviously be more hungry than usual but even if you are expecting twins or more, you don’t need to eat extra portions. In the final 3 months of your pregnancy, you’ll need an extra 200 calories a day – that’s the same as 2 slices of wholemeal toast and margarine.

Foods to avoid during pregnancy include:

• Soft cheeses with white rinds such as brie and camembert. This includes mould-ripened soft goats’ cheese, such as chèvre. These cheeses are only safe to eat in pregnancy if they’ve been cooked.
• Soft blue cheeses such as danish blue, gorgonzola and Roquefort. Soft blue cheeses are only safe to eat in pregnancy if they’ve been cooked.
• Eggs that are not Lion Code (have a logo stamped on their shell showing a red lion) unless they are thoroughly cooked until the whites and yolks are solid to prevent the risk of salmonella food poisoning.
• Pâté, including vegetable pâtés, as they can contain listeria.
• Raw or undercooked meat including meat joints and steaks cooked rare, because of the potential risk of toxoplasmosis. If you’re pregnant, the infection can damage your baby, but it’s important to remember toxoplasmosis in pregnancy is very rare.
• Cold cured meats such as salami, prosciutto, chorizo and pepperoni, are not cooked, they’re just cured and fermented. This means there’s a risk they contain toxoplasmosis-causing parasites.
• Liver or products containing liver, such as liver pâté, liver sausage or haggis, as they may contain a lot of vitamin A. Too much vitamin A can harm your baby.
• Game that has been shot with lead pellets as it may contain higher levels of lead.
• High-dose multivitamin supplements, fish liver oil supplements, or any supplements containing vitamin A.
• Fish to avoid includes shark, swordfish or marlin when you’re pregnant or planning to get pregnant. You should also limit the amount of tuna you eat to no more than 2 tuna steaks or 4 medium-sized cans of tuna a week because tuna contains more mercury than other types of fish which could affect your baby’s developing nervous system. Avoid having more than 2 portions of oily fish a week, such as salmon, trout, mackerel and herring, as it can contain pollutants like dioxins and polychlorinated biphenyls (PCBs).  Tuna doesn’t count as oily fish, so you can eat tuna on top of the maximum amount of 2 portions of oily fish.
• Shellfish needs to be eaten cooked, rather than raw, including mussels, lobster, crab, prawns, scallops and clams, as they can contain harmful bacteria and viruses that can cause food poisoning. Cold pre-cooked prawns are fine.
• Sushi can be eaten raw or lightly cooked as long as any raw wild fish used to make it has been frozen first.
• Milk should be pasteurised, or ultra-heat treated (UHT), which is sometimes called long-life milk. Don’t drink unpasteurised goats’ or sheep’s milk, or eat foods made from them, such as soft goats’ cheese.
• High levels of caffeine can result in babies having a low birthweight, which can increase the risk of health problems in later life. Too much caffeine can also cause miscarriage. Caffeine is naturally found in lots of foods, such as coffee, tea and chocolate, and is added to some soft drinks and energy drinks. Green tea can contain the same amount of caffeine as regular tea. Some cold and flu remedies also contain caffeine. Talk to your midwife, doctor or pharmacist before taking these remedies. You don’t need to cut out caffeine completely, but don’t have more than 200mg a day. One mug of instant coffee contains 100mg, one mug of filter coffee contains 140mg, one mug of tea contains 75mg and one can of cola contains 40mg.
• Herbal remedy liquorice root should be avoided.

EXERCISE DURING PREGNANCY

Gentle exercise during pregnancy is good (and safe) for you and your baby. Not only does it help you maintain a healthy weight, it also helps prepare your body for labour. If you are used to doing regular exercise, keep it up, but do what feels comfortable for your body and don’t push yourself too much – exercise doesn’t have to be strenuous to be beneficial.

If you’re not used to exercising, or haven’t done any for a while, now is a good time to start. Try starting off with 10 minutes of daily activity – perhaps take a brisk walk or go for a swim. You can then build up to 150 minutes of weekly exercise.

Remember, whatever your fitness level, it’s important that you listen to your body and do what feels right for you. Always warm up and cool down. As a general guideline, you should be able to hold a conversation while exercising. If you can’t, you need to slow down.

Types of exercise that are good for pregnant women include – walking, running (if you are experienced at running), swimming, prenatal yoga, aerobic classes created for pregnant women and pelvic floor and abdominal exercises.

Types of exercise you should avoid include anything that risks your bump being hit, such as martial arts, rugby and football, scuba diving, exercising at high altitudes and exercises that involve you lying on your back for longer than a few minutes (particularly after 16 weeks).

VITAMINS AND SUPPLEMENTS IN PREGNANCY

You’ll get most of the vitamins and minerals you need by eating a healthy, varied diet. But when you’re pregnant you also need to take a folic acid supplement. It’s recommended you take a daily vitamin D supplement too – especially in the winter months (October – March) when you don’t get enough from the sunlight.

It’s best to start taking folic acid as soon as you start trying for a baby, or as soon as you find out you’re pregnant. You’ll need 400 micrograms (mcg) every day until the end of your first trimester (12 weeks).

Whether you are pregnant, or breastfeeding, you should consider taking a daily vitamin D supplement containing 10mcg.

ALCOHOL DURING PREGNANCY

It’s safer not to drink any alcohol if you’re pregnant, or planning to become pregnant, because it can damage your growing baby. By not drinking, you are protecting your baby and minimising the risks to their development and future health.

Alcohol passes from your blood into the baby’s placenta. Your baby can’t process alcohol like you can, and too much can be extremely harmful to their development. If you carry on drinking, especially in the first 3 months of pregnancy, the risk of miscarriage, premature birth and low birth weight are increased.

Sometimes drinking in pregnancy can cause a serious condition called foetal alcohol syndrome. When the baby can’t process the amount of alcohol being consumed, it can affect their development in the womb, including their brain, spinal cord and other parts of the body. This can result in miscarriage, and if the baby survives, they may be left with lifelong problems such as poor growth, facial abnormalities, learning and behavioural problems.

Remember – the more you drink, the greater the risk.

SMOKING

Stopping smoking can be hard, but if you’re pregnant, this is the time to quit. When you smoke, carbon monoxide and thousands of other harmful toxins travel from your lungs, into your bloodstream, through your placenta and into your baby’s body. When this happens, your baby struggles for oxygen. This lack of oxygen can affect your baby’s development.  If your partner or anyone else around you smokes, this can be harmful to your baby too.

When you give up, the harmful gases (like carbon monoxide) and other chemicals will soon clear from your body. Reasons to stop smoking include:

• You’re doing the best for your baby
• Your chances of having a miscarriage or still birth are reduced
• Your baby is less likely to be born early (premature) or underweight
• You’ll minimise the risk of cot death (SIDS)
• You will be helping your baby in later life – there is an increase in asthma and other serious illnesses in children of mothers who smoked during pregnancy

Talk to your GP, midwife or pharmacist for help and advice.

SLEEPING IN PREGNANCY

Depending on how you normally like to snooze, you might have to rethink your favourite position while you’re pregnant.

If you sleep on your back, it’s safe to continue during the first trimester, but as your bump gets bigger and heavier you’ll need to sleep on your side, so it’s best to get into the habit as soon as you can.

By the third trimester (after 28 weeks of pregnancy), sleeping on your side is the safest position for your baby as it helps prevent the risk of stillbirth. Don’t worry, if your pregnancy is uncomplicated your risk of stillbirth is low (1 in 200 babies are stillborn) and going to sleep on your side will make it even lower.

It’s OK if you end up in all sorts of positions when you are asleep. The important thing to remember is to fall asleep on your side, as this means you are sleeping safely for your baby. If you wake up on your back, don’t be alarmed, just turn onto your side and go back to sleep.

Try sleeping on one side with your knees bent, it’ll help reduce the amount of pressure on your uterus and help you breathe better. Plus, this position can help relieve backache. You can use pillows under your belly, between your legs, and behind your back if you like.

You should go to sleep on your side whenever you have a snooze, including:

• going to sleep at night
• getting back to sleep, after waking up at night
• daytime naps

It’s normal to feel tired or have strange dreams during pregnancy. Have a chat to your midwife if you’re struggling to sleep.

Page last updated – August 2022

High blood pressure is medically known as hypertension. It means that your blood pressure is consistently too high and your heart must work harder to pump blood around your body. High blood pressure can have serious consequences if untreated. Although your arteries are stretchy to cope with your blood pressure going up and down, if you have high blood pressure your arteries become stiffer. This makes it easier for fatty material (atheroma) to clog them up.

Persistent high blood pressure can increase your risk of conditions such as:

• angina
• heart attacks
• strokes
• heart failure
• peripheral arterial disease
• aortic aneurysms
• kidney disease
• vascular dementia

If you have high blood pressure, reducing it even a small amount can help lower your risk of these health conditions.

Often, there are no symptoms, and it is only picked up through a blood pressure check. All adults over 40 are advised to have their blood pressure checked at least every 5 years.

Most people develop high blood pressure because of their diet or lifestyle. Sometimes high blood pressure runs in families and can also worsen with age. It is also more common if you are of black African or black Caribbean descent. Even in these cases, you may still be able to improve your blood pressure by changing your diet and being active.

The following behaviours can all increase your risk of developing high blood pressure:

• Drinking too much alcohol – having more than three drinks in one sitting temporarily increases your blood pressure, and regular excessive drinking can lead to long-term increases in blood pressure.
• Smoking – damages the walls of your arteries, and allows fatty material to stick to them, making them narrower and stiffer. Also, nicotine (the addictive substance found in cigarettes) increases your heart rate and blood pressure. Blood pressure starts to improve as soon as 20 minutes after quitting smoking.
• Being overweight – Everyone needs some body fat to stay healthy but too much, particularly around the waist, puts your health at risk. While people tend to worry about the fat they can see and feel directly under their skin (subcutaneous fat), it’s the fat that surrounds our internal organs such as our heart and liver (visceral fat), that poses the greatest health risk. To reduce blood pressure, you may need to change your eating habits and be more active. The best way to do this is to start with small regular changes (see Losing Weight).
• Not doing enough exercise – Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. This means there is less pressure on your arteries (the blood vessels that take blood to your major organs), which helps your blood pressure stay at a healthy level.
• Eating too much salt – cut down on salty food and don’t add salt at mealtimes. Try cooking with herbs instead of salt.  If you like takeaways, try to limit how many you have in a week.

Page last updated – August 2022

High cholesterol is when you have too much of the fatty substance called cholesterol in your blood. Having high cholesterol can increase your risk of heart and circulatory diseases such as heart attack, stroke and vascular dementia. There are ‘good’ and ‘bad’ types of cholesterol – it is the ‘bad’ cholesterol that leads to narrowing of your blood vessels, restricting the flow of blood.

High cholesterol does not always cause symptoms. You can only find out if you have it from a blood test.

Anyone can get high cholesterol, and it can be caused by many different things. Some things you can control like lifestyle habits, others you can’t. If you take care of the things you can control, you’ll help lower your risk. 

If you have diabetes, you are at greater risk from high cholesterol.

HOW TO LOWER YOUR CHOLESTEROL

Action you should take includes:

• being physically active
• maintaining a healthy weight and reducing your waistline
• not eating too much saturated fat
• stopping smoking, as smoking damages your arteries and makes it easier for cholesterol to stick to your artery walls

Exercise more – aim to do at least 2.5 hours of exercise a week. Some good things to try when starting out include walking, (although you do need to try and walk fast enough to ensure your heart beats faster), swimming or cycling. You are more likely to keep exercising if you enjoy it so try a few different exercises until you find something you like.

Maintain a healthy weight – eat plenty of vegetables, fruit, fibre, wholegrains and pulses; cut down on processed foods, fat and sugar.

Eat less saturated fat – you can still have foods that contain a healthier type of fat called unsaturated fat. Try and eat more oily fish, like mackerel and salmon, brown rice, brown bread and wholemeal pasta, nuts and seeds and a variety of fruits and vegetables. You should avoid eating fatty and processed meats, butter, lard and ghee, cream and hard cheese, cakes and biscuits and food that contains coconut oil or palm oil.

Stop Smoking – smoking multiplies your risk of developing heart and circulatory disease.

Page last updated – August 2022

Being overweight means that you have too much body fat. Obesity is defined as a body mass index (BMI) of 30 or more, while being overweight means you have a BMI of 25 to 29.9. A BMI between 18.5 and 24.9 is considered an ideal weight. You can calculate your BMI using one of the online BMI calculators. It is important to try and maintain an ideal weight as being overweight can lead to a number of serious and potentially life-threatening conditions including type 2 diabetes, coronary heart disease, some types of cancer such as breast or bowel cancer and stroke. 

Weight loss can be achieved by following a Healthy Diet (See Healthy Diet section).

Tips for losing weight while maintaining a healthy diet include:

• Eat water-rich foods – Water adds bulk to foods without adding calories. People tend to eat a fairly consistent weight of food on a daily basis. The more water-rich the food, the fewer calories are being taken in overall. They also take longer to eat, which slows the rate of consumption and increases the sensation of food in our mouth and throat. The more we chew, taste and feel food in our mouths, the more our brain thinks we are filling up. Foods high in water content include:
  • 100-90% Water Content – asparagus, beets, bell peppers, broccoli, cabbage, cauliflower, celery, cucumber, grapefruit, green beans, lettuce, melon, mushrooms, onions, pumpkin, strawberries, tomatoes and courgette.
  • 89-80% Water Content – apples, apricots, artichokes, brussels sprouts, carrots, cherries, grapes, kiwifruit, mangos, oatmeal, other berries, other citrus fruits, pears, peas, pineapple, plums, tofu, and yoghurt.
  • 79-70% Water Content – avocados, bananas, tinned beans, sweetcorn, couscous, edamame, eggs, pomegranates, potatoes, quinoa, rice and sweet potatoes.
  • 69-60% Water Content – barley, beef, tinned tuna, hummus, lobster, pasta, pork, poultry and salmon
• Choose food with a low glycaemic load – Glycaemic load is a measure that takes into account the amount of carbohydrate in a portion of food together with how quickly it is digested and raises blood glucose levels. This is important because it can affect our appetites, our metabolic rates and how much fat we burn. Foods with a low glycaemic load of less than 10 include beans, chickpeas and split peas, fruit, lentils and whole-grain bread. Foods with a medium glycaemic load of between 11-19 include oatmeal, spaghetti, brown rice, sweet potato and white bread. Foods with a high glycaemic load which should be minimised include corn flakes and rice crispies, dates, white rice, white potatoes and raisins.
• Eat calorie dense foods sparingly – A healthy diet consists of a lot of food low in calorie density. When trying to lose weight low calorie density food is good because it will fill you up without adding excessive calories to your diet. You should:
  
  Eat More of these foods with less than 100 calories per 150g: most fresh fruit, most vegetables.
  
  Eat some of these foods with less than 300 calories per 150g: avocados, bananas, starchy vegetables, pasta, wholegrains, beans, lentils, chickpeas, yogurt and sea food.
  
  Eat Less of these foods with 300-600 calories per 150g: dried fruit, chips, onion rings, bread, eggs, beef, pork and poultry.
  
  Eat these foods with more than 600 calories per 150g sparingly: nuts, butter, oil, chocolate, cheese and bacon.   
• Drink more water – It can help reduce sugar cravings and aid weight maintenance because the brain can’t actually tell the difference between hunger and thirst, so often we can mistake thirst as a ‘sugar craving’. The next time you feel the need for something sweet, try drinking a glass of water first. Research has shown that having water before a meal may fill you up more and therefore promote weight loss by eating less at the meal.
• Exercise more – Exercise is helpful for weight loss and maintaining weight loss. Exercise can increase your metabolism, or how many calories you burn in a day. It can also help you maintain and increase lean body mass, which also helps increase number of calories you burn each day. Being physically active can also reduce your risk of major illnesses, such as heart disease, stroke, type 2 diabetes and cancer by up to 50% and lower your risk of early death by up to 30%.

Page last updated – August 2022

Norovirus, which causes diarrhoea and vomiting, is one of the most common stomach bugs in the UK, especially during the winter months. You can usually treat yourself or your child at home. You should start to feel better in 2 to 3 days. Norovirus is highly contagious.

Symptoms of Norovirus will include:

• Watery diarrhoea
• Vomiting
• Painful stomach cramps
• Aching limbs
• Suddenly feeling sick
• Fever
• Headaches

Norovirus is highly contagious and spreads easily in public places such as workplaces and public transport. If you catch the infection, be careful not to spread it to other people. You can catch it via:

• Contact with someone who has norovirus – they can easily pass the virus to you directly
• Touching contaminated surfaces or objects – norovirus has the ability to survive outside of the body on surfaces for up to several days
• Eating contaminated foods – foods could become infectious if a person who already has Norovirus doesn’t wash their hands before handling food.

An individual with Norovirus is at their most contagious from when their symptoms start until 48 hours after the symptoms have passed.

To stop the spread of Norovirus you need to do the following:

• Stay off work or school until at least 48 hours after the symptoms have passed
• Wash your hands frequently and thoroughly with soap and water, particularly after using the toilet and before preparing food. Try not to rely solely on anti-bacterial or alcohol hand gels as these do not kill the virus
• Flush away any infected poo or vomit in the toilet. Ideally disinfect the toilet seat and flush after use
• Avoid preparing product for others, and avoid eating raw, unwashed produce. – only eat oysters from a reliable source as oysters can carry traces of Norovirus
• Disinfect any surfaces or objects that could be contaminated using a bleach-based household cleaner – such as house phones, work surfaces and bannisters
• Immediately remove and wash clothing or linens that may be contaminated with vomit or poo. Handle soiled items carefully—try not to shake them —to avoid spreading virus. If available, wear disposable gloves while handling soiled clothing or linens and wash your hands after handling. Wash soiled items with detergent at the maximum available cycle length and then machine dry
• Don’t share towels and flannels

It is important to have plenty of fluids to avoid dehydration. Drink water or squash and avoid fruit juice or fizzy drinks. Take small sips if you are feeling sick.

Eat only when you feel able to. You do not need to eat or avoid any particular type of food.

Get advice from 111 now if:

• you’re worried about a baby under 12 months
• your child stops breast or bottle feeding while they’re ill
• a child under 5 years has signs of dehydration – such as fewer wet nappies
• you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets
• you or your child keep being sick and cannot keep fluid down
• you or your child have bloody diarrhoea or bleeding from the bottom
• you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days

Call 999 or go to A&E if you or your child:

• vomit blood or have vomit that looks like ground coffee
• have bright green or yellow vomit
• might have swallowed something poisonous
• have a stiff neck and pain when looking at bright lights
• have a sudden, severe headache or stomach ache

Page last updated – August 2022

Osteoporosis is a condition where your bones lose strength, meaning that you are at higher risk of breaking a bone than the average adult. As bones lose strength, they can break after a minor bump or fall. You may hear your doctor refer to these as fragility fractures. A broken bone and a fracture are the same thing. There are several things that you can do to help you live well with this condition.

Osteoporosis and broken bones have several known risk factors, which cause bones to lose strength. Some do this by reducing how much bone tissue your body makes and repairs, known as bone density. Others influence how strong your bone tissue is.

Understanding your risk factors for osteoporosis and broken bones can help you identify if there’s anything you can change. Remember, it’s never too late to start taking action for your bones – even after a diagnosis.

Risk factors that you can change:

• Smoking – Smoking slows down the cells that build bone in your body. If you’re a woman, smoking also increases your chances of an earlier menopause. Postmenopausal women have an increased risk of osteoporosis and breaking a bone.
• Low body weight – If you have low body weight, you’re more likely to have less bone tissue. If you’re older, having low body weight also means you have less fat padding around the hips, to cushion the impact of a fall. This makes broken bones more likely if you trip and fall.
• Drinking too much alcohol – Alcohol affects the cells that build and break down bone. It also makes you unsteady on your feet, making you more likely to trip, fall and break a bone.
• Slips, trips and falls – If you have low balance, coordination and reflexes, you are more likely to trip or stumble, and potentially break a bone in a fall. Try and keep your home clear of trip hazards and wear sensible footwear to help your balance. Make sure you have regular sight and hearing tests.
• Not exercising regularly – Exercise promotes bone and muscle strength, keeps you steady and cares for your back. Weight bearing exercise and resistance exercise are particularly important for improving bone density and helping to prevent osteoporosis.
• Not eating a healthy diet – A healthy diet is important for everyone, not just for people with osteoporosis. Make sure you have a balanced diet that contains all the food groups to give your body the nutrition it needs. Calcium is important for maintaining strong bones. Vitamin D is important for healthy bones and teeth as it helps your body to absorb calcium.

There are several risk factors for osteoporosis that you can’t change, including:

• Genes determine the potential size and strength of your skeleton
• Risk increases with age
• More common in women than men
• Higher risk if you are of Caucasian or Asian origin
• Certain medication can increase your risk, including high dose steroids and some medicines used to treat breast cancer and prostate cancer that affect hormone levels
• Certain hormone related disorders can trigger osteoporosis including an overactive thyroid gland, adrenal gland disorders, reduced amounts of oestrogen and testosterone, disorders of the pituitary gland and overactivity of the parathyroid glands.

If you have a history of broken bones, then you are at higher risk.

Recovering from a broken bone

Osteoporosis doesn’t affect the healing process of bone; broken bones can heal as normal.

Some broken bones need an operation to help them heal, while others get better on their own. A broken bone usually takes between 6 and 8 weeks to heal, although this can be longer. There are things you can do to speed up the healing process:

• Eat a healthy balanced diet, with plenty of protein
• Avoid smoking, as smoking limits the blood supply to your bones

Page last updated – August 2022

When we talk about being physically active, we don’t mean putting on sports kit and joining the gym. You don’t have to get hot and sweaty. We are really talking about getting up and moving around more. Activities such as walking, gardening, housework, taking the stairs instead of the lift, swimming or cycling.

Always look out for ways to get bursts of activity into your day. There is increasing evidence that, unless you are a wheelchair user, sitting down too much can be a risk to your health.

Being physically active reduces your risk of major illnesses, such as heart disease, stroke, type 2 diabetes and cancer by up to 50% and lowers your risk of early death by up to 30%. It’s free, easy, has immediate benefits and you don’t need a GP to get some.

Exercise is the miracle cure we’ve always had, but for too long we’ve neglected to take our recommended dose. Our health is now suffering as a consequence.

Being more physically active could mean you:

• Have more energy
• Feel more relaxed and better able to manage stress
• Achieve a healthier body weight
• Sleep better
• Have better concentration and memory
• Feel more confident
• Have a lower risk of depression
• Have a lower risk of dementia

To reduce your risk of suffering from health conditions, it is best to be active every day. Aim for at least 150 minutes of exercise a week which equates to 20–30 minutes a day. It counts every time you are active for 10 minutes or more. Make sure you do 10-minute bursts to add up to at least 20–30 minutes a day.

Do something for 10 minutes or more that makes you:

• breathe harder
• feel warmer
• feel your heart beat faster.

You should still be able to hold a conversation while you are active (moderate activity).

Activities where you have to work even harder are called vigorous activity. There is evidence that vigorous activity can bring health benefits over and above that of moderate activity. You can tell when it’s vigorous activity because you’re breathing hard and fast, and your heart rate has gone up quite a bit. If you’re working at this level, you won’t be able to say more than a few words without pausing for a breath.

Adults need to do strengthening activities that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms) on at least 2 days a week. There are many ways you can strengthen your muscles, whether you’re at home or in a gym. These can include carrying heavy shopping bags, yoga, pilates, lifting weights, doing exercises that use your own body weight, such as push-ups and sit-ups, heavy gardening, such as digging and shovelling, wheeling a wheelchair or lifting and carrying children.

Finding time can be tricky, but if you fit activity into things you’re already doing, you’ll be a lot more likely to get into a habit you want to stick to. This could mean walking to school or work instead of driving, getting off the bus a few stops early or taking the stairs instead of a lift. Try writing a list of everything you do in a day and see where you can slot in 10 minutes or more to be active. Lots of little things build up to make a big difference.

Choose an ‘active’ vs a sedentary lifestyle:

• Brisk walk to/from the station vs Car to the station and train to work
• Use the stairs vs Using the lifts or escalators
• Go for a 15-30-minute walk with a colleague or friend vs Staying in your office during your lunch break
• Prepare and cook food yourself (30 minutes) vs Ordering a takeaway for dinner
• Play with the children vs Sitting down to watch TV as a family

The best time to make a change is now. Think about what you can do right now to be active. You might not feel like it to start with, but it gets easier over time, and in the end it will be a habit that you don’t need to think about.

RECOMMENDED AMOUNTS OF EXERCISE

• Babies under 1 year – Babies should be encouraged to be active throughout the day, every day in a variety of ways, including crawling. If they’re not yet crawling, encourage them to be physically active by reaching and grasping, pulling and pushing, moving their head, body and limbs during daily routines, and during supervised floor play. Try to include at least 30 minutes of tummy time spread throughout the day when they’re awake.
• Toddlers (aged 1 to 2) – Toddlers should be physically active every day for at least 180 minutes (3 hours). The more the better. This should be spread throughout the day, including playing outdoors. The 180 minutes can include light activity such as standing up, moving around, rolling and playing, as well as more energetic activity like skipping, hopping, running and jumping. Active play, such as using a climbing frame, riding a bike, playing in water, chasing games and ball games, is the best way for this age group to get moving.
• Pre-schoolers (aged 3 to 4) – Pre-schoolers should spend at least 180 minutes (3 hours) a day doing a variety of physical activities spread throughout the day, including active and outdoor play. The more the better. The 180 minutes should include at least 60 minutes of moderate-to-vigorous intensity physical activity. Children under 5 should not be inactive for long periods, except when they’re asleep. Watching TV, travelling by car, bus or train, or being strapped into a buggy for long periods are not good for a child’s health and development. All children under 5 who are overweight can improve their health by meeting the activity guidelines, even if their weight does not change. To achieve and maintain a healthy weight, they may need to do additional activity and make dietary changes.
• Young people (aged 5 to 18) – Children and young people need to do both aerobic exercise and exercises to strengthen their muscles and bones. They should aim for an average of at least 60 minutes of moderate intensity physical activity a day across the week and a variety of types and intensities of physical activity across the week to develop movement skills, muscles and bones. Children and young people should reduce the time spent sitting or lying down and break up long periods of not moving with some activity. Aim to spread activity throughout the day. All activities should make you breathe faster and feel warmer.
• Adults (aged 65 and over) – Older adults should do some type of physical activity every day. Any type of activity is good for you, even if its light activity such a making a cup of tea, moving around your home, cleaning and dusting or making your bed. The more you do the better. Adults aged 65 and over should aim to be physically active every day. Do activities that improve strength, balance and flexibility on at least 2 days a week and try to incorporate at least 150 minutes of moderate intensity activity a week or 75 minutes of vigorous intensity activity if you are already active, or a combination of both. Aim to reduce time spent sitting or lying down and break up long periods of not moving with some activity.

Page last updated – August 2022

Pre-diabetes is a term used to describe people who are at a high risk of developing Type 2 diabetes. Pre-diabetes means that your blood sugar is higher than usual but not yet high enough for you to be given a diagnosis of Type 2 diabetes. Knowing that you are pre-diabetic is the first step to being able to do something about it and there are lots of things you can do to reduce your risk of Type 2 diabetes.

Pre-diabetes doesn’t have any symptoms. If you start to have any symptoms it means that you have probably already developed Type 2 diabetes.

Being pre-diabetic doesn’t mean you will definitely develop Type 2 diabetes, but it is a warning that now is the time to start making healthy changes to your lifestyle to reduce your risk of Type 2 diabetes. This includes:

• Managing your weight – If you are overweight and at high risk of Type 2 diabetes, losing just 5% of your body weight can significantly reduce your risk. There are lots of ways you can lose weight and it’s about finding what works best for you. Making healthier food choices and being more active are both positive ways to start.
• Eat a healthy, balanced diet – The food and drink we have in our overall diet is linked to your risk of developing Type 2 diabetes. To reduce your risk, aim to eat more of the foods like fruit and veg, wholegrains and unsweetened drinks. Cut down on red and processed meat, refined carbohydrates, sugar sweetened drinks and potatoes.
• Be more active – If you spend a lot of time sitting down, this is known as a sedentary lifestyle. Being sedentary is linked with an increased risk of Type 2 diabetes. This doesn’t mean you need to take up a new sport or join the gym, you could make small changes so that you are a little more active every day. Think about taking phone calls standing up, using stairs instead of the lift, and going for a walk on your lunch break.

Page last updated – August 2022

AAA SCREENING

Abdominal aortic aneurysm (AAA) screening is a way of checking if there’s a bulge in the aorta, the large blood vessel in your abdomen that takes blood from the heart to the lower part of your body. 

In England, it is offered to men during the year they turn 65, as men aged 65 or over are most at risk of getting AAAs. It is not routinely offered to women or men under the age of 65.

Screening for abdominal aortic aneurysm is important because if it is not spotted early it can grow in size and eventually rupture, which is life threatening.

A simple ultrasound scan is all that’s needed. If you’re a man and registered with a GP, you’ll receive a screening invitation in the post when you’re 64 or soon after your 65th birthday. You can then arrange an appointment that suits you. If you’re a man over 65 and have not been screened before, you can ask for a test by contacting your local AAA screening service directly.

BOWEL SCREENING

NHS bowel screening is a way of testing healthy people to see if they show any early signs of cancer. It’s available to everyone aged 60 or over. From April 2021 the NHS is starting to reduce the age range for bowel cancer screening to anyone aged 50 & over. 

You use a home test kit, called a faecal immunochemical test (FIT), to collect a small sample of poo and send it to a lab. This is checked for tiny amounts of blood.

Blood can be a sign of polyps or bowel cancer. Polyps are growths in the bowel. They are not cancer but may turn into cancer over time.

If the test finds anything unusual, you might be asked to have further tests to confirm or rule out cancer.

Always consult your GP if you have symptoms of bowel cancer at any age, even if you have recently completed an NHS bowel cancer screening test kit – do not wait to have a screening test.

The symptoms of bowel cancer can be subtle and do not necessarily make you feel ill. However, it’s worth trying simple treatments for a short time to see if they get better.

More than 90% of people with bowel cancer have 1 of the following combinations of symptoms:

• a persistent change in bowel habit – pooing more often, with looser, runnier poos and sometimes tummy (abdominal) pain
• blood in the poo without other symptoms of piles (haemorrhoids) – this makes it unlikely the cause is haemorrhoids
• abdominal pain, discomfort or bloating always brought on by eating – sometimes resulting in a reduction in the amount of food eaten and weight loss

Constipation, where you pass harder stools less often, is rarely caused by serious bowel conditions. Most people with these symptoms do not have bowel cancer.

See a GP if you have any of the symptoms of bowel cancer for 3 weeks or more.

BREAST SCREENING

Screening aims to find breast cancers early, when they have the best chance of being cured.

To have screening you have an x-ray of your breast called a mammogram.

Breast screening is for women between the ages of 50 and 70, it is also for some trans or non-binary people.

You should get a letter with your results within 2 weeks. This will tell you what you need to do next.

It is important to remember that screening will not prevent you from getting breast cancer but aims to find early breast cancers.

Each year more than 2 million women have breast cancer screening in the UK. The NHS Breast Screening Programme invites all women from the age of 50 to 70 for screening every 3 years. This means that some people may not have their first screening mammogram until they are 52 or 53 years. 

In some parts of England, the screening programme has been inviting women from 47 to 73 years old as part of a trial.

If you are older than 70, you can still have screening every 3 years but you won’t automatically be invited. To make an appointment, talk to your GP or your local breast screening unit.

If you are younger than 50, your risk of breast cancer is generally very low. Mammograms are more difficult to read in younger women because their breast tissue is denser and the patterns on the mammogram don’t show up as well. There is little evidence to show that regular mammograms for women below the screening age would reduce deaths from breast cancer. 

Breast screening is also for some trans or non-binary people. Talk to your GP or Gender Identity Clinic about this. 

Possible benefits of breast screening

Breast cancers found by screening are generally at an early stage. Very early breast cancers are usually easier to treat, may need less treatment, and are more likely to be cured.

The current evidence suggests that breast screening reduces the number of deaths from breast cancer by about 1,300 a year in the UK.

Almost all women diagnosed with breast cancer at the earliest possible stage survive for at least 5 years after diagnosis and have a good prospect of being cured.

Breast Awareness

Even if you are having mammograms every 3 years it is important to make sure that you know how your breasts normally look and feel. Many breast cancers are still found by women themselves. Cancers can develop between mammograms. This is known as an interval cancer. Mammograms can also miss some cancers.

If you notice any unusual changes in your breast don’t wait until your next mammogram. See your GP straight away. 

CERVICAL SCREENING

Cervical screening saves lives. Don’t ignore your cervical screening invite. If you missed your last one, book an appointment at your GP practice now.

Two women die every day from cervical cancer, yet it is one of the most preventable cancers. Around 2,700 women in England are diagnosed with cervical cancer each year and it is the second most common cancer amongst women under 35 years of age.

Cervical screening is a free health test available on the NHS as part of the national cervical screening programme. It helps prevent cervical cancer by checking for a virus called high-risk HPV and cervical cell changes. It is not a test for cancer. 

You should be invited for cervical screening if you have a cervix. Women are usually born with a cervix. Trans men, non-binary and intersex people may also have one.

In the UK, you are automatically invited for cervical screening if you are:

• between the ages of 25 to 64
• registered as female with a GP surgery

You may get your first invite up to 6 months before you turn 25. You can book an appointment as soon as you get the invite.

Your cervical screening result will help decide when you are next invited for cervical screening. 

You may be invited:

• every year
• every 3 years
• every 5 years
• straight to colposcopy for more tests

Cervical screening aims to identify whether you are at higher risk of developing cervical cell changes or cervical cancer. This means you can get any care or treatment you need early. 

England, Scotland and Wales now use HPV primary screening, which is even better as it is based on your individual risk. This means how frequently you are invited for cervical screening is based on your last result and within a timeframe that is safe for you. 

See a GP if you’re worried about symptoms of cervical cancer such as:

• bleeding between periods, during or after sex, or after you have been through the menopause
• unusual vaginal discharge

Do not wait until your next cervical screening appointment.

Page last updated – August 2022

If you smoke, quitting is the single most important step you can take to protect your health.

Nicotine is a highly addictive drug that is inhaled when you smoke. It is often a struggle to break free from nicotine addiction but fortunately there are a number of treatments available to help.

When you stop smoking:

• After 20 minutes – Pulse rate returns to normal.
• After 8 hours – Nicotine and carbon monoxide levels in blood reduce by more than half and oxygen levels return to normal.
• After 48 hours – Carbon monoxide will be eliminated from the body. Lungs start to clear out mucus and other smoking debris.
• After 48 hours – There is no nicotine in the body. Ability to taste and smell is improved as your mouth and nose recover from being dulled by the hundreds of toxic chemicals found in cigarettes.
• After 72 hours – Breathing becomes easier. Bronchial tubes begin to relax and energy levels increase.
• After 2-12 weeks – Your circulation improves. This makes all physical activity, including walking and running, much easier. You’ll also give a boost to your immune system, making it easier to fight off colds and flu. The increase in oxygen in the body can also reduce tiredness and the likelihood of headaches.
• After 3-9 months – Coughs, wheezing and breathing problems improve as lung function increases by up to 10%. In later years, having maximum lung capacity can mean the difference between having an active, healthy old age and wheezing when you go for a walk or climb the stairs.
• After 1 year – Risk of heart disease is about half compared with a person who is still smoking.
• After 10 years – Risk of lung cancer falls to half that of a smoker.
• After 15 years – Risk of heart attack falls to the same as someone who has never smoked.

CIGARETTES AND STRESS

The withdrawal from nicotine between cigarettes can heighten feelings of stress. As the stress of withdrawal feels the same as other stresses, it’s easy to confuse normal stress with nicotine withdrawal, so it can seem like smoking is reducing other stresses. But this is not the case. In fact, scientific studies show people’s stress levels are lower after they stop smoking. If you find that you’re prone to stress, replacing smoking with a healthier, better way of dealing with stress can give you some real benefits.

CIGARETTES, SEX AND FERTILITY

Stopping smoking improves the body’s blood flow, so improves sensitivity. Men who stop smoking may get better erections. Women may find their orgasms improve and they become aroused more easily. Non-smokers find it easier to get pregnant. Quitting smoking improves the lining of the womb and can make men’s sperm more potent. Becoming a non-smoker increases the possibility of conceiving through IVF and reduces the likelihood of having a miscarriage. Most importantly, it improves the chances of giving birth to a healthy baby.

CIGARETTES AND YOUR APPEARANCE

Stopping smoking has been found to slow facial ageing and delay the appearance of wrinkles. The skin of a non-smoker gets more nutrients, including oxygen, and stopping smoking can reverse the sallow, lined complexion smokers often have. Giving up tobacco stops teeth becoming stained, and you’ll have fresher breath. Ex-smokers are also less likely than smokers to get gum disease and prematurely lose their teeth.

SECOND-HAND SMOKE

There aren’t just risks for smokers, there are risks of exposure to second-hand smoke. Those risks include:

• Increased risk of lung cancer and heart disease in non-smokers
• Reduced lung function in people with asthma and those with chronic chest problems
• Increased risk of lower respiratory infections and middle ear disease in children
• Double the risk of bacterial meningitis in children
• Double the risk of cot death for babies who live with smokers

As 80-85% of smoke is INVISIBLE, what you see is only a very small percentage of the second-hand smoke that is produced when a cigarette is smoked. You need to remember that there is no safe level of exposure to second-hand smoke. If you’re exposing others to second-hand smoke, not only will stopping smoking improve your own health but the health of your loved ones too.

QUIT SMOKING TO LIVE LONGER

Half of all long-term smokers die early from smoking-related diseases, including heart disease, lung cancer and chronic bronchitis. Men who quit smoking by the age of 30 add 10 years to their life. People who kick the habit at 60 add 3 years to their life. In other words, it’s never too late to benefit from stopping. Being smoke-free not only adds years to your life, but also greatly improves your chances of a disease-free, mobile, happy old age.

Coping with the Cravings

If you can control your cravings for a cigarette, you’ll significantly boost your chances of quitting. The most effective way to tackle cravings is a combination of stop smoking medicines and behavioural changes. Going cold turkey may be appealing and works for some, but research suggests that willpower alone isn’t the best method to stop smoking.

Using nicotine replacement therapy (NRT) and other stop smoking medicines can double your chances of quitting successfully compared with willpower alone. 

Cravings happen because your body misses its regular hits of nicotine. There are 2 types of craving.

• The steady and constant background craving for a cigarette that decreases in intensity over several weeks after quitting.
• Sudden bursts of an intense desire or urge to smoke are often triggered by a cue, such as having a few drinks, feeling very happy or sad, having an argument, feeling stressed, or even having a cup of coffee.

These urges to smoke become less frequent over time but their intensity can remain strong even after many months of quitting. There are 3 tried and tested ways to tame cravings:

1. Nicotine replacement therapy

Nicotine replacement therapy (NRT) gives your body the nicotine it craves without the toxic chemicals that you get in cigarettes, so it doesn’t cause cancer. It helps you to stop smoking with fewer unpleasant withdrawal symptoms. NRT won’t give you the same “hit” or relief you would expect from a cigarette, but it does help reduce cravings.

NRT is available as gum, patches, lozenges, microtabs, inhalator, nasal spray, mouth spray and oral strips. Some products, like the patch, release nicotine into your system slowly and steadily, so they’re ideal for relieving background cravings. Others, such as the nasal spray and mouth spray, release nicotine quickly in short bursts, so they’re better suited to sudden intense cravings.

A good strategy is to use the nicotine patch to manage the steady and constant background cravings and carry a fast-working product with you to deal with the sudden intense cravings.

Discuss the NRT products available over the counter with your pharmacist or talk to your local NHS stop smoking adviser or GP.

2. Stop smoking medicines

The prescription tablet Champix (Varenicline) is not currently available.  It has been withdrawn as a precaution because of an impurity found in the medicine. The prescription tablets Champix (varenicline) and Zyban (bupropion) are an alternative to NRT in helping you stop smoking. They don’t contain nicotine but work on your brain to dampen cravings and can be very effective. As they take a few days to work fully, you need to start these medicines for a week or two before you stop smoking. Ask your doctor or a local stop smoking adviser whether prescription medicines may help you.

3. Change your behaviour

NRT and stop smoking medicines can help curb cravings, but they can’t completely eradicate them. There are some additional things that can help including:

• Avoiding triggers – For you, some events or times of the day may have a strong association with smoking: after food, with a coffee, after putting the kids to bed, when chatting to a friend, or having an alcoholic drink. Try doing something different at these times. You don’t have to make this change forever, just until you have broken the association with smoking.
• Staying strong – Expect your cravings to be at their worst in the first few weeks after quitting. The good news is that they’ll pass, and the quickest way to achieve this is to commit to the “not a single drag” rule. When you’re ready to stop for good, promise yourself “I won’t even have a single drag on a cigarette”. If you feel like smoking, remember “not a single drag” to help the feeling pass.
• Exercising – Physical activity may help reduce your nicotine cravings and relieve some withdrawal symptoms. It may also help you to reduce stress and keep your weight down. When you have the urge to smoke, do something active instead.
• Being prepared – Expect cravings at special events like holidays, funerals or weddings. You may never have experienced these events as a non-smoker before, so you’ll associate them strongly with smoking. Have some fast-acting NRT with you just in case. When an urge to smoke strikes, remember that although it may be intense, it’ll be short lived and will probably pass within a few minutes. Each time you resist a craving, you’re 1 step closer to stopping smoking for good.

Page last updated – August 2022

A stroke is a brain attack. It happens when the blood supply to part of the brain is cut off, killing brain cells. Damage to the brain can affect how the body works. It can also change how you think and feel. The effects of a stroke depend on where it takes place in the brain, and how big the damaged area is.

As we age, our arteries become harder and narrower and more likely to become blocked. However, certain medical conditions and lifestyle factors can speed up this process and increase your risk of having a stroke.

There are three different types of stroke: ischaemic strokes, haemorrhagic strokes and transient ischemic attacks.

• An ischaemic stroke is caused by a blockage cutting off the blood supply to the brain. This is the most common type of stroke
• A haemorrhagic stroke is caused by bleeding from a blood vessel in or around the brain
• A transient ischaemic attack or TIA is also known as a mini stroke. It is the same as a stroke, except that the symptoms only last for a short amount of time, as occurs when the blockage that stops the blood getting to your brain is temporary

Spotting the signs of stroke – FAST

Face: Can the person smile? Has their face fallen on one side?

Arms: Can the person raise both arms and keep them there?

Speech problems: Can the person speak clearly and understand what you say? Is their speech slurred?

Time: If you see any of these three signs, it’s time to call 999.

The FAST test helps to spot the three most common symptoms of stroke. But there are other signs that you should always take seriously. These include:

• Sudden weakness or numbness on one side of the body, including legs, hands or feet
• Difficulty finding words or understanding what others are saying
• A sudden, severe headache
• Sudden blurred vision or loss of sight in one or both eyes
• Sudden memory loss or confusion, and dizziness or a sudden fall
• A sudden, very severe headache
• Loss of consciousness

If you spot any of these signs of a stroke, don’t wait. Call 999 straight away.

Reducing the risk of stroke

You can help to reduce your risk of a stroke by making some healthy lifestyle choices. Whether it’s your diet, activity levels, smoking or drinking, it’s never too late to make a change.

Smoking – Smoking doubles your risk of dying from a stroke. But the minute you quit, your risk of a stroke starts to drop.

Alcohol – Regularly drinking too much alcohol raises your risk of a stroke. You should drink no more than 14 units a week and spread the units over the week. The limit is the same for men and women.

Maintaining a healthy weight – Being overweight makes you more likely to have a stroke. Extra weight affects your body in many ways, such as raising the risk of high blood pressure and type 2 diabetes, which are both linked to stroke.

Eating well – Eating healthily helps to lower risk factors such as high blood pressure and diabetes. Even small changes to your diet can make a difference.

Being physically active – Exercise helps to reduce your risk of a stroke. Moving around will also help your emotional wellbeing by releasing chemicals into your brain that make you feel better.

Preventing further strokes

Some health problems raise your risk of a stroke. These include:

• High blood pressure
• Atrial fibrillation (irregular heartbeat)
• Diabetes and pre-diabetes
• High cholesterol

Strokes can run in families, so speak to your GP or nurse if you have a family history of stroke. You may need some tests and health checks, and advice on reducing your risk.

If you have had a stroke, your chances of having another one is significantly increased. You’ll usually require long-term treatment with medicines that improve the risk factors for your stroke. For example:

• Medicine to help lower your high blood pressure
• Anticoagulants or antiplatelets – to reduce your risk of blood clots
• Statins – to lower your cholesterol levels

You’ll also be encouraged to make lifestyle changes to improve your general health and lower your stroke risk.

Page last updated – August 2022

You should aim to strike a balance between protecting yourself from the sun and getting enough vitamin D from sunlight. Sun ages the skin and sunburn increases your risk of skin cancer. There is no safe way to get a tan from sun exposure, so you might want to use ‘fake tan’ products instead. 

Safety Tips to consider when enjoying the sunshine:

• The sun is at its highest between 11am and 3pm in the UK, so spend time in the shade during this period.
• Cover up with suitable clothing and sunglasses.
• Make sure you never burn by using a sun protection factor of at least SPF 30, with at least a 4-star UVA protection. 
• Take extra care with children. Children under 6 months should be kept out of direct strong sunlight.

Sunscreen should be applied to all exposed skin before going out, including the face, neck and ears, and head if you have thinning or no hair, but a wide-brimmed hat is better. Sunscreen needs to be reapplied liberally and frequently, and according to the manufacturer’s instructions. This includes applying it straight after you have been in water, even if it’s “water resistant”, and after towel drying, sweating or when it may have rubbed off. It’s also recommended to reapply sunscreen every 2 hours, as the sun can dry it off your skin.

People who spend a lot of time in the sun, whether it’s for work or play, are at increased risk of skin cancer if they do not take the right precautions. People with naturally brown or black skin are less likely to get skin cancer, as darker skin has some protection against UV rays. But skin cancer can still occur.

You should take extra care in the sun if you:

• Have pale, white or light brown skin
• Have freckles or red or fair hair
• Tend to burn rather than tan
• Have many moles (if any moles or lumps are new or have changed shape, size or colour, have these checked as soon as possible).
• Have skin problems relating to a medical condition
• Are only exposed to intense sun occasionally (for example, whilst on holiday)
• Are in a hot country where the sun is particularly intense
• Have a family history of skin cancer

Coping in the hot weather can be particularly difficult for at risk groups, including older people over 75, babies and young children, people with a serious long-term condition, especially heart or breathing problems, people with mobility problems, people with serious mental health problems, those who misuse drugs or alcohol, those taking photo-sensitive medicines, and people who are physically active, for example, labourers or those doing sports:

• Avoid the heat: stay out of the sun between 11am and 3pm
• Wear light, loose-fitting cotton clothes
• Keep windows that are exposed to the sun closed during the day; open windows at night when the temperature has dropped
• Keep rooms cool by using shades or reflective material outside the windows. If this is not possible, use light-coloured curtains and keep them closed (metallic blinds and dark curtains can make the room hotter)
• If possible, move into a cooler room, especially for sleeping
• Have cool baths or showers, and splash yourself with cool water
• Drink plenty of fluids and avoid excess alcohol. Water, lower-fat milks, and tea and coffee are good options
• If you must go out in the heat, walk in the shade, apply sunscreen and wear a hat and light scarf
• Protect your eyes by wearing sunglasses with the CE Mark and British Standard Mark 12312-1:2013 E
• Check up on friends, relatives and neighbours who may be less able to look after themselves

Sunburn

It always best not to get sunburnt, however if you do, carefully sponge the skin with cool water and apply soothing aftersun.  Painkillers, such as paracetamol or ibuprofen will help ease the pain and stay out of the sun until all redness has gone.  If the skin swells or blisters badly, seek medical attention.

Page last updated – August 2022

Vaccination is the most important thing we can do to protect ourselves and our children against ill health. Vaccines prevent up to 3 million deaths worldwide every year. Since vaccines were introduced in the UK, diseases like smallpox, polio and tetanus that used to kill or disable millions of people are either gone or seen very rarely. Other diseases like measles and diphtheria have been reduced by up to 99.9% since their vaccines were introduced.

However, if people stop having vaccines, it’s possible for infectious diseases to quickly spread again.

Be aware that anti-vaccine stories are spread online through social media. They may not be based on scientific evidence and could put your child at risk of a serious illness.

Vaccines teach your immune system how to create antibodies that protect you from diseases. It’s much safer for your immune system to learn this through vaccination than by catching the diseases and treating them. Once your immune system knows how to fight a disease, it can often protect you for many years.

Having a vaccine also benefits your whole community through “herd immunity”. If enough people are vaccinated, it’s harder for the disease to spread to those people who cannot have vaccines. For example, people who are ill or have a weakened immune system.

Why vaccines are safe

All vaccines are thoroughly tested to make sure they will not harm you or your child. It often takes many years for a vaccine to make it through the trials and tests it needs to pass for approval.

Once a vaccine is being used in the UK it’s also monitored for any rare side effects by the Medicines and Healthcare Products Regulatory Agency (MHRA).

Side effects of vaccination

Most of the side effects of vaccination are mild and do not last long. The most common side effects of vaccination include:

• the area where the needle goes in looking red, swollen and feeling a bit sore for 2 to 3 days
• babies or young children feeling a bit unwell or developing a high temperature for 1 or 2 days

Some children might also cry and be upset immediately after the injection. This is normal and they should feel better after a cuddle.

Allergic reactions

It’s rare for anyone to have a serious allergic reaction to a vaccination. If this does happen, it usually happens within minutes. The person who vaccinates you or your child will be trained to deal with allergic reactions and treat them immediately. With prompt treatment, you or your child will make a good recovery.

Vaccines Do:

• protect you and your child from many serious and potentially deadly diseases
• protect other people in your community – by helping to stop diseases spreading to people who cannot have vaccines
• get safety tested for years before being introduced – they’re also monitored for any side effects
• sometimes cause mild side effects that will not last long – some children may feel a bit unwell and have a sore arm for 2 or 3 days
• reduce or even get rid of some diseases – if enough people are vaccinated

Vaccines Don’t:

• do not cause autism – studies have found no evidence of a link between the MMR vaccine and autism
• do not overload or weaken the immune system – it’s safe to give children several vaccines at a time and this reduces the number of injections they need
• do not contain mercury (thiomersal)
• do not contain any ingredients that cause harm in such small amounts – but do speak to your doctor if you have any known allergies such as eggs or gelatine or, you have had any serious reactions to vaccines previously.

NHS vaccination schedule

8 weeks

6-in-1 vaccine

Rotavirus vaccine

MenB

12 weeks

6-in-1 vaccine (2nd dose)

Pneumococcal (PCV) vaccine

Rotavirus vaccine (2nd dose)

16 weeks

6-in-1 vaccine (3rd dose)

MenB (2nd dose)

1 year

Hib/MenC (1st dose)

MMR (1st dose)

Pneumococcal (PCV) vaccine (2nd dose)

MenB (3rd dose)

2 to 10 years

Flu vaccine (every year)

3 years and 4 months

MMR (2nd dose)

4-in-1 pre-school booster

5 to 15 years

COVID-19 vaccine (1st and 2nd dose)

12 to 13 years

HPV vaccine

14 years

3-in-1 teenage booster

MenACWY

16 years and over

COVID-19 vaccine (1st, 2nd and booster doses)

50 years

Flu vaccine (and every year after)

65 years

Pneumococcal (PPV) vaccine

Flu vaccine (and every year after)

70 years

Shingles vaccine

Pregnant Women

Flu vaccine – During flu season

From 16 weeks pregnant – Whooping cough (pertussis) vaccine

If you’re starting college or university you should make sure you’ve already had:

• the MenACWY vaccine – which protects against serious infections like meningitis. You can still ask your GP for this vaccine until your 25th birthday
• 2 doses of the MMR vaccine – as there are outbreaks of mumps and measles at universities. If you have not previously had 2 doses of MMR, you can still ask your GP for the vaccine

Extra vaccines for those at-risk:

If you have an underlying health condition and are identified as being ‘at-risk’ you may be offered extra vaccines as protection. If you are unsure which vaccines are recommended for you, speak to your GP.

If you have been identified as clinically extremely vulnerable, or you are now eligible you should be invited to receive the Covid-19 vaccine.

Speak to your GP surgery if:

• you think you or your child have missed, or not been invited for any vaccinations
• you or your child have a vaccination appointment, but you’ve missed it or cannot attend

They can book or rearrange the next available appointment.

It’s best to have vaccines on time but you can still catch up on most vaccines if you miss them.

Page last updated – August 2022

Some people are more vulnerable to the effects of cold weather. Those most at risk include:

• people aged 65 and older
• babies and children under the age of 5
• people on low income (so cannot afford heating)
• people who have a long-term health condition
• disabled people
• pregnant women
• people who have a mental health condition.

As we get older, changes to our bodies mean that cold weather and winter bugs affect us more than they used to this can include:

Our immune system doesn’t function as well as we age. Our immune system helps us fight off germs and infections. Colds, flu and pneumonia are all more common in winter. It doesn’t have to be a cold winter for seasonal viruses such as flu, colds, and norovirus to spread.

Everyone aged 50 and over is entitled to a free flu jab from their doctor or pharmacist. The vaccines for this age group have an ingredient which helps to boost the immune system’s response to the vaccine. Even if you’re fit and healthy, it’s a great idea to have the jab to protect yourself and others. If you care for someone aged 65 or over, or are a frontline care worker, you should think about vaccinating yourself against the flu too.

There is also a vaccine available for pneumonia. Check with your doctor or pharmacist to see if you are eligible.

If you have been identified as clinically extremely vulnerable, or you are now eligible you should be invited to receive the Covid-19 vaccine.

Other things you can do to help prevent winter illness is by washing your hands regularly. This helps stop germs from spreading.

If you do have a cold or sore throat, speak to your pharmacist about the medicines available to help.

The cold puts more pressure on our hearts and circulatory systems. As we get older, our body must work harder to keep us warm. If you’re exposed to a cold environment for a long time, or extreme cold for only a short time, your blood pressure rises, and your blood thickens. This can increase the risk of heart attack and stroke.

Make sure that you wrap up warm when you go out in the cold. Layering is the best way to keep warm in winter. A scarf can help you breathe more easily by wrapping it around your face before you go out in the cold. It will warm up the cold air before you breathe it in, reducing the risk of chest infections.

Make sure your home is warm enough. You should be aiming for about 21 degrees centigrade in your living room and about 18 degrees in your bedroom.

Changes to our bodies as we age can mean it’s harder to keep warm. From about the age of 55, we lose around 1% of our muscle mass every year so it is normal for you to feel the cold more than you used to.

Try not to sit still for more than one hour at a time. Even if just move your arms and legs, it will help you to keep warm.

Tips for keeping your home warm in colder weather

Follow these tips to keep you and your family warm and well at home:

• if you’re not very mobile, are 65 or over, or have a health condition, such as heart or lung disease, heat your home to at least 18C
• keep your bedroom at 18C all night if you can – and keep bedroom window closed
• if you’re under 65, healthy and active, you can safely have your home cooler than 18C, as long as you’re comfortable
• use a hot water bottle or electric blanket to keep warm in bed – but do not use both at the same time
• have at least 1 hot meal a day – eating regularly helps keep you warm
• have hot drinks regularly
• to reduce the risk of sudden infant death syndrome (SIDS), babies should sleep in rooms heated to between 16C and 20C
• draw curtains at dusk and keep doors closed to block out draughts
• have your heating system checked regularly by a qualified professional

Page last updated – August 2022