Episode 1 Trust Me, I'm a Doctor


Episode 1

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When it comes to our health,

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it seems everyone has an opinion and everyone has an agenda.

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But what's the health advice you can really trust?

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We're here to weigh up the evidence

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and use our expertise to guide you...

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Through the contradictions and the confusions.

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We do the research no-one else has done.

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And put your health at the heart of what we do.

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We listen to the questions you want answered.

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And ensure you get the information you need.

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We're here when you want to know the latest findings.

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And not just the latest fads.

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I'm Michael Mosley.

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In this series, I'm joined by a team of doctors.

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Together, we'll cut through

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the hype, the headlines and the health claims.

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This is Trust Me I'm A Doctor.

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Hello, and welcome to a new series of Trust Me I'm A Doctor.

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This time we're coming from Inverness in the Highlands,

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where we're carrying out a fascinating experiment

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to see if consuming probiotics will change your gut bacteria

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and maybe even improve your health.

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We'll also be finding out, can we lose weight while we sleep?

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And can red wine really help us live longer?

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We'll just have one more.

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One more small one.

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I'll discover how to beat the winter blues.

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We'll witness a UK first, a UK surgery using 3-D printing.

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I can see his heart!

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And we'll find out if going decaf is dangerous.

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But first...

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When it comes to losing weight, there are really two methods.

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There's dieting and there's exercise.

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I've come across reports that exercise makes us hungrier

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and more likely to snack on unhealthy treats afterwards,

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undoing all our good work.

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So, we might be better off sticking to dieting.

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But is that true?

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To find out, over the next two days we're running a study

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with the University of Bath.

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We've enlisted sports scientist Dr Javier Gonzales

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and recruited ten hungry volunteers

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who are getting ready to diet or exercise.

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Yeah, I think exercising will make you hungrier.

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I think after a few hours, the hunger will definitely kick in.

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I just think dieting always makes me hungry.

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Because when you've been exercising, you know,

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it takes your mind off your hunger.

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First, we find out how hungry everyone in the group is

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on a typical day.

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They all do no exercise and eat the same amount of food for breakfast.

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Over the next three hours,

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they all rate how hungry they feel on a questionnaire.

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And we're doing some blood tests to get some baseline measurements

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as a control.

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On day two, we split them into two groups.

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Diet and exercise.

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Before breakfast, the exercise group are burning off 500 calories.

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Which is between ten and 18 laps, depending on their body weight.

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Great stuff. Keep pushing.

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Meanwhile, our dieters are engaged in much more restful activities.

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Great job.

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Breakfast time, and it's the dieters' turn to suffer.

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They get 500 calories less to eat.

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Over the next three hours, we're testing which group gets hungrier.

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Again, they rate how hungry they feel.

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Just hold that there for me.

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And we repeat the blood test.

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We're looking at the levels of a hormone called ghrelin.

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Why are you focusing on ghrelin?

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There are many hormones that influence appetite.

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Many of these are secreted by our gut.

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The interesting thing about ghrelin

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is it's the only one we know of that stimulates appetite.

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All of the other hormones seem to suppress appetite.

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And when you have higher ghrelin, what does that mean?

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So, more ghrelin equals more hunger.

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OK. And what we're going to be looking at

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is whether exercise, or dieting, affects it more.

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When I do exercise, I feel hungrier.

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You may perceive that, but we'll find out today.

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-If that's true. OK.

-Yeah.

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Once Javier's analysed the data,

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we gather to find out what he's discovered.

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OK. Results time.

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-What did you find?

-Let's have a look.

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Wahey!

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So, these are the self-reported

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ratings of your appetite,

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compared to your control conditions.

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So, on average,

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the diet group felt hungrier,

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compared to the exercise group.

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Did you all feel hungry afterwards?

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-Very hungry.

-Super hungry.

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Very hungry. Yeah.

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So, there were no exceptions in this group?

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-No.

-No.

-OK. I must admit,

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I was surprised by how big a difference it was

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between these two groups.

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And did people feel less hungry?

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Yeah, so I felt really, really hungry before the run in the morning.

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But then, after the run,

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I didn't feel particularly hungry

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and, actually, I wasn't nearly as hungry as I'd been before.

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So, on average, the dieters felt hungrier than the exercises.

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But what about their levels of hunger hormone ghrelin?

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First, the exercise group.

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On the left is their ghrelin level on the control day.

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On the right, the level on the day they burned 500 calories by running.

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We've got the exercise group, where you can see

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there's not much difference in ghrelin concentrations,

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compared to control.

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But for the dieters who consumed 500 calories less,

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it's a different story.

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Poor old dieters getting less calories there

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and their ghrelin levels going up

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and it's shouting at you, "Feed me! Feed me!"

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What's interesting is, it's completely consistent with your questionnaire.

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-Yes.

-So, if you do the exercise,

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it's going to give you lots of benefits,

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It's not necessarily going to increase your appetite.

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-Yeah.

-Anyway, I think you've all been patient long enough.

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Please tuck in.

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Hooray!

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So, the good news is that our study adds to a body of research

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which suggests that doing exercise is not going to make you hungrier.

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So, if you combine it with a little bit of calorie restriction,

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there's a very good chance that you will not only get healthier,

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but you will also lose weight.

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That is a win-win.

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Now, it's always a struggle to cut back on the good things in life,

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not least the booze.

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Do we really have to?

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Over to Dr Chris van Tulleken.

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Many of us have the evidence of lived experience

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that alcohol makes you clever, charming

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and more attractive to the opposite sex.

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Unfortunately, there is the more powerful evidence of robust science

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which says that even small amounts of alcohol are pretty bad for you.

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But there is one drink which claims to be an exception.

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Red wine.

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We're endlessly bombarded with news reports telling us

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it might be just a little virtuous.

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It's a part of the Mediterranean diet

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which is meant to make you live longer.

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We know that it's not the alcohol that's responsible

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for the supposed health benefits of red wine.

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But could there be something else in here

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that offsets the harm caused by the alcohol?

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Red wine is thought to be good for you

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because it's made using the grape skin,

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which contains a family of chemicals called polyphenols.

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These have been the source of intense study for decades

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and one has been probed more than most.

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Resveratrol.

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Now, we've known about this chemical for a long time,

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but it wasn't until the 1990s that it was discovered in red wine.

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So, why has it got scientists so excited?

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This is an East African killifish.

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Let's call him Arthur.

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Arthur is a handsome beast,

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but sadly, his time on this Earth is short.

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Just a few months.

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But that's useful for scientists who study longevity.

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So, the scientists ran an experiment to see if giving resveratrol to fish

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like Arthur made them live longer.

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What they found was that the fish in the experiment given the resveratrol

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lived up to 40% longer.

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Now, that's pretty astonishing if you're an African killifish.

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What you'll find if you read beyond those headlines

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that say something like,

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"A glass of red wine a day keeps the doctor away,"

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is that at the bottom of the article, it will say

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that the experiments were actually done on a fish like Arthur,

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a worm, a fruit fly,

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or sometimes just cells in a dish.

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So, although the research may be promising,

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it doesn't amount to evidence

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that red wine may have health benefits that means you and I

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will live any longer.

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And even if we do one day discover that resveratrol has a significant

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beneficial effect on people,

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there's still a catch when it comes to getting it from wine.

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This is a glass of Pinot noir,

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it happens to be from the Yarra Valley in Australia.

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Now, Pinot noir is a light red with low acidity,

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medium tannins and some of the highest levels of resveratrol

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of any wine in the world,

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at about 10mg per litre.

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Unfortunately, though, most of the studies on resveratrol

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have been done using capsules, like this.

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And in order to get as much resveratrol out of my wine

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as there is in this capsule,

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I would need to drink all of these bottles here.

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So, I'd better get going.

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So, despite many years of research, we're still not entirely sure

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what lies behind red wine's healthy reputation.

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And it may well be that we've been looking at it the wrong way.

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When drunk in moderation as part of the Mediterranean diet,

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red wine accompanies nutrient-rich foods,

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like fruits, vegetables, fish and nuts.

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And the evidence suggests that it's the diet taken as a whole

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that leads to a longer, healthier life.

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Now, having one small glass of red wine with food

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is not going to do you any harm, but you have to ask yourself honestly,

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when was the last time you did that?

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If you're anything like me, you have one glass over dinner

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and then probably another glass over dinner,

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then you finish off the bottle

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in front of the television with dessert.

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So, sadly, red wine is not some kind of delicious medicine

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where the more you drink, the better it is for you.

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I will just have one more.

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One more small one.

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SNEEZE

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Every year in the UK, we spend over £700 million

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on probiotic products that promise to improve

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our health by enhancing the mix of bacteria in our gut.

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More and more research is showing how our gut bacteria

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influence every aspect of our health.

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And yet, there is still so much that we don't know

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about this inner ecosystem.

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If you believe the hype,

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our gut bacteria can help tackle a dizzying array of disorders.

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From poor digestion and bowel diseases to allergies, acne,

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obesity, and even mental health problems.

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Popular probiotic products say they can alter

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our gut bacteria for the better.

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But do they actually work?

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Probiotics are essentially supposed to work

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in the opposite way to antibiotics.

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Instead of killing harmful bacteria, it it's claim they add

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new, beneficial bacteria to the complex swamp of microbes

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that already live in our intestine.

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However, there's a catch.

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Before the bacteria in probiotic products

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can change our gut for the better,

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they have to survive the perilous journey

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through the acid bath that is our stomach

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and set up home in the intestines.

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How well they can really do this is a hot topic right now

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and is exactly the kind of thing that Trust Me likes to test.

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So, with the help of NHS Highlands,

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we've enrolled 30 residents of Inverness

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who are going to volunteer their guts in the name of science.

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We split our volunteers into three groups.

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They'll be helping us test a market leading probiotic

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against some alternatives.

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All closely scrutinised

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by Dr Adele Costabile of Roehampton University.

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Our first group will be taking a daily dose

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of a top-selling probiotic yoghurt, available in most supermarkets.

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Products like these are specially formulated to contain

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particular bacteria strains thought to be beneficial.

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This yoghurt contains just one specific bacteria.

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One specific bug that can help your gut

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to make a little bit healthier.

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However, some researchers claim these drinks don't work.

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They think our stomach acid, which kills off harmful bacteria,

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is also killing the good bacteria in these products.

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So, will our volunteers see any difference?

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Our next group are trying a different type of probiotic.

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A fermented milk drink called kefir.

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It's long been a traditional part of the diet in Central Asia,

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but it's recently started to appear in our supermarkets.

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This stuff naturally contains dozens of strains of live bacteria,

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way more than the familiar yoghurt drinks.

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Kefir has been in our diet for several hundred years.

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It doesn't contain only one species, but contains more bacteria,

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plus some yeast.

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But does having more bacteria make it more likely

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that some will survive our stomach acid?

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In four weeks' time, we should see if these bacteria

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have managed to make a new home for themselves within your gut.

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But to avoid the problem of stomach acid altogether,

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our final group will try a different way to boost their gut bacteria.

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Instead of taking a probiotic,

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they'll be given what's called prebiotic diet -

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foods that contain a type of fibre

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that the good bacteria already in our gut thrive on.

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It's a fibre that can target the good guys

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that are already down there in your digestive system.

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The prebiotic fibre we're going to test

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is one that's readily available in common veg.

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It's called inulin

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and it's found in leeks, onions, garlic, asparagus

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and Jerusalem artichokes.

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I got the inulin. Soup is the way to go, maybe some stir-fries.

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I don't know. I think variety's the thing, isn't it?

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I got kefir, which I've never heard of before.

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So, I'm interested to see what it tastes like.

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I got the yoghurt drink.

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The advert says that they did you good, so I tried them.

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I didn't notice any difference.

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So, that's why I'm doing this trial,

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because I want to know, do they work or not?

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Before our volunteers start the experiment,

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we're taking urine and stool samples

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which will allow us to test the volume and variety

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of their existing bacteria.

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In four weeks' time, we will test our volunteers again

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to see if there've been any changes to their guts.

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Many of us would like to be able to cut back on our calories,

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but we find it hard to do.

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GP Dr Zoe Williams has been investigating

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a surprising way to do this without even noticing.

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When it comes to keeping our weight in check,

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we naturally turn to diet and exercise,

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but intriguing research suggests that there may be an easier way.

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Surprisingly, getting enough sleep could make all the difference.

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On a cold, dark night,

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we've invited four volunteers into the Kent countryside.

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We're going to test a recent research claim

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that suggests the amount they sleep will affect how much they eat.

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So, we're giving them something that will keep them up all night.

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Oh, my God!

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The hairs!

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Oh, it's holding my finger, look.

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These pretend babies are designed to cry a lot.

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I can't do it!

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We've told our volunteers that we're looking into sleep,

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so they have no idea that we're really going to measure

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how their lack of sleep affects their food intake.

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I'm going to be watching their progress with sleep expert

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Dr Denise Robertson from the University of Surrey.

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Sleep interacts with every other aspect of your life.

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So, sleep is going to affect your ability to make good food choices,

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your ability to, sort of, resist snacks.

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It's bedtime for our volunteers.

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But not for long.

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BABY CRYING

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A bad night's sleep disrupts two key hormones that play a role in hunger.

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One, we heard about earlier in programme, ghrelin.

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You see an increase in ghrelin.

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And ghrelin is a hormone that's been linked to food intake.

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It drives your hunger.

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The other has the opposite effect, signalling when we're full.

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It's called leptin.

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At the same time, you'd see a suppression of leptin

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and leptin is a satiety signal.

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-OK.

-So the combination of hunger going up, satiety going down,

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you'd expect them to feel physically more hungry.

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The morning after the night before.

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This is the thirstiest baby in the world.

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I've had, maybe, three or four hours' sleep.

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For breakfast, we laid on a spread of healthy and not-so-healthy foods.

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Look, the granola's going down well.

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-Yeah.

-And the pastries are very popular.

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What you would expect is things like pain au chocolat, for example,

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because it's high-fat, it's high sugar,

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you could almost expect to see them going back for seconds or thirds

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if they were sleep deprived.

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Rather than hitting the bananas and the apples.

0:19:290:19:31

As a comparison, we also gave our volunteers a night

0:19:310:19:34

of normal, undisturbed sleep

0:19:340:19:36

and, again, in the morning, counted the calories.

0:19:360:19:39

Knowing the calorie content of each food,

0:19:390:19:42

Denise is using our footage to tot up each person's total.

0:19:420:19:45

And it's time for the results.

0:19:450:19:48

Hi, guys. It's good news.

0:19:480:19:50

You're all very good parents, except for one person.

0:19:500:19:52

-Ronan.

-We knew it!

0:19:540:19:56

But we're not really interested in that,

0:19:560:19:58

because that's not really what we were looking at, at all.

0:19:580:20:01

They were actually monitoring how much you ate.

0:20:010:20:04

Because we're interested to know if the amount of sleep you get

0:20:040:20:08

affects how much food you put on your plate.

0:20:080:20:10

-Mm.

-OK.

-And what we found is Ellie and Bertie, you had quite a...

0:20:100:20:15

quite a difference in your sleep.

0:20:150:20:16

You were losing three and a half or four hours.

0:20:160:20:19

You did respond to the sleep loss, actually, you ate considerably more.

0:20:190:20:24

You just let yourself go for it.

0:20:240:20:26

Overall, Ellie ate 57 calories more at breakfast when she was tired.

0:20:260:20:31

While Bertie ate 108 calories more.

0:20:310:20:34

Eating 100 extra calories every day

0:20:340:20:36

is enough to make you put on 5kg in weight over a year.

0:20:360:20:40

Ronan barely slept a wink and whilst he didn't eat more,

0:20:400:20:44

he did choose more sugary foods.

0:20:440:20:47

But the person who got the most sleep responded rather differently.

0:20:470:20:50

Howie, you managed to sleep quite well.

0:20:500:20:53

-Yeah.

-Even with the baby.

0:20:530:20:54

-I was.

-You just ignored her.

0:20:540:20:56

No, I didn't ignore her.

0:20:560:20:59

Interestingly, after his good night's sleep,

0:21:010:21:03

Howie's eating habits were unaffected.

0:21:030:21:06

These experiences are consistent with an analysis by King's College London

0:21:060:21:10

that reviewed dozens of smaller studies involving sleep and appetite.

0:21:100:21:15

It showed that although not everyone is affected in the same way,

0:21:150:21:18

on average, getting less than seven hours of sleep night led to people

0:21:180:21:21

eating significantly more overall.

0:21:210:21:23

These guys are going to go back home where they don't have babies.

0:21:240:21:27

What can they do to make sure that they have a good night's sleep?

0:21:270:21:29

You would have blackout blinds.

0:21:290:21:32

You would make sure the room wasn't too hot.

0:21:320:21:34

You'd want to take out the laptop, the tablet, the mobile phone.

0:21:340:21:39

I guess one way of thinking about it

0:21:390:21:41

is that the bedroom is for two things and two things only.

0:21:410:21:45

One of those is sleep and...

0:21:450:21:46

You can probably work out the other one.

0:21:460:21:49

Although Ronan looks confused.

0:21:490:21:51

So, if you're struggling with your weight,

0:21:550:21:57

then it's well worth considering not just your diet and exercise,

0:21:570:21:59

though they're important, but also think about how much sleep you're getting.

0:21:590:22:03

Aim for at least seven hours per night

0:22:030:22:05

and not only will you feel better,

0:22:050:22:07

but you'll be more able to resist those sugary treats.

0:22:070:22:10

For information on how to get a better night's sleep, visit...

0:22:120:22:15

Lots of you have been sending in your health questions.

0:22:260:22:29

And we've been getting you answers.

0:22:290:22:32

What is gout and what can I do to avoid it?

0:22:320:22:35

Gout is actually a form of arthritis

0:22:390:22:42

causing pain in the joints,

0:22:420:22:43

and it's on the increase,

0:22:430:22:45

thought to be due to an ageing population and rising obesity.

0:22:450:22:49

It currently affects around a million people in the UK.

0:22:490:22:53

Gout can affect any joint,

0:22:540:22:56

but typically it starts here, in the big toe.

0:22:560:22:59

Now, what causes it is the build-up of a substance called uric acid.

0:22:590:23:03

And if your kidneys don't clear it,

0:23:040:23:06

then you get deposition of crystals in the joints.

0:23:060:23:10

And that's what causes all the pain and inflammation.

0:23:100:23:13

But research has shown that there are things

0:23:140:23:17

you can do to help avoid developing it.

0:23:170:23:20

Now, gout is associated with being overweight,

0:23:200:23:22

which is perhaps why it's becoming more common.

0:23:220:23:24

The particularly bad form of fat is the visceral fat

0:23:240:23:28

you get around your gut, which seems to block the clearance of uric acid.

0:23:280:23:32

The good news is, if you lose weight

0:23:320:23:34

then you'll see a rapid improvement in your gout.

0:23:340:23:37

But there are also specific foods and drinks to avoid

0:23:390:23:41

if you're prone to gout.

0:23:410:23:43

Any drinks with lots of sugar, even fruit juices, are out.

0:23:430:23:47

Instead, you should drink plenty of good old-fashioned water.

0:23:470:23:52

Alcohol can raise uric acid levels too.

0:23:530:23:56

And some foods contain a high level of proteins called purines,

0:23:560:24:00

which our body breaks down into uric acid.

0:24:000:24:02

Red meats and poultry are OK in moderation,

0:24:030:24:06

but it's best to avoid seafood and gamey meat.

0:24:060:24:09

On the other hand, skimmed milk, water and low-fat yoghurt

0:24:100:24:13

actually seem to help.

0:24:130:24:15

Along with plenty of fruit and veg, of course.

0:24:150:24:18

If you do develop gout in a joint, rest and ice can help.

0:24:190:24:23

Anti-inflammatories, like ibuprofen or naproxen,

0:24:230:24:26

can reduce inflammation and pain.

0:24:260:24:29

Aspirin's OK in low doses,

0:24:290:24:31

but if you're taking more than 75mg a day,

0:24:310:24:34

it can actually increase your uric acid levels.

0:24:340:24:37

Your GP can give more advice and treatment options.

0:24:370:24:40

Your doctor may decide to inject your joint with steroids

0:24:410:24:44

or perhaps give you medication to balance out the uric acid levels.

0:24:440:24:48

Either way, hopefully it'll get you back on your feet and pain-free.

0:24:480:24:52

Now and again, a new bit of technology emerges

0:25:010:25:04

in a completely unrelated field, like engineering or design,

0:25:040:25:08

which has the potential to transform an area of medicine.

0:25:080:25:11

Surgeon Gabriel Weston has been following one such story

0:25:110:25:15

and has witnessed an operation, the first of its kind in the UK.

0:25:150:25:19

Edward Evans had always been a keen sportsman and coach.

0:25:210:25:26

But one day, seven years ago, when he was 54,

0:25:260:25:29

he began to experience a pain that would change his life.

0:25:290:25:33

I come down on most Sundays to watch my sons play rugby,

0:25:330:25:37

and on this particular Sunday,

0:25:370:25:39

I started to feel a dull ache in the centre of the chest.

0:25:390:25:43

What Edward was feeling was a rare infection that had taken hold in his sternum -

0:25:430:25:49

the bone at the centre of his ribcage.

0:25:490:25:52

This made him extremely unwell.

0:25:520:25:54

Doctors had no option to remove his sternum.

0:25:550:25:59

Replacing it with an implant wasn't an option at the time

0:25:590:26:02

because any foreign body inserted when Edward was already so ill

0:26:020:26:07

carried a high risk of further infection.

0:26:070:26:09

All the surgeons could do was cover the gap with some of Edward's own muscle,

0:26:100:26:16

leaving his heart and lungs so vulnerable

0:26:160:26:19

that a blow to his chest could be fatal.

0:26:190:26:21

I was playing five-a-side up until that point,

0:26:230:26:25

teaching the boys to play rugby on and off.

0:26:250:26:27

So, that... Stopped doing that.

0:26:280:26:30

And I miss it.

0:26:300:26:31

I like to keep active.

0:26:340:26:36

I want to keep fit. I want to cycle, I want to walk.

0:26:360:26:38

In my mind, there's a massive correlation

0:26:390:26:43

between keeping fit and feeling strong and feeling old.

0:26:430:26:48

Edward could continue to live without a sternum,

0:26:490:26:52

but his vulnerability is limiting his quality of life.

0:26:520:26:56

Over time, his body has recovered from the infection,

0:26:570:27:00

which means that surgery would be less risky.

0:27:000:27:03

And he's been offered a new kind of implant

0:27:030:27:07

that's never been tried in the UK.

0:27:070:27:09

Normally, the only option for people like this

0:27:090:27:13

would be an implant made out of mesh and cement.

0:27:130:27:16

But what Edward's about to receive is completely different.

0:27:160:27:20

It's a titanium sternum made especially for him

0:27:200:27:24

and 3-D printed on the other side of the world.

0:27:240:27:28

CT scans of Edward's chest

0:27:300:27:32

have been sent to Anatomics in Melbourne, Australia.

0:27:320:27:36

World leaders in the design and production

0:27:360:27:40

of bespoke surgical implants.

0:27:400:27:42

Their designs are loaded into the 3-D printer

0:27:420:27:45

which has a chamber filled with powdered titanium

0:27:450:27:48

and an electron beam which fuses the particles together, layer by layer.

0:27:480:27:53

And now, it has printed Edward's new sternum.

0:27:550:27:58

The loose powder is blown away,

0:28:000:28:02

revealing the implant for the first time.

0:28:020:28:04

The titanium is light, strong and rigid,

0:28:060:28:10

and less susceptible to infection than cement.

0:28:100:28:13

The finished sternum will be implanted

0:28:160:28:18

at the Heartlands Hospital in Birmingham,

0:28:180:28:21

by thoracic surgeon Mr Ehab Bishay.

0:28:210:28:23

They, in fact, have reconstructed the defect

0:28:240:28:28

to match completely what we took out.

0:28:280:28:30

It will protect the underlying structures.

0:28:300:28:33

The thing that we cannot tell you is

0:28:330:28:35

whether it will improve your lung function,

0:28:350:28:38

the mechanics of your breathing.

0:28:380:28:40

-OK.

-You're a pioneer.

0:28:400:28:42

And hopefully, you'll show the advantages of something like that.

0:28:430:28:48

The procedure begins with the plastic surgeon, Mr Khalil,

0:28:510:28:55

taking down the muscle flap that was used to cover the defect

0:28:550:28:59

several years ago.

0:28:590:29:00

The structures that these gentlemen are operating up against

0:29:010:29:05

are the very structures which keep us all alive.

0:29:050:29:08

What Mr Khalil has already found

0:29:090:29:11

is that the muscle has become very thin,

0:29:110:29:15

so he's coming to the lung much more quickly than he'd anticipated.

0:29:150:29:18

Once Mr Khalil is finished,

0:29:200:29:22

Mr Bishay will perform the delicate task

0:29:220:29:25

of fitting the new sternum into place.

0:29:250:29:27

Normally, we would have to mould the cement ourselves, by hand,

0:29:270:29:31

handling it. So, the risk of infection is increased.

0:29:310:29:35

Here, you've got some that's ready-made, should slot in.

0:29:350:29:38

You might not see that today,

0:29:380:29:39

because, obviously, this is our first time using this technique,

0:29:390:29:42

but I have faith in the fact

0:29:420:29:44

that it's been reconstructed so precisely.

0:29:440:29:46

In order for Mr Bishay to get the outside of the implant

0:29:500:29:53

going over each rib head,

0:29:530:29:56

he's had to ask his anaesthetic colleague

0:29:560:29:59

to deflate the lung on purpose.

0:29:590:30:01

Now, the implant will be tried in situ for the first time.

0:30:040:30:08

There's an enormous amount of surgical skill and adjustment

0:30:100:30:14

that comes into play, trying to make it perfectly fit,

0:30:140:30:17

where it will hopefully stay for the rest of Edward's life.

0:30:170:30:20

OK.

0:30:260:30:27

At last, the perfect fit is achieved.

0:30:270:30:31

It's an amazing thing to see and it's now just for Mr Bishay

0:30:310:30:34

to fix it there with screws.

0:30:340:30:36

Although the operation has gone smoothly,

0:30:400:30:42

it remains to be seen how well the implant will function for Edward.

0:30:420:30:47

Several weeks later,

0:30:520:30:54

Edward has recovered from the procedure and it's time to find out.

0:30:540:30:58

Throughout this process,

0:31:010:31:02

Dr Nicola Oswald has been using motion capture and cameras

0:31:020:31:07

to monitor Edward's breathing and movement.

0:31:070:31:10

Past 100. Well done, keep going.

0:31:100:31:13

So, has the implant made any difference?

0:31:130:31:17

This was before surgery.

0:31:170:31:19

And you can see when he takes a breath in,

0:31:190:31:22

that the ribcage moves in rather than moving out, like you expect,

0:31:220:31:26

-taking a deep breath.

-How does that compare with the one after surgery?

0:31:260:31:31

The overall shape of the chest looks more normal.

0:31:330:31:36

Then when he takes a deep breath in there,

0:31:360:31:38

the ribcage moves out in time with him breathing in and then back in,

0:31:380:31:43

in time with him breathing out.

0:31:430:31:44

So, it's gone back into synchrony again.

0:31:440:31:46

These results are extremely encouraging and could pave the way

0:31:470:31:52

towards even larger and more complicated implants.

0:31:520:31:55

So, what's the main difference for you, Edward, now compared to before?

0:31:580:32:02

I feel confident now.

0:32:020:32:04

It feels like, probably, how I felt when my chest was...

0:32:050:32:08

was normal.

0:32:080:32:10

Whatever I do, simple or difficult, you know,

0:32:100:32:14

I feel better doing it.

0:32:140:32:16

I can fall over with confidence, basically.

0:32:160:32:20

That's the truth!

0:32:200:32:21

Coming up - how to spot an asthma attack and save a life.

0:32:340:32:38

And can decaffeinated coffee actually be bad for you?

0:32:380:32:43

But first...

0:32:430:32:45

Four weeks ago, we started an experiment in Inverness to see if

0:32:450:32:49

probiotic products are really the best way

0:32:490:32:51

to improve the mix of healthy bacteria in your gut.

0:32:510:32:54

30 volunteers have been trying one of the three options.

0:32:540:32:58

Our first group have been taking a market-leading probiotic yoghurt drink.

0:32:580:33:02

These drinks are formulated to contain one or two specific types

0:33:020:33:06

of bacteria that manufacturers know to be beneficial.

0:33:060:33:10

I was taking probiotic yoghurt.

0:33:100:33:12

And how was that for you?

0:33:120:33:13

Personally, I thought my health improved.

0:33:130:33:16

Our second group have been taking a traditional drink called kefir,

0:33:160:33:20

made by fermenting milk, which makes it naturally full of different types

0:33:200:33:23

of live bacteria.

0:33:230:33:25

It was quite an acquired taste to begin with, because it's very sour.

0:33:250:33:28

But I got used to that.

0:33:280:33:29

And our third group have been on what's called a prebiotic diet,

0:33:290:33:33

rich in the type of fibre called inulin,

0:33:330:33:36

thought to boost the good bacteria already in our gut.

0:33:360:33:40

It was fine. It was a bit of a challenge on some days.

0:33:400:33:42

I love leeks, I love artichokes, I love asparagus,

0:33:420:33:45

but there's only so much you can eat in a day.

0:33:450:33:47

Dr Adele Costabile now has the delightful job of analysing

0:33:480:33:53

our volunteers' stool samples.

0:33:530:33:55

This will reveal whether any of our methods have improved the mix of

0:33:550:33:58

bacteria in our volunteers' guts.

0:33:580:34:01

First, the probiotic yoghurt.

0:34:010:34:03

This group saw a promising change in the levels of bacteria that had

0:34:050:34:09

been linked to obesity.

0:34:090:34:10

This is consistent with other,

0:34:100:34:12

bigger studies that suggest a range of benefits,

0:34:120:34:15

particularly in treating specific gut conditions.

0:34:150:34:18

Next, the group who were on the diet rich in the fibre inulin.

0:34:190:34:24

In our trial,

0:34:240:34:26

this group saw a rise in one bacteria type known to be good for

0:34:260:34:30

maintaining gut health.

0:34:300:34:32

And this again is consistent with other studies that have shown inulin

0:34:320:34:36

to be beneficial.

0:34:360:34:38

But our most significant result was in the group

0:34:380:34:41

taking the fermented milk drink, kefir.

0:34:410:34:44

We saw for this group differences between before and after

0:34:440:34:49

the four weeks' treatment.

0:34:490:34:51

We saw a beneficial effect.

0:34:510:34:54

Basically, the good guys down there in your gut,

0:34:540:34:58

they were different compared with the beginning.

0:34:580:35:01

This is something promising.

0:35:010:35:03

Our kefir group saw a rise in a whole family of bacteria

0:35:030:35:07

called lactobacillus.

0:35:070:35:09

These bacteria are thought to be good for general gut health

0:35:090:35:12

and they're known to help certain conditions,

0:35:120:35:15

including traveller's diarrhoea and lactose intolerance.

0:35:150:35:18

So, in our trial, amazingly, it was the fermented drink, kefir,

0:35:200:35:24

that most of our volunteers had never even heard of before,

0:35:240:35:27

that actually caused the most changes to their gut bacteria.

0:35:270:35:31

I would actively be interested in trying the kefir drink,

0:35:310:35:34

just to see the results of that.

0:35:340:35:36

Andy, were you surprised by the results of the kefir?

0:35:360:35:38

The fact that it was this fermented drink with maybe quite a variety

0:35:380:35:42

of bacteria made me think it would have an affect.

0:35:420:35:45

Now, the kefir was such a clear winner in our test

0:35:470:35:49

that we want to find out more.

0:35:490:35:51

What makes it so full of healthy bacteria, and are there other foods

0:35:510:35:55

like it we should all be eating?

0:35:550:35:57

This smells really nice.

0:35:580:36:00

More on that later in the programme.

0:36:000:36:02

The winter months can play havoc with our health.

0:36:140:36:16

Colds, flu, joint pain and even heart attacks are more common.

0:36:160:36:21

But is it also messing with our minds,

0:36:210:36:24

giving us the winter blues?

0:36:240:36:26

SAD, seasonal affective disorder, is also known as winter depression,

0:36:260:36:31

but tends to come on during the winter months.

0:36:310:36:33

Now, common symptoms include tiredness, low mood,

0:36:330:36:38

a craving for carbs and weight gain.

0:36:380:36:41

In some cases, it leads to severe depression.

0:36:410:36:44

SAD was first recognised in the early 1980s.

0:36:460:36:50

Since then, it has become an accepted medical condition

0:36:500:36:54

and it makes the headlines most winters.

0:36:540:36:57

A recent survey found a third of us think we might suffer from it.

0:36:570:37:00

So, how do you know if you've got it?

0:37:010:37:03

How do you treat it?

0:37:030:37:05

Should I worry about SAD?

0:37:050:37:08

Personally, I've not thought much about SAD,

0:37:090:37:12

since I'm pretty sure it's something I've never experienced.

0:37:120:37:15

But I'm putting that assumption to the test.

0:37:150:37:18

I'm having my SAD potential assessed by Dr Brenda McMullen,

0:37:180:37:22

a neurobiologist and psychiatrist from Copenhagen University Hospital.

0:37:220:37:28

I start with a questionnaire,

0:37:280:37:29

the basis of most mental health assessments.

0:37:290:37:33

This asks about my mood and behaviour through the year.

0:37:330:37:36

For a full diagnosis,

0:37:360:37:38

it would usually be followed by an interview with a psychiatrist.

0:37:380:37:42

So, what do my answers reveal?

0:37:420:37:43

You mention in this that you have changes in all of the items that

0:37:450:37:49

we look for in a person who suffers from seasonal affective disorder.

0:37:490:37:52

So you say here you've experienced changes in the length of your sleep,

0:37:520:37:56

in your appetite, in your weight,

0:37:560:37:59

in your social activity and in your energy levels.

0:37:590:38:02

It seems like you are feeling the best in August and July and you are

0:38:020:38:08

feeling worse, gaining most weight, sleeping most in December.

0:38:080:38:13

Yes. I was surprised when I started to fill it in,

0:38:130:38:16

I started to realise I probably...

0:38:160:38:18

I do have shades of seasonal affective disorder,

0:38:180:38:21

which is something I hadn't really thought about before.

0:38:210:38:25

Where would I fall in terms of the average, do you think?

0:38:250:38:28

You are worse off than average.

0:38:280:38:31

It's 11.

0:38:310:38:33

A maximum of 24.

0:38:330:38:34

So, you're in the middle range,

0:38:340:38:36

but on average is probably closer to six or seven.

0:38:360:38:39

How common is it?

0:38:390:38:41

Seasonal affective disorder is not something

0:38:410:38:43

that you either definitely have or do not have.

0:38:430:38:45

It is a spectrum.

0:38:450:38:47

So, many people would have some degree of seasonality,

0:38:470:38:50

but not being depressed at all.

0:38:500:38:52

And you would have probably 5% having a depression

0:38:520:38:56

and maybe 5% having no symptoms at all.

0:38:560:38:59

So, like a lot of people, I have some SAD symptoms.

0:39:000:39:04

But I'm not amongst the small percentage who've been diagnosed

0:39:040:39:08

with severe seasonal affective disorder.

0:39:080:39:11

Those patients have been the subject of Brenda's research.

0:39:110:39:14

Using brain scans,

0:39:140:39:15

she noticed a difference in brain activity suggesting they were being

0:39:150:39:18

deprived of serotonin,

0:39:180:39:20

a chemical that is thought to regulate mood and appetite.

0:39:200:39:25

Although we're not sure why this happens,

0:39:250:39:27

it seems the seasons can affect us much more powerfully

0:39:270:39:31

than I had realised.

0:39:310:39:32

Now, that was a big surprise.

0:39:320:39:34

I've known for a long time that I do not like dark, wet, wintry days,

0:39:340:39:38

but I never imagined that I might have SAD.

0:39:380:39:41

It certainly means I am intensely curious to find out more.

0:39:410:39:45

To understand the condition better,

0:39:490:39:50

I'm meeting Professor Anna Wirz-Justice

0:39:500:39:53

from the University of Basel, Switzerland,

0:39:530:39:56

who has been researching this condition for decades.

0:39:560:39:58

So, what are the main theories about the causes of SAD?

0:40:000:40:03

There are two aspects that are important.

0:40:030:40:06

If we go back to basic biology of seasonality,

0:40:060:40:10

it is the day length that triggers certain changes in physiology

0:40:100:40:15

and behaviour.

0:40:150:40:16

Hibernation in winter,

0:40:160:40:19

adding weight, eating a lot more, sleeping longer.

0:40:190:40:23

And the other one is that we don't get enough light

0:40:230:40:26

to set the biological clock

0:40:260:40:28

to synchronise our rhythms to 24 hours and, therefore,

0:40:280:40:31

they drift later and later.

0:40:310:40:33

And if you have a late clock, you are more vulnerable to depression.

0:40:330:40:38

In what ways is light resetting the clock?

0:40:380:40:40

The last 15 years has been a revolution in that a new kind of

0:40:400:40:45

photoreceptor was found in the eye which is sensitive to light.

0:40:450:40:49

These photoreceptors transmit directly to the biological clock

0:40:500:40:55

in the brain - information that it's dawn or dusk,

0:40:550:40:59

that it's light or dark.

0:40:590:41:01

By having light in the morning,

0:41:010:41:02

you are regularising all your rhythms in your body,

0:41:020:41:06

they are all getting synchronised.

0:41:060:41:08

Right, so it goes straight in there, just sort of...

0:41:080:41:10

And goes, click! And says your biological clock is now awake

0:41:100:41:13

and functioning.

0:41:130:41:15

So, what sort of treatments are available for SAD?

0:41:150:41:18

Light is the treatment of choice, of course.

0:41:180:41:22

With or without antidepressants.

0:41:220:41:25

And the third, the different psychological treatments.

0:41:250:41:29

One of my main messages for anyone who suffers from the winter blues

0:41:290:41:33

or from winter depression,

0:41:330:41:35

is the easiest treatment would be a regular walk outside.

0:41:350:41:39

Most of the studies show that light in the morning is better.

0:41:390:41:44

So, if I just sit around my house,

0:41:440:41:46

I'm not going to get it just from, sort of, overhead lighting

0:41:460:41:49

-or things like that?

-No, you are not.

0:41:490:41:51

-You need special lamps.

-You go outside.

0:41:510:41:54

OK. It's cheaper.

0:41:540:41:56

Is there any value in buying a light box?

0:41:560:41:58

A light box is the most reliable method of treatment.

0:41:580:42:01

You have it in your house and you sit in front of it

0:42:010:42:04

for half an hour every day.

0:42:040:42:06

So, have you seen a lot of lives transformed by light?

0:42:060:42:08

A great many people.

0:42:080:42:11

They finally have a diagnosis

0:42:110:42:14

and they have a treatment that is fairly straightforward

0:42:140:42:18

and it works rather quickly, within one or two weeks.

0:42:180:42:21

And I think one of the important things for light therapy,

0:42:210:42:25

you are treating yourself before you sink really into

0:42:250:42:29

this winter depression.

0:42:290:42:31

Speaking to our experts has been a real eye-opener.

0:42:330:42:36

I was surprised to discover there was a spectrum of winter depression

0:42:360:42:40

on which we might all find ourselves.

0:42:400:42:42

So, should I worry about SAD?

0:42:430:42:45

Well, it turns out I should.

0:42:450:42:47

And should you worry about it? Well, that depends on whether

0:42:470:42:50

you regularly get the winter blues or not.

0:42:500:42:53

If you do, then the answer is simple.

0:42:530:42:56

Light. Go out for a morning stroll,

0:42:560:42:58

and it's important it is done in the morning,

0:42:580:43:00

or invest in a light box.

0:43:000:43:03

For more information,

0:43:030:43:05

go to the Trust Me website where you can also try a questionnaire

0:43:050:43:09

to see if you have any symptoms

0:43:090:43:11

of seasonal affective disorder.

0:43:110:43:13

If you do have health questions you've always wanted answered,

0:43:220:43:25

then do send them to us via our website.

0:43:250:43:28

I've heard that decaf coffee is full of the chemical

0:43:350:43:38

used in the removal process, so it's best avoided.

0:43:380:43:41

Is this true?

0:43:410:43:43

These days, people are turning away from traditional coffee

0:43:450:43:49

to decaffeinated options instead.

0:43:490:43:51

Even in the case of posh coffees, like this one.

0:43:510:43:54

And that's because some of them think that it is a healthier option.

0:43:540:43:57

But is it?

0:43:570:43:59

The first thing to look into is how decaf coffee is made.

0:43:590:44:03

There have been reports in the media claiming that some of the methods

0:44:030:44:06

used to remove the caffeine

0:44:060:44:08

involved substances that are actually bad for us.

0:44:080:44:10

All decaffeination methods start with this.

0:44:100:44:13

The green, or unroasted coffee bean.

0:44:130:44:16

Most methods use water to get the caffeine out of the bean.

0:44:170:44:21

Then a chemical solvent is often used

0:44:210:44:23

to get the caffeine out of the water.

0:44:230:44:26

The solvent is then removed and the remaining water is dried off.

0:44:260:44:30

There are two possible chemical solvents that can be used

0:44:300:44:33

in this process - both of them, technically speaking, toxic.

0:44:330:44:37

But by the time the process is complete,

0:44:370:44:38

they're found at such vanishingly low levels that they are below

0:44:380:44:42

the European regulated safe limit.

0:44:420:44:44

But to avoid any solvents,

0:44:440:44:46

there are other methods that some manufacturers use

0:44:460:44:49

to remove the caffeine.

0:44:490:44:50

One alternative uses a charcoal filter.

0:44:500:44:53

Another uses carbon dioxide at extremely high pressures.

0:44:530:44:57

So, you can choose solvent-free coffee if you want.

0:44:570:45:00

But there's not any evidence that it's actually healthier.

0:45:000:45:03

Now, coffee aficionados will tell you at great length, of course,

0:45:030:45:07

that the method used to decaffeinate coffee can affect the taste.

0:45:070:45:10

So if you really worry about these things, then I would be guided by

0:45:100:45:13

your taste buds and don't sweat about the methods

0:45:130:45:15

used to produce the coffee.

0:45:150:45:17

There is, however, something else that you should be aware of

0:45:170:45:20

if you're thinking of going decaf.

0:45:200:45:22

Your decaf may not contain any chemical nasties,

0:45:220:45:25

but you might be surprised to know

0:45:250:45:27

that it probably does contain some caffeine.

0:45:270:45:30

A 2006 study conducted in Florida

0:45:300:45:32

found that nine out of the ten decafs they tested

0:45:320:45:35

had at least some caffeine in them.

0:45:350:45:38

So, the two-shot decaf latte that you're drinking might contain

0:45:380:45:42

as much caffeine as a can of Coke.

0:45:420:45:45

For most of us, though, if you're worried about what your

0:45:450:45:48

daily cuppa's doing to your health,

0:45:480:45:50

there's something other than caffeine

0:45:500:45:53

you might want to think about.

0:45:530:45:55

A cup of black coffee is virtually calorie free.

0:45:550:45:58

Add milk and sugar, it goes up to about 50 calories.

0:45:580:46:01

But by the time you're looking at one of these, a giant mocha latte,

0:46:010:46:04

it can be up to 500 calories.

0:46:040:46:07

The same as a big burger or a large piece of cake.

0:46:070:46:10

So, caffeinated or not,

0:46:100:46:11

you can enjoy a small cup with an easy conscience.

0:46:110:46:14

But treat this as a treat.

0:46:140:46:16

Asthma is one of those things we associate with childhood,

0:46:270:46:30

yet one in 12 adults are also affected.

0:46:300:46:33

We think of it as mild, and yet it can be life-threatening.

0:46:330:46:36

Which is why it is so important

0:46:360:46:38

to be able to recognise the signs and the symptoms.

0:46:380:46:41

Over to Dr Saleyha Ahsan.

0:46:410:46:44

There are over 5.5 million people with asthma in the UK and every year

0:46:460:46:51

around 1,000 of them will lose their lives to an asthma attack.

0:46:510:46:55

But if more people knew the warning signs,

0:46:550:46:57

some of these deaths could be prevented.

0:46:570:46:59

My brother has had asthma all his life.

0:47:000:47:03

My father got it as an adult and has needed intensive care.

0:47:030:47:07

His brother, my uncle, died of it.

0:47:070:47:11

That's why I'm so keen to talk about the signs and symptoms of asthma,

0:47:120:47:17

so that people can spot a dangerous attack quickly and save lives.

0:47:170:47:22

Asthma is a condition that affects the airways,

0:47:250:47:27

the tubes that carry air in and out of the lungs.

0:47:270:47:30

If these become irritated,

0:47:310:47:33

that can lead to inflammation of the airways,

0:47:330:47:36

the muscles tighten and the tubes narrow.

0:47:360:47:39

And this causes shortness of breath, wheezing,

0:47:390:47:42

and it can even lead to a life-threatening asthma attack,

0:47:420:47:46

needing hospitalisation.

0:47:460:47:48

We still don't know what causes asthma in the first place,

0:47:530:47:55

but for those who have it,

0:47:550:47:57

there are many things that can trigger an episode.

0:47:570:47:59

And even emotions and stress.

0:48:030:48:05

Another surprisingly common trigger is exercise.

0:48:080:48:12

But despite that, doctors actually recommend it for asthma,

0:48:120:48:16

especially swimming, as it can calm and regulate breathing.

0:48:160:48:19

So, I've come to an outdoor swimming club in Kent.

0:48:190:48:22

I dipped my toe in and the water's freezing.

0:48:230:48:26

A few of the members here have asthma.

0:48:260:48:28

Describing their experiences help others recognise the symptoms.

0:48:280:48:32

It feels like a tightening in your chest.

0:48:320:48:34

It doesn't matter how many times you breathe in,

0:48:340:48:36

or how deeply you breathe in.

0:48:360:48:38

It stops you sleeping, I cough a lot in the night.

0:48:380:48:40

My breath shortens and I think I'm not getting the air out of my lungs

0:48:400:48:43

and, therefore, I find it hard to get the air back in again.

0:48:430:48:46

To show the non-sufferers in the group

0:48:490:48:51

what asthma actually feels like,

0:48:510:48:52

we've set up a demonstration with the help of Dr John Dickinson

0:48:520:48:56

and a device that impedes your breathing

0:48:560:48:59

in a way that mimics asthma.

0:48:590:49:01

When the non-asthmatics put this in their mouth,

0:49:010:49:03

they'll find it pretty easy to breathe in...

0:49:030:49:05

-Yeah.

-But they'll find it pretty hard to breathe out and that's

0:49:050:49:08

what happens in asthma.

0:49:080:49:09

Just think how long it takes to empty your lungs,

0:49:090:49:12

think about that asthma response.

0:49:120:49:13

You can see how easy it is to get panicky

0:49:130:49:15

when you're feeling like that, to start hyperventilating.

0:49:150:49:18

That's horrible.

0:49:180:49:20

That is actually horrible, because you can't get breath out

0:49:200:49:22

-and you're already wanting to breathe back in.

-Exactly.

0:49:220:49:25

Feel how much longer it takes to breathe out.

0:49:250:49:28

-What did you think?

-It's hideous.

0:49:280:49:30

-Yeah.

-It's horrible.

0:49:300:49:32

That's using all your muscles.

0:49:320:49:34

That's huge exercise.

0:49:340:49:36

You all right?

0:49:380:49:39

-Horrible.

-Yeah.

-Yeah.

0:49:390:49:41

I'm having a lot of sympathy and empathy for you guys right now.

0:49:410:49:45

I really am.

0:49:450:49:46

'Anyone who has asthma should always carry an inhaler,

0:49:460:49:50

'a spray containing a muscle relaxant to open up the airways

0:49:500:49:54

'and ease breathing.

0:49:540:49:55

'If you see someone struggling with asthma,

0:49:550:49:57

'you can assist by keeping them calm because this can help bring

0:49:570:50:01

'their breathing under control.

0:50:010:50:03

'But sometimes, if the symptoms continue,

0:50:030:50:06

'things can become much more serious.'

0:50:060:50:08

Every ten seconds, someone is having a life-threatening asthma attack.

0:50:080:50:13

So, what are the warning signs?

0:50:140:50:16

The person is extremely breathless, perhaps struggling to speak.

0:50:160:50:20

Their symptoms are getting worse.

0:50:200:50:23

Their asthma inhaler isn't helping.

0:50:230:50:26

Children may complain of a tummy ache.

0:50:260:50:29

If an asthma attack continues untreated,

0:50:290:50:32

the lack of oxygen can be fatal, but there are things you can do to help.

0:50:320:50:38

So, if someone is having an asthma attack, follow these instructions.

0:50:380:50:42

Keep them and yourself calm.

0:50:420:50:45

Sit them upright.

0:50:460:50:48

Make sure that you've located their inhaler.

0:50:480:50:51

Get them to take one puff of their inhaler every 30 to 60 seconds.

0:50:510:50:57

It can feel like a long time in between, but it's the right thing.

0:50:570:51:01

Repeat up to a maximum of ten puffs.

0:51:030:51:05

Take another puff of that, please.

0:51:050:51:07

Excellent, well done.

0:51:090:51:11

If they didn't have their inhaler with them on the day,

0:51:110:51:13

-what would you do then?

-Call 999 straightaway.

0:51:130:51:16

You should also call an ambulance

0:51:160:51:18

if they don't feel better after ten puffs, or if they're a child.

0:51:180:51:21

If, in an extreme situation, the patient stops breathing

0:51:230:51:26

and their heart stops, you must start CPR immediately

0:51:260:51:30

and don't stop until the ambulance arrives.

0:51:300:51:32

Nice and easy.

0:51:340:51:36

Nice and calm.

0:51:360:51:37

If you have asthma,

0:51:370:51:39

learn to recognise your triggers and always carry your inhaler.

0:51:390:51:43

Make a plan with your GP of what to do if you have an asthma attack.

0:51:430:51:48

And for the rest of us,

0:51:480:51:50

we should learn to recognise the warning signs of an asthma attack,

0:51:500:51:54

particularly for children.

0:51:540:51:56

Wheezing, shortness of breath,

0:51:560:51:58

they are unable to finish a sentence without having to breathe,

0:51:580:52:01

and sometimes children complain of a tummy ache.

0:52:010:52:05

For a list of symptoms and more, check out...

0:52:050:52:08

Earlier in the programme,

0:52:210:52:23

we did a big experiment to test three different ways to boost

0:52:230:52:27

the good bacteria in our gut.

0:52:270:52:29

The surprise winner was a little-known drink called kefir,

0:52:290:52:33

made by fermenting milk.

0:52:330:52:34

Having discovered in our trial that fermented foods worked best,

0:52:370:52:41

we wanted to look at the subject in greater depth.

0:52:410:52:44

What exactly is going on when food is fermented, and should we all

0:52:440:52:48

be eating more of these foods?

0:52:480:52:51

To find out, I first need to take a closer look.

0:52:510:52:53

Fermentation is the process by which bacteria and yeast turn carbohydrate

0:52:540:52:59

into things like gases, acids and alcohol.

0:52:590:53:03

Now, we are familiar with the idea you need micro-organisms to produce

0:53:030:53:06

your beer and wine, but until fridges were invented,

0:53:060:53:10

it was actually one of the main ways to preserve foods.

0:53:100:53:13

Fermented foods include pickled vegetables, cheese, chutneys,

0:53:130:53:18

sourdough bread, soy sauce and drinks like kefir.

0:53:180:53:22

And it turns out, they're surprisingly good for us because

0:53:220:53:26

the way they're made encourages the growth of helpful bacteria.

0:53:260:53:29

Anna, Simon and Gabba all regularly make fermented foods and drinks

0:53:340:53:39

using traditional methods.

0:53:390:53:41

Today, Anna is making some soft cheese and Kombucha,

0:53:410:53:45

a fermented tea-based drink.

0:53:450:53:47

I'm using the culture to make it.

0:53:470:53:49

Simon is making sauerkraut - preserved white cabbage -

0:53:490:53:53

and kefir, the milk-based drink that did so well in our trial.

0:53:530:53:57

You just get these grains. Put them in with milk.

0:53:570:54:00

And Gabba is making kimchi,

0:54:000:54:03

a traditional Korean dish of fermented vegetables.

0:54:030:54:06

When you try it, it's just fire!

0:54:060:54:08

There are different methods,

0:54:100:54:11

but a common one is to chop up vegetables and leave them

0:54:110:54:14

in a salty liquid.

0:54:140:54:16

Over time, the salt kills off the bad bacteria,

0:54:180:54:21

allowing good bugs like lactobacillus to thrive.

0:54:210:54:25

These bacteria produce lactic acid which preserves the vegetables

0:54:280:54:32

and gives the food its distinctive flavour and aroma.

0:54:320:54:35

Polish Korean kimchi. Here we go. Here.

0:54:360:54:39

-Spicy.

-It's spicy.

0:54:420:54:44

Whaa... Ooh!

0:54:440:54:46

But if you don't have time to ferment at home,

0:54:460:54:49

these foods are increasingly available in supermarkets.

0:54:490:54:52

I want to see how the amount of healthy bacteria in them compares.

0:54:520:54:56

What we're going to do is we going to take these home-made fermented

0:54:560:54:59

foods and we're also going to get the shop-bought equivalent.

0:54:590:55:02

We're going to send them all off to a laboratory to be analysed.

0:55:020:55:06

Now, I know which I prefer,

0:55:060:55:07

from the point of view of smell, taste and texture,

0:55:070:55:11

but it will be extremely interesting to see how the bacterial content

0:55:110:55:15

of these foods compare to those which you can buy in the shops.

0:55:150:55:19

Scientists at the University of Roehampton have placed samples from

0:55:190:55:24

each product on petri dishes

0:55:240:55:26

and are painstakingly counting any helpful bacteria that grow.

0:55:260:55:29

To discuss the result,

0:55:310:55:32

we brought in the leading expert in fermented food and gut bacteria,

0:55:320:55:36

Dr Paul Cotter from the Teagasc Food Research Centre in Cork.

0:55:360:55:41

So, what are the results showing?

0:55:420:55:43

So, in the kimchi, the sauerkraut, cheese, kefir and Kombucha,

0:55:430:55:48

from the home-made products in the blue,

0:55:480:55:50

you're seeing quite high levels of bacteria,

0:55:500:55:52

particularly lactobacillus bacteria.

0:55:520:55:55

And in a commercially sourced products, you're only seeing

0:55:550:55:57

those lactobacillus present in the kefir and Kombucha.

0:55:570:56:00

These commercial providers presumably used a more traditional

0:56:000:56:04

fermented food processing or preparation.

0:56:040:56:07

Some commercially-produced foods will be pasteurised in order

0:56:070:56:11

to make sure they're safe and to give them a long shelf life,

0:56:110:56:13

But during that process, you're also killing the good bacteria

0:56:130:56:16

along the way.

0:56:160:56:17

Is there much evidence that lactobacillus, if you take it in

0:56:170:56:20

the form of a preserved food, is actually good for your health?

0:56:200:56:23

It depends on which lactobacillus are present.

0:56:230:56:26

There are many different species and even within a particular species,

0:56:260:56:30

there are different strains, some of which have good properties and others which don't.

0:56:300:56:33

And I suppose that's why, in the case of probiotics,

0:56:330:56:36

people will have studied an individual strain and know a lot about it.

0:56:360:56:39

But by eating a fermented food with lots of different varieties,

0:56:390:56:42

at least there's a chance that some of them in there will be good for you.

0:56:420:56:46

So, for general good gut health and to acquire a range of helpful

0:56:460:56:50

bacteria, fermented foods are an excellent way forward.

0:56:500:56:54

And our tests suggest that you'll find more of these helpful bacteria

0:56:540:56:58

in traditionally-made fermented foods.

0:56:580:57:00

But if you want to make your own,

0:57:000:57:02

then do follow a recipe and make sure your hands,

0:57:020:57:04

jars and raw ingredients are clean.

0:57:040:57:07

I think the key thing if you are making it at home is it's safe and

0:57:070:57:10

you're not encouraging the growth of disease-causing or spoilage microbes.

0:57:100:57:14

So, you need to have good-quality raw material, you need to have a recipe,

0:57:140:57:19

correct ingredients,

0:57:190:57:21

follow the recipe so that you're not storing it too long

0:57:210:57:24

or at the wrong temperature.

0:57:240:57:26

And I think in those circumstances,

0:57:260:57:28

you can't go too far wrong.

0:57:280:57:30

The biome, the gut bacteria,

0:57:330:57:35

is clearly a really hot area of research and there is obviously

0:57:350:57:38

still an awful lot that we need to learn.

0:57:380:57:40

That said, I am convinced that fermented foods are good for the gut.

0:57:400:57:44

In fact, I am going to go home now and make my own kefir.

0:57:440:57:49

That's it from Inverness.

0:57:580:58:00

Next time, we're in Walsall, where we're doing a really fascinating

0:58:000:58:03

experiment to find out what the best ways are for you

0:58:030:58:06

to boost your metabolism.

0:58:060:58:08

We'll also investigate a hidden danger lurking in your rice

0:58:080:58:13

and ask, do we really need to push our bodies to the limit?

0:58:130:58:17

# My voice just cooed

0:58:190:58:21

# My mind let loose

0:58:210:58:24

# Mm, Dr Love

0:58:240:58:27

# Doctor, I want you

0:58:310:58:33

# Ooh, Doctor Wanna Do

0:58:330:58:36

# I can't get over you

0:58:360:58:38

# Dr do anything that ya Wanna Do

0:58:380:58:41

# Doctor, I want you

0:58:410:58:44

# Mm, my Doctor Wanna Do

0:58:440:58:46

# I can't get over you

0:58:460:58:48

# Dr do anything that ya Wanna Do. #

0:58:480:58:50

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