Episode 1 Doctor in the House

What would a doctor discover if they lived with you...

Hello, Doctor, how are you?

..24 hours a day?

How much would you be willing to reveal?

-Do you think you may be addicted?

-No.

Would they be shocked by what they find?

That's frankly pretty dangerous.

That looks horrible!

Like most busy NHS GPs,

Rangan Chatterjee only gets about ten minutes with each patient.

-PHONE RINGS

-Excuse me one second. Hello?

Now, he's taking on the biggest challenge of his career.

I believe that 99% of a patient's health outcome

is what happens in that time outside the surgery room.

He's about to live alongside individual families

who struggle with their health.

-Who needs help with what?

-My lower back.

I feel out of control of my own body.

Worried about cancer.

For the first time, he'll gain insight

into every aspect of his patients' lives.

This is a unique opportunity.

I think I'll be able to learn so much.

Do they cook fresh foods?

-Is this how you eat every day?

-Pretty much, yeah.

-Yeah?

Is it a noisy street? Are there stressful relationships?

Oh!

All these things have a huge and significant role

in determining their health.

Go!

He'll detect undiagnosed diseases.

I think you've already got it.

He'll deliver some home truths.

-Do you get how serious this is?

-He doesn't!

-Yeah.

I...honestly want to help you.

And discover ways we could all live longer, healthier lives.

SHE YELLS

It really has the potential to change the way

we all look at health in this country.

It's imperative that we do something about it

not tomorrow, but now.

-Have a little bite to eat before you go?

-I'm really not hungry, Mum.

As your stepdad, I encourage you

-to eat as many onions before you leave tonight.

-Thanks!

Just eat as many... In fact,

chew on one of these before you leave tonight.

Kingsbury in north-west London is home to Priti Vyas

and Sandeep Mistry.

Both divorcees, they got together four years ago.

Sandeep and I used to go to school together 30-odd years ago.

Had a bit of a crush on her back then.

I don't think she did with me, as she made it abundantly clear.

Also living at home is Priti's 19-year-old daughter, Serena.

Me and my mum, we are best friends.

She is my best friend. And I'm hers.

They all lead busy lives.

49-year-old Sandeep designs bathrooms for a living,

and 48-year-old Priti runs a beauty therapy business.

The family are particularly worried about her health.

For the last three years, I just feel like,

"Oh, my God, my body is just going through..."

It feels like I'm in a tidal wave. I'm putting on weight.

My skin reacts, I come out in eczema.

Stress is a daily occurrence.

I get upset much more,

I'm much more emotional about things.

At night I cannot sleep.

All these herbal medicines, every vitamin that you can think of,

she'll think, "Oh, this'll help some way,

"so I might as well just take it all." But I'm sure that's not right.

Priti and the family are eager for help,

so they've signed up for something radical.

GP Dr Rangan Chatterjee is taking a break

from his NHS practice in Oldham.

He's going to live alongside the family

to see if he can transform their health.

Day to day, I get... I don't know, seven, ten minutes with patients,

and I've really got to filter very quickly that information.

This, on the other hand, is giving me a month or so

to really find out everything about this family

and, by doing that, I can make a bigger impact with their health.

DOOR BELL

-Hello.

-Hello.

-Hi, how are you doing?

-Yeah, good, thanks. How are you?

Great. My name's Sandeep and this is Priti, my partner.

-Hi. Let me show you to your room. We'll take you straight up.

-OK.

The doctor is staying over so he can experience life in the house,

morning, noon and night.

-Amazing.

-Green for healing.

-Green for healing, very good!

Rangan wastes no time in getting to know the family

and finding out what he can help them with.

If I go through, one by one,

and find out what everyone needs help with. Is that OK?

-Priti, can we start with you?

-Quite a lot with me.

I was married for 18 years

and I had a very turbulent, stressful married life

and I think the stress, although I don't outwardly show it,

I think my body was under a lot of stress.

Since then, my weight has really started to...

Well, I can't slow it down at all, I just seem to be getting heavier.

-I can't sleep. I get cramp in my legs...

-OK.

My skin flares up quite a lot.

Headaches... I feel very out of control of my own body.

I don't know what's happening to it.

-Sandeep, can we come to you?

-I have Type 2 diabetes.

When were you actually diagnosed with diabetes?

Maybe about 10 to 12 years now.

I take my whole string of medicines,

so I feel like a tub of Smarties at the best of times.

Type 2 diabetes is a progressive disease

that causes high levels of blood sugar.

Sandeep takes medication to control it.

We're all a little different.

I'm a bit stubborn about the doctor.

I don't really feel like running into the office

and going to see him every five minutes, and she's the opposite.

I can really see the difference in your personality,

almost the classic cliches which we hear about.

You know, the male who doesn't worry too much about their health,

doesn't want to see the doctor, and then your...

you know, your stereotypical female,

who some people would say would over-worry.

-Crazy!

-I'm not saying this, I'm just...

ALL LAUGH

With Priti's life affected by so many symptoms,

Rangan wants to know what remedies she's already tried.

-So, this is my little "treasure trove", as I call it.

-OK.

I have melatonin to help me sleep

and then I take a multivitamin...

Using more than 20 different over-the-counter pills

and lotions has failed to get things under control.

..I wanted to prevent them. Triphala, which helps with the skin

and it helps to clear your system. And I've got stuff for my headaches.

-OK.

-There's the herbal stuff for stress.

If used appropriately,

some of these things could be very, very useful.

But what this really says to me is that

you're trying different things to try and help you.

But judging from the amount of things you're taking...

-..something's not quite right.

-Yeah, true.

-You haven't found that solution yet.

-Absolutely.

Sandeep, come for dinner. Fancy chopping?

Absolutely. I like the way you've got me doing the salad.

It implies that everything you eat is really healthy.

With a doctor in their kitchen,

the family can't hide what they ACTUALLY eat every day.

-This cupboard is our goodies cupboard.

-Yeah.

In here, we'll have crisps and chocolates and that sort of thing.

I can see a soft drink there in the corner. Who has soft drinks?

-That was me. I had that.

-That was you?

-That was her.

If I get the urge for sugar,

then I'm in real problems.

Is that... I'm not sure if I'd be able to resist,

-if that was in my kitchen.

-Exactly.

Do you need a spoon?

I've got one.

You've got to try these onions, as well, they're so good.

Absolutely, I will do.

It's a good way to keep her single for a long time, isn't it?

'Just really enjoyable for me to actually have chats with them.

'They're really nice family.'

From a medical view...

I spent a lot of time talking to Priti.

She's got a lot of different problems

and I think trying to tease out

some sort of commonality there

is going to be a bit tricky.

Moving on to Sandeep,

this is a guy with established Type 2 diabetes

and actually there's a lot of stuff in his kitchen

that I would argue shouldn't be in your kitchen if you've got diabetes.

I kind of feel really at home here already.

In fact, Sandeep actually ironed my shirt this morning,

so that was a nice treat for me.

Rangan wants to find out if Priti's symptoms are all linked.

-Ever had bloods done on your coffee table before?

-Can't say I have.

He's running some medical tests to get an idea

of what's going on inside her body.

He's also doing some routine tests with Sandeep...

So, that's 39 inches.

..to make sure his general health and diabetes are all in check.

Can't remember the last time I measured myself.

-SHE GASPS

-Sweet Lord!

Priti weighs over 15 stone,

meaning, medically, she's classed as obese.

Oh, my God. Stop looking!

I just wanted to have a peek.

When I met Sandeep, I was 12 stone.

Now he's slimmer than I am!

Nearly three million people in the UK

have been diagnosed as Type 2 diabetic, like Sandeep.

-So, it's something you've had many times before, OK?

-Oh, yes.

One of the key functions in a normal body is to keep your blood sugar

in a tightly controlled range.

Not too high and not too low.

And the body releases a hormone called insulin

to keep that blood sugar down.

Now, the problem with Type 2 diabetics like Sandeep

is their lifestyle choices and, in particular, their diet

has actually, over time, damaged their cells.

So that insulin no longer works properly.

The cells are resistant to insulin.

You've mentioned stress a lot to me

and I can see that it's a massive thing for you.

-I've got a way that we can try and measure that for you.

-Oh, OK.

So, this is a test that's going to measure cortisol.

Now, you may know cortisol is...

it's like your master stress hormone.

And your body releases it in response to stress.

You just spit into four tubes, four parts of the day.

-Spit?

-Spit.

-OK.

And we can measure the cortisol in your spit.

And what it does, it just gives me a really nice idea

of how stressed you are.

Spitometer. Like it.

24 hours later, the blood samples have been analysed

and the results have been e-mailed through.

Oh, OK.

-How are you doing?

-Hello.

So, blood results have just come back.

So, Priti, if I start with you, first of all.

-Not too bad, actually, OK?

-OK.

So, I need to do a bit more detective work,

-have a little bit more of a think about things.

-OK. But, yeah.

-Sandeep.

-Uh-oh.

-Ooh, go on, then.

Shall I hold your hand for this?

I mean, the first thing that jumps out at me was your vitamin D level.

When vitamin D is low, it's associated with a lot of problems -

immune system, bone strength.

You know, weight, all kinds of things.

But that's quite easy to fix.

But you've got a high homocysteine level.

Homocysteine is an independent risk factor for heart attacks.

OK? And in conjunction with everything else, you know,

it definitely sets off an alarm bell in my head.

-Now...

-HE SIGHS

..the most worrying test for me,

your blood sugar level

is 9.

We're looking for it within the sort of 6 area or under.

Probably, ideally, under that?

What's more alarming for me is that you're on three separate drugs

to control your diabetes,

and despite that...

Oh, my God.

-..your sugar is uncontrollably high.

-Yeah.

Why is it like this? I mean, what's he doing that wrong? Is it...?

The biggest determinant of this?

HE TAPS PAPER

-Diet.

-Really?

You've got too much sugar going round your body

and it gets deposited everywhere.

Goes in your eyes, causes blindness.

Goes in your kidneys, causes kidney failure and then dialysis.

Gets deposited in your nerves.

I know that I have a slight neuropathy in the right foot.

-What does that mean, "neuropathy"?

-Yeah, neuropathy...

Just a loss of feeling, you know, changed up a lot of things.

-You've never mentioned that!

-I didn't know that.

-So you already know some of this?

-Yeah.

-Do you get how serious this is?

-He doesn't! He doesn't!

Yeah, I can see how serious it is,

but it doesn't mean I have to show out front,

because I have two ladies here that will probably get...

-and I don't like to freak 'em out.

-TEARFULLY:

-I'm really upset.

Why? It's OK. Relax!

We're going to fix it.

So don't stress out.

Sandeep, you need to take it more seriously.

Yeah, but I'm saying to you, just relax.

You know, this is educational.

It's education and I don't feel that you've had it yet.

Diabetes, yeah, heart attacks,

strokes, you're five times more likely to get that.

-That's pretty alarming in itself.

-That's high, that's so high.

But often it doesn't kill you, it just makes your life a misery.

-And everyone else around you.

-Yeah.

I'm actually really shocked

and I'm really worried.

Now I'm REALLY worried.

It's never easy delivering serious, important news to any patient.

I had not been getting any sense from Sandeep,

but probably all of them, actually,

if I really think about it,

about how serious things are.

He's had a diagnosis for 10 to 12 years of diabetes.

Yet he's sailing along as if things are fine. They're not fine.

Staying as they are is not an option.

We need to do something and I'm going to help them.

Rangan has gone back to his practice to come up with a strategy.

He believes the family's food choices are a serious problem.

I'm really trying to find a plan that works for all of them,

because I think they're more likely to stick to something

that they all have to do together.

Make a quick snack.

The main problem is Sandeep's diabetes and Priti's weight.

-That's a lot of cheese, mate!

-Not really.

They've been eating certain foods for a long period of time now

that raise insulin and raise blood sugar.

So I've got to really teach them which foods do that.

and ask them to stop eating them.

Oh, my God, it's like I can feel the Doctor

burning a hole in my head and he's not even here.

Hi.

Hello, how are you?

Before he gives the family his plan,

the Doctor has one more test for Sandeep.

Last time I was here you mentioned

you were getting some pins and needles sometimes.

Yes, I was. My right hand.

It's predominantly just in the morning.

Well, sometimes pins and needles is associated with diabetes...

-..and nerve damage.

-You're not full of good news.

Sandeep's blood sugar levels are dangerously high

and could be seriously damaging to his blood vessels and nerves.

This might explain his pins and needles.

If left untreated, it could lead to loss of feeling

and, in extreme cases, amputation.

In the UK, diabetes causes over 130 amputations every week.

So this will test two nerves in your hands

and you're going to feel ten impulses for each nerve, OK?

If the signals aren't transmitting well along Sandeep's nerves,

it could be that the sugar in his blood has damaged them.

-What the test has shown...

-Yeah?

..when we're measuring the electric signal,

the amplitude is a lot lower in one of the nerves than we would expect.

That means you've had nerve death.

-OK, that's great. Not!

-HE LAUGHS

If you're getting pins and needles predominantly in the morning,

that suggests to me that the damage isn't that extensive yet.

OK? So it's imperative that we do something about it.

Not tomorrow, but NOW.

OK, we've got to put this plan into action.

So, first thing, don't drink your calories, OK?

Where are the sugary drinks?

-Right, our sugary drinks...

-You mean, no squashes at all?

-No squashes at all.

-No added sugar.

-Nothing.

No more juices, squash or fizzy drinks.

Just water, black coffee and tea from now on.

Next, all products with added sugar are banned.

OK, this is fajita mix.

Can you just read me the first ingredient?

-Sugar.

-Sugar.

-Well, this has got glucose syrup.

-Sugar.

-Forgot the chilli sauce.

Second ingredient is sugar.

Tomato and basil and...

How about sugar?

It's not just tomato and basil.

Refined processed carbohydrates.

Wheat, corn, rice, potatoes and dairy products are going, too.

Because the Doctor suspects they will all turn to sugar

too quickly in Sandeep's body.

Popcorn?

SHE GASPS IN HORROR

Oh, my God! Like...

What we going to eat?

And, slightly, it's making me think, "I wonder if I can stick to it."

-I'll be honest with you.

-I feel bad at the moment.

HE LAUGHS

-Excellent.

-You should!

The foods they are allowed include meat, fish, eggs and nuts.

And there's another rule to stick to.

-You've heard of five-a-day, right?

-Yeah.

-Yeah.

-Yeah.

-OK.

I want you do five-a-day,

-but my focus is going be on five different vegetables each day.

-OK.

So, the final phase of this

is something called time-restricted feeding,

and I would like you

to restrict your eating

to a ten-hour window.

There are so many different health benefits,

one of them being...weight loss.

And I'll see you very soon. Call me with anything.

-Yeah.

-OK?

-Will do.

-See you later, guys.

-Bye-bye now.

-Goodnight.

-See you. Bye.

Rangan also wants the family to take a few food supplements

he thinks will help.

Phew! We've got some things to talk about.

The banned foods are bagged up to be given to family friends.

This is what I love about being a doctor.

This is what I live for as a doctor.

Trying to give patients information they understand

and that's going to really transform their health.

I'm just so excited at the moment.

I really, really hope they stick to it.

See, I like celery, you don't like that.

No, I like celery. Who said I don't like it?

On the first day of the diet, the family have to decide

which ten-hour window they're allowed to eat within.

-Maybe we just don't eat in the evenings.

-No, we can't do that.

No, because, like... Because, like he said, we can have nuts,

-we can have...so maybe we...

-I can't do that.

Really? See, I'd be all right.

Cos I'll probably want to eat my arm by half-nine.

Time-restricted feeding is based on new science

that suggests that people eat less

if they're limited to restricted times.

Their bodies might also process and manage food better.

I'll give you the slightly bigger portion.

Priti and Sandeep choose 9am to 7pm.

With the family's diet in place,

Rangan's switching his focus

from Sandeep to Priti. He thinks her symptoms could be a sign

she's approaching the menopause,

when a woman's reproductive system shuts down.

At this time, changing hormone levels

can lead to a huge number of symptoms.

I've brought with me a sort of questionnaire.

-For each question there's three answers.

-OK.

-Zero is "not at all".

-Mm-hm.

-One is "mildly".

-Mm-hm.

-And two is "severely".

-OK.

-Headaches?

-Two.

-Emotional? Tearful?

-Two.

-Yeah. Unable to sleep?

-Definitely two.

-Daytime sweats and flushes?

-Er, two.

-Two.

-Yeah.

Night-time sweats and flushes?

Two.

Priti's scoring high in the questionnaire,

suggesting she is menopausal.

It's incredibly common for women her age

to be getting these sorts of symptoms.

75% get hot flushes at the very least.

What does it feel like when you have a hot flush?

Best way I can describe it

is I feel like my blood's boiling a little bit.

So I feel it on my head here.

It's literally like it's boiling underneath

and you can touch my skin, but it doesn't feel hot.

So what's actually happening in a hot flush

is that you've got a heat-control sensor in your body,

sitting in your brain, OK, like a thermostat.

And the changing hormone levels basically trick the thermostat

into thinking that the core temperature of your body

-is actually hotter than it is.

-Oh, I see.

That pushes out the heat towards the outside of your body

to try and cool you down. That's why you feel hot.

Have you been offered anything by your doctor?

They didn't even offer it to me, HRT.

But I wouldn't take it anyway cos I don't like

putting extra stuff into your body.

The symptoms that a lot of women experience

in the lead-up to the menopause

are actually caused by falling hormone levels.

Now, Hormone Replacement Therapy, or HRT, it replaces hormones.

It artificially gives you those hormones back

to help alleviate those symptoms.

But Priti doesn't want to take HRT.

And I think that there's a few things I'd like to try with her

that might, hopefully, help her with those menopausal symptoms

without going down the HRT road.

The severity of menopausal symptoms isn't just dependent

on changing hormones.

Lifestyle also plays a part.

Rangan is meeting Priti at work to find out some more clues.

Priti's got multiple symptoms.

She's got symptoms that she attributes to her menopause.

She's got stress problems,

anxiety issues, headaches, weight issues.

'I don't think there's one single magic bullet for her.'

-Yeah, good, thanks. Good to see you.

-Yeah, you too.

'It's going to be lots of little things

'in multiple aspects of her life.'

-OK, so you drive here?

-Yeah.

-You get here for about ten o'clock?

-Yes. I eat here.

-Do you eat here at the desk?

-I eat here at the desk.

-Whilst on the computer?

-Whilst I'm working, yeah.

If you were to log onto your e-mail,

I just want to see what sort of posture you take.

I mean, I look at you,

and see the height of your screen compared to your eyes,

and I think you're having to bend over to get down to that level.

Whereas just an obvious thing for me would be

if you put like a thick book under there

and raise it up, you would automatically

put your spine in a much better position. It's not the whole story.

-That's a good point.

-It's just something I'm noticing here.

So are you able to lift that?

I'm just wondering if this'll balance on that or not.

OK. Does it feel different?

You know, the thing is, I'm finding I have to sit like this,

where I would be very much like this. You're right, actually.

-So, it's such a simple thing...

-Mm.

..that cumulatively, minute after minute,

hour after hour that you're sitting here,

instead of being like that

you're going to be a little bit more upright

-and I hope you can see the value in that.

-Yeah.

Activity levels are vital to health,

so Rangan's giving Priti a monitoring device.

This will measure her movement,

counting the number of steps she takes every day.

The Doctor also wants to get to the bottom of another problem -

Priti's sleep.

The device she's wearing will also record how much she's getting

and how disrupted it is.

During the menopause, the symptoms of changing hormone levels

can include night sweats and anxiety.

As a result, up to 60% of menopausal women experience insomnia.

Priti gets between five and six hours' broken sleep most nights.

Rangan hopes he'll be able to get her resting better and for longer.

There's the stress test the Doctor gave her.

Saliva samples, taken four times a day,

will be analysed for cortisol, the master stress hormone.

The family are four days into their diet

and they're preparing for work.

I really want sugar,

and I was saying to Sandeep, "I don't care what anybody says now,

"I'm just going to sneak a little bit of sugar into my tea."

And then there was no sugar so I couldn't do it!

But, um...

it's really, really hard.

I feel like a junkie. I feel like I'm having withdrawal symptoms.

You know, my tongue's really dry, my head's hurting...

There's nothing in the house, so I can't even go

"Ooh, I'll just have that to fill that sweet gap."

So, I get these... I mean, I don't know about you, Sandeep,

but I get like, during the day, these little...

-It's not nine o'clock.

-Oh, God, yeah!

Whoops!

I've held off.

-I do feel like...

-SHE GROANS

ALARM BEEPS

-Chow time!

-Yay!

Sandeep's initial medical tests

revealed his diabetes and blood sugar

are dangerously out of control.

To investigate a bit further,

Rangan's arranged a scan to find out what's going on inside his body.

With your Type 2 diabetes, you've had it a long period of time now.

What worries you about it?

I don't actually want to be in the position my father is,

-which is a couple of heart attacks.

-Yeah.

He struggles, you know, just to walk from here to there

or get up and down the stairs.

I don't want to grow up being someone's invalid.

Sure.

I don't want Priti to be looking after me

and I don't want to be looking after her.

I want to have a bit of longevity

-with the both of us in reasonable health.

-Yeah.

Hi, how're you doing? Nice to meet you.

Sandeep is here for a DEXA scan,

which uses low doses of X-rays to analyse his body.

Just lie down. Breathe normally,

don't tense up or anything like that. Just relax and be still.

Recent research has shown that the fat you carry

affects your health in different ways,

depending on where it's stored.

-Rangan, Sandeep, I have the results.

-OK.

-Let's take you through them.

The good news is that yeah, you're a little overweight.

You know that, right? You're carrying a bit too much fat.

Um, but in comparison with the male population,

you're just over halfway, so it's not as bad as it could be.

The bad news, though, is where you're carrying your fat.

And you can see from the image here, the orange...

the light orange is body fat and the red is lean mass.

You're very much carrying it here in the trunk

-and in the belly area.

-Trunk and belly, OK.

Now, particularly, when we come to visceral fat...

Now, visceral fat is bad fat, OK?

Visceral fat is the fat around the internal organs.

It's linked with diabetes. It's linked with heart disease.

It's very unhealthy.

This number here is 162...

-..and I have to tell you that 160 is high risk.

-OK.

So that number, we like to be, for a guy, below 100.

Maybe even below 90.

So, between 100 and 160,

that's "increased risk"

and over 160 is "high risk".

And you are at 162, and I'm obliged to point that out to you.

Ooh.

And where would that fat really right now be sitting?

Well, that's around all your internal organs.

Around your heart, your liver, kidneys, all around the organs.

-So, it's sitting AROUND the organs?

-Yes.

-This is the dangerous fat.

That's the fat that's linked with diabetes, with heart disease,

-and I know you're worried about that from your dad.

-Yeah.

You can have a lot of fat. What they call a TOFI,

a thin on the outside, fat on the inside.

Can we hide this from Priti?

ALL LAUGH

I might be smiling about it and joking,

but it's quite an eye-opener.

Visceral fat increases the risk of many diseases

by interfering with essential organs like the liver.

Unfortunately, people with a South Asian background

have genes that make them prone to store more dangerous fats

and are more at risk of Type 2 diabetes.

Rangan wants to target Sandeep's problems

with visceral fat and blood sugar.

They're spending the day together

to see if there's any other lifestyle changes Sandeep can make.

You could go in the shed. There's a pressure washer in there.

-I'll get it out for you.

-Yeah, and I'll finish this up real quick.

-Hey, Sandeep, I see you've got some golf clubs in there.

-Yeah?

-Do you golf at all?

-Used to.

Sometimes you've got to give up a few things for family.

Yeah, I was a very keen sportsman.

Yeah, you've got loads of sports gear here.

-Yeah, a lot of stuff.

-HE GRUNTS

What sort of things did you do at school?

I did judo, badminton, cricket...

-Running track, 100, 200, 400, sprint.

-You used to run all that?

Sprints, yeah.

Sandeep's had over ten years of Type 2 diabetes.

It really is a shame that he's not that active.

Yeah, he kind of potters around day to day.

That's great and that's much better than sitting on the sofa,

and I'd encourage him to keep doing that,

but if he could get back into one of these sports,

it will be amazing for just the way he feels about himself,

but also his diabetes.

It's going to enhance insulin sensitivity,

which he needs cos he's diabetic,

but it's also going to help him target his visceral fat,

which is, you know, an area we really need to work on.

Let's go!

Exercise could lower Sandeep's blood sugar

by making his body use insulin better.

Rangan has a specific activity in mind.

Exercise doesn't need to be this big thing

where we get a gym membership

or you have to get yourself to the park on a nice day

to have your workout.

OK, you can do it right here, right now, on your street.

Three, two, one, go!

Sandeep has to walk as fast as he can in two minutes.

His progress will be measured against the numbers on the street.

Speed up, as fast as you can.

Just gone one minute.

Out of breath yet?

-Not yet.

-Not yet.

OK, five seconds to go. Keep it up!

Done.

ALARM BEEPS

Let's see what number that is. 46.

-Shall we go again?

-Yeah.

-Yeah?

-This is a form of high-intensity interval training.

-OK.

-Some people abbreviate it to HIIT, H-I-I-T.

-Right.

We know it really helps with visceral fat.

-Ah... I've got lots of that.

-Yeah, exactly.

So, do it any time you can fit it in.

Go!

How are you feeling? Good?

Good. It's good to have a marker to try and beat, isn't it?

-Are you getting a bit breathless at all?

-Yeah, a little bit.

A little bit. Good.

-Two, one, stop!

-One more.

-ALARM BEEPS

-48. Exactly.

-Good.

Back to the start?

Well, I won't make 50...

I don't think so, but I'll try again. Go on.

-There you go. Amazing!

-ALARM BEEPS

You smashed it this time!

-Agh!

-Now, that is out of breath.

-Way out of practice.

How have the last few days been? How are you getting on with the diet?

I'm missing sweet things a lot.

That's been the hardest thing for me, where I've just said,

"I'm sure it won't harm us to have one cup of tea

"with two sugars in the morning."

I feel positive.

Because of the weight loss.

-Weight loss?

-Yeah. So I feel positive about that, um...

-Have you been weighing yourself?

-Yeah.

My weight has like probably gone down a smidgen, you know,

I wouldn't say... maybe one kilo, that's about it,

but see, he looks much slimmer than me. He doesn't suffer.

He hasn't got a headache and he looks great.

-OK, you don't have diabetes.

-Yeah, that's true.

-Would you rather have diabetes?

-No, no, definitely not.

-Right, so everyone's different. Focus on yourself.

-True, true.

Let Sandeep worry about him.

In fact, for you, Priti, I think the best thing for you

would be not to look at the scales

-for the entire time that I'm here, unless I say so.

-OK.

Be nice if he just got one headache.

SHE LAUGHS

Using the scales every day when you're dieting can be demoralising.

How do you take the batteries out?

The body gains and loses water all the time.

Done!

Cruelty.

So weighing yourself won't always reflect

exactly how much fat you're losing.

It's now three weeks since Rangan first met the family.

Hi, Priti, how're you doing?

I'm good, not too bad.

Priti's activity monitor has been sending its readings to her phone.

She's taken between 2,000 and 7,000 steps every day.

I want to help you build more activity into your daily life.

-But particularly your working life.

-Yeah.

So you, like many people, are stuck in an office.

You're stuck at a desk,

but I'd, ideally, like you to take 10,000 steps every day.

But this will even help with your menopausal symptoms,

your hot flushes.

OK, I will, definitely. I'll start it from today, yeah.

Walking more will help Priti lose weight

and should reduce the severity of her menopausal symptoms.

It takes about ten minutes to walk an extra 1,000 steps

at a moderate pace, burning off something like 40 calories.

This ain't half so bad, San.

Both Sandeep and Priti have their individual plans to follow.

Now, 19-year-old Serena would also like a little help

whilst Rangan is around.

Since she started working at a nursery about a year ago,

her health has taken a turn for the worse.

Since I started working at the nursery

I was just always ill.

And even in this week with the heatwave,

I've managed to get a bit of a cough and a cold.

And then I feel so tired the whole time,

it's ridiculous.

And I feel like, at 19, I shouldn't be like this.

I shouldn't be feeling so tired the whole time.

What I'd like to do, if you don't mind,

-is take some bloods from you.

-Yes.

-Would you be OK with that?

A blood test will reveal

if Serena is low on any vital vitamins or minerals.

OK.

Rangan is now over halfway through his time

trying to help the family.

We thought we'd have a nice big breakfast.

He's just dropped by to check on them.

I've already have some sausage and bacon.

-Would you normally have eggs, sausage and bacon...

-Yeah.

..as a normal breakfast?

Er...

not all the time.

Can I just see, what are the sausages?

The family have been told

to avoid any foods that contain wheat and potato.

-Yeah, have any of you looked at this?

-Not really.

OK, so, you've got a sausage.

40% of it is meat.

OK, so what is the other 60%?

Starch.

"Wheat rusk, potato starch, wheat starch."

-And how much of these have you been eating?

-Not a lot.

-Not a lot, yeah.

-Yeah.

-At the moment, we might have a couple at a time.

-Yeah.

-These are definitely not on your plan...

-OK.

-..in any shape or form.

-OK.

-OK.

And so, yeah, anyway. But that's what's quite interesting...

-The other day I bought some frankfurters, as well...

-Did you?

-Oh!

-..thinking they would be all right...

-Did you eat them?

Well, after I ate them, um, somebody reminded me

to have a look on the packaging, which I did.

I did say to Sandeep, though, didn't I,

"Aren't sausages fattening?" And he said, "No."

So you're still going to eat them. Despite you having diabetes

that is putting you at close risk of having a heart attack,

you're going to still have them?

But what am I going to eat instead, then?

Um, I'll have to have the omelette and just forego the sausages,

-but I mean, as I said, I haven't...

-I'm not saying you shouldn't do,

I'm just trying to highlight that this is a serious issue.

I don't think we should forget how bad things were for you.

I know you've made some great changes already, but, you know,

you've got nerve damage from the things you're eating

and your blood sugars aren't perfect yet.

If you're putting foods in that have got two or three

different wheat ingredients, they'll spike your blood sugars.

Simple as that.

'They're making great changes.'

They're feeling better, that's great.

But I think they're slacking off and it worries me.

If they're slacking off already, what happens when I'm not here?

It doesn't give me much hope they can stick to it long-term.

Um, you know, they were asking me questions, "Is this OK?"

Actually, I've taught you how to find out if it's OK.

You started looking at packets right at the start.

They've not even looked at the ingredients.

They don't need me for that.

I've shown them how to do that and they've not done it.

After their setback, the family are redoubling their efforts

to stick to the rules.

My own thought - he hasn't said anything to me -

but my own vibe on it is that he's panicking.

When Rangan said to him, you know, "You're likely to drop dead.

"You're five times more likely to have a heart attack or stroke."

And, you know, he's literally a walking time bomb,

I think it hit him hard.

But he's finding it extremely taxing.

Today, he said to me, "I'm absolutely exhausted," you know?

And I was saying "What about your exercise?"

and he was like, "I am just... I am just exhausted."

Come and sit down, Sandeep.

Two weeks ago, Priti completed a saliva test

to measure her underlying stress levels.

Her spit samples were analysed for cortisol,

the body's master stress hormone,

to see how these levels change throughout the day.

What we want is it being nicely in the middle of this green range here.

There should be this nice rhythm,

-where it's around 20 in the morning...

-Right.

..and it gradually falls down throughout the day

-till it's very low before you go to bed.

-OK.

So here, in the morning,

sample one your cortisol level is nearly at 50.

OK.

You can't even see how bad that is on this graph.

This only goes up to 35.

-Actually, that is up here.

-Yeah.

-It's really, really high in the morning.

-Yeah. Yeah.

Sample three, middle of the afternoon.

-Hugely high.

-Yeah.

-OK.

And yeah, it was normal in the evening.

So you can't literally take a supplement

to help calm the cortisol levels or anything?

-I don't think you need to be taking supplements for this, OK?

-OK, OK.

Cortisol does many things in the body but, fundamentally,

-I want you to think of it as your stress hormone.

-Right.

If you get this in better balance,

I find that women don't get as many menopausal symptoms.

Not always. It suppresses your immune system when cortisol is high.

-Yeah, I can believe that, too. Yeah.

-It does so many things.

That's interesting, isn't it?

-And I think this is the missing link for you.

-Mm.

Stress is a problem that's on the rise in the UK.

Studies suggest nearly two-thirds of adults are more stressed now

than they were five years ago.

The diet and exercise changes Priti's already put in place

should be helping things.

But now the Doctor wants to try something a bit more direct.

Meditation might not seem like something

a doctor would normally recommend.

But these days, nearly one in three GPs

regularly prescribe it for some patients.

So, it's really on a very simple level, it's just...

noticing the way the body is feeling right now.

Recent studies have shown that meditating regularly

can improve stress levels, mood and reduce fatigue.

'There's science now saying'

that regular meditation can lower your blood pressure

and do a host of other things.

-Mm-hm.

-Are you seeing people coming more from their doctor?

-Mm-hm. Absolutely.

-Really?

-I would have thought, in the last ten days,

I've had at least five people come straight from a GP referral.

-Really?

-Yeah.

-Wow!

-That's amazing, isn't it?

-Yeah, that's really...

Most doctors don't really go down that route, do they?

They're more "Let me give you a pill to help you de-stress."

The body knows how to relax.

The body has a natural talent for relaxation.

It's putting the body first,

putting our trust back into the body.

Rangan has told Priti to try meditating 15 minutes every day.

He's also given her a magnesium supplement.

The body uses this mineral to relax muscles

and he believes it could help her sleep better.

Serena is also taking a supplement.

Her blood test revealed that, like a quarter of girls

around her age, she has low iron levels.

Lovely.

This could be the reason she's tired,

as iron is essential for the body's metabolism.

I think the iron has made a really big difference.

I have a lot more energy levels.

I can go out probably a bit more without feeling,

"Oh, my gosh, I need to go home, I need to go to sleep."

I can just do more day-to-day things

without thinking, "I just want a nap."

But Serena is still suffering endless coughs and colds.

Hello.

She works in a nursery and the Doctor wants to demonstrate

how one of the causes might be her environment.

All right, then, I've got a game for you here.

Make a circle first - that's part one of the game, all right?

These dishes contain a special gel.

One, two, three.

When the children touch it, any bugs on their skin

get transferred onto the surface.

That's brilliant!

-One...

-That's it, Batman!

-..two, three!

Over the course of the next week,

the germs feed on the gel and multiply.

The coloured blobs forming here indicate different colonies

of bacteria and fungi.

It's a result you could expect from any nursery.

Viruses like coughs and colds

are transferred just as easily as these bugs.

And children get around three times as many colds as adults,

so if you work with kids,

you're simply more exposed than other people.

I've got some results. Do you want to see them?

Oh... Oh, my God...!

That one... That looks horrible.

Oh... What is it?

Basically, all these different colours, like, these white splodges

are probably a bacteria called staphylococcus.

Some of these look as though they might be...fungus. So, candida.

Oh, my God!

-That's disgusting.

-This is just on the kids' hands.

-I know!

-Do you remember, the kids just put their fingertips there?

-Yeah.

For what, two or three seconds? You see how easily it's transferred.

-Yeah.

-If you think about it,

you're playing with the kids, touching the toys...

And they lick all the toys, so that's even more germs.

You're not going to get rid of those germs there, OK?

-But what can you do? Well...

-Just wash my hands.

Wash your hands. And in particular before touching your face.

So if you think about these bugs are on your hands,

OK, and you touch your face,

it's very easy to get in through your nose or in through your mouth.

-I'm hyper-cautious before I touch my face that I've washed my hands.

-OK.

-I hope this makes you think of it in a different way.

-Yeah, it does.

-It makes you realise how much you're probably exposed to.

-Yeah.

Sandeep and Priti are sticking to Rangan's diet.

The stakes are particularly high for Sandeep,

whose diabetes is putting him at risk of early death.

-ALARM BEEPS

-Oh, my God, stop eating.

Now there's a final, radical intervention left

Rangan wants to try.

I was hoping we might be able to step it up a little bit now,

to see if I can really accelerate

what I can do with you for the next few weeks.

OK.

I was going to propose that you

do a one-day complete fast.

Fasting might seem like quite a drastic thing to do,

but there's more and more research

suggesting that it can actually help reverse Type 2 diabetes.

Now, one of the ways it can do this

is by improving the body's sensitivity to insulin,

and that can help you manage blood sugar levels much more effectively.

Now, diabetics should only fast under the guidance of their doctor.

But whilst I'm working with Sandeep,

I think it could reverse things enough to help get him off

some of the medications that he's currently relying on.

After I eat tonight,

I don't have to eat again until tomorrow night...

-Oh, my God!

-..except for water. I'm going to starve tonight.

You're miserable enough with a little amount of food.

Thank you. I think he may be responsible for a divorce!

The next day, Sandeep is keeping busy.

He's consumed nothing but water for nearly 22 hours.

DOORBELL

-Hi, how are you doing?

-Yeah, all right. Not too bad.

To assess how fasting has affected him,

Rangan is getting Sandeep to check his blood sugar level

with a home monitoring kit.

A healthy reading would be between 4 and 6.

-5.9 is excellent.

-Yeah.

-So that's absolutely perfect!

You keep doing what you're doing,

I think we're going to see really big changes.

So what's your recommendation on the fasting?

One on, two off?

Well, I'm delighted to hear you ask that, actually,

because I was worried it would be a struggle

to get you to even fast for one day,

but you really sort of took it on and said, "Yeah, OK, bring it on."

If you could do it two or three days a week,

I think we would see amazing rapid improvement.

-Well, look, it's time now to break the fast.

-Yeah.

OK? You've done your day.

I'm really pleased,

-so let's go out for dinner.

-No problems.

-Yeah?

A trip to one of the family's regular haunts

gives Rangan the chance to show them they can stick to his rules

even when eating out.

So if we normally came here,

my favourite thing is a big naan with lots of butter on it.

But I have what they call a Bombay mix here,

which is chilli crisps, peanuts...

Indian meals can have loads and loads of great vegetable dishes,

so I think we could maybe ramp up some really tasty veg.

-Yeah(!)

-No? Doesn't excite you like it excites me?

-No, I can handle that.

-I'm trying, I'm...

Why don't you choose for us and then we'll try it.

-No butter.

-No butter.

-No yoghurt.

No yoghurt, as well?

Yeah. No cream. But, you know, a samosa has got a wheat batter.

We're trying to avoid wheat, as well.

As someone else is doing the cooking tonight,

the family have to interrogate the waiter

to make sure they're sticking to their diet.

Lovely! Looking forward to this now.

Does that not look good?

That does. It does look good.

-Great!

-THEY CHEER

This is good, though.

There's aubergine in here, green beans, courgette, tomatoes.

Can I just ask, before we start,

-are we being deprived at the moment?

-No.

I am quite.

OK, all right! OK!

Really excited about how far I can go with Sandeep now,

because he's got the diet,

he's got the ten-hour eating window,

but now he's got the fasting, as well.

He absolutely nailed the fast today!

If he could do that two or three times a week,

I think the results could be fantastic.

The last symptom to tackle with Priti is her hot flushes.

They're the most common menopausal symptom

and, for many, they're very disruptive.

Priti tells me she doesn't want to take any pills

for her menopausal symptoms,

but I wonder if acupuncture might help her hot flushes.

The research isn't clear on this.

Some trials say it works, some trials say it doesn't,

and some people think it's simply a placebo effect.

Personally, I think it's something a little bit more than that,

and I've seen it work really well sometimes.

But for someone like Priti, who's so open to this kind of therapy,

I think it could be just the ticket.

Absolutely symmetrical...

Acupuncture involves putting needles into shallow points around the body.

It's a bit controversial.

Some researchers think it works by stimulating the nervous system.

But not all scientists are in agreement.

What ones are going to help for the hot flushes?

Hopefully, all of them would do.

The ones in the feet I would consider

are two of the most important ones. Also the ones in the ankle.

So will I just not feel the hot flushes as much?

Hopefully, yes, it'll just reduce.

So how are you feeling, Priti?

-Oh, I feel good. I feel very relaxed.

-Excellent.

It's been two months since Rangan first came to the house,

and the family have been working hard to change their lifestyle.

One, two...

As well as the diet and exercise,

Priti's meditating regularly.

And Sandeep is fasting three times a week.

The doctor's getting Sandeep to check his blood sugar regularly.

And over the last few weeks

he's weaned him off two of his three diabetic drugs.

Now it's time to measure exactly how far they've come.

They're undergoing the same battery of tests

they went through at the start.

It's slightly bizarre that I'm going to deliver

some very important medical results to a family

who I now consider close friends.

-DOOR BELL CHIMES

-Hello!

'It's quite odd. It's very different from my day-to-day work.

'There really isn't that distance there'

and I think that makes it a little bit more challenging.

First, Rangan's delivering Priti's final results.

Her original saliva test revealed a serious stress problem.

The four points on the graph should sit in the green zone.

Yeah, so that's super high, far too high. And the new ones...

Wow! The morning one's gone down to 26.

-The morning one's almost halved. It's now 26.

-Very good.

It's fantastic. Were you expecting that?

I wasn't expecting that, actually.

But I know I've been working towards trying to get...

You know, trying to get my stress levels down,

you know, with the meditation in particular.

Getting stress under control

can help with a number of other health issues,

including the menopause.

Once again, Priti's taking the questionnaire

to rate the severity of these symptoms, from 0 to 2.

-Daytime sweats and flushes?

-One.

-Night-time sweats and flushes?

-One.

-Headaches?

-Zero.

-Tiredness?

-Zero.

Loss of energy?

Zero.

-General aches and pains?

-Zero.

These top ones, which are basically your classic menopausal symptoms,

-you scored 14.

-Mm.

That's gone down to 3.

I'm not so tired, I don't have the headaches

and the acupuncture really helped with the hot flushes.

Definitely.

One of the biggest problems for Priti was sleep.

You've gone up from 5.5...

..to 8 hours.

-No wonder you're feeling so good!

-Yeah!

Rangan now wants to check how Priti and Sandeep have changed physically.

Take your finger off for me?

37 inches.

It was 41.25, right?

41.25.

-It's come down to 37.

-Wow...

That's 4.5.

4.25 inches.

-Wow!

-Put it there.

-Give me a hug!

ALL LAUGH

Wow! I'm so surprised!

Let's do her blood pressure now!

Oh, I'm really pleased. Oh, look, she's crying for me.

-Ah, she did it!

-I'm proud for her. I know how much it means.

Yeah, it is. It's a big, big thing for her,

-so we're really both happy for her.

-Are you OK?

-TEARFULLY:

-I just was trying really hard

and sometimes, anyway...

sometimes you just think you're not going to get results, and yeah...

-No, that's really good. I'm pleased.

-It's good!

I don't know why I'm so...

Right, weight time!

So...

14.75 stone!

You dropped a stone!

14 is still too heavy, obviously,

but it's on the way down.

I'm super impressed with that. Super impressed.

I'm very... I am actually incredibly happy, thank you.

Looks a lot better, that's for sure.

Eight weeks ago, Sandeep's stomach was quite pronounced.

Wow!

34.5 inches. It was 39 inches.

Huh! My God!

4.5 inches off your waist.

One, two, three, four, when we started.

Yep, on you go.

12st 8.75lbs.

You were 14st 3lbs. That's more than 1.5st.

I know I've lost weight,

-but it's not the weight that I'm worried about.

-Mm.

It's the internal body scan.

At the start,

Sandeep had dangerously high levels of visceral fat.

Linked with heart disease, strokes and his diabetes.

Your level was 162.

-Ideally, we want it under 100.

-That's right.

Your new visceral fat score...

Oh, 30 points, 32.

It's come down to 129. You're halfway there...

-Right.

-..in just a few weeks.

I was hoping to get even better, but it's a good result,

you know, considering where I was.

Now, the test for me, that I'm most excited about...

..is your Type 2 diabetes test.

I did a reading called your HbA1c

and that gives me an average look at your blood sugar

for the last three months.

And I was frankly worried when I saw that.

It was 9 on three diabetic drugs,

and had you not been on any drugs at all

-that could have been 11 or 12.

-Yeah.

Your new average blood sugar reading...

That's good.

..is 7.

OK, that's two points down. A lot better.

-And during that time, you've come off two diabetic drugs.

-Yeah.

I think that's a fantastic result!

I'm really happy with that. Don't look it, but I am.

Just a few weeks of making some lifestyle changes

-is not going to magically wind the clock back to the start.

-Right.

But you can magically wind back the clock if you keep going.

Thank you for everything.

For me, I really have to stay the course

and I have another probably solid two months

of hard work ahead of me.

I really do believe this whole process has saved his life.

You know, I said to him, "It'll give us another five, ten years

"to spend healthily together where I'm not looking after you

"after you've had a stroke or a heart attack

"because of your own doing."

THEY LAUGH

That experience with this family

dealing with the complex dynamics that were there,

that's taught me a lot. That has been a complete transformation.

I feel really chuffed, as well! I mean, those results are fantastic!

-Perfect. Thank you so much.

-See you later.

-Safe journey.

-Bye.

-Bye-bye.

-Bye.

Next week, Rangan's in Manchester...

Hello, Doctor! How are you?

..with a family urgently needing help.

-Say night-night.

-Night-night.

-Bye.

-Bye!

He'll try to solve a five-year-old's terrible skin condition...

-Gets all red and itchy, doesn't it?

-Yeah.

..and treat a bodybuilder whose severe back pain

has lead to a dangerous problem.

Do you think you may be addicted?

I am NOT dependent on taking painkillers.

I am dependent on being pain-free.