Episode 4 Doctor in the House

What would a doctor discover if they lived with you 24 hours a day?

-Hello.

-Hello.

Corel, come and meet the doctor.

-How much would you be willing to reveal?

-Hello...

I'm scared I may get bullied for how I look, and my weight.

I feel like I'm drugged.

But Nicola, you're right - you ARE drugged.

Would they be shocked by what they find?

Nobody has explained to her,

in language that she understands, how to manage her condition.

It is not acceptable.

Most GPs only get about ten minutes with each patient.

Dr Rangan Chatterjee wants to try a different approach.

All the time in my consultation room, I'm seeing problems that are

lifestyle problems, and they don't need a pill,

they need a lifestyle change.

He's about to spend time with families

who struggle with their health.

Everything we've tried has basically failed.

WOMAN GROANS

He'll gain insight into every aspect of his patients' lives.

How do they eat, how do they sleep, how do they move and exercise,

and how do they, sort of, switch off and relax?

He'll detect undiagnosed illnesses...

It probably puts you at a higher risk of early death.

..deliver some home truths...

I think this fear is holding you back.

Please don't turn it into this is, erm...

this is because I'm mentally fearful.

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

It's amazing how many times, when you get those basics right,

all the other problems get so much better.

Feeling good, energy up...

I can even dance!

-Have a dance, yeah!

-Hey, hey!

Tonight, Rangan is going to help two families with busy working mums,

both suffering from stress and exhaustion.

Right, so, not only have I got one, I've got the short one...

First up is the Singletons in Bolton -

17-year-old Cameron, 12-year-old Logan,

and six-year-old Zachary...

Two against one.

I've been craving a chocolate biscuit all day.

I am a biscuit addict.

..41-year-old dad Ian, a teacher, and mum, 39-year-old Nicola.

They've called the doctor for Nicola, whose illnesses leave her

exhausted and often in pain.

I always say to people, think of your most tired day

and then times it by ten.

Day in, day out, for weeks, months, years on end.

I actually, honestly, cannot remember what

it's like to feel awake.

It's a fight every single day, and...

and, you know, she looks perfectly normal.

You know, walking past her on the street, you wouldn't have a clue,

and I think a lot of people just don't see it.

They don't understand it, and, "Oh, you're just being lazy."

Cos, well, no, it's not laziness.

Dr Rangan believes that the best way to find the root cause

of a person's illness is to investigate

every part of their lives.

He's devoting the next few months to helping the Singleton family.

-Hello.

-Hello.

-Hi.

-Hi.

-Can I introduce you?

-Cameron.

-I'm Cameron.

-Cameron, hi.

-This is Zachary.

-Hi, Zach. Hi.

-Logan.

Logan, hi. I'm Dr Chatterjee. How are you doing?

So, can you tell me a little bit about

what's actually going on with your health?

I have fibromyalgia -

that's been about a year I've had fibromyalgia.

-I've had ME for about nearly...

-Four.

Diagnosed officially about four years,

but I think since I got pregnant with

my youngest child, who is now six.

An underactive thyroid... I also have sciatica.

Nicola has been diagnosed with numerous conditions.

Fibromyalgia and ME are characterised by extreme tiredness

and unexplained pain all over the body.

Sciatica is nerve pain in the back and legs.

-Everything hurts.

-Every day?

-Every day.

-Is that when you move the joints, or is that just

you just sitting here now?

I can be lying there in bed at night, and your fingers become

really heavy and stiff, or you get pins and needles.

Every time I bend, every time I move, it hurts.

Is there one thing that you think we could achieve?

What would that one thing be?

What I'd like to do is really just to...

hopefully to gain, sort of, some energy,

you know, for it not to hurt. Everything hurts.

It's just staggering. I've got at least eight different diagnoses.

Erm...

For me, there's never eight separate things going on

in someone's body, never.

I'm trying to see, can I identify the root cause that's...

that may be, sort of, pulling all of this together?

There's something going on that we haven't identified yet

and we need to find out what that is.

SHE CHUCKLES

To fully understand Nicola's illness, Rangan wants to speak to

those closest to her.

I had a long chat with your mum before and she was telling me a lot

about the things that affect her health.

Erm...

How does that affect you?

I know I'm helping someone out with, er,

sort of, like, a disability of back pains, leg pains, nerve pains,

I think, and it makes me feel good on the inside,

but I wish we could, like, play.

Do you remember before your mum got this ill? Can you remember that?

She actually helped me ride my bike.

I had stabilisers. We just went up and down the street...

-Right.

-..and it was a bit bumpy, so she helped me

just get stable and everything.

Do you think she'd find it hard now?

Definitely, with all the legs...leg pain which she has,

-she would find it hard.

-Yeah.

Do you ever think about your mum's health?

It can feel very hopeless sometimes, cos we've spent the last

four or five years trying to do something about it,

one way or another, and we've not gotten anywhere, really.

How does it feel for you,

having me coming out of the blue into your house?

I don't expect anything, because everything they've tried has

basically failed.

They've just had to put her on tablets, and then on more tablets,

and then on a stronger dose of more tablets,

and then on a different tablet entirely that

she probably shouldn't even be on,

and then she's got all these side-effects, and it's just a mess.

It's an absolute mess.

One thing I CAN promise you, right here, right now, is that

I will do everything I possibly can to try and work out what's going on.

You've got my word, I'm going to try my best on that, OK?

I really want to help Nicola, but I feel even more compelled to

do my best after chatting to her kids.

This is impacting the whole family - it's not just her.

It's really become clear to me how...

much of an impact Nicola's health is having on their entire lives.

Nicola, would it be all right to have a look at

-the medications that you're on?

-Yeah, of course you can.

Rangan fears that, to tackle her constant pain,

Nicola has been overdosing on heavy painkillers.

There's a lot there, isn't there?

You take, maybe sometimes up to eight of these...

-Up to eight sometimes.

-..codeines a day.

Two tablets of Zapain, naproxen up to four,

and the Lyrica up to three.

That's 17 pills,

on a bad day, you're taking.

-I feel like I'm drugged.

-Yeah.

I feel like I'm completely and utterly spaced out.

But Nicola, you're right, you ARE drugged, because you're nearly

on 20 pills every day.

You are still feeling bad, but then you think you have to

take them to help you, and I think there's a vicious cycle.

Yeah. This is my future.

And I don't like it one little bit, so...

hence asking you to come here.

Rangan has been assessing Nicola for over eight hours...

No, we're not going in the car. Come on.

..but it's on her evening walk that he sees first-hand

her extreme levels of exhaustion.

So, it's my challenge of the day.

-For me, this is like climbing Mount Everest.

-Yeah.

Nicola walks for an hour each day,

until the pain and exhaustion forces her to stop.

-I feel stiff.

-Stiffer...

-Stiffer, yes.

-..and more sore than when we started the walk?

-Yes.

-Yeah.

You definitely look as though you've had it taken out of you.

Yeah. It does,

it IS tiring. It is really tiring.

But that sense of achievement is huge for me.

You know, actually, I've noticed...

Now, have YOU noticed this?

That sometimes your eyelids, they're blinking slower now?

And that tells me your body is very tired.

Sometimes your eyes want to close by themselves.

Yeah, yeah. Is that how you feel now, a little bit?

Yeah. I don't move. I just don't move.

I'll try and come up with a plan to help you.

This family, and in particular Nicola, is desperate.

I think she...

I think she hides it a lot,

and I think I'm their last chance.

In the morning, Rangan begins analysing Nicola.

Fibromyalgia, chronic fatigue syndrome -

they're a bit of a medical mystery, and it can be quite hard for us to

do things that get these patients better.

She's got all these different diagnoses, but ultimately,

the two big things that are affecting her quality of life,

when you strip it all away, is pain and fatigue.

That walk, when she came up the hill,

she just suddenly stopped being able to generate energy,

and there's a lot of research suggesting that in some patients

with chronic fatigue syndrome and fibromyalgia, actually,

their mitochondria aren't really working as well as they should be.

Mitochondria are basically the powerhouse of the cell.

It's... It's like an energy factory for the body,

so I'm going to give Nicola some nutritional supplements

to help get these mitochondria, these energy factories,

working much better.

Rangan's next job is to explain his vision to Nicola.

I'm going to use an analogy of a train to try and demonstrate the way

I'm thinking about this at the moment, OK?

So, this train is meant to be you, Nicola, OK?

And I think that over many years of picking up labels,

I think you're being held back.

OK? So, for example,

your chronic fatigue syndrome, OK?

That's been attached onto you.

This is your fibromyalgia...

that you've been labelled with as well.

This... So your underactive thyroid..

This...is the anxiety symptoms that you feel.

Your gut symptoms that are bothering you...

I could make this train even longer.

The point is, you've picked up all these different labels,

you've got all these diagnoses and these pills to try and treat the

symptoms of all these problems, OK?

But actually, I think they're holding you back.

They're not allowing Nicola to keep going on with her life,

so what I propose we do

is we get rid of all these labels, OK?

We get rid of all these different labels

that have been attached to you,

and what I want to do is I want to focus on you as Nicola,

and say, "What's not working? Let's fix it and see where we get to."

That sounds great to me.

It's just so overwhelming -

the ME, learning to cope with that, which took a long time,

and then the fibromyalgia,

and then, on top of that, the sciatica.

It was just like, "Any more..."

What is it? What is it that's upsetting you?

Well, it just sounds hopeful...

..and we've not had that for a long time.

HE SNIFFLES

While Rangan waits for Nicola's blood results,

he travels to his next patient,

who is also suffering from severe exhaustion.

Yeah, tiredness, exhaustion, I see that every single day -

particularly amongst women -

and the interesting thing is, there can be so many different causes,

and actually, I'd say it's something that, as a profession,

I don't think we're that good at treating.

I think there's a lot of people out there who are tired,

who are stressed, who are exhausted, and actually, they don't know

how to get any help.

-Hello, nice to meet you. I'm Laverne.

-Hi, I'm Dr Chatterjee.

-Hi.

-Hi.

Corel, come and meet the doctor.

-Hello.

-How are you doing?

-OK.

-Hi, my name's Rangan.

Really nice to meet you. Are you well?

Rangan is meeting the Hayes family...

Hello, Mum, are you all right?

..granny Doreen, mum Laverne,

and her two sons, 16-year-old Sampras and five-year-old Corel.

Come through.

I am concerned for Laverne.

-What are you concerned about?

-I'm diabetic.

Before I was diagnosed with diabetes, I remember

all the symptoms that I had and all the things I was going through,

and now I can see it's straight on Laverne.

What sort of problems do you need help with?

My headaches, you know, my stomach bloating,

the fact that I'm just, like, always tired...

How long has this been going on for?

I would say at least...

..seven years?

Seven years.

A long time.

Rangan wants to see if markers of type 2 diabetes

are present in their blood...

-There, thank you very much.

-You're welcome.

..but he also wants to investigate Laverne's exhaustion

by following her daily routine.

I'm running a bit late, as I do.

First stop, the school run.

Do you sleep well?

Sometimes.

Then it's off to her job at a local car showroom.

-Morning!

-Hello!

Then Laverne shops for the family...

But I want the fresh ones here.

..and goes home to cook dinner.

And this fatigue,

-have you ever spoken to your doctor about that before?

-Yeah.

When I go to the doctor, I see lots of different doctors.

I don't get to see the same one. So you see different ones,

they tell you this, they tell you that,

but no-one actually comes up with, you know, a solution to the problem.

Back out for the school pick-up...

I heard she's just had Spanish class.

..and then it's time for her gym session.

Do you pretend that IS someone, when you're hitting it?

Rangan wants to discover if Laverne's hectic lifestyle

is affecting her health.

What I'd like to do is measure how busy your life is

-and how much stress that's putting on you, OK?

-OK.

And so I've brought a test. It's actually... It's very simple to do.

-It's basically... It's a... It's a stress test.

-OK.

OK? You would have to spit into a tube four times during the day.

Oh, right.

And each time it's going to measure something called cortisol,

which is basically your stress hormone,

and what it does, it gives me an idea of how stressed your life is,

and when I get the results, I might, I hope,

be able to come up with a plan to address it.

-Right now?

-If you don't mind, yeah.

-OK.

-Is that OK?

And I just want to check that you're doing it right

and then check we've got enough that we need, OK?

-OK.

-Yeah?

-Yeah.

OK.

The spit test isn't the only way Rangan

is going to gather information.

I've actually brought the waterproof wrist monitor, that

I would like you to wear 24 hours a day for the next few days.

-It's going to measure your activity levels.

-OK.

It's going to measure your exposure to light.

It's going to measure your sleep quality,

and I'm hoping that, by getting that data, it's going to give me a much

better understanding of what's going on with you.

She's your classic case of a woman who is frankly go, go, go,

the entire time. She's doing what she needs to for her kids,

for her mother, whatever her work requires, she's there.

In many ways, she's Superwoman,

but actually that's coming at a cost, and the cost is her.

CHILD SQUEALS

After dinner, when most people are thinking about bed,

Laverne heads out to her second job as a nightclub bouncer.

DANCE MUSIC PLAYS

Up to five nights a week, Laverne runs the door of a local club.

She's on her feet for up to 12 hours,

patrolling the venue and dealing with Northampton's revellers.

I've always had two jobs.

Right.

For financial reasons, and also because of my boys,

I've always tried to work part-time, so I'm there for them after school.

-Right.

-It's just the way it is, It's just what I have to do.

Yeah.

And even after the club has closed, Laverne's work is far from finished.

How was it tonight?

Very, very busy - a hard one tonight.

-Yeah?

-A really hard one tonight.

Thanks for showing me around today,

and I hope you get a good night's sleep, OK?

-Thank you.

-Take care. Bye.

Bye.

It's midnight.

She must be absolutely exhausted.

She's been going all day, nonstop.

She's been working in that club.

She is just pushing it too hard,

and I'm not quite sure at the moment how I'm going to get through to her

that something needs to change.

Rangan travels back to Bolton, to begin his treatment plan

with the Singleton family.

He starts by giving Nicola vitamin boosters.

So Nicola, there's a few things I've identified in your bloods that

I think we could do with optimising.

One of them is your B12 level,

but also I noticed that your vitamin D level was very low,

and I'm suspicious that you may need some nutrients

to help you with generating energy in the body.

He also gets her to fill out a questionnaire that

gives her a score for her health.

But Rangan suspects one reason for Nicola's exhaustion and pain

could be her diet.

A lot of foods, in particular processed foods,

refined foods and sugar,

what they do is they cause inflammation in your gut, OK?

That's not a good thing. It's a bit like a fire in your gut.

That's what they cause, OK?

This inflammation is associated with many of your symptoms.

It's very hard for me to distinguish between what IS harming you

and what has the potential to,

so the way we tackle it is with what's called an elimination diet.

So we cut out the common known food triggers -

I'm talking about wheat, dairy products,

processed foods, and sugar.

OK...

The elimination diet removes common foods like wheat and dairy,

which could be causing Nicola problems.

Eliminating foods can identify allergies and intolerances that

might affect a lot more than Nicola's gut.

I'm looking at what the food's going to do to your body, as opposed to

how many calories or how much fat's in it,

that honestly doesn't interest me when I'm looking at these.

I'm interested in thinking,

"Is this the correct fuel for you to be putting in your body

"at the moment or not?"

If there's only wholesome, healthy food for you in the house,

that takes willpower out of the equation.

So this is going to be tough on you too.

But getting the boys to part with their favourite food

is easier said than done.

-Yeah, that's the biscuit tin.

-The biscuit tin.

Dad's favourite place.

He's got a biscuit belly.

-He's got a biscuit belly?

-Yeah!

There are more biscuits.

I will definitely miss cheese.

I don't have many crisps, and I don't have many biscuits.

You do. You have a bag of crisps a day, honey.

-No, I don't have a bag of crisps a day.

-You do.

-No, I don't.

-At least I'm not going to cry over a piece of cheese.

-I know...

-OK, right, well, we'll get on to that.

-Shh!

Stop, stop. Logan, I'm not having a go...

Hey, guys, would you mind if I added something in here?

I've come in, and I'm interested in how to move forward, to primarily

help your mother,

and I hope the rest of the family as well at the same time,

but primarily my focus is on your mum.

We've been stuck with this for the last six years or so,

so if you've got a solution, let's roll with it.

Why not?

The family have agreed to three weeks on the elimination diet.

Rangan also wants to address Nicola's reliance on painkillers.

The problem I'm seeing is a problem I see a lot these days, OK?

You're on multiple different medications to

help multiple different symptoms.

The medications aren't helping the underlying cause,

they're just treating symptoms,

and the medications themselves are potentially very dangerous.

One of Nicola's painkillers is an opiate called co-codamol.

They are very, very, very strong.

You've already had four.

It's about half eleven, and you've already taken

a lot of opiate and a lot of paracetamol, erm...

And I think it's just a reflection of how long you've been coping with

this, is that you don't bat an eyelid.

Now, I would love, over the next few weeks,

to see if we can reduce how much you need these medications.

I'm not talking about stopping them all,

because I think you've got symptoms for what you...

and you have actually become reliant,

so whether it's, you know, reliant on being pain-free...

That's what scares me.

It's dealing with the level of discomfort that I'm going to

be feeling without the pills.

Rangan wants to reduce Nicola's 17 painkillers a day by at least half,

a process that should always be done under medical supervision.

By five o'clock, Nicola is exhausted,

leaving the boys to tackle their first meal of the elimination diet.

-What are we...? What are you cooking?

-Spaghetti Bolognese.

Instead of putting spaghetti with it, which has got the wheat in,

-we're having some rice noodles to replace the...

-I love noodles!

..to replace the spaghetti.

Some people struggle to digest gluten in wheat pasta,

and it can lead to inflammation in the gut.

And Dr Chatterjee is just preparing some sweet potatoes.

Guys, I have this a lot at home, and my kids do as well -

they love it, so I'm optimistic at the moment.

I'm not a normal kid.

Does it sound good?

We've not had it yet. Let's find out...

-It sounds fine.

-Sounds good - how it tastes is different.

Nicola wakes up just in time for the boys to deliver their offering.

That looks pretty good, yeah.

It tastes like chicken.

It's.. It's, like, you know, it's...

It's fine. It's nice. It's...

It could have been a lot worse.

This is really nice, actually.

We don't normally have rice noodles,

-but actually they're absolutely fine.

-Mmm!

Shall I just pop it there for you?

'As doctors, we all want more time with our patients,

'and I can't complain about that here,'

but with that comes a huge challenge.

The challenge is that, as you spend more time, you get closer,

you start to build up a personal connection,

that actually can make it quite hard to remain objective.

I think that's going to get more and more challenging.

In Northampton, the blood results are back.

Rangan tested both mother Doreen and daughter Laverne,

and he's received some worrying results.

Let's say, for example, we've got optimal health here, OK?

Blood sugar is excellent,

the whole body's functioning really, really well.

And up here we've got type 2 diabetes, OK?

This is a curve.

You're round about here.

OK? Things have been going wrong for a long period of time.

Your fasting insulin level was far too high.

Now, yours was very high, OK,

yours was 25, and we like to see it, really, under six, OK?

But yours was 13 - you're moving up that curve.

Was that a bit of a shock?

Yeah, it is.

It's actually not a shock to me.

I was going to the doctor's all the time and taking all the tests,

but I wasn't diagnosed with diabetes, not until when it got to,

as you said, that level.

-Things have gone wrong a long time before then.

-Yeah.

And I actually find it intensely frustrating

that we wait until people have a diagnosis

-to say, "Oh, now you're type 2 diabetic."

-Yeah.

Well, hold on a minute - we can pick this up beforehand,

so let's pick it up beforehand and tell people what they can do

to NOT become diabetic.

I'm actually, really, sort of,

thankful for this sort of information,

because I definitely want to do something about it.

I definitely don't want it to get to that stage where it's just too late.

Rangan has also found something alarming in Doreen's blood results.

I'm a little bit concerned by your blood results,

and I'll tell you why.

There's a few markers that are elevated, that worry me.

Mm-hm.

One of them is your homocysteine level.

Now, homocysteine is basically a compound in the blood

-that we measure...

-Mm-hm.

..and it's associated with heart attacks and strokes,

-and it's very highly elevated in yourself.

-Mm-hm.

Your blood sugar control is not brilliant at the moment.

I really want to see it quite low, and yours is very high.

Putting it all together, it probably puts you at a higher risk

of early death.

OK...

I'm sorry to give you information like that,

but I honestly do feel that I wouldn't be doing my job properly

if I didn't tell you honestly what I thought

-about the state of your blood tests.

-I'm glad.

I'm glad you're honest, because at least something can be done

about it, whereas if I just go on the way I've been going on,

then I probably would have had a heart attack or something suddenly

because it wasn't picked up on, so I'm actually...

I'm quite happy.

One of the most effective ways of dealing with type 2 diabetes is

through the food we eat.

Rangan has asked a nutritionist to show them how

to cook more healthily.

-Guys, this is my friend Darryl.

-Hi, Darryl, nice to meet you.

-Nice to meet you.

-Are you all right?

You know, Darryl used to be prediabetic.

Oh, right, OK.

-Yeah.

-So, Darryl has been...

-I've been exactly where you are now.

-Where I'm at, at the moment, yeah.

-I didn't want to take any medication, OK?

-Yeah.

So I had to change my lifestyle,

and making these food choices reversed my prediabetes,

so I'm now in the clear, and I have been for well over a decade,

-by eating this way, yeah.

-Wow! That's great.

Darryl is keen to point out the common foods that can raise the risk

of type 2 diabetes.

White bread, highly refined, highly processed -

it really spikes your blood sugar.

What might surprise you is that actually two pieces of that bread

will actually raise your blood sugar more than a chocolate bar.

-No way!

-Yeah.

-Wow, that's very... I'm amazed.

-Oh, my gosh.

-Yeah. We've got some white rice here.

Yeah, white rice as well.

A lot of people think white rice is very healthy,

but, for you guys and the problems you've currently got,

white rice can also spike your blood sugar quite quickly.

And that's one thing that I do eat a lot of.

-Yeah, me too.

-I do.

So, one of the things you can have instead of the white rice

is cauliflower rice.

-OK.

-OK? So it's much lower in carbohydrate content,

so it's going to... It's not going to have the same impact

-on your blood sugar. OK?

-That can't taste nice.

Yeah, well, I mean, to be fair, it's an acquired taste.

-SHE GROANS

-OK?

They start cooking a family favourite, curried goat...

Oh, that smells absolutely fantastic.

..served, of course, on a bed of cauliflower rice.

And use coconut oil.

Because it's a fat,

this is going to have no impact at all on your blood sugar, OK?

So it's a really healthy oil to use.

One of the ingredients here that we spoke about earlier

-was the turmeric.

-Mm-hm.

So turmeric is a really good way to reduce inflammation.

Lovely. Mmm!

Do you feel deprived in any way, eating this?

-No.

-The cauliflower rice is actually a lot nicer

than I thought it would be.

-OK.

-Yeah.

-This has really opened my eyes up to say,

"I can actually do a lot of things with this."

-That's great.

-Absolutely.

-Yeah.

I think there may be challenges along the way, OK,

I don't think it's going to be quite that easy.

Obviously, Darryl has come in and he's cooked for them.

How that plays out day in, day out, that I need to see.

I feel so good for the beginning that it makes me want to continue -

next step, next step, next step.

Oh, Mum!

Aw, you big baby!

But it's... The feeling's good.

-LAVERNE SIGHS

-Aw, come on, come on.

Come on.

Doreen and Laverne begin their new diet immediately,

and at the same time,

Rangan continues to monitor Laverne's stress and her sleep.

When the tests are over, Rangan has the results.

Great, thanks.

I mean, the good news is you're getting

a pretty reasonable amount of sleep, OK?

-It's relatively normal, how many hours you're sleeping for.

-Mm-hm.

The problem is, is that...

-the quality of your sleep doesn't appear to be very good.

-Mm-hm.

There's no regular, sort of, erm...

There's no regular go to sleep and wake-up time,

-so it's moving around day-to-day quite a lot.

-Yeah, yeah.

And when it IS this erratic,

it's very hard for your body to properly rest and recuperate,

and you're describing that often you will be in bed for a long period of

-time, but you're still knackered when you wake up...

-Yeah.

-..and clearly that's not a good thing.

-No, it's not.

Not sleeping well is associated with an increased risk of

heart attacks and strokes.

Really?

Although, what happened on this day? This was a Friday, and...

..according to this, you went to sleep at around 1:00am

and you woke up around 6:00pm the following day, which is...

what? 12, five...

17 hours.

I was exhausted, I really was.

Yeah. Well, clearly you must have been exhausted because...

-Yeah, I remember now.

-..unless you are absolutely whacked,

no-one's going to stay in bed for 17 hours.

So, again, I think this is just another reflection of

how tired your body is.

If you're stressed and tired,

sleeping for over nine hours may not be beneficial.

Too much sleep has a similar effect on the body to jet lag,

often leaving you low and miserable.

What was your mood like then?

How did you feel?

I was just happy with the fact that I could sleep...

Yeah.

..and I just took advantage of that, and that's what I did, I slept.

I didn't even eat.

I didn't eat until about 7:30, I think it was, that night.

-Are you OK?

-It's...

I can't... I obviously can't go on like this, can I?

If I'm being honest, no, you can't.

So if you go on like this...

I'm going to just work myself into an early grave, aren't I?

You... Yeah, I think you are.

Rangan immediately makes changes to her bedtime routine.

Can you tell me a bit about what happens?

You'll come here, either from work

or from, what, putting the kids to bed?

The TV will go on. Erm...

If there's something interesting on there, I'll watch it.

So the TV always goes on?

-Yeah.

-Yeah, OK.

-As soon as I get...

As soon as I walk in my room, I'll put the TV on.

I've actually brought something with me.

-In fact, I'll get it out and show you.

-Oh, my gosh!

What are you worried about?

You're going to tell me that me putting the TV on

is not good, it's interfering with my sleep...

Me having my phone, I should maybe switch it off at night.

That's what you're going to say, aren't you?

I'll tell you what I'm going to say.

-SHE LAUGHS

-I'm going to show you what I think

may be a contributory factor to what's going on with you.

There's a hormone in our body called melatonin

-which helps us fall asleep.

-OK.

-We know that certain colours of light...

-Mm-hm.

-..the main one being blue light...

-OK.

..actually switches off melatonin in your body.

So, this will help me to measure different colours,

and I'm particularly looking, is there any blue light in this room,

that may be switching off your melatonin,

and actually is contributing to you not sleeping very well?

Can you see? Are you ever in bed without your phone?

-Never.

-OK.

-Yeah.

-All right, so...

Loads of blue light.

Blue light contains short, powerful wavelengths that boost our attention

and reaction times and wake us up...

There's a distinct possibility that these are contributing to

your sleep problems.

..but there is a solution.

-OK, they're called amber glasses.

-OK.

-If you have these on, and watch what happens...

-Yeah, OK.

-It's...

-Wow.

There, that's it, and is that something you think

-you may be able to implement?

-Yeah, definitely.

-Yeah, you just literally clip them on.

-Just... Yeah, absolutely.

Rangan also tweaks the temperature to an optimum of 17 to 19 degrees,

and gives her ear plugs to promote good sleep.

Rangan will continue to monitor Laverne's sleep pattern,

and hopes to see a marked improvement.

In Bolton, Nicola is struggling with Rangan's treatment plan.

It's Saturday morning, and I feel rotten.

She's not been able to eat while she's been not really feeling well.

Hellish, hellish, hellish, hellish...

It's definitely going to be an adventure, to live with this one.

I had no idea just how traumatic it would be from the beginning.

I mean, how ARE you getting on?

I'm used to feeling nauseous, but it's just all day.

It's great for weight loss.

I lost four kilograms in four days, so that's quite good.

So, I've found it very hard to cope this week.

To the point of giving up?

Yeah, absolutely.

I've actually got one of your results back, that

has only just come back,

and it's actually confirmed one of my suspicions.

You have got - we abbreviate it SIBO -

it's called small intestinal bacterial overgrowth,

and basically it's suggesting to me that you've got

the overgrowth of bugs in the wrong part of your gut.

I have seen, with a lot of patients with chronic fatigue,

that they have this issue.

Rangan believes Nicola's extreme tiredness and pain

could be caused by bacteria in the wrong part of her gut,

causing inflammation not just locally, but throughout her body.

These are meant to be short-term things to help get you to

where you need to get.

Although SIBO is in its early days of research,

he decides to treat Nicola with antibiotics.

I'm a little bit concerned as to whether she's got the willpower

to get through the next few days.

At the moment, it wouldn't surprise me if she calls it a day.

But Nicola finds it harder and harder.

There's a good girl. Good girl.

Come on, then...

She sent me a text this week, very politely, sort of, saying,

"Look, I need some space." You know, "Don't come round."

Erm...

And it was quite hard actually to get that,

because I want to help her,

but she has agreed to let me come and see her today, and so...

Yeah, I'm a little bit nervous about what I'm going to find.

-Hello.

-Hello. How are you?

-I'm good. How are you?

We're all right. We're managing.

-Are you?

-Ish.

-OK.

-How are you doing, all right?

-Hello.

-Hiya.

-You all right?

How are things?

-They've been better.

-Yeah.

-OK.

-They've been better.

-SHE WHISPERS INDISTINCTLY

-Yeah. They've been better, haven't they?

-Yes.

-Well, shall we sit down, and you can tell me what's been going on?

-OK.

-Yeah? What do you think?

-Yes.

I thought I'd hit the ceiling,

or every day shouldn't be this tough,

and mentally I'm on the floor,

and that's the toughest.

I think we really are in the middle of that horrible, horribly difficult

process where we're saying,

"OK, the only way we're going to get these walls bigger and stronger

"is by dismantling them."

I think that this fear, whilst it's totally understandable,

I think this fear is holding you back from getting better.

No, it's not. Absolutely not.

This isn't... No, this isn't... Don't...

It sounds like you're turning it into a mental thing.

I'm mentally pissed off because I'm physically unwell.

I've been focusing on getting through each and every day,

and still being able to be, like...

for the boys, so please don't turn it into, this is...

this is because I'm mentally fearful,

because, yeah, I am to a point,

but it's not THAT that is stopping me from becoming well.

It's the physical feeling of being unwell.

I don't want it to be said that actually it's that fear

that is keeping me unwell, because that just makes me so, so cross.

-OK.

-Yeah.

Can I just have a minute, please? Just...

I need to explain, I think, what I meant by that.

I didn't mean to, erm...

I certainly didn't mean to upset her,

and I'm not for one second saying this is in her head.

-I don't think that.

-I...

I don't think she thinks you do, as such.

Obviously she reacted like that,

-but I think a lot of people do...

-Yeah.

Because it's not...

You know, she's not got a broken leg,

she's not got a cast on her leg, she's not got a set of

whatever they're called, crutches,

so it doesn't look like she's ill.

I'm frustrated that we've not hit that turning point yet,

the turning point where not only I believe she's getting better,

but SHE believes it as well, cos she doesn't.

She really doesn't at the moment. And I need to come up with a plan.

I need to find something else to do with her, that's going to get her

over that threshold, so that she starts to feel it

and she starts to believe it.

I'm confused now. I don't even know what to buy!

Meanwhile, Laverne Hayes is also losing faith

in Rangan's treatment plan.

Cos I would have got fruit juice before,

but I know fruit juice is not good.

I am not sitting down to a glass of water with my dinner. I'm not.

I'm not... I'm just looking.

The doctor will never forgive us for the fizzy drink - never ever.

They're following the type 2 diabetes diet plan,

but cutting out sugar and carbohydrates is far from easy.

Why are you picking up this?

-I...

-But it's carbohydrate.

No, it's not! It's iron.

See what I mean?!

-You've become, like, a professional...

-No!

-..on what's right and what's wrong.

-No, no, no.

No, since I've spoken to the doctor,

-and I've done a bit of research...

-Yeah.

There are other easy swaps that can reduce the chances

of type 2 diabetes -

eat porridge, not breakfast cereals,

snack on nuts rather than crisps,

and switch meat for fish a couple of times a week.

We do need some form of carbohydrate,

and sweet potato's got less carbohydrate

than the ordinary potato.

I don't like sweet potato.

Tough on you, then.

Oh, I'm not... I don't want to do this!

SHE GROANS

I'm telling you, I am just, like...

I... I've had enough! I'm really...

I'm about to have a meltdown, because I just can't deal with this.

I really, really just cannot deal with this.

I can't deal with this. I can't do it. And if I...

And if I keep doing what I'm doing, I'm going to get diabetes,

and I'll probably lose a leg or an arm.

They may have managed to buy ingredients for mealtimes,

but Laverne is struggling to find snacks she can eat on the run.

-'Hello.'

-Hi, Rangan, it's Laverne.

'Oh, hello, Laverne. How have you been getting on?'

I'm struggling!

'Oh, what's going on?'

It's not...

It's not really the food part - it's the snacking part.

It's, like, during the day, when I start getting hungry.

'OK, so what are you normally having?'

Er... A sausage roll.

-'Do you like carrots and hummus, for example?'

-No.

'You don't? OK. Do you like olives?'

Oh, no!

'You don't? OK, OK!'

-Oh, gosh!

-'Do you like eggs?'

I'm a nightmare, ain't I?

-'You're not...'

-Yes, you are a nightmare, Laverne.

We have got to make the time, we have got to make those changes,

and all we can do is support each other.

-But it's not that easy.

-It's not easy.

-I'm struggling.

-'Laverne, you're right, it's not easy.

'It's not easy. And the main reason it's not easy is because

'what I'm asking you to do is very different from

-'what you're doing now.'

-Yeah.

'It's just a new habit to get used to.

'Like, all the habits you're doing,

'are things you have got used to over many years.'

I'm going to do this. I'm definitely... I'm going to do this,

I'm going to do it. I just... I don't want to be a diabetic.

Now you need to make sure you've got enough ingredients to

disguise this cauliflower rice.

Yes?

Well...

Thank you for the different thing.

It's very nice. Amen.

Amen. Good boy.

I think it's given me a reason now to experiment with it,

-and I WILL experiment with it.

-You will, you will.

-I know you will.

-I will experiment with it.

Actually I'm enjoying it. I'm enjoying it.

In the morning, Rangan returns to tackle the other big problem in

Laverne's life - her fatigue.

He's received the results from her stress test.

Is it good or bad? Just tell me, please.

OK. Well, it's probably best if I show you.

-Cortisol is one of your stress hormones, OK?

-OK.

-And it should be highest in the morning...

-Yeah.

..and throughout the day it gradually goes lower.

So it wakes you up in the morning, OK?

And then as you go through the day it gets lower and lower,

-till just before you go to bed...

-Right.

..it's at its lowest, and that's one of the things

-that helps you fall asleep.

-OK.

-OK?

-Now, if I show you on yours...

-Yeah.

..the green is the normal range, OK, so...so far, so good.

-Right?

-OK.

-But can you see,

-in the evening, when cortisol should be at its lowest...

-Yeah.

..yours is actually a lot higher than it should be,

-and this...

-So that means I'm stressed before I go to bed?

Is that what basically it means?

Well, it can mean lots of different things.

Your body hasn't got much reserve left at the moment.

You're tired all the time, your body clock's out,

your evening cortisol is up, you know,

all kinds of things are not...are not...

are not really where they should be with your body,

and I think that all that sort of cardio work that you're doing

is too much for you at the moment,

and so I've brought you here to have a yoga session.

OK. Yoga? OK.

-Have you...?

-I've never done yoga before!

-Does it appeal to you?

-I'm willing to give it a go.

We're going to do a sun salutation,

which is like a really chilled-out burpee, OK?

-OK.

-Big circle,

and then a big circle coming into a forward bend,

and you can completely...

Yoga is an ancient form of exercise,

originating in India around 5,000 years ago.

Down to the floor.

That's perfect. That's really good.

It focuses on strength, flexibility, and breathing,

through a series of controlled movements or postures.

Coming up...

This is difficult. Got to really concentrate!

-It's good though, isn't it?

-Mmm!

-Yeah.

Yoga is generally low-impact and safe.

Clinical trials show that it has a positive effect on reducing fatigue.

Yes!

-Oh, my God!

-Oh, that's fantastic!

Did you catch that? Did you catch that?!

-How do YOU feel, Laverne?

-Amazing.

Yeah, that was really good.

I do think something like this has been missing from...

from my, sort of, routine,

and even once a week, I think, would make such a difference.

I honestly think that was the very first time

that I saw you switch off.

Cos I really enjoyed that.

-I didn't think I would, to be honest!

-Ah...

You're a star!

-You're a star!

-Oh, I'm so happy! Really, really chuffed.

Rangan believes a fresh approach might also help Nicola

with HER pain and exhaustion.

He's persuaded her to join him trying out something very different.

It's a class that is a mindfulness class,

that does a bit of work on breathing and meditation,

but it's a...

it's a Breathworks class that's specifically designed for people

who have got chronic health conditions.

OK.

Now, the reason I want to bring you to this class is because I want you

to learn some, sort of, mindfulness and some relaxation

-and some breathing-type exercises that you might be able to do.

-Yeah.

-Yeah?

-Yes.

-Are you up for exploring it?

-Yes, definitely.

Yeah? OK. Come on, let's go.

I was where you are, ten years ago.

Ten years ago, it was overwhelming and the future looked bleak.

Through a process called mindfulness,

former NHS nurse Karen managed to control her own pain.

I slipped a disc when I was about 19,

and I eventually just would have these periods of time

where my back would collapse. I'd have terrible pain,

I'd be taking tonnes of painkillers, nothing was working.

Mindfulness is a therapeutic treatment

being used in some NHS trusts.

There's encouraging evidence that it may help control the pain

of patients with fibromyalgia and ME.

You might notice as you're breathing in that your belly swells

a little bit, and as you breathe out, it subsides.

It works through a form of mental training and relaxation.

So far, Nicola has been coping by trying to

ignore her pain and illness.

It hasn't helped her get better.

-I don't... I do my damnedest not to think, or feel...

-Yeah, yeah.

So it's...

-So, do you have children?

-Yeah.

OK. So, if one of your children came up to you and said,

"I don't feel very well," would you say,

"Yeah, don't think about that. Don't think about it.

"Let's just watch the telly"?

If you could be as kind to yourself as you are to your children,

then there'd be a difference in the way that you behave.

-How was it?

-It was really good.

-Anything...?

-A lot of what she said made a huge amount of sense.

I just need to get my head around that everything I thought

I was doing right, I'm actually doing wrong.

Do you feel like that?

Yeah.

Which makes me cross.

Why does it make you cross?

Because I thought I was doing it right,

but actually I was doing it all wrong.

What were you doing wrong?

What were you doing wrong?

SHE SOBS AND SNIFFLES

All the ways I thought I was coping.

At the minute I'm feeling a pretty massive failure.

Aw...

But it's just working on that, isn't it, and changing it?

But can I just add there, in, sort of,

relation to what we've just heard,

and I know it's hard to suddenly just shift the way you think,

but you'd never tell your friend, would you,

"Oh, you're such a failure for the way you've done things"?

No, you wouldn't do that to your friend, but...

-I don't know.

-But you're doing it to yourself.

Yeah.

Yeah, I'm super excited after that.

Er...

I think that was a real breakthrough.

I think she needed to let out all that emotion.

She's been trying to... She's been trying to keep a lid on it.

The walls that she's built up around her are actually

holding her back now. And we've got to break those down,

and I think we just started that process in there right now.

DOG BARKS

Hi. Is it on? Is it on?

I can see the glimmers of the changes.

She's not been quite as tired as normal...

As the weeks go by, Nicola continues to improve.

Oh! Halloween, sorry.

I wouldn't say she's better,

but I'd say there's been a notable improvement.

She practises mindfulness, is reducing her painkillers,

and continues with her diet.

-Oh, coconut milk.

-Coconut milk.

Oh, fab, I can have a Pina Colada!

At least I feel more human again, and that is a massive impact.

While Nicola is improving daily, over in Northampton,

Laverne is practising one of Rangan's solutions

to her stressful, busy life.

Excellent stuff.

-Hello!

-Hello!

Introducing yoga into Laverne's exercise regime

was a key part of Rangan's therapy.

This is great to see.

How long has it been going on for now?

About four weeks now.

I just find that

at the end of the day it helps me to calm down and...

you know, it's amazing. That's what I think the problem was,

I wasn't winding down, and it just relaxes my mind.

-I love it.

-Aah.

-It's just really good.

Have YOU noticed anything, Doreen?

When I call her in the evenings,

she's not as stressed as she used to be,

so that must be because she's doing the yoga,

but I didn't actually know what she was actually doing.

I didn't realise that, Mum.

But there's lots of other little things that I'm doing as well.

But I think that everything combined is just helping.

My sleep has been a lot better,

so I think that's why I'm not as stressed as well.

I tell you, you're feeling better NOW -

-give it another two or three months...

-Yeah.

..you will feel like a different person.

I could not have gone on the way I was.

Six weeks ago, Doreen was failing to manage her type 2 diabetes.

Right, let's crack on.

I'm looking forward to having some of this food, actually.

Rangan's type 2 diabetes diet is bearing fruit.

You coming along sort of gave me the motivation and the will to do it.

You cared. You're not just five minutes with me,

"Yeah, you've got diabetes,

"you need to take this, this and this, OK,

"come back and see me in three months' time" -

I felt as if you came to me and you were personal to me,

and I needed to respect that,

that's how I felt. And that's why I thought, "Well, let's give it a go."

Doreen's blood sugar level is now a healthy four or five.

-What was it before?

-15, 17, 19, 21.

-Brilliant. Very, very good.

-Yeah.

Doreen's also lost four kilos, and has far more energy.

When was the last time you felt this good?

Nine, ten years.

You've not felt this good for nine, ten years?

Thank you for the dinner on the table.

We hope you enjoy it.

We hope you continue to provide food here and in Jamaica,

and to those who don't have food. Amen.

ALL: Amen.

It's remarkable, this.

Just... The turnaround has been phenomenal.

I'm feeling good, energy up...

I can even dance!

I don't believe, as a doctor, in just giving people pills,

for things that are fundamentally driven by lifestyle.

That's what I've done with these guys.

I've not given them a fancy prescription,

I've just explained to them how to change their food, their sleep,

how they move, and how they de-stress.

It's quite simple, really. And look at the results!

Cheers to good health, good diet, and continue with a good diet.

-Yeah, absolutely.

-That's it.

-Cheers to that.

Couldn't have said it better myself.

Six weeks ago,

Nicola Singleton was experiencing constant pain and chronic fatigue.

Hello! Come in.

Rangan overhauled her diet,

reduced her dependency on painkillers, and introduced her

to new relaxation techniques.

Pretty soon after we started, I gave you a medical symptom questionnaire.

It was a series of questions that gives me a score about

where you were, and I've brought it with me today,

to see if you could redo it and we could see actually, objectively,

has there been a change?

The MSQ questionnaire asks the patient to rate the severity

of a number of symptoms.

At the start of the treatment, Nicola scored 90,

putting her in the highest-risk group.

Optimal health is a score of ten.

Thanks for doing that. I know it's

-quite a lot of questions, isn't it?

-Yeah.

The new score on the same questionnaire, instead of being 90,

in six weeks, it's down to 53.

That is huge.

It's a huge, huge improvement.

Yes.

To put it in perspective, if you'd gone from 90 down to 70,

I would have been really impressed.

So to get 37 points better, you know...

-You OK?

-Yeah.

That is just... That is huge, actually.

Rangan's next assessment is to join Nicola on her daily walk,

to see if there's been any improvement.

It'll be fun. I'm glad you could come,

Cos it's very antisocial for you, isn't it?

I'll tell you, last time we were at this point in the hill...

..I think you'd stopped talking to me.

Probably!

We don't have to do that whole walk again, if you don't want to.

-I don't want to tire you.

-I'd like to do it.

-You want to do it?

-Yeah.

-OK.

-You feel you'll be all right?

-Yeah. I'm pain-free.

It is so much easier. So much easier.

Not having the physical aches.

-Yeah.

-So much easier.

-Oh, brilliant.

'Big, big change from last time.'

Nicola didn't need to be pushed up the hill.

She was chatting to me, she was talking, she had energy.

She almost skipped into the house, said she could do it again.

I can't believe the change so far, and I'm

really, really pleased to see it.

The next day is Nicola's 40th birthday,

and there's a reason for the whole family to celebrate.

Ooh!

Rangan wants to know if THEY'VE seen any change in Nicola.

This morning I...

..I did something cheeky, I can't remember what,

and she chased me up the stairs and everything, so she can do that now.

Are you... You're saying that

you feel there is some improvement.

I've definitely picked up... She's more like Mum, basically.

Hi-de-hi!

-ALL:

-Ho-de-ho!

For the last seven years, physically,

it has got harder and harder and harder each day.

It has been really, really tough to actually even move

without feeling discomfort.

So to meet Dr Chatterjee,

who has spent time listening to all my problems,

and actually now I can move without wincing,

and that is huge.

CHEERING

Nicola is free from the pain of fibromyalgia,

and the brain fog that has blighted her for years.

And thanks to Rangan's diet plan,

both Nicola and Ian have lost two stone each.

It's just been a privilege for me,

been an absolute privilege to be part of it,

and you'd just never get a chance

to be on that sort of deep journey with them.

And it feels great. Feels really, really good.