Episode 1 Trust Me, I'm a Doctor

When it comes to our health,

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

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

We're here to weigh up the evidence

and use our expertise to guide you

through the contradictions and the confusions.

We do the research no-one else has done...

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

..to ensure you get the information you need.

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

and not just the latest fads.

I'm Michael Mosley.

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

Together, we'll cut through the hype, the headlines

and the health claims.

This is Trust Me I'm A Doctor.

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

This time, we're coming from Nottingham

because the university is helping us run a really interesting experiment

to see which is the quickest and most effective way

to get fit and healthy.

We'll also be asking which fabrics make you sweat and smell more.

Bury your face right in there.

With the NHS set to change guidelines

on the use of acupuncture, we ask once and for all,

does it really work?

Do all bangs on the head need medical attention?

As antibiotics become less effective,

could this fridge contain a surprising answer?

And can you really trust home fitness monitors?

Woo!

But first...

The government recommends that we do at least 150 minutes

of moderate-intensity exercise every week.

But frankly, a lot of us struggle to make the time.

So Dr Chris van Tulleken

has been working with the University of Nottingham

to test approaches which promise similar benefits,

maybe even greater benefits, in just a few minutes a week.

We're all looking for shortcuts to getting fit and healthy.

And where exercise is concerned, the most talked-about shortcut

at the moment is high-intensity interval training, or HIIT.

It involves alternating short bursts of intense exercise

with brief recovery periods.

The promise of high-intensity interval training

is maximum impact in minimum time

with lots of study showing it's actually better for you

than longer forms of exercise.

But most of the studies have been done on people

using specialist exercise bikes in laboratory conditions.

So we wanted to put it to the test in the real world.

Can we make HIIT even more convenient by doing it at home?

We've taken a group of 24 volunteers,

aged between 40 and 60,

who all have jobs and lifestyles

that they describe as "pretty sedentary".

We're breaking them into four groups and, over the next few weeks,

each will undertake a different exercise regime.

Our first group will follow the government guidelines.

150 minutes each week of moderate physical activity.

Enough to make you start to sweat,

but during which you could still have a conversation

and we're going to compare that with some exercise shortcuts.

Unlike the moderate exercise team,

who will be doing the recommended 150 minutes a week, they'll all do

around 15 minutes.

Firstly, two forms of high intensity interval training, or HIIT.

One group is going to do HIIT on a special resistance bike in a lab.

The next group have a HIIT regime with a twist.

So the researchers at the University of Nottingham

have designed a version that you guys can do at home.

You're going to spend exactly the same amount of time

as the guys doing the HIIT in the lab.

But your periods of high intensity, of the hard work,

are going to comprise exercises that don't need any specialist equipment.

They're going to do star jumps, high knees and mountain climbers.

Everyone's favourite!

Get your feet wide.

Get them out and back in.

Both our lab and home HIIT groups will do three sessions a week,

each including five bursts of intense exercise

lasting just 60 seconds,

alternating with 90-second rest periods.

But for those of us not willing, or able,

to do this kind of high-intensity exercise,

we want to test whether you can get at least some of the benefits

without even getting out of your chair.

So for our final group, we've got the wild card entry.

You guys are going to be doing something

called grip strength dynamometry.

That may sound fancy but it's very simple.

All you have to do is squeeze a device like this.

This is a new form of training with lots of potential,

but it's still in the early stages of research.

I'm particularly interested in seeing how you guys get along.

Just like the other two interval training groups,

they'll be doing their exercise in short, intense bursts,

three times a week.

But they only have to squeeze a grip strength meter,

holding it for 30% of their maximum strength for two minutes,

four times in a row, with a two-minute rest between each.

Dr Beth Phillips from Nottingham University

is overseeing all the groups in our experiment.

So what's the theory behind this high-intensity training?

Why is that brief period of intensity so important?

There's still a lot of work going on trying to explore the mechanisms

behind why HIIT has the effects that it does

but we think the function of the mitochondria -

that's the powerhouse of the cells - we think that improves.

That improves our oxygen and our energy delivery.

We think that the intensity of the high-intensity bouts,

that improves our cardiorespiratory fitness.

That is the function of our heart and lungs.

Overall, we think these come together

to give us all the benefits that HIIT does.

There are lots of studies about the benefits of HIIT that have

been done in labs like this, I guess,

but what about home HIIT, do we know much about that?

Well, as far as I'm aware, no study has ever looked at home HIIT.

What we wanted to do was use everyday body weight actions

and see if people could get the same benefits.

What about the hand grip training? What's the theory behind that?

There have been published papers

that have shown that hand grip training can actually improve

cardiovascular markers for health.

Things like blood pressure, resting heart rate

and also the amount of blood flow that flows through your arteries.

Really? OK.

That does sound almost too good to be true

but we will find out, I guess.

Before they started,

our volunteers did what's called a VO2 max test

to show how well their heart and lungs get oxygen around their body -

a recognised measure of overall fitness.

We also measured their blood pressure.

And we'll be repeating those measurements after four weeks

to see which of our exercise regimes has made a difference.

Now we've always been told about foods that supposedly hold

the key to good health.

Headlines about one in particular have caused our mailbox

to overflow with requests for us to investigate.

Now apple cider vinegar is a traditional folk remedy,

but in recent years, it's become increasingly popular

because of a whole load of claims.

It's claimed, for example, it may help with split ends,

obesity, arthritis.

The thing is that the European Food Safety Authority,

who actually look at these claims, have yet to validate any of them.

So what, if anything, is apple cider vinegar really good for?

To help us put it to the test,

we've teamed up with Dr James Brown from Aston University.

He thinks there might be some science behind the hype.

There is some evidence to suggest

that there are a number of diseases which could benefit

from consumption of apple cider vinegar.

You're not entirely cynical? I'm not entirely cynical.

I'm interested to see what data we get.

James wants to test the claim that it might be good for

controlling blood sugar levels and, therefore, type 2 diabetes.

We've taken two groups of volunteers and asked them to eat bagels,

containing a whopping 44g of carbohydrate.

We measured their blood sugar levels before and after and,

as James expected, the white bread gives them an unhealthily

quick hit of sugar in the blood.

The next day, we get them to eat more bagels,

but this time they're taking a deleted shot

of either cider vinegar or humdrum malt vinegar beforehand,

and we measure their blood sugar levels once again.

This should reveal whether any benefits

are down to the vinegar bit, or the apple bit,

of apple cider vinegar.

It turns out in our study that the cider vinegar

reduced the amount of sugar going into the blood by about 40%

but the malt didn't.

Were you surprised with it? I was. I was actually very surprised.

There is data to suggest you would expect this in people

who are at high risk of diabetes.

This has been shown with vinegar drinks before.

I'm not sure it's been shown in healthy volunteers, previously.

This could be a first. Absolutely.

I was delighted and nicely surprised to see this data.

It's thought that the acid found in all vinegars may reduce

the amount of sugar our bodies release from starch.

This results in lower blood sugar after a meal

which is healthier for us, in the short term.

So could there be something in vinegar's long-term health claims?

And is apple cider vinegar really better than malt?

We've recruited three more groups of volunteers to help us find out.

For eight weeks, the first group will take two tablespoons of

dilute apple cider vinegar just before their two main meals.

The second group will take dilute malt vinegar instead.

The third group will take a placebo of coloured water.

We want to find out whether the blood sugar-lowering effects

of cider vinegar will actually improve our volunteers' health.

So...

We're weighing them, testing their blood fats,

which are linked to heart disease,

checking how well their bodies deal with sugar,

linked to type 2 diabetes, and looking for any reduction in

the markers of inflammation, which would be linked to claims

that apple cider vinegar can help arthritis.

If the results are the same for both vinegars,

that suggests it's the acetic in all vinegars that having the effect.

But could it be that cider vinegar has something extra,

adding some of the famous good health benefits of apples.

Two months later, and our volunteers have clearly been impressed.

I think I ate slightly less

and I didn't crave sweet, sweet food after a meal.

I was quite satisfied to just have the meal.

I found I had less aches and pains in my joints,

especially after exercise.

Anecdotal evidence is one thing but what did the data show?

The first thing we looked at was body weight

and I can tell you that none of you lost any weight.

LAUGHTER

Sorry!

Disappointingly, the blood sugar and inflammation results also

showed no change in any of our groups.

Our study shows no likely benefits

in terms of type 2 diabetes or arthritis.

But what of our last test, the blood fats?

So you'll also remember we looked at cholesterol.

In our placebo group, sadly,

no change in your cholesterol levels.

In the malt vinegar group, no change in your cholesterol levels.

GROANS

But in the apple cider vinegar group,

there was a 10% reduction in your total cholesterol.

That's really important because bringing cholesterol levels down,

even by a small amount, like 10%,

can significantly reduce your chances

of having a heart attack in the future.

So we were really excited to see that finding.

So while many of the claims around apple cider vinegar

seem to be unfounded, unexpectedly,

even our healthy volunteers saw

a 10% reduction in cholesterol

when taking dilute apple cider vinegar

over just eight weeks.

So...

There was no effect with the malt vinegar group,

suggests there is something special about apples.

What do you think it might be?

Apple cider vinegar has lots of different bioactive molecules

which are found in apples and at least two of those molecules

have been shown to have really beneficial effects.

It's likely that there is a component of apples which is

found in a concentrated form in apple cider vinegar

which is giving us this impact on your cholesterol levels.

An apple cider a day keeps your cholesterol at bay.

LAUGHTER

So a surprise finding all round.

Apple cider vinegar is not a cure-all, but as we've seen,

it may have some short-term health benefits,

particularly in those who struggle with their blood sugar levels,

and potentially some longer term benefits,

particularly around the area of cholesterol.

That said, however, there is a word of warning.

This stuff is really acidic, so don't glug it down.

Drink it diluted, or sparingly.

Next up, surgeon Gabriel Weston is tracking down the answer

to a particularly pungent problem.

When we exercise, we sweat,

and the resulting odour seems to permanently infiltrate

certain gym clothes.

It's often claimed that to avoid odour, we should wear cotton,

yet most sports clothes are made of synthetic fabrics

that claim to wick away sweat.

So what's the truth?

What's the best thing to wear if you don't want to get too sweaty

and smelly when you exercise?

Most of us tend to blame our sweat for unpleasant aromas

but sweat itself doesn't actually smell.

It's when it interacts with the bacteria that naturally occur

on our skin that things get stinky.

That's because bacteria feed on fats in our armpit sweat

and this produces odour.

So can our choice of clothing make a difference?

Here at Trust Me, we're going to put some different fabrics

through their paces.

We want to see how they affect the way we sweat and find out,

once and for all, which fabric packs the pongiest punch.

We gathered a group of volunteers and asked them to work up

a sweat in a high-intensity spin class.

Half of them wore 100% cotton T-shirts,

the other half wore 100% polyester.

A week later, we asked them to repeat the experiment

in the other T-shirt.

We swabbed their armpits so that we could study the bacteria

on their skin and we gathered up the T-shirts for analysis.

The synthetic T-shirts did feel drier,

whereas the cotton ones absorbed more sweat,

but what about smell?

These T-shirts have been festering for a full 48 hours,

so it's time now to put them to the smell test.

So we've got two sets of stinky, sweaty sports gear here

and what I want you to do is to bury your face in it

and tell me which of the two piles you think is most disgusting?

The yellow cotton, or the blue polyester?

The blue ones. Absolutely. Absolutely.

I would say the blue ones. Would you?

That one smells a bit worse.

The blue one.

Your face says it all there. Yeah.

You made a face. That one's worse? Yeah

I'd say that's more putrid.

Tell me why?

It's just got a more noticeable smell.

Now our smell test wasn't exactly scientific but,

believe it or not, real studies have been done on this and have concluded

that synthetic fabrics are stinkier than cotton ones after exercise.

So can the results of our experiment

give us any clues as to why?

Firstly, we sent our sweaty samples

to Professor Andrew McBain and Dr Gavin Humphreys

at the University of Manchester to see if the different fabrics

affected our volunteers' armpit bacteria.

When we'd had time to analyse the data,

there was anywhere in the region of 100 to almost 300 different species

in the armpits of some of these individuals. Wow.

300 species!

That's a huge amount.

But there's one species in particular called Corynebacteria

that is relevant to our study.

Corynebacteria like fats

and a lot of the metabolism that they do with those fats

is associated with malodour and the production

of these compounds that smell.

What you do tend to see is in males,

there is a higher abundance of Corynebacteria.

So that explains possibly why male sweat smells more horrible

than female sweat? Yes, possibly.

So are these Corynebacteria getting onto our clothes and

causing them to smell bad?

So when we looked at bacterial transference from the armpit

to the T-shirt material, we didn't actually see

a difference between a T-shirt made out of natural or synthetic fibres.

We also noted that we did not find Corynebacteria

on the surface of the fabric.

It could be because they're not transferring or they're not growing.

So interestingly, it seems that the Corynebacteria that make

our armpits smell aren't responsible for our stinky clothes.

Instead, there's another reason, and it emerged from a study

comparing a range of clothing materials.

When researchers in Belgium analysed the bacteria on different fabrics,

they found that a bacteria called Micrococcus grew in abundance

on synthetic material.

Now, Micrococcus doesn't generally live on the skin,

nor did the research team find much of it on cotton.

It seems to particularly enjoy

the environment of synthetic material

and it's a bacterium that's known to produce odour.

And the longer bacteria are left, the more they will multiply,

which means unwashed polyester clothes will keep getting stinkier.

So which material should you choose for exercise?

Smelly but dry synthetics, or sweet-smelling and soggy cottons?

So it really depends on what you care most about,

keeping dry or smelling fresh.

In terms of personal hygiene, keeping dry is more important

and certainly more comfortable when exercising.

I'm going to be sticking to my sweat-wicking synthetic gear

but perhaps making just a bit more effort not to let it fester

at the bottom of my sports bag.

On our website, you can send us the health questions

that you'd most like to see answered.

Is cranberry juice good for a urinary tract infection?

Over to Dr Saleyha Ahsan.

Many people suffer from urinary tract infections, or UTIs.

In fact, half of all women will get one at some point in their life.

The symptoms are pain around the lower back

and just below the belly button,

and there's a constant urge to pass urine,

which can be really painful and stingy,

and the urine itself could be quite cloudy.

And if you're really unwell with it, you could get a fever.

What's causing these symptoms is a bacterial infection that can

affect the whole urinary system, including the bladder and kidneys.

Thank you very much.

The bacteria to blame are usually our own gut bacteria,

often the famous E-coli.

So a good way to prevent UTIs

is simply to be careful when going to the loo.

Wipe from front to back rather than the other way round.

Some people still get frequent infections, and for them,

cranberry juice is often recommended.

That's because cranberries contain a particular type of chemical

that's supposed to stop bacteria

from getting to grips with your waterworks.

But does it really work?

The evidence isn't strong.

Although some scientists believe that cranberry juice can help

prevent recurring UTIs,

many don't agree and drinking a lot of it can bring other problems.

Raw cranberries tend to be sharp,

so cranberry juice contains a lot of sugar.

It's expensive and it has an important reaction

with the blood-thinning drug warfarin,

so you've got to be careful.

So what are the alternatives? Well, if you've already got a UTI,

then cranberry juice is not going to help.

You're going to need antibiotics from your doctor to treat it.

And if you're taking painkillers,

avoid aspirin or non-steroidal anti-inflammatory drugs

like Ibuprofen, as they can increase the risk of kidney problems.

If you do suffer from recurrent infections

and you want to try to prevent them,

then you could speak to your doctor about a drug called Hiprex.

Now, that works by making your urine hostile to the bacteria.

Another thing that will help is emptying your bladder frequently.

There's nothing wrong with trying cranberry juice,

but the evidence for it is pretty weak,

and just be wary about the amount of sugar that you'll be drinking.

Earlier in the programme, we started an experiment to try and find

the fastest and most effective way to get fit and healthy.

But if you're doing it, how do you know whether it's working?

Well, we've invited GP Dr Zoe Williams to test out

a range of gadgets.

There are dozens of consumer devices that aim to help us monitor

our own health and fitness at home,

with one in seven of us in the UK currently owning one.

'But are they worth it?'

Hi, everyone.

So, I've got some fitness gadgets for us to try today.

I've also got a chest strap heart monitor,

so that's the gold standard.

'The chest strap I have is a professional monitor that

'works in a similar way to the machines we use in hospitals.'

The chest strap actually measures the electrical current

directly coming from the heart.

'The common consumer wrist straps and phone apps, though,

'use a completely different technique to measure your pulse.'

They have little sensors that look at the blood vessels and

actually monitor the change in colour,

so as the blood vessels fill up with blood,

and then it reduces again,

they're actually checking that colour change

and therefore counting your heart rate in that way.

'It's really useful to know your heart rate. When you're at rest,

'a healthy rate is anything from about 60 to 100 beats per minute.

'When you're really pushing yourself,

'it should definitely go above 100.

'So are any of our consumer gadgets accurate enough

'to get those readings right?

'Some of the monitors seem suspiciously inaccurate.'

Where are we up to? Please tell me it's over 100 at least.

No, 86. Oh!

It can't be working. THEY LAUGH

Because, if I'm doing exercise

that's getting me slightly out of breath, how can my heart rate...

It's going down. Let me check.

If I could just have a little feel there.

Yeah, that's at least 100.

I think the only way we can put these gadgets properly to the test

is if we have one person wearing all of them at the same time

and doing that exercise all over again.

Any volunteers?

Great, we've got loads of volunteers.

'Each of us tries wearing the professional chest strap,

'beaming its results to a device on one wrist...

'..at the same time as two readily available

'consumer heart rate monitors on the other wrist.

'Can the wrist monitors help us accurately judge

'the intensity of our exercise?

'Your maximum heart rate is roughly 220 minus your age.'

184 is my maximum heart rate, so...

There's the challenge for you.

SHE LAUGHS

'For high-intensity exercise,

'you should be aiming for at least 80% of your maximum heart rate.'

How are you doing, Dr Zoe?

Woo! 182.

'But compared to that accurate chest strap reading,

'the wrist devices are way off.'

74.

THEY LAUGH

And...108.

'So, to know in real-time how intense your exercise is

'and how quickly your heart rate falls after it,

'which is a key indicator of fitness,

'then the wrist monitors we tested seemed too slow.'

My heart rate on the chest monitor is now 163,

still 102, and 72.

'We found two potential problems

'with using colour sensors to measure our pulse.'

I think perhaps this is dark skin.

Yeah, it could be. Because it didn't work at all for either of us. Yeah.

'And they can be difficult to fit tightly enough on the wrist.'

Look, that's quite a big gap there.

I mean, how is it going to read accurately?

And that's the tightest it goes?

'So they're not great at telling you the intensity of your exercise

'or even, it turns out, how much you're doing.

'We tested step counters on phone apps,

'chest straps and wrist devices by taking exactly 100 steps...'

MUSIC: Theme from The Benny Hill Show

'..several times, in different ways.'

So I had 90... 130.

93 and 92. 92.

90 and 75. Mine was 78. Wow.

I think what we can say is that a lot of these fitness devices

are not that accurate.

'And they are relatively expensive.'

Before doing those experiments,

I would have thought about buying one of these devices.

I'll use the app that's already on my phone.

I don't know how accurate they need to be.

I mean, in terms of...

If you're just a regular fitness enthusiast,

does it need to be 100%?

It's not serving the purpose of what

you're actually buying it for, so for me, in the bin.

Thank you all very much for being involved,

and thank you for helping me reach my maximum heart rate.

I'm not sure I've done that for a long time.

Recently, legal action was started against manufacturers

of some consumer heart rate monitors over their accuracy.

So my advice is, give them a go,

but take the readings with quite a large pinch of salt.

To be honest, whilst these gadgets can give you a rough guide and

a little bit of inspiration,

when it comes to measuring your heart rate for your health,

I'd say the cheapest way, and the easiest way,

is just put two fingers on your pulse,

use a watch and count the beats per minute yourself.

As always, there's more information on the website...

Still to come...

With more of us suffering anxiety, how do you deal with panic attacks?

And is there a shortcut to getting fit?

The results of our big experiment.

Which is enormous. That's huge, yeah.

But first...

We've all had a bang on the head or know someone else whose had one.

It could be the result of falling off a bicycle

or simply tripping over.

But when can you safely ignore it and when should you see a doctor?

Over to Saleyha.

As an emergency medicine doctor, I see a steady stream of people

coming through the hospital doors who've suffered a bang to the head.

In fact, in the UK, over 400 people are admitted to hospital

with head injuries every day.

Some of these injuries are harmless, but others can cause damage

to the brain, which could be life-threatening.

The most common injury to the brain is concussion,

which leads to a temporary disruption

in the brain's ability to function.

It can happen to anyone,

but a lot of what we know about it comes from the world of sport.

Because of the concussion risk that activities like football,

rugby and boxing have, these sports have found themselves

at the cutting edge of concussion research and treatment.

And the measures that they are now taking

are something we can all learn from.

A new set of national guidelines

on concussion management in grassroots sport

are in use in Scotland,

so I've come to Currie Rugby Club near Edinburgh to find out more.

The players here are no strangers to head injuries.

My head had gone into someone's thigh during the tackle

and I'd lost consciousness.

And then the coaches ran on checking I was all right. I was a bit dazed.

I didn't really know what was going on so much.

Lewis, what about you? What happened to you?

I thought I was in for the try and I put my head down

and a boy came straight across the front of me,

hit the side of my face and I just...

There was a big flash and then I remember waking up on the ground.

And how did you feel? What can you remember from that time?

How your head felt, how you felt?

I felt extremely dizzy and then it turned into, like, a sickly feeling.

But that didn't last for too long. That must have been a day or two.

These are clear cases of concussion, but it's important to know

that concussion isn't always caused by a bang to the head.

It can also happen due to impacts to the upper body

or a sudden movement, like whiplash.

And you don't have to be knocked out.

Only 10% of concussed patients lose consciousness.

In most cases, the signs are more subtle,

as team medic Karen knows only too well.

The kind of things you might see are if somebody's slow to get up,

they might be holding their head, clutching their head.

They may be unsteady on their feet, stagger a little bit,

or they might just look a bit, kind of, vacant and dazed.

These symptoms can take up to two days

after the initial injury to show.

So if a person's had a bang to the head,

you really need to watch them quite carefully over this period of time.

And stay on the lookout for signs of a more serious head injury.

With worrying signs and symptoms, obviously we're suspicious

that there might be a more significant head injury.

So that's, you know, loss of consciousness at all,

repeated vomiting, really unsteady, symptoms getting worse,

a headache that gets worse rather than better with time.

Whether you're a sportsperson or not,

if you develop any of the more serious symptoms after a concussion,

then you do need to come and see us in A

cos we might need to do some further tests.

If someone does have concussion, the best treatment is rest,

for both the body and the brain.

This means avoiding any demanding activity, including work,

sport, driving and even reading or texting.

It's also dangerous to drink alcohol

and the advice in the guidelines here in Scotland

is that you should only return to everyday life

when you're free of all symptoms.

Symptoms that we're looking out for are headache, pressure in head,

neck pain, nausea or vomiting,

dizziness, blurred vision...

We're looking to make sure their brain function is back to normal.

Concussion is a disruption of how your brain works.

We want to make sure that your brain is working as it was.

We're looking for kind of balance testing,

just to make sure the balance is back to normal.

Perfect. OK.

How can that translate to people outside of this arena?

Well, some of the questions we do are, you know,

you could ask them of anyone.

So things like your name, date of birth, your address.

If you're looking at kids, what's your teacher's name,

you know, what subject did you study yesterday or the last lesson?

That kind of thing.

The overriding message from the guidelines here is

if in doubt, sit them out,

and that can be applied to any of us in any situation.

If you are worried about a head injury, look for the red flags.

Things like visual disturbance, memory loss,

confusion and loss of consciousness.

If the symptoms get worse,

then you need to seek medical advice immediately.

It seems as if every day,

we read about so-called alternative therapies

that claim to do things like relieve pain,

cure addiction or improve our mental health.

But which, if any of them, really help?

This time, we're looking at acupuncture.

Now, fans of acupuncture have claimed it can be used

to treat a whole range of things,

from pain to headaches, even infertility.

But although it's been around for thousands of years,

other people are deeply sceptical.

Acupuncture uses thin needles to pierce the skin

at specific points on the body.

But new NHS guidelines due in the near future

are expected to withdraw approval

for its use in lower back pain because of lack of evidence.

So I want to get to the truth and decide...

Should I try acupuncture?

# Let's go, baby. #

I'm going to start by trying acupuncture for the first time.

It's most commonly used for pain relief, but,

as I currently have no pain,

someone is going to inflict it on me.

As soon as the pressure turns to pain,

I want you to press the button. OK?

Professor David Walsh from the University of Nottingham

is an expert in the treatment of chronic pain.

He is measuring my pain threshold, a classic way to study pain,

because pain is complex.

So there's an emotional component to all pain.

So if not just what's going on in your knee,

if you've got a painful knee,

but the way that you understand what that pain means,

your expectations about whether it's going to get better or not,

whether your mood's low, whether you're feeling anxious,

all those will affect the fact that you're experiencing pain.

So, will acupuncture affect how I experience pain?

Dr Mike Cummings is medical director

of the British Medical Acupuncture Society.

I first started using it in very acute muscle-pain-type conditions

in the military and I saw instant effects on the end of a needle,

and so it didn't take long of me using it - for a week or two -

and I was convinced something was happening.

I was really surprised, but convinced.

Mike's going to perform two rounds of acupuncture on me.

One with real needles and one with what's known as sham needles

that don't actually puncture the skin.

I have no idea which is which.

After each one, David tests my pain threshold again.

Yeah, felt that.

I couldn't tell the difference between

the sham acupuncture and the real acupuncture.

I have absolutely no idea

whether any of that made any difference to my pain threshold.

But it's not over yet.

Mike's also going to test a hi-tech version, electro-acupuncture.

This time, a small current is passed between pairs of needles.

Theoretically, the difference is that you can stimulate

all nerve fibres in the vicinity, not just those that respond

to the pressure of the needle.

After all that prodding and piercing,

has acupuncture actually had a measurable effect?

Well, both acupuncture and electro-acupuncture seem to do

what they promised.

My pain threshold was higher after both.

But interestingly, sham acupuncture

was almost as effective as the real thing.

They are all clearly doing something.

There's all sorts of possible explanations.

It might be the acupuncture that's changed things,

it could be you were more relaxed.

We can certainly say there was a big change. Yeah.

You were tolerating, before you felt it as pain,

twice the pressure at the end of the study

as you were right at the beginning. Right.

Well, that was certainly fascinating,

but it was also just one small demonstration,

So, what's the scientific consensus?

I'm going to talk to Professor Asbjorn Hrobjartsson

from the University of Southern Denmark.

He's spent much of his career

studying the effectiveness of acupuncture

and so is perfectly placed to explain

why the medical community is so sceptical.

So, how many studies have been done looking at acupuncture?

A lot of trials on acupuncture. Several thousand.

Probably, I think, the estimate today

would be 4,000, maybe 5,000 trials.

Why do you think we still don't know after so many thousands of trials?

The problem is a lot of these trials are small.

They are preliminary trials.

They're pilot trials, a lot of problems with them.

If you look at the number of trials that are...good trials,

high-quality trials, they are fewer.

And when you look at those trials,

there is a signal coming out that the pain reduction for those

who have gotten acupuncture is slightly larger

than the pain reduction of those who have got placebo,

or sham acupuncture.

It's roughly four or five millimetres

measured on a 100-millimetre scale.

And the debate is whether this small effect is small enough

to be of clinical relevance to patients,

and whether that effect is not a true effect,

but a spill-over of imperfections in the trials done

because it's very difficult to have sham acupuncture

that is indistinguishable from a true acupuncture.

And when you stick a needle in, you do see an effect.

Doesn't that suggest to you that acupuncture is doing something?

That would be highly implausible that you stick

a needle into the body and nothing happens.

The interesting question is,

does that have a therapeutic effect on you as a person?

And that is still, er...

That is still unclear, even after hundreds and thousands of trials.

What's the harm...

I'm a doctor, a patient comes to see me with chronic back pain

and I say, "Well, I'm going refer you to acupuncture".

What's wrong with that?

One issue is that we base our system on trust.

So when I go to you as a doctor,

I would assume that the interventions you recommend

are based on good evidence.

However, the second thing is that in a publicly funded system,

good use of resources are important.

It's not free to use money for acupuncture that could be

used for things that we know work.

Is there any evidence that electro-acupuncture

is any more effective?

There are studies or trials of electro-acupuncture that indicate

that it might be more effective,

but when you look at the trials done that actually randomise

patients to electro-acupuncture and standard acupuncture,

they find no real difference.

Have you ever tried acupuncture, and would you?

No, I have never tried acupuncture.

I might do it for fun,

but I think that the evidence to support that use is far too weak

and I decide not to, but that's an individual decision.

Asbjorn has looked at a lot of studies

and is clearly very sceptical

about the benefits of acupuncture.

So, should I try it?

Well, I think it depends.

If I had problems with fertility or depression,

then almost certainly not.

On the other hand, if I had a chronic headache

and I'd tried everything else and none of it worked,

then I think I would certainly give it a go.

As ever, there is more information

available on our website.

We've all heard about the problem of antibiotic resistance -

the fact that so many bacteria are becoming increasingly resistant

to all the medicines we can throw at them.

There is, however, new hope

coming from work done many years ago behind the Iron Curtain.

Surgeon Gabriel Weston has been to Georgia

in the former Soviet Union to investigate.

For decades, we've been helping bacteria to develop resistance

to antibiotics by taking these medicines when we don't need them

and by failing to finish prescribed courses.

Already, drug resistance kills over 700,000 people a year worldwide

and it's forcing many to travel to Tbilisi, the capital of Georgia,

where an alternative to antibiotics is available.

Sophie has travelled here from France.

She suffers from cystic fibrosis,

which causes chronic lung infections

which are no longer responding to antibiotics.

But now Sophie has been offered new hope

in the form of a 100-year-old therapy.

The treatment that I've come to see here in Tbilisi

is called phage therapy

and involves using naturally occurring viruses

called bacteriophages to fight infection.

Now, these viruses were actually discovered about 100 years ago,

but when antibiotics became popular in the 1950s,

they were soon overshadowed and forgotten.

But behind the iron curtain in Stalin's Soviet Republic,

antibiotics were scarce.

So scientists continued to use phages.

And in 1923, a researcher named George Eliava

founded an institute for bacteriophages here in Tbilisi.

When the phages encounter bacteria, they latch on

and inject their DNA inside the cell, where it reproduces.

The new phages then burst through the cell walls

and repeat the cycle until the infection is beaten.

Sophie's treatment begins with doctors collecting a sample

of bacteria so they can identify the types causing her infection.

This is really important because,

unlike with broad-spectrum antibiotics

which kill a large number of bacteria,

each bacteriophage kills just one strain or species.

So it's really important that the doctors here figure out exactly

which bacteria they're dealing with

so they can find and develop a phage

that will target that specific type.

This crucial part of the process takes place in Eliava's phage labs,

where they've learnt how to optimise the most effective phages.

We've got a fresh bacteria on a Petri dish

and we just pop different phages on this

and then we incubate it overnight

and check the result the next day, which looks like this.

And where you get a clear spot, that's where it's working? Yes.

Once a phage has been identified,

the researchers begin the process of turning it into

a treatment which can be drunk,

inhaled or applied externally to target the problem precisely.

The science of phage therapy is really specific.

But by contrast, the range of clinical diseases

that are being treated with phages is vast.

This clinic is incredibly busy

and notably, on each door,

there are names of different specialties.

And all of these clinic specialties are being treated right here,

every day, with phages.

Whether it's for ear or throat infections

or infected burns and wounds,

phages have been found to be effective,

and one of the reasons behind this success

is their sheer abundance and diversity.

Here at the Eliava, they've been collecting phages for decades.

In fact, some of these vials have been here since the 1930s.

But even this is just a drop in the ocean.

Bacteriophages are actually

the most abundant life form on earth, with an estimated

10 million trillion trillion of them.

That's more than all the other organisms in the world,

including bacteria, put together.

So if bacteria evolved to resist a phage, the researchers

can simply turn to their library or to nature to find another

and they can help stop resistance developing in the first place

by creating mixtures of phages

to attack bacteria from different angles.

This is one of the reasons why the director of the Eliava Institute,

Mzia Kutateladze, believes that phages can play an important role.

What do you see the future has for phage therapy?

First of all, we can eradicate a lot of infectious diseases

which we cannot treat by antibiotics today.

And also, they can decrease the antibiotic resistance.

This is a very, very important achievement.

So together, combined usage of antibiotics and phages

is really very effective and promising.

Despite its success here in Georgia,

phage therapy needs to be approved and regulated

before it can be used in the West.

But the good news is that clinical trials are now underway in Europe,

so patients like Sophie might one day find the help they need at home.

From my time here in Tbilisi,

it's clear that phage therapy is going to play

a really important role in our continuing fight

against bacterial infection.

After all, if we've learned anything from the antibiotic era,

it's that we need as many weapons as possible in our arsenal

to fight these superbugs.

Maybe now, 100 years after they were first discovered,

it's time we finally gave bacteriophages

the attention they deserve.

SNEEZE

Now, when we talk about health, we often think about the body.

But in fact, one in four of us will, at some point in our lives,

suffer from a problem related to mental health.

Now, I am fortunate I don't ever get depression,

which is fantastically common,

but I do experience panic and fear in some contexts.

A while ago, I was filming in a caving experiment

and I thought I'd got stuck and I completely freaked out.

Oh. I feel panic. Calm down.

Oh, God!

Oh, God!

Since I got stuck underground,

it seems to have triggered something,

so that when I recently went into a brain scanner,

as soon as my head started to go into the machine,

I just freaked.

It was like I was being buried alive.

It was just wild, unreasoning fear.

There was nothing I could do

that would actually...or felt as though it would control it,

and my primal, primeval part of my brain

was just screaming, you know, "This is really, really bad.

"Get out, get out, get out now."

It's almost indescribable to somebody who doesn't experience it

and to people who don't understand it,

it makes no sense at all.

One in ten of us will have a panic attack at some point,

often triggered by a fear or phobia, as in my case, or simply by stress.

But for one in 50, it becomes a recurring problem,

as it has for me.

So, what can we do?

I've come to meet Dr Nick Grey of King's College London to find out.

Now, I went into the brain scanner and I felt overwhelming fear.

I couldn't stay there - I came out again.

Am I experiencing a form of panic attack?

Did the symptoms come on in a rush? Oh, immediately.

As soon as I went in, I... I thought, "I'm fine",

then I went in and I thought, "Get me out of here!"

My heart rate shot up from, sort of, 50 to 120,

and my breathing shot up.

Yeah, so it sounds almost certainly that that is a panic attack.

So, panic attacks are essentially a sudden rush of physical symptoms

such as heart racing, feeling sweaty, feeling hot,

might have kind of numbing, tingling in the fingers,

and it's sometimes is described as a crescendo of fear.

What should you do if you are experiencing a panic attack?

Firstly, to learn that this is just an anxiety reaction -

there's nothing bad happening, there's no real danger.

Obviously I know that. Intellectually I know that.

So one of the things they then need to do is to learn it emotionally.

So the most effective treatment for anxiety, generally,

is cognitive behaviour therapy,

and it's the treatment that's recommended across the UK.

One of the things we do is try and get you imagining yourself

in that situation and seeing if that brings up any of the fear

until you learn that this is just a fear reaction,

nothing bad is going to happen. So how do you teach them that?

Not just through talking, but really through putting things

to the test so that rather than, say,

if their heart's racing, kind of sitting down,

taking some kind of, you know, medication or rescue remedy

or something like that and breathing calmly.

Actually, if they just carry on what they're doing and even, perhaps,

move a bit more quickly, it's still not going to cause them any harm.

Particularly for anxiety and people with panic attacks

in specific phobias and panic disorder, you know,

the treatments are really highly effective. They work.

Not for everybody, but they're amongst the most effective

psychological therapies we've got, that's for sure.

These therapies are now readily available through the NHS,

so if you suffer anxiety and panic attacks,

it should be easy to get treatment.

If you want to seek treatment,

you don't need a referral from your GP

or from any other mental health practitioner, you can self-refer.

And you can get it for free. You can get it for free, absolutely.

You can find your local therapy centre online and sign up.

We've got links to the service on our website.

If you do have a panic attack, then say to yourself,

"Look, I know this feels terrible,

"but nothing awful is going to happen to me."

Try and control your breathing - steady in, steady out.

Clearly, if you're worried,

you should go and seek professional help,

but the good news is it is incredibly treatable.

For more information, visit our website.

Earlier in the programme, we set up a test with four groups

of volunteers to discover whether there's

a shortcut to the benefits of exercise.

One group has been doing

exactly what the government guidelines suggest -

150 minutes of moderate exercise,

like jogging or cycling, every week.

The other three groups have been doing

around 15 minutes a week of exercise.

Two have been doing what's called high-intensity interval training,

or HIIT, short bursts of very intense exercise -

one group on specialist equipment in a lab,

the other at home using our specially designed home workout,

something that's never been tested before,

and our fourth group have been doing what seems to be

the laziest option -

three weekly sessions of squeezing a hand grip monitor.

I was doing the home HIIT.

First week was very intense, very difficult,

but as the weeks went by, it did get easier.

It worked really well for me, it fitted into my lifestyle.

Just managed to get the ten minutes of home HIIT

done each time and done and dusted.

Dr Beth Phillips at Nottingham University

has been looking for improvements in our volunteers' health.

She's been testing their blood pressure and also putting them

through a test called VO2 max.

This shows how well your heart and lungs

are getting oxygen around your body -

a good indicator of your fitness and future health.

Four weeks later, it's time to reveal the results.

First, the VO2 max test.

These were really exciting results.

So, we found about a 17% improvement in our lab HIIT group in VO2 max.

Which is enormous. That's huge, yeah.

A really significant increase.

And actually, following not far behind with

a 12% improvement were our home HIITers.

A 12% improvement in VO2 max is immense.

Yeah, I mean, that's similar to what's been shown with

much longer traditional endurance training programmes,

so, yeah, it's definitely a significant improvement.

Whilst those doing moderate activity

showed little change to their fitness

and those doing just hand grip exercises not much better,

both those doing high-intensity exercise

showed a significant improvement.

But when it came to the blood pressure results,

there was a surprise winner.

I guess some of you may be surprised to hear that actually it was

our hand grip group were the only group to demonstrate a significant -

and actually a remarkable - reduction in blood pressure.

A really significant decrease in that, yeah.

Compared with the other three groups,

the hand grip exercises were way ahead

with their drop in blood pressure -

a massive 15% on average.

That is a very weird result.

I'm sure everyone must be surprised. How can that be true?

We think it's basically that you get improved vascular function,

so your vessels become more adept at responding to

a stimulus and therefore they lower your blood pressure because

the resistance in your vessels becomes much less.

I was on the hand grip training.

I didn't expect the results to be what they were today

so I'm really impressed and now I'm hoping to carry on.

If I just have a spare five, ten minutes, I'll do some HIIT,

because it has been a real benefit to my life, I think.

So it seems that doing exercise in short, intense bursts

can get us fitter and in much less time.

And we found evidence that just squeezing a grip meter

a few times a week might lower one of the biggest risks of

strokes and heart attacks.

It's remarkable that something as simple as grip exercises

might have a really powerful effect, and it just shows that

some exercise is much better than no exercise.

I'm a firm believer in quality over quantity

and that's what HIIT is all bout.

It's time-efficient, it's practical and it has real benefits,

so our busy diaries are no longer an excuse for not exercising.

And for a demonstration of the exercises

that our volunteers undertook,

you can go to the Trust Me website and find out more.

But there are risks to doing this kind of intense exercise

and it's worth getting a checkup

before launching into any of these options.

That's it from Nottingham.

Next time, we're in Worcester,

where we're finding out what benefits, if any,

there are from going gluten-free.

Also...

How we could all improve our eyesight,

and a revolutionary new treatment for rheumatoid arthritis.

# My eyes went ooh Uh-huh, uh-huh

# My voice just cooed You know it

# My mind let loose

# Mmm, Dr Love

# Doctor I want you

# Mmm, my Doctor Wanna Do

# I can't get over you

# Doctor do anything that you wanna do

# Doctor I want you

# Mmm, my Doctor Wanna Do

# I can't get over you

# Doctor do anything that you wanna do. #

What's new on BBC Two?

A proper divorce is built on a solid foundation of hate.

GAVEL BANGS

Mum?!

I can see you.

If it was men doing the feeding,

there'd be blokes all over this cafe with their breasts out.

This is a semidetached house.

If we argue, we argue away from the neighbours.