Episode 2 Trust Me, I'm a Doctor

When it comes to our health, it seems everyone has an opinion

and everyone has an agenda.

But 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.

We listen to the questions you want answered.

And 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.

Welcome to Walsall.

We're here to do what I hope will be a series of fascinating experiments,

to see what, if anything, you can do to boost your metabolism.

We'll also investigate the toxic chemical lurking in your rice.

And what you can do about it.

I have absolutely no idea where you're going with this

but I like surprises!

We'll reveal how to deal with cold sores,

and exciting new treatments for eczema,

and how air pollution is really affecting our health.

I don't think that enough people are aware of

the scale of the problem.

And should you go heavy or light at the gym?

We'll find out.

But first, it's over to GP Dr Zoe Williams.

When it comes to burning calories, we tend to think of exercise,

but actually, between 40 and 70% of our energy is spent not on exercise,

but on simply keeping us alive.

There are countless processes going on inside our bodies just to keep

them ticking over.

From the blood pumping around our bodies, to our heart beating,

breathing and even thinking,

and the minimum amount of energy to keep all of that going is called our

resting metabolic rate.

The higher this rate, the faster your metabolism,

and the more calories you burn. So can we give it a boost?

The media is full of quick fixes that claim to help us do just that.

But is it really possible?

To find out, we've recruited 28 volunteers who are going to put some

popular methods to the test.

First, we're taking some baseline measurements to establish their resting metabolic rate

before they start the experiment.

This is measured accurately using these masks, which detect the amount

of oxygen and carbon dioxide in their breath.

Dr Ian Lahart from the University of Wolverhampton can tell me what

might affect their readings.

There will be slight variations due to somebody's age, gender,

genetic factors, body size - such as having more muscle.

Somebody with more muscle will have a higher resting metabolic rate.

Muscle tissue needs a lot of energy just to maintain it.

More than fat tissue does.

So one of the key things affecting our metabolic rate is the amount of

muscle and fat in our bodies.

We'll be measuring our volunteers' muscle mass and body fat with a

DEXA scanner.

Now, we're going to split our volunteers into three groups,

who will each try one of the most popular methods claiming to boost

your metabolism.

All three methods we'll test are cheap and easy,

and all have some basis in science to suggest why they might work.

These are simple, small changes that anybody can do, that over time,

can make a big impact.

Our first group are going to be drinking a litre of water,

chilled to 5 degrees, every day.

The theory is they'll use up extra energy heating the cold water to

body temperature.

Our second group will try green tea,

this contains natural chemicals called catechin polyphenols,

that it's claimed can raise our metabolic rate and tell our bodies

to burn more fat.

Our final group are going to be doing resistance exercises totalling

one hour each week.

This should help them build some new muscle.

Our volunteers will be doing their tasks for eight weeks,

and at the end of that time,

will repeat all the same tests to see if

we can find any changes in their metabolism.

Because our experiment is a relatively short period of time,

are we actually going to see any change?

We might see small changes in resting energy expenditure.

And the point being that if we can accumulate those small changes

over a longer period of time,

that can make a real difference in somebody's weight.

We'll be back later in the programme for the results.

Now, whether you're a gym junkie or a first-timer,

the weights end of the training room can be intimidating.

What should we be lifting?

Over to Doctor Chris van Tulleken,

who has the latest research.

The problem that lots of us have with lifting weights,

is that there's so much conflicting advice out there

about exactly how much weight to lift.

So there's an old weightlifting adage, that goes, "Go heavy...

"or go home."

But recent headline suggests that in fact,

lifting lighter weights might be just as effective.

So what's the truth?

The answer comes from a study published last year

from McMaster University in Canada.

49 weight trainers were split into two groups,

one half lifting heavy weights, and the other lighter ones.

The other key difference was the number of repetitions, or reps,

each group performed.

Now, when we lift weights, sooner or later, no matter how heavy

they are, we reach a point where we just can't lift...any more.

And that's known as failure.

But it's not a judgment on your level of effort.

Technically speaking, failure is to do with motor units,

groups of muscle fibres controlled by a nerve that make our muscles contract.

When we lift weights, lots of motor units are activated,

and as they get tired, more need to be used.

Eventually, all our motor units become exhausted,

and that's when we can't lift any more.

Now, with heavy weights,

you might reach failure after just a few reps,

with lighter weights, you'll still get there,

it just might take a bit longer.

The key thing about the McMaster study

was that because both groups lifted to

the point of failure, they could be compared.

So, the team found that the group using the lighter weights actually

gained as much strength as the heavier-weight group.

Now, this doesn't mean that you always need to lift to failure.

For most of us, the crucial thing is that you do need to push your

muscles a little bit beyond what's easy.

If you want to use a lighter weight that's fine,

but you're going to have to do more reps.

The important thing is to have a training programme that's safe.

So if you haven't done weights before, make sure you take instruction from

a suitably qualified person.

And if you're going to go really heavy, make sure you get medical

advice before you start.

So for most of us,

unless you're going to be a bodybuilder or a power-lifter,

don't worry too much about weights versus reps.

The important thing is just to push yourself a little bit out of

your comfort zone.

In the UK we are eating more rice than ever.

In fact, we now eat at least four times more rice

and rice products than we did

40 years ago. And many of us do so because of their healthy reputation.

But at the same time, I've also noticed lots of newspaper reports

which suggest that rice has quite high levels of arsenic in it.

So, is this something I should be worried about,

or is it just another scare story?

I'd love to find out.

Arsenic is well known as a poison,

but most of us don't realise it occurs naturally in soil and water.

So tiny amounts can get into food.

Levels tend to be higher in rice

because it's grown under flooded conditions.

Last year, the EU brought in new regulations on the levels

allowed in rice products.

I'm meeting Professor Andy Meharg at Queens University, Belfast,

who's been researching the subject for nearly 20 years.

I must admit, Andy, it had never ever occurred to me that there was

arsenic in rice.

And does it matter?

I mean, the doses you find it in, does it really affect your health?

Totally. We know that low levels of chronic exposure to arsenic causes a

wide range of disease.

And over a lifetime exposure,

it leads to increased risks of cancer.

We know that if you have low levels of exposure during infancy it causes

a range of other developmental problems.

-What sort of things?

-Immune development, growth rate,

IQ development - are all linked to arsenic exposure.

Andy has tested levels of arsenic in different types of rice,

and compared them with other cereal crops.

He found that white basmati rice has five times as much arsenic as wheat

or barley. Other white rice typically has ten times the amount,

and brown rice, 20 times.

These levels are all below the new legal limit set in Europe,

but Andy is still concerned.

All they've done is set them at levels which are typically found

in rice. They've done nothing to make rice growers,

or rice food manufacturers do anything about it.

And I would argue very strongly that it's not fine to have those levels.

The UN Food and Agricultural Organisation, who advise on

acceptable limits, said levels need to be low enough

to protect public health,

but still allow sufficient trade and availability of rice in the

developing world. Their full statement is on our website.

Another concern Andy has is with rice products like rice crackers,

rice cereals, and baby rice - which is many babies' first food.

Rice has become very popular,

it's given to young children because it's supposed to be healthy.

And you're saying it's pretty unhealthy?

I would not want to be giving my child high amounts of rice,

because of the arsenic content.

The legal limits for arsenic in children's rice products, like baby

rice, are set at half the adult amount.

But puffed rice cereals don't have to meet the child requirements,

because they are deemed as not being directly marketed at children.

The Food Standards Agency also advises that children under

four-and-a-half should not be given rice drinks,

as these too contain arsenic.

But while some manufacturers put this on their packaging,

there is no legal obligation to do so.

What about someone like me, I like rice, I like basmati rice, you know,

I have it a couple of times a week.

Your actual exposure is relatively low, but there's many people,

for many different reasons,

taking two, three, four bowls of rice per day, or equivalent to that in rice products.

And if I was doing that day in, day out,

I certainly would be highly concerned about my arsenic intake.

So is there anything we can do when we're cooking rice at home to reduce

the amount of arsenic?

Andy's brought me to the university kitchens to try an experiment.

So, Michael, tell me how you normally cook your rice?

OK, so I get the rice.

Occasionally wash it, normally I don't bother.

Add some water, so that's probably slightly less than twice as much

water as there is rice. Cook it until all the water is absorbed.

Letting all the cooking water absorb into the rice is also the way most rice cookers work.

Andy's method is very different.

He is cooking with a lot more water.

Five times as much water as rice.

Give it a pre-rinse first.

In Southeast Asia, this is how people used to cook rice.

OK.

But we're also trying a third method, Andy has soaked this rice overnight.

He drains it, rinses,

and cooks it. Again using five times more water than rice.

That's probably a bit more fluffy.

Not a huge amount in it.

More importantly, did the different cooking methods change

the levels of arsenic?

In my rice, nearly all the arsenic remained.

Whereas in Andy's method,

just 43% of the arsenic was still in the rice.

But when the rice had been soaked overnight, incredibly,

less than 20% of the arsenic was left.

In all the cooking methods, arsenic escaped into the water.

In my method, the rice reabsorbed almost all the water,

and all the arsenic it contained.

Using Andy's method, more water, and therefore more arsenic,

were poured away.

But soaking the rice first is even better,

because this opens up the structure of the grains, allowing more arsenic

to escape into the cooking water.

What I love about this, is it tastes better, it looks better,

there's no chance you're going to burn it,

which is what I do an awful lot of the time anyway.

And it has only a fraction of the arsenic.

-Yes.

-That's cool. I'm impressed.

Thank you.

I was really surprised by how much difference it made to

the arsenic levels in rice when you cook it different ways,

particularly if you pre-soak it.

I'm certainly going to give that a go.

Now, if you are concerned about the amount of arsenic in the food you're

eating, particularly if you have young children,

then do visit our website for more information.

SNEEZE

On our website, you can ask the health questions you've

always wanted answered.

I would like to ask the team if they could give any advice or tips on

staying healthy as a night-shift worker?

One for regular shift worker Dr Saleyha Ahsan,

who's off to New Covent Garden Market as the night shift ends.

In the UK, it's estimated that about one in six working adults do shift work.

It's not a healthy lifestyle, really.

It's almost a jet-lagged type of existence.

It kills you. It takes years off you.

Shift work is bad for us,

because it plays havoc with what we crudely call our body clock.

Which is actually a delicately balanced system.

We've recently started to understand that it's a lot more complex than

we previously thought, because we don't just have one body clock,

we have loads.

We have them in our stomach,

our gut, our liver, and even our muscles.

All of them are influenced by one

master clock in our brain,

which works to keep everything in sync.

But working shifts with unnatural rhythms of activity and rest,

knocks all of these clocks out of sync.

And research has linked shift work to weight gain, diabetes,

and heart disease.

So is there a way to minimise the damage?

There's no simple answer,

and you might need to try a few different things until you work out

what's right for you.

But there are a few key things that researchers agree on.

So we've come up with a Trust Me guide.

The key is finding ways to keep the clocks in time, even when you're

working through the night, and the first problem is sleeping.

I don't get copious amounts of sleep, so I'm tired quite a lot.

Sleep when you can. You do.

I've got two kids and I'm married, so you sleep when you can.

We all need around seven solid hours of sleep,

but many shift workers struggle to get this.

A big problem is light.

From dawn till midday, daylight is mostly blue.

And blue light is known to stimulate our brain, which wakes us up,

and can make it difficult to get to sleep after a night shift.

So what can you do about it?

One solution is to wear sunglasses like these.

The lenses have an orange-coloured filter which blocks out blue light.

In fact, wearing any good sunglasses on your way home from a shift can help.

And wear an eye mask while sleeping through the day, to block out light

and help you get your seven hours.

The next problem, eating correctly.

You don't normally have your breakfast, lunch and dinner.

You just eat when you can.

The evidence for the best time

for shift workers to eat really varies.

But researchers suggest that you should try

to stick as closely as possible

to your normal eating pattern that you have during the day.

In fact, some researchers advise avoiding food altogether between

midnight and 6am.

The reason for this is our blood sugar and fat levels are higher at

night, and eating more at this time can push them to levels that can be

bad for our health.

So if you do need to eat during the night, pick lean meat, fish, nuts,

seeds, fruit and veg.

And to help maintain your body's natural rhythm, have a light meal

when you get home, while most people are eating breakfast.

And the final problem, exercise.

This is important for us all,

but it can be difficult to fit in when you work shifts.

And doing it at the wrong time can disrupt your body clock.

Exercise increases alertness, so the best advice is to do it before work,

and not when you're heading home to bed.

Many of us can't help having to work shifts.

Me included.

But research is revealing more about the health risks,

and what we can do about them.

The key is to work with our body clocks, and not against them.

Do that, and you could live a healthier life, despite your work patterns.

We are running a big experiment in Walsall to test three different ways

that it's claimed can boost your metabolism.

I feel a lot more alert, I feel like I want to do more things and not doze off to sleep.

We will find out later on in the programme whether any of our methods

have worked, but in the meantime,

we're going to take a look into

another aspect of our metabolism that many of you

have told us you are concerned about.

On Trust Me, we get a lot of questions about the thyroid.

This is a gland in your neck that produces hormones which regulate

your metabolism, and is vital for your health.

The thing is, there is a lot of controversy about the treatment and

diagnosis of issues related to the thyroid.

So how do you know if you have got a problem

and what can you do about it?

We have had so many people write to us worried they might have thyroid

problems, that I have done something that is a first on Trust Me.

I have set out to investigate this particular illness myself.

The thyroid gland is a bit like the accelerator pedal on your car.

It produces hormones that speed your metabolic rate right up.

If that doesn't happen, then your metabolic rate will slow right down.

MUSIC: Down Down by Status Quo

MUSIC WINDS DOWN

And it is a finely tuned machine.

First, your body needs to produce what is called

thyroid-stimulating hormone or TSH,

which tells your thyroid to get working.

Next, your thyroid releases hormones into the blood.

Mainly one called T4.

Later, T4 is converted in our tissues to T3.

The active hormone that revs up our metabolism in our cells.

But sometimes, the thyroid doesn't produce enough hormones.

This is known as hypothyroidism.

The result is normally a slower metabolism.

Now, it affects around one in 1,000 men, but it is more common in women,

affecting around one in 50.

Sufferers put on weight and have other common symptoms,

as Jo Parker experienced.

The most prominent symptoms where the fatigue and the cold.

Other symptoms were hair loss,

migraines five days a week, low mood.

I wouldn't say clinical depression, but low mood.

Jo's symptoms were caused by an underactive thyroid,

but getting it diagnosed was a struggle.

And there are thousands more women in the UK with symptoms like Jo's,

who feel they have not been properly diagnosed.

One of the problems lies in the way

the activity of the thyroid is measured.

If you have symptoms of hypothyroidism,

your GP will test your blood.

The telltale sign they are looking for is high levels of

thyroid-stimulating hormone, TSH,

together with low levels of the main thyroid hormone, T4.

It sounds straightforward, but it isn't.

What are considered normal levels of these hormones varies around the world,

and the threshold for a diagnosis in the UK is higher than many.

Dr Anthony Toft is former president of the British Thyroid Association.

He thinks the test results are sometimes interpreted too

rigidly, and that results which fall just within the limits of the

normal range can merit further investigation.

If the T4 is right down at the lower limit of normal,

the TSH is up at the upper level limit of normal, that is suspicious.

That is a prompt to take it a little further.

I think the trouble is there isn't enough debate about interpretation.

If you are diagnosed with an underactive thyroid,

then you will most likely be prescribed a synthetic version of T4.

This works for the majority of patients,

but in around 10% of cases, the symptoms don't improve.

One reason might be because some patients can't convert T4 into the

active hormone, T3. T3 hormone in tablet form does exist,

but price is a problem in the UK.

The cost of T3 has escalated incredibly.

It is now about £300 for two months supply of T3,

whereas it costs pennies to make.

So if I go along to my GP and ask for T3,

-there is a good chance they will say, "No, it's too expensive."

-Yes.

There is a less expensive thyroid supplement, taken from animals.

It contains both T3 and T4 hormones.

But it isn't licensed in the UK.

So do you think most patients should have T4 and T3?

I suspect that in time that is what will happen.

The trouble is the evidence base is not as strong as we would wish it to be,

but I suspect it will be a long time before we have

sufficient evidence.

Many doctors won't prescribe T3,

and there are patients who choose to buy pills online from abroad.

Self-medicating is always risky.

And taking T3 in large doses may cause side-effects in the long term,

such as heart problems. But, like many women,

Jo has accepted these risks.

On balance, I think I will go with what I feel the best.

If I am at an increased risk of anything,

at least I am living my life to the full,

rather than being locked indoors, overweight, cold,

not able to function mentally.

Have people suggested to you that this is simply the placebo effect?

I can only say one thing. If it is a placebo effect,

I am the best I have been in all my life and shouldn't that be good enough?

The diagnosis and treatment of hypothyroidism is tricky.

The same symptoms can be caused by a

number of factors such as stress,

depression, and a poor diet.

If you have had a blood test and results have come back normal,

then you can investigate it further.

But you may also have to accept that medication is not for you and that

lifestyle changes may be more appropriate.

To find out more, do visit our website.

Every day, we all use toiletries

like shampoos, shower gels, and soaps.

Most of these contain a particular ingredient that helps wash us clean.

But can also have nasty side-effects.

Chris has been investigating.

If you look on the ingredients list of skincare products like moisturising creams

or shampoo,

you will see near the top of the list something called SLS,

sodium lauryl sulfate.

It is a really strong detergent.

Now, I have reported on Trust Me, I'm A Doctor before,

that if you leave it on your skin,

it can cause skin damage and eczema-like symptoms.

But it isn't only found in skin products.

SLS is a very common ingredient in toothpaste.

It helps make it foam and spread around your mouth better.

It also kills microbes and reduces plaque.

But some of you have been telling us you are better off without it.

We have had a lot of people write in and say that switching to an

SLS-free toothpaste has helped them with their mouth ulcers.

Now, this to me is very plausible.

The tissue on the inside of our mouths is much more sensitive than the skin

on the rest of our bodies,

so sluicing it out with SLS twice a day might not be good for us.

So we have decided to look into it.

There have been a number of studies on ulcers and SLS in toothpaste.

The results have been, well, quite varied.

Some reported that using

SLS-free toothpaste reduced the amount of mouth ulcers by 70%,

whilst others found no difference at all.

In the two most recent trials,

scientists put people who suffer with mouth ulcers into two groups.

One using SLS-free toothpaste and the other using SLS toothpaste.

And whilst there was no difference in the number of ulcers between

the two groups, those people who used the SLS-free toothpaste

found that their ulcers were less painful and they healed

more quickly. So if you do get ulcers,

it might just be worth trying an SLS-free toothpaste.

Coming up, we reveal a brand-new eczema treatment that could also

help us fight antibiotic resistance.

And we talk to survivors of eating disorders about how to spot the

signs and save lives.

But first -

a few years ago on Trust Me,

we looked at ways to reduce air pollution in our homes.

But outside the home, it is a growing problem.

It's recently been labelled the biggest environmental killer in the

world today. And already this year has been in the news with reports of

new research linking it to dementia.

But is there more to all of this than hype?

I want to delve a bit deeper, find out exactly what it is I am inhaling and

what effects, if any, that is having on my body.

Should I worry about air pollution?

Some have suggested that in Britain alone air pollution is responsible

for the premature deaths of up to 40,000 people a year.

Now, I regularly cycle and walk through the busy streets of London

and I am fully conscious of all that traffic belching out nasty toxic fumes.

The thing is, just how bad for me is it?

Well, I am wearing this equipment which is provided by King's College, London,

and I am about to go for a lengthy stroll through the busy

streets. I am almost nervous to find out what I have been inhaling these

last few decades.

We could have conducted this experiment in almost any town or

city in the UK. Because so many have high levels of air pollution.

Big offenders include Southampton, Glasgow, Port Talbot, Eastbourne,

and Leeds.

It isn't just vehicles that cause it.

Factories, airports, and even shipping plays a role.

Over the next five miles,

the kit in my backpack will be measuring black carbon from

diesel cars and particulate matter.

That is tiny particles, much smaller than the width of a human hair,

that can get deep inside your lungs and can lead to long-term health problems.

My walk will take me on busy roads from the Strand to Marble Arch

and then I will return through quieter backstreets,

so we can compare the different routes.

Well, that was actually quite a pleasant stroll, apart from the traffic,

which was sort of moderate for London.

There was a bit of breeze coming along, which I imagine swept

some of the pollution away.

I have no idea what I was inhaling, but the machine will reveal all.

A few days after my walk,

I am back at King's College to look at the results.

Dr Ben Barratt is an air pollution scientist who has been

assessing London's air for more than 22 years.

OK, so what was I inhaling?

You started off very clean in the Somerset House courtyard.

As you head out onto the Strand, very congested, slow-moving traffic,

and you can see, immediately pollution levels rise up really quite high.

And then you head towards Marble Arch.

The general level of pollution gets really quite elevated and this is

typical of the Central London area.

And was there any difference when I was kind of returning?

On the way back, the levels drop off really quite dramatically.

You can see, towards the end here, we have got some really very low levels,

-but then you have got these very high spikes.

-OK.

So this is probably one vehicle that is passing, that you have breathed

in a lot of the exhaust coming from that.

-OK, right, well.

-But I can see from the data that at the end of your walk,

-you got into a vehicle, probably a taxi.

-Oh, of course. Yes, we did, didn't we?

Yes. And the taxi got stuck in traffic

for quite a long period of time.

Actually, the highest levels of exposure that you received were in

that taxi on the way back.

The inlet for that vehicle is right behind the exhaust pipe of the vehicle in front

and the pollution comes straight into your cab and it is important,

it's not your vehicle that you are in,

it's the vehicles that are surrounding you that are causing the problem.

Right. So what's the best way?

Active travel. Walking, cycling...

Cycling, but preferably over back streets?

Better for your health in many ways and better for the environment.

OK. It's the unintended experiments which are the most

illuminating and entertaining.

But are all these small particles we're breathing in, causing us any

serious harm?

Professor Frank Kelly from King's College, London, advises on

the health impacts of air pollution across the world.

So why are small particles bad?

Because they're smaller,

they will penetrate deeper into your lungs when you breathe.

They're carriers of a complex set of chemicals on their surface and these

chemicals then will interact with your blood vessel walls and they'll

set up reactions, which over a long period of time damage those walls,

which we associate with heart disease.

What about other diseases?

Diabetes involves changes to your vessel walls as well.

So that's why it's been linked.

And neurodegenerative diseases such as Alzheimer's, that also...

has damaged the blood vessels in the brain and now there is

a strong series of studies which suggests

that the air you breathe also is associated

with your susceptibility to stroke.

How much does it sort of knock off your life on average, do you think?

If you take the current data that we have,

we think somewhere between three and nine months.

Some people it's maybe one day

and some people it may be up to ten years.

If you'd asked me, I would've said things are getting better,

the air we breathe is probably getting healthier and healthier.

Am I naive?

No, you're trusting your eyes.

In the 1950s,

when we had black smoke and sulphur dioxide from burning coal,

that was pretty visible most of the time.

The pollution problem we have these days is from burning diesel

and burning petrol,

so it's road transportation primarily in our cities.

One of the things I find quite distressing

is I see a school playground and then I see a van

or perhaps some parents outside, their engines are just ticking over,

am I right to feel anxious about such things?

This is a particularly worrying new finding.

It seems that if a child is growing up with air

which is of poor quality,

then that holds back their lung growth

and as your lung normally stops growing around the age of 18,

it means that if you've reached that point with a smaller lung,

you're not going to be able to recover that capacity.

So as I say, we've seen this in America, we've seen it in London,

we've seen it in China.

Wow! How do you respond to your own data, your own information?

Have you changed your life?

I'll think about the route I take and if I can take a side street,

if I can walk on the other side of the road, where I know the wind is

blowing away from, I know my exposure to pollution will be less.

Are you optimistic?

In the short-term, no.

I haven't been for a while, in the medium to longer term, yes.

I think we will sort this problem out.

Whether we sort it out in time to protect the

current generation of children's lungs or not, I don't know.

So, should I worry about air pollution?

The short answer is yes.

I was particularly shocked by the amount of the bad stuff I was

inhaling while I was in that taxi in heavy traffic.

Now, in future,

I will continue to cycle and walk where I can in London because I

enjoy it and because it's good for my heart and lungs,

but I will try and stick to quieter backstreets because I'm now

convinced that that will make a big difference.

To look for data on air pollution in your area,

visit the Trust Me website

where there are also tips on how to reduce your exposure.

In the UK, one in five children and one in 12 adults

suffers from eczema, that red, scaly skin condition.

Now there is a new treatment which could help not only eczema sufferers

but also our battle against the superbugs.

Surgeon Gabriel Weston has been to the Netherlands to investigate.

The clinical trial that I'm on my way to see is focusing on a

condition that has played a significant role in my own life.

It's hard to imagine if you've never suffered from eczema, just how

debilitating the itching, redness and soreness can be.

I suffered from severe eczema as a child

and right into my early adulthood

and at times it made me really miserable.

And then miraculously, one day, it all disappeared.

But for thousands of people suffering from eczema,

things don't turn out so well.

I've eczema since I was two years of age.

It started on my knees and on my elbows.

The main problem or main symptom I have is itching of skin and also

redness and dryness of my skin.

Sometimes it will bleed because of the wounds I get from the itching.

So it's painful sometimes.

Anouk is a student in Rotterdam and like many eczema sufferers,

has found that one of the only ways to manage the symptoms is with

powerful steroid creams,

which ideally should only be used in short bursts.

But now, Anouk is taking part in a trial of an alternative treatment at

the Erasmus Medical Centre in Rotterdam.

We still don't fully understand what causes eczema in the first place,

but it can be triggered by many different things.

This trial is focusing on the role played by the different bacteria

that naturally live on our skin.

The researchers are taking skin swabs from each patient and sending

them off for analysis.

Doctor Bjorn Herpers is a clinical microbiologist and a medical adviser

to the company who've developed the treatment I've come to see.

He's working with the team analysing the bacteria.

These samples were taken from the skin from a healthy patient and here

you see a lot of different bacteria growing.

So there's a lot of diversity

of bacteria on the skin in this culture.

The next plate is a skin sample swab taken from a patient from the trial,

-and here you see a completely different story.

-Wow.

You don't see the diversity any more,

but you see this one green colony overgrowing all the rest of it

and this is staphylococcus aureus,

and in some patients who have an eczema flare,

up to 80 or 90% of all bacteria

has become staph aureus and this is called dysbiosis,

an imbalance of the bacterial skin flora.

Why does that matter if you have one more than others on your skin?

It matters for two things.

First of all, a lot of bacteria that normally inhabit the skin are

actually protective and needed

for healthy and good skin and the problem

with staphylococcus aureus is that it can produce substances,

toxins, and with these types of toxins,

staphylococcus aureus produces or ignites the inflammation like the

redness and the itch seen in eczema.

Researchers have shown that in eczema,

one particular bacterium tends to dominate, staphylococcus aureus.

Now they want to know whether reducing the amount of it on

the skin could alleviate the symptoms.

The challenge is how to get rid of staph aureus without destroying

the healthy bacteria too.

And that's exactly the problem the new treatment they're trialling

is designed to solve.

In nature, viruses kill bacteria and they do this by latching onto them,

reproducing inside them

and then bursting out through their cell wall.

Now the thing that allows them to break out in this way is an enzyme

and it's called an endolysin

and it's this that the treatment is based on.

Each natural endolysin kills a specific strain of bacteria,

leaving all the others unharmed.

So the researchers have harnessed those that only target staph aureus.

These test tubes contain staphylococcus aureus bacteria,

which makes the liquid appear cloudy.

But when the endolysin is introduced, the results are astonishing.

In little more than an hour, the bacteria are destroyed.

Now this endolysin has been turned into a cream and is being tested

in the eczema trial.

This independent clinical trial has recruited 100 patients,

50 of them get the cream with the endolysin inside and 50 get

the placebo and because this is a randomised, double-blind trial,

neither the doctors nor the patients know who's getting what treatment.

Alongside their treatment,

each participant is also using a steroid cream which is weighed at

each appointment, so the researchers know how much has been used.

I asked two of the researchers,

Dr Joan Totte and Professor Suzanne Pasmans

what they were hoping to see.

We hope to reduce the level of staph aureus and restore the balance of

the microbial composition a bit.

What we want to investigate also -

if it really reduces the staph aureus

load and then, complementary,

we want to see if that reduction of the staph aureus load also leads to

a reduction in symptoms and a reduction in steroid use.

So it won't be a cure, but an additional therapy.

What are the measures of improvement in your patients?

The severity of the eczema has decreased and the patient probably

also has discovered then that he has less inflammation in the skin.

How soon do you think it's going to be

before you'll know some of the results?

The first data will be there after a year,

so probably a few months later,

we have, really, the visuals analysed.

This research is the first clinical trial of this treatment and will

show whether it's effective.

But because this cream doesn't contain any substance

that's classified as a drug, it's less tightly regulated

and is already available outside of the trial.

One person using it is Miriam.

Her son, Renzo, has had eczema since he was very young.

Miriam, tell me what it was like when you first discovered that your

-son had eczema?

-Well, his skin was very dry and red and he had a terrible itch.

He had eczema all over his body and also his skin got infected.

It was terrible.

Tell me about what changed that.

When I used the endolysin,

he slept the whole night through and his skin, also, was calm,

it wasn't red any more, it was the difference between day and night.

He's happy, so when he's happy, I'm happy.

It's totally different.

The endolysin treatment has made a big difference in Renzo's case,

but as well as alleviating eczema,

there are other reasons to get excited about this new treatment.

Researchers have found that bacteria cannot develop resistance to

endolysins and this offers amazing advantages for the treatment of

a range of infections.

With endolysins, because they do not induce resistance,

you can have a continuous suppression therapy, so I see before

me that with burn wounds, with diabetic wounds,

you can have a continuous treatment and I think that a lot of problems

we now see in the hospital with infected wounds can be prevented by

using endolysins in a very early colonisation stage before

this colonisation leads to infection,

and I think this is a real paradigm shift we will see

in the coming next years.

On this trip, I've seen a lot to get excited about.

I can't wait to discover the results of this trial and if it's positive,

who knows how many conditions

we might be using endolysins for in the future?

Next, we've been finding the answer to another one of

your health questions.

How do you get cold sores and what can you do about them?

Cold sores, those unsightly blisters around the lips.

It's been estimated that one in five of us get them.

-Do you get cold sores?

-Yeah.

Only when I get stressed, really.

When I'm run down or when I'm tired and I'm stressed out.

They always seem to pop up at the most inconvenient times.

Cold sores are caused by the herpes simplex virus.

You might be surprised how many of us harbour it.

Hi, there. Can I have my usual, please?

Estimates suggest that around two out of three of us are infected.

Most of us get it in childhood.

Perhaps a friendly kiss from an aunt.

The thing is, once you've got it, it's there for life.

You can't get rid of it.

So why is it we don't have cold sores all the time?

The virus lies hidden,

usually without causing any visible symptoms.

So you probably have it and don't even know.

That is, until it's triggered.

The things that cause a cold sore to erupt vary from person to person.

Essentially it's about weakening your immune system.

This could be the result of stress, feeling run-down,

even exposure to lots of strong sunlight.

You can often detect the beginnings of a cold sore from a tingling or

burning sensation under the skin.

Then a blister that shows up which can burst and leave a scab.

Once you feel that familiar tingling,

you should stop kissing people or doing anything more intimate.

Cos that is a very common way for the virus to spread.

You should also avoid touching the cold sore as this may delay healing

and wash your hands often, so you don't spread the virus.

So, can you do anything about a cold sore?

Well, home remedies like mint

might reduce the pain and antiviral creams,

if you are very conscientious,

may reduce the amount of time that it hangs around for.

If you do nothing at all, then it should go in about ten days.

So, you could just wait it out, but if the cold sore persists or if

you're getting them often, then do go and see your doctor.

They may prescribe stronger oral antiviral medication.

If you only get them occasionally, then prevention is probably best.

So do try and find out the sort of things that trigger your cold sores

and avoid them if possible, and if you have an active cold sore,

no kissing until it gets better.

SNEEZE

These days people are much more open

when it comes to discussing mental illness

but there are still some conditions which are hard to talk about.

In the UK, around three quarters of a million people suffer from an

eating disorder, and it's really important this gets picked up early.

Over to Dr Saleyha Ahsan.

Anorexia has the highest mortality rate of any mental illness,

with up to 20% of sufferers dying prematurely.

And a quarter of people with eating disorders will go on to develop

a chronic illness.

Most people have heard of eating disorders like anorexia,

bulimia and binge eating,

but they often assume that they only affect teenage girls.

Well, actually, they can affect anyone at any age.

Men as well as women.

The causes are usually complex,

psychological factors like low self-esteem, anxiety

or depression can be triggers.

But it's the physical signs that we are most likely to spot

and learning to recognise these could save a life.

Julie and Dave both suffered from anorexia,

an illness where a person keeps their weight extremely low

and restricts how much they're eating.

I would generally be in the bathroom five, ten minutes,

just weighing myself. Because if it was a good weight, I'd be, like,

I have to know that's correct.

So I'd reset the scales. I'd do it five or six times.

If it was a bad weight, I'd be, like, no, this can't be happening.

And then I'd reset the scales five or six times.

My hair was falling out, I had ear infections, eye infections,

skin infections. I had no skin on my fingers.

It was painful but I was at a point where I just didn't...

I didn't care.

Holly and Rebecca have both grappled not only with anorexia but also

with bulimia, which involves eating excessive amounts and then purging

yourself by means of laxatives or vomiting.

I'd either go through massive periods of seeing how far I could get on as little

as I could, or I'd binge and then I'd purge

and it was very much that for a good six years.

I'd do my morning exercise.

I'd then go and usually I would buy a lot of food that I would maybe

consume all in one go and then I would purge that food and then

I'd do some more exercise.

One of the things that's common to eating disorders is that

the condition is often shrouded in secrecy.

So what are the signs to look out for?

Some of the key red flags,

common to most eating disorders, are an obsessive focus on food,

dieting and exercise, complaining of being overweight,

even when they are not, weighing yourself repeatedly, skipping meals,

bingeing, regular visits to the bathroom especially after meals,

being withdrawn and secretive.

Most sufferers in the early stages of the disease are often ambivalent

or even in denial about the condition,

so it can fall to friends and family to break the silence and suggest

there's a problem.

My cousin noticed that I would go to the bathroom after each meal and he

actually came up and said to me,

"You've got to stop going to the bathroom after we've eaten."

Broaching the subject can open the door to a sufferer getting the right

professional support and treatment.

I was working in a summer school and one of the teachers said,

"Look, I've been in therapy for bulimia three times.

"Have you ever thought you might be anorexic?"

Just down to earth.

That was a different approach, wasn't it?

-Absolutely.

-I've got a really good friend.

When I was first poorly,

he would take me out for breakfast every Saturday and even if I just

had water, then that's fine,

and then gradually we built up to toast and a coffee.

-Oh, that's lovely.

-It was amazing.

-He was really good.

-But if you do decide to raise the subject,

do so carefully, because some of the most powerful triggers of

the disease are feelings of anger and anxiety.

When anyone would address it during mealtimes,

I found that very difficult.

For example, someone saying to me,

"You've put absolutely no carbs on your plate."

And that just made me not want to eat anything at all.

What helped?

Not always seeing the eating disorder, but the person,

because people can forget that underneath

you are still the girl who loves to read and, you know, watch films.

But people won't ask you - "What books have you enjoyed lately?"

Instead, they just talk about food.

Talking and listening are powerful tools in the fight against these

diseases, and they are beatable, as our survivors have proved.

I've been fully recovered for about two years now.

It feels very freeing.

Like, you're in control of your life now,

not this voice that is telling you how to behave.

You are doing what you want to do, because you enjoy it.

The biggest thing that I've learnt is the management of kind of

I love and care for myself, so it's just

change the language to be just, like,

don't beat yourself up about it, if you feel a certain way.

-It's OK.

-I'm still kind of, you know,

seeing my therapist, but I feel furthest away from it now than

I ever have done before.

I'm really having a new life because I've wasted so long.

It's a waste of life.

Remember that however difficult it may seem,

these diseases are manageable, and you can help.

Breaking the silence and helping someone acknowledge a problem,

can be a big step towards treatment and recovery.

Go to our website...

..for more information on eating disorders and the support available.

Eight weeks ago, we started an experiment testing different methods

that claimed to boost our metabolism.

In other words, help our bodies burn more calories.

Raising your metabolic rate in the long term,

should help you lose weight.

28 volunteers from the Midlands

have been trying out one of three options.

Our first group has been drinking chilled water twice a day.

The idea is that warming this up to body temperature will make them

use more energy.

I have lost a little bit of weight and feel as though

I'm doing my body some good.

It's had an overall positive effect on me, without a doubt.

Our second group have been drinking green tea.

This contains chemicals, that it is claimed, will make their bodies burn

-more calories.

-It's given me more energy.

I've been up and about busying myself, you know,

and just keeping myself active, so, again, mentally I felt better

for the thing, and I don't know why but I just have.

Our final group have been doing some simple exercises using a

resistance band, to build some muscle and lose fat.

As muscle uses more energy than fat, even at rest,

this should up the number of calories they are burning through the day.

My energy levels improved and I know that because I was whizzing around

the house doing housework a lot more.

Dr Ian Lahart from the University of Wolverhampton measured

the resting metabolic rate of our volunteers before and afterwards.

We also did DEXA scans, which allowed us to measure the amount

of muscle and fat in each volunteer's body

before and after the experiment.

Now it's time for the results.

First up, the cold water.

In this group, there were some dramatic individual results.

Alison's resting metabolic rate went up by 21% and she lost 1.4kg

of body fat.

While Judith lost 1.9kg of body fat.

But overall, the metabolic rate of our group didn't rise and they

didn't burn much fat.

It's likely that simply taking part in our experiment, triggered Alison

and Judith to adopt a healthier lifestyle.

On average, we weren't able to find an effect,

so that might be that there is no effect or that the effect is

so small we weren't be able to detect it.

Next, the green tea group.

Here, we saw very similar results.

There was no overall increase in our volunteers' metabolic rate.

One person, Clive, did lose an impressive 2.6kg of body fat.

Again, though, that is unlikely to be down to the green tea alone.

And how does that reflect in previous research?

I think overall it's in line.

There's inconsistent results around green tea, so the jury's still out.

And finally, our resistance exercise group.

Again, there were some impressive individual results.

Arlene lost an incredible 3.5kg of weight.

But this time there were also encouraging signs for the rest of

the group, particularly in the DEXA scans.

We found that six out of nine people improved their muscle mass,

so given a longer period of time performing those exercises,

people might increase their muscle mass further and that would raise

their resting metabolic rate.

We can't forget the other benefits

associated with being active, such as

better quality-of-life, improved fitness and reduced risk of disease.

So while the results for water and green tea were inconclusive,

our short study showed that resistance exercise was already

bringing improvements in just eight weeks.

This reflects other studies that have shown that increasing

the amount of muscle you have, burns more calories.

Our experiment has shown just how difficult it is to boost your

metabolism and you're unlikely to lose significant amounts of weight

from any of these quick fixes,

however, it also showed that simple changes to your everyday routine

can help you reap the benefits.

In our test, doing just a few sessions of simple exercises a week,

made a meaningful difference.

For full details of these exercises and more information about our

experiment, go to the Trust Me website...

That's it from Walsall.

Next time, we're in Liverpool, where we are carrying out a really big

experiment to find out what's the best way to include more healthy

fish oils in your diet.

We'll also be finding out whether we should worry

about plastics in our food.

And how a high-fat diet affects our bodies.

MUSIC: Dr Wanna Do by Caro Emerald

# Doctor, I want you

# Ooh, my Dr Wanna Do

# I can't get over you

# Doctor, do anything that ya wanna do

# Doctor, I want you

# Dr Wanna Do

# I can't get over you

# Doctor, do anything that you wanna do. #