Episode 3 Trust Me, I'm a Doctor

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

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 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 the latest fads.

I'm Michael Mosley, and 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 Trust Me, I'm A Doctor.

This time we're in Guildford.

We're carrying out a fascinating experiment to see whether eating

carbs in the evening is bad for your health.

Also in the programme...

How to spot the hidden condition that makes millions of us feel cold.

A pioneering new technology in the fight against cancer.

Ooh, yep. Starts to give a signal.

And what can you do to avoid jet lag?

But first...

There's plenty of evidence that eating lots of carbs,

whether in the form of bread or white rice,

is bad for your waist and for your blood sugar control.

Now, it's widely believed that eating your carbs in the evening is

worse than having them for breakfast.

But, of course, most of us have our main meal in the evening.

Though, should we be changing our habits?

The carbs and sugars in your food end up as glucose in the blood,

which is used for energy or stored as fat.

If you have more glucose than you need,

your body has to work harder to remove the excess from your blood.

If this happens regularly, it can lead to serious health problems,

like type 2 diabetes.

In theory, it should be better to get your carbs in first thing in

the morning when your body is raring to go

rather than last thing at night when your body is preparing to sleep.

But is that true?

To find out, we've set up a

brand-new experiment with the University of Surrey.

We've recruited four volunteers to help us compare how our bodies

cope with eating most of our carbs in the morning, or in the evening.

Dr Adam Collins is leading the study.

What we're changing is the amount of

carbohydrate in breakfast and dinner,

so what we want to see is, following one pattern or another,

does that give you better or worse blood glucose,

or does it make you better or worse

at dealing with carbs across the day?

So what I love about this is you don't actually know what's going to

happen, do you? That's the joy of science.

We don't! We don't! It could go one way or the other.

The aim is not to see what happens after a single high carb meal,

it's to find out whether your body's ability to keep your blood sugars in

check through the day is affected by what time of day you eat your carbs.

For ten days, our volunteers are eating a fixed amount of carbs.

For five days, they'll eat most of their allowance at breakfast.

And for five days, they'll eat most at dinner time.

Following each five-day block,

they have a day where their carb allowance is spread equally over all

three meals. And we measure their blood glucose throughout.

This will show whether the body's

ability to deal with carbs has changed.

A few weeks later,

the volunteers and their friends

have come back to find out the results.

Hi, all. Hello. Before you're allowed to eat anything,

I think Adam's going to give you some results.

OK, so what we're looking at is

overall glucose response across the day,

and the higher the number, the worse you are.

So, when you followed the high carb breakfast and the low-carb dinner,

your blood glucose response was 15.9 units.

This level after five days of high carb breakfast

was roughly as expected.

But what happened after five days of high carb dinners?

When you followed the low-carb breakfast and the high carb dinner,

that went down

to 10.4 units,

so that's a reduction in terms of that glucose response.

Remarkably better.

Suggesting your high carb dinner was actually better.

Which is the exact opposite of what you would have predicted, isn't it?

Absolutely, yeah.

So after just five days of high carb dinners,

their ability to process carbs through the day had improved.

An unexpected result.

So, these results were very surprising.

-What do you think's going on?

-When they're following the high carb

breakfast, they're having their peak carbohydrate intake in the morning,

so they can't really improve very much because people are inherently

already good at dealing with carbs in the morning.

But when you give them a high carb dinner,

that entrains them to become better

at dealing with carbs in the evening.

Our test is a pilot for a much larger study that Adam is launching.

But already it's given a surprising result.

Contrary to what we've long believed,

it suggests our bodies are better

than we thought at adapting to eating carbs in the evening.

Within limits, of course.

So, as long as you're healthy,

you needn't worry too much about what time of day you eat them.

In other words, if you've had a lot of carbs in the evening,

try and minimise them in the morning.

And on the other hand, if you've had,

say, a pile of toast for breakfast,

then do try to avoid the pasta that night.

Now it's wintertime,

and up to 10 million people in the UK are thought to be affected by a

painful and potentially disabling

condition that often goes unrecognised.

GP Zoe Williams

has been investigating Raynaud's syndrome

and what we can do about it.

Feeling cold is something that most of us find pretty unpleasant,

but for people with Raynaud's syndrome,

the winter months can bring with them a sense of absolute dread.

And the drop in temperature can cause their fingers and toes to be

extremely cold and numb.

And simple things like just

fastening up a coat can become impossible.

It can also be extremely painful,

but many sufferers simply live with it.

It's estimated there are millions of

people with undiagnosed Raynaud's in the UK.

To help change this,

a pop-up clinic is giving people the chance to be tested for Raynaud's.

Leading the initiative is Dr Francesco Del Galdo.

To show me what's happening inside the hands of people with Raynaud's,

he set up a test with a thermal camera.

Hi! How are you?

Yvonne Searle is one of his patients.

Ready? One, two, three, go.

We'll stay one minute.

We're comparing how our hands respond to changes in temperature.

It's not too bad, actually.

I thought it was going to be much colder.

Yeah, it's only 15 degrees Celsius.

OK, you can take your hands off now.

Our hands have been kept dry,

so should warm up quickly.

-Let's have a look.

-Here you go.

My hand's on the right.

The red and yellow colours show that it's warming up quickly back to

normal body temperature.

Yvonne's hand is on the left.

The green, blue, and purple colours

show that most of her hand and fingers are still cold.

Yvonne's fingers have disappeared!

Yvonne's fingers are the same temperature of the table now.

Unlike mine, Yvonne's hand is just not warming up.

So, why is that? Normally, when we're exposed to cold,

our blood circulation changes.

To help us conserve heat, the blood

vessels in our hands and feet narrow.

This reduces blood flow to the

extremities of our body and helps keep our vital organs warm.

But in Yvonne's hand, the blood vessels are hyper sensitive,

and shut down with even the mildest drop in temperature.

I can feel my fingers getting warmer.

-For Yvonne, it would take a lot longer.

-I can't feel much.

They feel cold!

I can tell that they're cold, yeah.

Yvonne's hands look fine at the moment.

But clearly on the screen, with the thermal camera...

-You can see.

-They're cold!

-They're really cold!

-I wish I could show my husband this.

Did you expect there to be such a difference?

No. No, I didn't.

So, yeah, that just... It's quite a contrast, isn't it, to see it there?

It is. It really is.

As well as shutting down more readily,

the blood vessels in someone with Raynaud's

will also take longer to reopen fully,

and then the blood returning to the fingertips causes pain.

It's not just cold that can trigger the symptoms.

It's anything that affects the circulation.

Anxiety, stress, or simply gripping a heavy bag.

But for one in ten sufferers, it's more serious.

And that's because their Raynaud's is caused by an underlying disease

or an injury that's permanently

damaged the arteries or the nerves that supply them.

And this is known as secondary Raynaud's.

Causes include some autoimmune diseases,

vibration damage, smoking,

and it can be a side-effect of some medicines,

so do check with your doctor.

So, how can you spot if you might have Raynaud's,

and what can you do about it?

One common sign is if your fingers change colour when you're cold.

They may go white or even blue, and have a waxy texture.

And you'll experience numbness and pain.

But there are some simple steps you can take to help.

To improve your circulation,

quit smoking and exercise regularly.

And to avoid pain, wear gloves.

More than one pair if it's cold.

Start wearing your gloves before you go outside,

and once you are outside, keep moving to increase your circulation.

Some people do need medication to help manage their Raynaud's.

But the most effective drug is one famous for a very different purpose.

One of the drugs we use the most is Sildenafil now.

Hang on a minute, that's Viagra!

Yes, yes. It was known as Viagra. Viagra is the brand name.

And, as you probably know very well,

it was branded to increase

circulation for that specific extremity,

but it works on all extremities.

And it's very effective for treatment of Raynaud's.

So presumably you have men on this treatment as well,

and are they walking around in a state of...?

That is one of the possible side effects, of course, but no,

we didn't receive any of these complaints about this side effect.

I'm not surprised there was no complaints.

It's very manageable,

and it's quite effective for Raynaud's.

If you have unusually cold hands,

or if the tips of your fingers go white and waxy,

or if you get pain when they're warming up,

then you could have Raynaud's.

There are effective treatments to treat the discomfort,

and it could be a sign of a more serious underlying condition.

So if you think you might have it, please do go and see your GP.

Still to come - if you're heading off for some winter sun,

how can you avoid jet lag?

And a new technology that could transform cancer surgery.

But first...

In this series of Trust Me,

we're exploring some common mental health conditions.

This time, psychiatrist Dr Alain Gregoire

is looking into post-traumatic stress disorder, PTSD.

So, how do you recognise the warning signs, and what can you do about it?

Post-traumatic stress disorder is often thought of as something that

affects soldiers returning from war zones.

However, the reality is that anyone can develop PTSD after experiencing

or witnessing traumatic events.

And those events aren't necessarily just physical or violent ones.

They're often emotional traumas such as bullying or abuse,

and they tend to be worse the younger you are.

In fact, about a third of us will have a traumatic experience

at some time in our lives.

And in the last month,

4% of us will have suffered from PTSD.

Michelle and Brett are both long-term sufferers.

The PTSD itself

started from a needle-stick injury that I sustained from where I work.

It was a used hypodermic needle with dried blood on it.

So there was a fear that you'd be infected.

Frightening experience.

It was horrendous.

That thought pattern of, "What if?"

Sometimes the symptoms of PTSD only surface many years after the

experience of trauma.

Brett was physically and mentally abused when he was young,

but symptoms only emerged in adulthood.

I had a good job. I was a teacher.

I was being primed for senior management.

I had a lovely partner.

And then suddenly I started doing things that I wouldn't normally do.

I ended up running away.

Flashbacks started...

..of the actual incident.

I couldn't sleep, I was irritable, I couldn't sit still.

It was like boxes that flick open, and all these thoughts,

and what can I do with them?

I can't put them back in and close the lid.

I just thought my life was over.

Left untreated,

PTSD can develop into a serious condition that prevents a sufferer

from functioning normally.

If you're concerned that you or somebody you know might be suffering

from PTSD, what are the signs to look out for?

Symptoms include flashbacks where the person vividly re-lives the

traumatic event or something similar.

Difficulty sleeping or nightmares.

Physical sensations, such as pain, sweating, nausea, or trembling.

Negative or self-destructive thoughts or behaviour.

Being emotionally switched off.

To access treatment, your GP should be your first port of call.

A psychological therapy will probably then be the next step.

Something like trauma focused cognitive behaviour therapy or CBT.

We've been doing mindfulness things,

and a part of that is I've done a camera course,

I'm doing an art course,

and the approach there is actually thinking about what you're doing

when you're doing it and being in the moment,

and it works for me.

Mindfulness. It's helping me to understand my mind.

How I feel, how I react with my emotions.

Sometimes you can be sat at home,

thinking you're the only one who is like this.

And that's not true.

You share your experiences,

and it makes you feel better because you're not on your own.

Dealing with mental health issues made me where I am now,

and it does make you a stronger person.

PTSD can be very difficult to recognise.

Even professionals can misunderstand and misdiagnose it,

particularly if the trauma was a long time ago or in childhood.

It can be very disabling, but treatment can be very effective.

So persist in your efforts to get the right help

and make use of it.

Thousands of you have been sending

questions to the Trust Me website and

we've been finding answers to some of the more popular ones.

What can I do to avoid jet lag?

Zoe has been investigating.

Most of us are familiar with the

unpleasant feeling we call jet lag,

the disruption to our body clock

when we travel to a place several time zones away.

The feeling that time difference gives you has a medical name -

desynchronosis.

For many people, the most obvious symptom is disrupted sleep.

But you can also suffer indigestion,

constipation, nausea, disorientation,

headaches, memory loss, muscle soreness, sweating,

or a general feeling of being unwell.

The underlying cause of desynchronosis

is more complex than you might think.

That's because we don't just have one body clock - we have many.

And they all need to be perfectly coordinated

to keep our body working well.

These clocks don't just influence when we sleep.

They also influence all kinds of other processes in our body,

like our digestion, temperature, and blood pressure.

Amazingly, every cell in our body has its own tiny clock keeping time.

And all of these little clocks are

synced up every day by our master body

clock in our brain called the suprachiasmatic nucleus or SCN.

And our master body clock is kept on track by daylight.

If you rapidly change to a new time zone,

this master body clock gets reset.

But it can take a lot longer for

the message to filter down to all the

other clocks in our organs and cells.

Meaning everything is out of whack and we feel awful.

Our body clocks naturally want to run slightly longer than 24 hours,

so travelling west is easier than travelling east.

That's because your day becomes longer and it's easier to cope with.

Go east, and your day gets shorter,

something your body clocks don't like.

In short, going west is best, while going east's a beast.

To work out roughly how long your jet lag will last,

count one day for every time zone you travel through.

So, is there anything you can do to avoid it?

Because our master body clock is set on daylight,

the single most effective thing you can do is to get some.

So, if you're arriving during daylight hours,

try and keep the window blinds open and try and stay up until it's dark,

even if you're tired.

But if you're arriving while it's dark,

you need to get your body ready for sleep earlier,

so you want to avoid light.

That's because exposure to light

makes your body produce less melatonin,

a hormone that helps you sleep better.

This is especially true of blue light,

like early morning daylight or the light from your electronic devices.

So avoid too much screen watching.

For serious jet lag, GPs can prescribe melatonin tablets,

which can help with sleep but only for those aged 55 and over.

Others prefer sleeping pills,

but they're not recommended for

long periods because they can be addictive.

Recent scientific research shows

that it's not just light that affects our

body clocks, but they're also influenced by food.

And for some of our clocks, our

mealtimes will override other signals.

When you get on the plane, or even before you travel,

try to eat your meals at the

appropriate time for your new time zone.

This simple trick can make a big difference.

And tempting though the free wine might be, alcohol is off the menu.

Although it can help you get to sleep quicker,

you have a lower quality of sleep.

It can also dehydrate you and could lead to a hangover,

which can exacerbate jet lag symptoms.

However bad it feels at the time,

there's no evidence that jet lag

causes any long term health problems.

So get out in the daylight, join the new mealtimes,

and embrace your new time zone as soon as possible because, before you

know it, you'll be doing it all again on the way home.

Every day in the UK, 140 women are diagnosed with breast cancer.

Many will require surgery.

But accurately locating small tumours can be a problem.

Surgeon Gabriel Weston has been

investigating a new technique which may help.

In the fight against cancer,

the key aim of screening programmes

is to detect tumours before they have

a chance to grow and spread.

The next step is to remove the tumour and to be able to do this,

the surgeon needs a way to find it

within the patient once the operation has begun.

So what surgeons use to help them is this guide wire,

which is inserted right into the tumour,

with the wire left hanging outside of the body,

and then the surgeon in the

operating room follows this wire down and

cuts out the cancer at the end.

This technique has been used effectively for over 40 years.

But with screening programmes now able to detect tumours early,

as many as 50% are so small that the

surgeon may not be able to feel them.

This makes it difficult to know the

best route of approach or what tissue to remove.

So surgeons need new ways to pin-point

the cancer with precision.

This tiny magnetic marker could

transform the way surgeons locate small

tumours in the breast.

The technique involves using a

mammogram or ultrasound scan to locate the

tumour, and then implanting the magnetic marker or seed.

The hope is that during surgery

the device will help guide the

surgeon to the tumour reliably and precisely.

Today, Julie Werne is having an operation for breast cancer at the

Royal Marsden Hospital in Surrey.

She's taking part in a new clinical study of the magnetic technology.

Three days ago, she had a magnetic marker implanted in her tumour.

Julie, where did it all start?

It all started when I was due for my

usual three-year check-up at the local mobile unit.

Went along, had the mammogram,

and I was just expecting to get the letter on the mat three weeks

later, saying everything's fine and we'll see you in three years.

And that didn't happen.

It's sort of every woman's worst fear, isn't it?

-Oh, a complete nightmare. Yes, yeah.

-How did you find out about the new

technology that you've been a part of trialling today?

Well, I had a phone call from my

surgeon and she explained all about this

new procedure, and she said would I like to try this out?

And I thought it sounded wonderful and, yes, I agreed to it.

Breast surgeon Jennifer Rusby will be operating on Julie.

If the patient has a lump, I can remove the lump.

But this lady's cancer is so small that I wouldn't be able to feel it.

This is the seed here.

The cancer is almost undetectable, so we've got the seed put in

because at the time of surgery I

need to know which bit of breast to remove. With the seed,

we can place the probe on the breast and X marks the spot.

How do you see this giving an

advantage in terms of curing or removing

cancer from your patients?

One of the benefits of the seed may

be that I can get to that point in the

breast more accurately and therefore take away less normal, healthy

tissue from around it. And the main

goal of cancer surgery is to remove the

cancer and to get clear margins,

but the secondary intention is to

leave the breast looking as natural as it possibly can.

And the way we achieve that in breast surgery is by minimising the

amount of normal tissue that's removed.

One key advantage of the magnetic

marker is that it can guide the surgeon

to the tumour from any angle of approach.

Doctor Quentin Harmer is chief

technology officer for the company that has

developed this system.

-Can I have a turn?

-Have a go.

-Thank you.

To demonstrate, the seed is buried under a silicone breast.

Oh, yup. It starts to give a signal.

Yes, so the noise increases as they get closer,

and in fact you can translate the reading into a distance,

so surgeons can use that to help work out where they are

relative to the cancer.

And that's the sound you're

after when it starts to get very high like that.

And it's quite interesting that just changing the sort of

angle of how I'm tilting it makes a difference.

The probe gives you the ability to

pinpoint where the seed is and that's critical

so the surgeon has a very clear picture in their mind.

It enables them to get closer to the perfect excision -

just the tumour and the little margin around it.

Julie is one of the first women in the UK to be operated on using the

magnetic system.

One, two, three.

Can you pass the probe, please?

Getting a very high signal there

because we're right over the cancer.

It's making a very clearly high-pitched sound

to show her that she's getting

much nearer to her surgical target.

Guided by the probe,

Jenny is able to choose the shortest,

most direct route to the tumour.

This is less destructive to healthy tissue and also means that the

operation could be quicker.

It should almost be free now.

Just going to disconnect it from the breast tissue at the bottom here.

The cancerous tissue is now sent to be X-rayed to check that the tumour

has been completely removed with the minimal margin

of healthy tissue around it.

This is the seed which was located within the tumour and here's the

cancer, the sort of white hazy area in there.

So I think we need to take a little bit more here,

just to check that we've got some normal healthy tissue around it.

But the seed is present in the specimen.

This image for me

really shows the beauty of this kind of surgical ability married with

technology. Because what this seed

is enabling a surgeon like Jenny to do

is to be very specific about where she's going and where she's cutting.

And enabling her as best she can

to obey those two surgical demands of

removing all the cancer whilst preserving

as much healthy tissue as possible.

A few hours later, and Julie is able to go home.

Further lab tests on the removed tissue

should confirm the success of the operation.

Depending on the results of this small pilot study,

the research will move to a bigger trial involving 200 patients.

And the application doesn't stop with breast cancer.

Surgeons are also considering this technology for lung cancer patients,

for whom the preservation of healthy tissue is vital.

It really does look as if this may

in the future have a huge role to play

in the treatment of all kinds of cancer.

That's it from Guilford.

Next time, we're in Glasgow,

carrying out a fascinating experiment to find out the best way

to get a neglected nutrient, iodine, into our diets.

# I just made an appointment for a special rendezvous

# To see a man of miracles and all that he can do

# I checked in at reception put my hat to my lap

# And when he walked in dressed in white I had a heart attack

# Doctor, I want you

# Do what you want to do

# I can't get over you

# Doctor, do anything that you want to do. #