Episode 4 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 Moseley, 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.

This time, we're in Glasgow

where we're carrying out a

fascinating experiment to find the best way to

get an essential but often neglected nutrient into our diet.

Iodine.

Also in the programme, should you worry about having X-rays?

Can stress make you fat?

That was freaking awful!

Oh, my God!

And is the NHS spending your money wisely?

But first...

..when you think of vital nutrients you might be short of,

then perhaps iron springs to mind, or vitamin C.

But there is another which really doesn't make the headlines,

and it should. Iodine.

Iodine is absolutely essential to our health.

It's used by the thyroid gland to produce hormones that keep your body

working normally. Having low levels

of these hormones is linked to weight

gain, fatigue, and mood swings.

Iodine is also crucial during pregnancy and for young children.

It's key for healthy brain development.

Astonishingly, the UK ranks in the

top ten most iodine deficient nations in the world.

A national study of over 700 teenagers found that more than

two thirds have insufficient iodine.

One reason could be down to a key change in our diet in recent years.

In the UK, we get most of our iodine from drinking cows' milk,

but consumption of milk has

fallen dramatically over the last decade.

So where else do we get iodine in our food, and is it as good?

To find out, we've set up a brand-new experiment.

We've recruited a group of

volunteers to help us test three different

foods known to contain iodine.

Milk,

white fish,

and seaweed.

On three separate test days,

our volunteers eat a precise portion of one of these foods.

And we'll be measuring how much

iodine their bodies are actually taking in.

Running the study is Dr Emilie Combet

from the University of Glasgow.

You know how much iodine there is in these foods.

The question is how much of that

iodine our bodies will actually absorb.

We anticipate that this is going to

be different according to the type of foods.

After eating each food,

our volunteers have the delightful

task of collecting all the urine they

pass for the next 36 hours.

OK, so you're all going to get your urine packs.

And in here you've got one for the first hour,

you've got another one for the second hour, and so on.

On day two, you've got a big one for the last 12 hours,

so everything goes in there.

And the toilets are just over there.

To see how well our volunteers are absorbing the iodine,

we're testing their urine for

compounds that are the by-products of

chemical reactions in our cells.

Taking the samples up to the university,

carrying 20 kilos of your own pee up a hill,

it was harder than I thought it would be.

After 12 days and countless bottles of urine, the results are in.

And our volunteers are back.

Hi there.

Thank you very much for taking part in the study, and I know you've had

to do lots of lovely things like

collect your urine and also eat these foods.

So, Emilie, results time.

OK, so we looked at the graphs of the combined data from this group.

And what we could see is that actually

milk and fish gave us the same results.

In the first 12 hours, 50% of the dose came out in your urine.

So at the end of the experiment,

90% of the dose for milk and fish came out.

It meant that it had been absorbed and excreted again.

The levels of iodine compounds in their urine showed after 36 hours

our volunteers' bodies had extracted most of the iodine

from the milk and the fish.

Seaweed - a totally different picture.

After 12 hours, maybe 30% of the dose came out.

And at the end of the experiment,

only 50% of the dose of iodine from

the seaweed had gone in the blood and back out in the urine.

Despite seaweed containing a similar amount of

iodine to fish and milk,

our results suggest our bodies don't absorb as much of it.

So, why do we get iodine more

readily from milk and fish compared to seaweed?

We think that it's all in the food matrix and the type of

compounds to which iodine is bound in those foods.

So you can see from seaweed, it's this kind of fibrous food.

And, potentially, our body struggles to break down.

In our tests, all three foods were good sources of iodine.

Our results showed little difference between milk and fish.

Our bodies can easily absorb the iodine from both.

Seaweed was a less effective source of iodine in our test.

So broadly speaking,

there is a risk on our current diet of insufficiency of iodine.

But if you're eating adequate amounts of white fish and milk,

that's likely to solve the problem. Is that right?

We think people are definitely not consuming enough iodine and the key

sources in the British diet are going to be dairy or fish,

ideally white fish.

Obviously seaweed's a good choice as well,

but less easy to understand the dose that you're getting.

I think I'm trying to consider having a better diet overall,

and iodine's not something I considered in that,

but I will from this point on.

For this seaweed, I don't think I'm going to include this in my diet.

I was surprised to hear that women have a greater deficiency in iodine,

so, yeah, I definitely will try and

incorporate more iodine into my diet.

The good news is that for people who don't like or can't tolerate dairy,

there are alternatives.

White fish or seaweed will give you a good old dose.

The important thing, as far as I'm concerned,

is to make sure you're getting enough.

We all know that lots of stress makes us feel terrible,

but what's it doing to our bodies?

Dr Giles Yeo has been

investigating one of the silent side effects of stress.

It's well-established that chronic

stress is associated with some serious

conditions like heart disease.

But, surprisingly, it's now also been linked with putting on weight.

So I want to know, why might stress be linked to weight gain?

And is there anything we can do about it?

To find out, I've come to the University of Leeds,

where Dr Eleanor Scott and Dr Neil Boyle

are going to conduct an experiment on me.

A key risk factor in putting on weight

is elevated blood sugar levels,

so they're going to measure what

happens to my blood sugar levels when

they put me through an extremely stressful situation.

So, I'm a bit nervous,

but I'm about to have my mental and physical ability to handle stress

tested. And at the same time,

they're going to measure my glucose

levels using this sensor over here.

These tests are specially designed to be stressful.

Welcome to the Maastricht Acute Stress Test.

-OK.

-Instructions for the task will be presented on the screen.

Please read them carefully and ask any questions if you're unsure about

anything. Press the space-bar you're ready.

Subtract 17 from 2,043.

2043, that's 2,000...

The first test consists of counting backwards in 17s

from a very large number.

1,902.

Incorrect. Please start again.

-2,043.

-2,000...

I'm really feeling the pressure.

1,890?

-Quicker, please.

-1,000...

And as if that wasn't enough, there

is also a physical challenge to come.

ALARM RINGS

Oh, my God...

Further in, please. To the wrist.

I'm being asked to place my hand in a bath of ice cold water,

which will also cause a stress response in my body.

That was freaking awful!

Oh, my God...

Now, that was actually very, very painful.

I could not do basic maths. I mean, it was... It was really quite awful.

This experiment was not just about giving me a horrible afternoon.

The point was to measure what happened to my blood glucose.

Both yesterday, when I wasn't stressed, and today when I was,

Eleanor has been monitoring my levels.

So, I wasn't stressed yesterday,

and I was measuring my glucose. I was definitely stressed today.

What were the differences in my glucose levels?

What we've seen is that your glucose levels have stayed up higher than

they should do, and they're taking

much longer to come back down to normal.

This graph shows what happens to my blood glucose after eating a similar

meal on both days.

On day one, when I wasn't stressed,

my level rose sharply and then

returned to normal within half an hour.

A healthy response.

But on day two, after being stressed out for 20 minutes,

my blood glucose rose as before, but

took three hours to return to normal.

Six times as long.

It's a startling result, but why is my body responding in this way?

So, when you're stressed, you

release a variety of stress hormones.

So, cortisol is one, adrenaline is another,

and the effect that they have is they essentially tell your liver to

release glucose into your bloodstream.

And the idea is that it then

provides a very ready supply of energy for

your muscles. So in the past,

when we were running away from predators or whatever,

then that would have helped us run away.

It would have allowed us to survive.

Of course now we're in an environment

where we often have stress sat at a desk in an office,

and we don't physically move away or deal with it.

And what happens if you don't end up using the glucose that was actually

designed for your muscles for you to run away?

So, if it's not used immediately by your muscles,

then you will store it in other organs,

so some will go to your liver,

but a lot of it will be used and stored in your fat.

And it makes your body more

resistant to the effects of insulin that would

normally lower your glucose,

and it becomes a bit of a vicious cycle.

So what you're saying is that if you are chronically stressed,

then you could have a little bit

more glucose than you need in your blood

all of the time. And if you have

this for too long and you're susceptible,

that could tilt you into type II diabetes.

Yeah, that's right.

How interesting. I mean, I'm genuinely surprised actually about

the effect that the stress had on my glucose levels.

The results of my test are

consistent with larger studies that suggest

that stress raises blood sugar.

Because of the latest technologies such as this monitor,

we now know more about how stress can raise our blood glucose levels,

which can lead to really quite serious health problems.

But there is something we can do about it.

First, try a stress reducing

activity such as mindfulness, exercise,

or outdoor pursuits.

All things that do help as long as you pick one you enjoy.

Social contact can also help,

so try to spend time with others.

Then there's the diet part.

High sugar foods are exactly what you need least when you're stressed.

Nuts are a better choice.

Still to come - how can you spot a

mental health problem in a friend or colleague?

And is the NHS spending your money wisely?

But, first...

Thousands of you have been sending

in questions to the Trust Me website,

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

Should I worry about getting an X-ray?

One for GP Dr Zoe Williams.

It's over a century since X-rays

were discovered and first allowed doctors

to look inside a living human body.

Hi. Just for one, please.

Today, the NHS in England alone carries out

more than 22 million a year,

and millions more are performed by dentists.

There can't be many of us that

haven't had an X-ray to check for fractured

bones, or to let the dentist have a proper look at our teeth.

They're also used in CT scans to

build up an incredibly detailed image of our bodies.

The seemingly magical property of X-rays comes from what they

are made of. X-rays are a type of

high energy radiation that can easily

pass through most body tissues

like muscle and fat, but they're

blocked by denser material like bone.

When the body's exposed to an X-ray, the skeleton casts a shadow,

and this can be picked up by a detector.

But the very properties that make

them useful for seeing inside our body

are what make them harmful.

As they pass through us,

these high-energy rays can damage some of our cells

by causing changes in our DNA.

Changes that have been linked to an increased risk of cancer.

But the truth is we've been aware of the risks since the 1950s.

And these days the strength, quantity,

and duration of your exposure to radiation are controlled within very

strict guidelines.

So how much are we actually getting?

It's useful to compare X-rays to the background radiation that we're

exposed to every day from our environment.

Radon gas from the ground, cosmic rays from space,

and even the food - shh -

that we eat.

Background radiation, though unavoidable, is not harmless,

but its effects are virtually unnoticeable.

So how powerful are medical X-rays in comparison?

Imagine this tasty piece of popcorn

is the amount of background radiation

that we're exposed to every day.

It's also equivalent to the typical exposure from a dental X-ray.

Now, three to four popcorns is equivalent to that of a chest X-ray.

Put into perspective, during the average transatlantic flight,

we're exposed to more than three times this amount.

About 11 popcorns.

A CT scan would give you a bit more -

the equivalent of a whole box of popcorn.

Most of us have had a dental X-ray.

Even if we were to have two a year, every year of our life,

it would only raise our chance of

developing cancer by about 100th of 1%.

To receive a really dangerous level of radiation,

you'd need quite a bit more.

This is what you would need to even come close to a lethal dose over a

month, and there are almost a million pieces of popcorn in there.

So, infrequent X-rays are not that

harmful in the grand scheme of things,

but some of us have complex medical conditions that require a lot of

X-rays over our lifetime.

Multiple X-rays have a cumulative effect on the body,

so the more you have, the greater the amount of cell damage over time.

So, when appropriate,

your doctors will recommend

other types of imaging that don't use radiation.

For example, ultrasound, or magnetic resonance imaging,

an MRI scan. But in some cases, an X-ray is the best way to do the job,

and you and your doctor will need to

balance the risks and the benefits of having one.

If you're still concerned,

then my advice is to tell your doctor about

any previous X-rays you've had,

and this may prevent unnecessary X-rays in the future.

Ultimately, X-rays do have a tiny risk of increasing the likelihood of

cancer, but in medicine, the benefits hugely outweigh the risks.

In this series of Trust Me,

I'm investigating some of the most controversial health questions that

have made the headlines in the three decades I've been a medical

journalist. This time,

we all read stories in the paper about people who have been denied

life-saving drugs.

Some of you will have been personally affected by a treatment

you need not being available on the NHS.

So how does the NHS decide which

drugs or treatments to fund and which not to fund?

And what, if any, say do you have in the matter?

First, I'm meeting Professor Karl Claxton.

He's a health economist who believes the body that advises the NHS, NICE,

are approving too much spending on new drugs.

So, in your opinion, are the right treatments being funded?

I think, overall, no.

I think we are seeing a skew towards new, expensive

drug treatments at the

expense of other things the NHS does very well and could do more of.

There's a huge discrepancy between

what we're approving and what the NHS can actually afford.

Imagine I'm a typical NHS patient.

When do I become really expensive?

You become really expensive towards the end of life.

That's where most NHS money is spent.

There's been a whole load of research trying to establish whether

as a society, as individuals,

we think we should be devoting more resources at the end of life.

All of that research really doesn't

show any strong social preferences for doing that.

Nonetheless, that is what NICE currently does.

What are cost effective things,

things which you know you get a good bang for your buck?

Good examples would be interventions

in common mental health problems,

or for example hip replacement.

Sure. But if I'm a cancer patient,

and they're going to give me a nice, shiny, new drug which may improve my

chances of survival, then obviously I'm going to embrace it, aren't I?

Of course you want access.

The solution to this problem

is to sort out drug pricing so that the prices reflect how much the NHS

can afford to pay for the scale of the benefits that they offer.

Thank you very much.

Next, Dr Jane Adam.

She chairs one of NICE's committees that makes recommendations to the

NHS about funding new medications and treatments.

Am I right in thinking the NHS puts more resources into end of life, if

you like, the last few months of your life,

than they do the rest of your life?

If people are going to die of their disease within two years,

and this new treatment will give

them at least three months extra life,

then that can be valued at a higher

value that it would at other times in your life,

on the basis that when you are dying,

those extra few months can be particularly precious.

That is one hell of an assumption, isn't it?

It's for us as a society really to decide if that is correct.

If society does value that,

and does feel that that deserves special consideration.

Does price play a big role in the decisions you make?

If a drug is really,

really good and brings a huge amount of benefit to patients,

then the NHS will pay more for it.

But if it is of relatively limited benefit,

then it has to still be good

value, which means you have to pay less for it.

I think it would be lovely to say that every time a new drug was

developed, however much it cost, that we could just say, "Fine.

"Let's just buy it for everybody who might benefit from it."

We all know that the NHS budget is not unlimited, and this is an

opportunity to actually look really,

really closely at a new area of spending,

and to see if it really is value for money for the NHS.

So do the public have a say?

The public can comment, yes.

Anybody can respond and make a web comment and every comment that is

posted on the web is fed back to the committee.

-Thank you.

-Thank you.

I am really impressed by the amount of time and effort that goes into

trying to measure the cost effectiveness of what the NHS does.

That said, I also think the system is clearly being set up so as to

encourage a disproportionate spend on drugs.

Particularly the drugs that might

extend the end of your life by just a few months.

I think that is hard to justify.

Around one in six of us suffer from a common mental health disorder

such as depression or anxiety,

yet many do not seek help.

So, how can you spot this problem in

other people and what can you do about it?

Psychiatrist Dr Alain Gregoire

has been to Stirling to find out how

one organisation has been tackling things.

This is Stirling Albion Football Club.

The club is one of the first in

Scotland to train their staff to recognise

some warning signs of mental health problems.

It's a pioneering approach that has its roots in a tragedy

that's keenly felt here.

Chris Mitchell from Stirling became a professional footballer at 16,

playing at clubs in Scotland and England.

A great goal by Chris Mitchell.

A fantastic strike by Chris Mitchell.

What a wonderful free kick.

On the 7th of May 2016, he took his own life, aged just 27.

To his girlfriend Louise and father Phil, it came as a shock.

Looking back, are there any things that might have indicated that Chris

was really feeling very desperate?

Genuinely didn't see anything change at the time.

It's not really until after Chris's

death that we've sort of picked up on things.

The main thing is small changes in behaviour.

Distancing himself from family, friends.

Just trying to cover things up,

to mask to us that things were OK

when really they weren't.

Although there were smaller changes in Christopher,

never knew that what he was suffering. It was there,

right in front of us,

but he never portrayed that.

In front of our noses,

but Christopher hid it and we never,

never came to that conclusion at all.

Suicide is the biggest cause of death for men under 50,

and for women aged between 20 and 34.

So here at Stirling Albion,

they've put in place a system to

train the staff in what's known as mental health first aid.

The aim is to prevent anyone here suffering in silence,

and to identify and deal with

problems before they become overwhelming.

Instructor Mark Fleming has been working with the club for two years.

So, Mark, what is it exactly that you do?

So, I'm a mental health first aid

instructor in various working contexts,

but particularly within football club settings.

And what does that involve?

Basically involves training people to be able to spot the signs and

symptoms of poor mental health and

provide an appropriate first response.

I'm not enabling them to become

therapists or counsellors or mental health

experts and certainly not psychiatrists,

but just putting tools in their hands

so that they can spot the signs and symptoms.

Some signs that someone might be at risk include being withdrawn

or lost in thought,

losing their sense of humour,

being erratic, irritable, agitated,

tearful, or conversely, emotionless,

changes in appetite, weight, or sleep patterns,

and increased alcohol consumption.

So, what are the benefits of this training, do you think?

I think, first and foremost,

it deals with the stigma attached to mental health.

Especially in a football context.

If a footballer has a twisted ankle or a pulled hamstring,

he doesn't feel embarrassed or

ashamed, or foolish, or useless, or weak.

He just goes to see the doctor and gets it sorted.

But when it comes to a mental injury,

then there's a stigma attached that.

There's a feeling that, "I am weak, and useless and hopeless and

"a liability."

I think it provides listening skills to people and it also

gives them the confidence to approach people,

ask appropriate questions,

and be a bridge to the appropriate professional help.

So, if you think someone you know might be at risk,

what should you do?

Start by saying that you've noticed a change in their mood or behaviour,

without being critical.

Say you're concerned and ask if they'd like to talk.

Don't downplay their problems or say things like,

"What do you have to be depressed about?"

Listen and give them space to describe how they're feeling.

Offer to go with them to see a health professional.

And if you think they're at risk of suicide,

you can call their GP for an emergency appointment.

What they're doing for footballers here could be done in any workplace,

group, or community.

So if you recognise the early warning signs,

or you know someone who's

struggling with their mental health,

don't be afraid to give them the opportunity to talk about it.

Listen to them. Give as much support as you can,

encourage them to go see their GP if they need to.

These first steps can make an

enormous difference to their health and their lives.

That's it from us.

Next time, we're in Exeter,

where we'll be finding out if

beetroot can give your body and your brain a real boost.

# 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. #