Episode 5 Trust Me, I'm a Doctor


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Episode 5

Can beetroot and leafy greens give your body and brain a boost? Plus a look at the new generation flu vaccine and advice on which health apps for your phone can be trusted.


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

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

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We're here to weigh up the evidence

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and use our expertise to guide you

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through the contradictions and the confusions.

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We do research no-one else has done

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

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We listen to the questions you want answered,

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and ensure you get the information you need.

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We're here when you want to know

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the latest findings and not the latest fads.

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I'm Michael Mosley, and in this

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series, I'm joined by a team of doctors.

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Together, we'll cut through the hype,

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the headlines and the health claims.

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This is Trust Me I'm A Doctor.

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Hello and welcome to Trust Me.

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This time we're in Exeter, where we're carrying out a fascinating

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experiment to see if beetroot can bolster your brain and your body.

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Also in the programme...

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Health apps.

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There are hundreds of thousands out there, but which can you trust?

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The implant that's helping to rewire the brains of stroke survivors.

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This truly could be a breakthrough treatment for patients after stroke.

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And can the flu vaccine make you ill?

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But first...

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As every mother knows, green

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vegetables are incredibly good for you.

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What is less well known is it's the

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nitrates in the veg that give you much of the benefit.

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Now, that might sound surprising, because nitrates,

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when added as a preservative to processed meats,

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have been linked to an increased risk of certain cancers,

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so they've had some bad press.

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On the other hand, there have been claims that naturally occurring

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nitrates in vegetables like beetroot, rocket and spinach,

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can improve both our physical health and our mental sharpness.

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So, is that true?

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Can eating nitrate-rich vegetables

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really make a measurable difference to your body and to your brain?

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To find out, we're carrying out an experimental first.

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We've recruited six volunteers of different ages to test

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both the physical and mental effects of nitrates from veg.

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Helping us run our study is

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Professor Andy Jones from the University of Exeter.

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So, what is new about this?

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A couple of things. We're going to measure blood pressure,

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exercise performance, but also

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cognitive function because that's something

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that's relatively new, and we throw that into the mix as well.

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But we're also interested in what

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happens with healthy middle-aged people.

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Most of our work so far has been with young athletic subjects,

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and we're interested to see to what

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extent that can translate into a different population.

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OK, so this is basically people

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more like me and less like elite athletes.

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Just like me, yeah.

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When we digest food or drink that's rich in nitrates,

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our body converts it to nitric oxide,

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which makes our blood vessels widen.

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This in turn could produce some very interesting changes.

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To find out, we'll measure our volunteers' blood pressure,

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test their physical performance, and their mental sharpness.

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We'll do all three of these tests

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before and after three different meals -

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a carefully weighed-out salad containing spinach and rocket,

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both of which have naturally high levels of nitrates.

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A portion of yummy beetroot juice,

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which contains exactly the same levels of nitrates.

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And a control,

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a salad made from foods that

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naturally contain almost no nitrates.

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It's a single meal, so we'll see what

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it does and if we get even a small effect,

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that can give us some insight.

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And presumably you'll also be

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able to tell whether there is a difference

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depending on whether you eat it

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as a salad or you knock it back as a shot.

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Same amount of nitrate in both cases.

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Physiologically, it should be the same, but we shall see.

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After three days, our volunteers have tried all three meals

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and completed the test before and after each.

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Andy has crunched the data.

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Time for the results.

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Salads delicious?

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-They were very large.

-Very big.

-Very large.

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First, the blood pressure results.

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When you consumed the high nitrate salad,

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your blood pressure on average

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was around three millimetres of mercury lower,

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and what we also found is that those

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of you that had the highest blood pressure at baseline

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were those that benefited the most.

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That was also true for the beetroot shot,

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showing it didn't matter what form you took the nitrates in.

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It's an impressive result with significant health implications.

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Actually, you can calculate that if

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that if that were reproduced across the entire population,

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the incidents of adverse cardiovascular events

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like heart attacks and strokes could be reduced by around 10%.

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Next, what about physical performance?

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We measured the oxygen demand

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of cycling and that was reduced by about 5%.

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It suggests that the effort required to exercise at that intensity

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is lower, so people might be more inclined to exercise.

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So you can kind of walk to the shops with less effort?

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The tasks of daily living - climbing a flight of stairs,

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walking to the local shops - should feel a little bit easier,

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people ought to be able to do that

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for longer or to do it without fatigue, really.

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And it's legal, presumably?

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-It is, absolutely.

-It's legal for now.

-Yeah.

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So, positive results on both our physical health measures.

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But what about our third test?

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Did nitrates improve our volunteers' mental performance?

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The final one I'm really interested in is the effect on the brain,

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on their cognitive ability. What happened there?

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Well, disappointingly there was no change at rest, so when we just did

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their cognitive function pre- and

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post the salad there was no difference.

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-But?

-But...

-There's a but there.

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Yeah, because they did the cognitive

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function test again after they'd cycled.

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In the control condition, their cognitive performance became worse,

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but when they took the high nitrate salad,

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their function was better preserved.

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So, looking at mental performance,

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our experiment took a surprising turn.

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When our volunteers were well-rested,

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taking in nitrates didn't make any difference.

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But, after exercising,

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the nitrates stopped their mental performance dropping off.

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So, they weren't smarter but they were less dumber, if you like.

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As you fatigue, there's just kind of more for your brain to process.

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That was certainly offset when they were consuming nitrate.

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I think that's fascinating.

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I often cycle to work, so it seems a beetroot juice before I head off

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could help me stay sharp when I get there.

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We are encouraged to eat five a day, but I think there may be a little

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twist to it which is that it's actually the green leafy vegetables

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containing nitrate that may be particularly important.

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I must admit, I do find it incredibly interesting.

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The idea that you can get these sort of changes in your body and things

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which I was completely unaware of.

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I definitely noticed on the third day I had the high nitrate diet

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and the exercise really genuinely felt easier.

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I think what I've learnt is that eating a diet higher in nitrates

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is going to help me age well, and who doesn't want to age well?

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Now, I was surprised that a single meal or a shot of beetroot juice

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could do all those things - reduce blood pressure,

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have an effect on muscle efficiency,

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and also prevent brain fade during exercise.

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For me, the very clear message is you've got to guzzle those greens.

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We all know that flu can make us feel seriously unwell.

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And though an annual flu vaccination is offered on the NHS to children,

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the over-65s and people at clinical risk,

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less than two thirds of those eligible actually have it.

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So, what's the problem?

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One for GP Zoe Williams.

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Over the winter months, like many GPS,

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I see dozens of patients with flu,

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yet many people who are eligible for the flu jab choose not to have it.

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So why are people worried about the vaccine, and should you be?

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The most common reason I hear from

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people declining the vaccine is that the jab actually gave them flu.

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Well, that's not possible because

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there's absolutely no live virus in it.

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It takes about 7-14 days for your

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body to develop the protection after the vaccine,

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so if you actually contract the flu during this time,

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or even in the week before, then you might not be fully protected.

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And that protection is important

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because flu kills up to half a million people worldwide every year,

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and during a pandemic, this can escalate to millions.

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The biggest challenge facing

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the scientists developing the flu vaccine is

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that the virus is always changing,

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which makes it one of the most

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difficult diseases to predict and control.

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Imagine this gift box is a flu virus.

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It infects a cell and then it multiplies...

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But when viruses are copied, sometimes mistakes are made,

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and the virus mutates. It's still flu,

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but it looks slightly different.

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Our immune system gets to work and

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learns to recognise the original flu virus and starts to destroy it.

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But our immune system can't recognise the mutated flu virus

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because it looks slightly different, so it doesn't get destroyed.

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The slightly new flu can then infect cells and multiply and infect

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more people and the cycle goes all over again.

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To keep up with these mutations

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requires a massive ongoing research effort.

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Scientists have to constantly

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monitor the latest flu strains so they can update the vaccine.

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But this involves predicting

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which strains will be most common each winter.

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Some years that's more successful than others,

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but it's always worth having

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the flu jab because some protection is better than none at all.

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And in future, we may not need to be vaccinated every year.

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Researchers are working to create

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a new broad spectrum or universal flu vaccine,

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which will protect against more viruses and last longer.

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The research takes place in a tightly controlled quarantine unit,

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as it involves volunteers actually being infected with the flu.

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The principle behind the new vaccine is to target particular

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protein molecules that lie deep inside the virus.

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So, these gift boxes all look different on the outside...

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..but if we look inside,

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you can see that the gift in each one is exactly the same.

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And this is similar with flu viruses.

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Although the proteins on the outside mutate,

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the proteins deep inside stay the same.

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So if you can get your immune system to look for a protein deep inside

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every strain, then it will be able to spot and destroy any type of flu.

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And even if a new strain comes along in the future,

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the vaccine will continue to work.

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Kim Denney, CEO of one of the companies

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developing the universal flu vaccine, has agreed to tell me more.

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So, we know that the immune system can recognise the proteins on the

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outside of the virus. How can it see the proteins on the inside?

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Part of that is how an actual virus infects a cell,

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so a virus doesn't have much in and of itself.

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It's very clever so it hijacks your own cells.

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It gets inside and turns your cells into its own factory, and in order

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to do that, it's got to fold and unfold. That's how it replicates.

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So when that virus opens up

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and exposes the internal proteins

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that we're targeting for our vaccine,

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it'll be able to see it and recognise it.

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At the moment as a GP, it's really challenging to try

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and get patients in year after year for their flu vaccine.

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With this new technology, how often will they need to come in?

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Well, we don't know quite yet.

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We're hopeful that it could be less frequent than every year,

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up to three years, potentially up to five years.

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Even if you had to go in and get a booster shot, though,

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it's going to still be much better

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than a seasonal vaccine because it's broad spectrum coverage.

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-Again, we won't have to, every year, guess what is circulating.

-Yeah.

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We're still five to ten years away from a universal flu vaccine,

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but with research facilities like this,

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we're getting closer to better treatments for flu.

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And although the current vaccine isn't perfect, it does save lives.

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So if your GP recommends it, then please take the opportunity because

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it'll help protect you and those

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around you and it will not give you the flu.

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Coming up - the new implant that's

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helping rewire the brains of stroke survivors.

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And medical apps - which can you trust to help keep you healthy?

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But first, in this series of Trust Me,

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we are exploring some common mental health conditions.

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In this programme, psychiatrist

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Dr Alain Gregoire is looking at anxiety disorders.

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For most of us,

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anxiety is a perfectly normal reaction to many of the challenges

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that everyday life throws at us.

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But for some people, the anxious

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feelings and thoughts become so intense,

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so frequent and so disabling that it

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becomes a condition known as generalised anxiety disorder.

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It's called generalised because the

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anxiety experienced by sufferers is not confined to specific issues.

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Instead it spreads to almost every aspect of life.

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Almost 6% of the UK population has experienced GAD.

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Adele and Russell are among them.

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So, what's it like to live with this day to day?

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Oh, I could just be walking down the street,

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the switch in your brain goes like that, and then it's almost like

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someone's got their hand around your windpipe and squeezing it.

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These panic attacks were happening every day and they're very draining

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and the thoughts that you have

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during that time period are just warped.

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Really, really strange.

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For many people with GAD, feeling anxious is a daily occurrence.

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I'd worry about my husband driving to work,

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whether he'd get involved

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in a traffic accident, and until he'd phoned me,

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I would be in a highly anxious state,

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and you can completely convince yourself that that has actually

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taken place and then you feel almost

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disappointed when you get a phone call to say they haven't been,

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which is just a ridiculous reaction.

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The thought's ridiculous and the

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reaction to it is ridiculous, but you can't control it.

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If you think you or someone else is

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suffering from generalised anxiety disorder, what do you need to know?

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Some common signs are feeling on edge or fearful much of the time,

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excessive concerns and anxious thoughts,

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restlessness, and avoiding situations that make you anxious.

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There are also physical symptoms - a racing heart or skipped heart beats,

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rapid breathing, dry mouth, sweating, trembling, dizziness.

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Some people get panic attacks

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in which all of these features combine intensely.

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The exact psychological and physical symptoms will vary from person

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to person, and similarly research

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has identified a wide range of factors

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that can increase our vulnerability,

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including current stresses and past adverse life experiences,

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even stretching back to when we were babies in the womb.

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So what's the best way to start dealing with this?

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First, acknowledge that you have a problem,

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and then start talking about it.

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I suddenly realised that the

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level of anxious feelings that I was having and the thoughts

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that I was having weren't quite right,

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and I didn't really want to admit that,

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because nobody wants to admit that they've got a mental health problem,

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partly through the stigma of it, but

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also because of the fear of what is going to happen next.

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And I think accepting, accepting that you have a condition,

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that you have an illness, that there is something you struggle with,

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I think that is...that that in itself helps to improve.

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The day to day anxious feelings and thoughts we all get tend to go away

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quite quickly, but anxiety disorders can last for months or years,

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so it's really important

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to recognise them and get help as quickly as possible.

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What were the sorts of things that made a difference to you?

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Definitely find a support group if you can

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to talk openly about this over a coffee.

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And it doesn't matter whether

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the people have got different conditions,

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it's because you have this shared experience that matters.

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Treatment for GAD usually involves

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a talking therapy such as cognitive behavioural therapy, CBT,

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sometimes medication, or a combination of both.

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The CBT sessions that I had, I think, if anything,

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that was the best thing for me.

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We learned about mindfulness

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and sort of bringing yourself into the sort of present moment.

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There are also many changes you can make to help reduce your anxiety,

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such as exercising regularly,

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stopping smoking and cutting down on

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the amount of alcohol and caffeine you consume.

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Generalised anxiety disorder does

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not have to become a long-term disability

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if you recognise it and you get the right treatment.

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Understanding and support from other people and professional help

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will maximise your chances of a good recovery.

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Thousands of you have been sending

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in questions to the Trust Me website,

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

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Do the health apps on my phone really work?

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Zoe has been investigating.

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The market for health apps has exploded.

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There are now more than a quarter of

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a million to choose from for just about everything.

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From measuring your heart rate to dieting,

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from stress relief to getting a good night's sleep.

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For the consumer, harnessing the

0:19:320:19:34

power of the internet to improve our health might seem a great idea.

0:19:340:19:38

After all, many of these apps are free or cheap and make big claims.

0:19:380:19:44

As a GP, I can understand how this technology has the potential to give

0:19:440:19:49

people more control over their health and wellbeing and,

0:19:490:19:53

in theory, it could lead to less visits to the doctor.

0:19:530:19:55

But do these apps actually do what they claim?

0:19:570:20:00

Surprisingly, the app market

0:20:000:20:03

is largely unregulated with very little policing.

0:20:030:20:06

In fact, anyone with basic programming skills can create an app

0:20:060:20:10

without any quality or safety checks.

0:20:100:20:13

Research has shown that many health

0:20:140:20:17

apps are based on very little solid science.

0:20:170:20:20

The big app marketplaces found online do some basic checks

0:20:220:20:26

to make sure that the software will

0:20:260:20:27

work on your phone and to check for malware,

0:20:270:20:30

but they don't do any clinical

0:20:300:20:32

trialling to make sure that the health advice is sound.

0:20:320:20:35

And there's another snag, which I

0:20:350:20:37

can demonstrate using a selection of smartphones.

0:20:370:20:41

One of the most popular forms

0:20:410:20:42

of apps are those that use your phone's hardware

0:20:420:20:46

to take a physical body measure.

0:20:460:20:48

For instance, this one, which claims to measure your heart rate.

0:20:480:20:52

It uses the phone's camera and flash to illuminate the skin and capture

0:20:530:20:58

minuscule colour changes that happen each time the heart beats.

0:20:580:21:03

But look what happens when I use

0:21:030:21:04

the same app to take my heart rate on this phone...

0:21:040:21:07

..compared to this one...

0:21:090:21:10

..and compared to this one.

0:21:120:21:15

Same app, three different readings.

0:21:160:21:19

The problem is the quality

0:21:190:21:20

of the hardware varies widely from phone to phone.

0:21:200:21:24

So the readings can often be inaccurate,

0:21:240:21:27

which could be misleading

0:21:270:21:28

and potentially more dangerous for your health.

0:21:280:21:31

This inaccuracy combined with a lack

0:21:310:21:34

of testing makes it really hard to know which apps you can trust.

0:21:340:21:38

Well, the NHS is a good place to start.

0:21:380:21:40

They have a library of medical apps, and although it's a small selection,

0:21:400:21:43

at least you know they've been tried and tested.

0:21:430:21:46

Apps here have all been put through

0:21:460:21:48

their paces by clinical professionals

0:21:480:21:51

and those labelled as "approved" will have proven health benefits.

0:21:510:21:55

They don't depend on complex hardware,

0:21:550:21:58

so both simple and effective,

0:21:580:22:00

but many of us will still want to download apps from the usual places,

0:22:000:22:03

so here are my top tips to help you weed out the duds.

0:22:030:22:06

Check that the app is made by an organisation you trust,

0:22:080:22:11

such as the British Heart Foundation or the NHS.

0:22:110:22:15

These apps are more likely to be based on solid science.

0:22:150:22:19

And look what the reviews say.

0:22:190:22:20

Read the comments carefully

0:22:200:22:22

and leave some of your own too, to help others.

0:22:220:22:24

I truly believe in empowering people to manage their own health and

0:22:250:22:29

prevent disease, and apps can be a really useful way of doing that.

0:22:290:22:34

They can also be useful for logging information to share with your GP.

0:22:340:22:38

But when it comes to diagnosis and managing disease,

0:22:380:22:41

they'll never replace a GP.

0:22:410:22:43

People who have had a stroke are

0:22:510:22:52

often left with a loss of function in their hands and arms.

0:22:520:22:56

Surgeon Gabriel Weston has been

0:22:560:22:58

investigating a novel therapy that really could change their lives.

0:22:580:23:02

Every year in the UK, 100,000 people have a stroke.

0:23:040:23:09

Most survivors face dramatic changes to their lives.

0:23:090:23:13

Almost two thirds leave hospital with a disability.

0:23:130:23:17

The most common form of stroke

0:23:180:23:20

is one that's caused by the blood supply to

0:23:200:23:22

the brain being cut off by a blocked artery.

0:23:220:23:25

Now, this can have bad effects throughout the body,

0:23:250:23:28

but up to 75% of stroke survivors report some form of weakness

0:23:280:23:33

or loss of mobility in the arms and hands,

0:23:330:23:36

and this is the single biggest

0:23:360:23:39

reason why these patients need long-term care.

0:23:390:23:42

But a new form of therapy promises to transform the chances

0:23:440:23:48

of restoring movement and strength for patients like Linda.

0:23:480:23:52

She had a stroke four years ago.

0:23:520:23:54

It was New Year. I'd been at my sisters.

0:23:550:23:58

We'd had our dinner and I went to my bed.

0:23:580:24:00

And then I woke up in the morning and I spoke to my husband,

0:24:000:24:02

and he realised when I'd spoke to him that there was something wrong.

0:24:020:24:06

He put the light on

0:24:060:24:07

and then discovered my face had been drooping.

0:24:070:24:10

Linda's stroke left her with severely impaired mobility.

0:24:120:24:16

I couldn't go to the toilet myself. I couldn't move any of my left arm,

0:24:160:24:20

my left leg. I was totally immobile. I just couldn't move at all.

0:24:200:24:24

Patients normally go through a

0:24:240:24:26

course of physiotherapy to help them regain hand and arm strength.

0:24:260:24:31

But in many cases, this isn't fully effective,

0:24:310:24:34

and patients are left with long-term problems.

0:24:340:24:38

Right, we're going to start off with the cutlery, then, first.

0:24:380:24:41

But Linda is now taking part in an

0:24:410:24:43

innovative new trial at the Queen Elizabeth Hospital in Glasgow.

0:24:430:24:48

The aim is to compensate for the damage to the brain

0:24:480:24:51

by stimulating a key nerve in the body, the vagus nerve.

0:24:510:24:55

Lovely wrist position there.

0:24:550:24:57

The vagus nerve runs from the brain through the neck to the abdomen

0:24:570:25:01

and has many functions throughout the body.

0:25:010:25:04

The innovation at the heart of this new treatment is a surgical implant

0:25:040:25:08

that uses the nerve to send electrical impulses to the brain.

0:25:080:25:13

The trial is being run by professor of stroke medicine, Dr Jesse Dawson.

0:25:130:25:19

So, this is the implantable pulse generator,

0:25:190:25:23

so this is the electrical box, if you like,

0:25:230:25:25

and it sits just under the collarbone,

0:25:250:25:27

underneath the skin on the left-hand side.

0:25:270:25:30

During the operation, the surgeon will connect this lead,

0:25:300:25:33

which will be inserted into the device

0:25:330:25:36

and will take the electrical

0:25:360:25:37

signals up to the vagus nerve on the left-hand side.

0:25:370:25:40

Check to make sure it's simulated.

0:25:400:25:42

And the lead will also be fully implanted underneath the skin.

0:25:420:25:45

Once the device is in,

0:25:450:25:47

the participant would have six weeks of very intensive physical therapy.

0:25:470:25:51

If you can pick this weight up and place it on its end here, right?

0:25:510:25:55

Linda had her device implanted over two years ago.

0:25:550:26:00

It's believed that stimulating the vagus nerve at the same time as

0:26:000:26:04

repeating physical actions

0:26:040:26:06

encourages the brain to bypass the areas damaged by stroke.

0:26:060:26:11

So each time Linda performs a task during the therapy session,

0:26:110:26:14

the therapist will press the push button,

0:26:140:26:16

and that will then activate the computer

0:26:160:26:19

and tell it to send a wireless signal to the device,

0:26:190:26:21

which then stimulates the vagus nerve.

0:26:210:26:23

That sends a signal to the main control centre in the brain,

0:26:230:26:26

the brainstem, and by activating the brainstem,

0:26:260:26:28

we then cause a release of several important chemicals onto the surface

0:26:280:26:31

of the brain and we think that it's

0:26:310:26:33

increasing the concentration of those chemicals at the same time

0:26:330:26:36

that somebody's training that

0:26:360:26:38

increases the ability of the brain to rewire itself and recover.

0:26:380:26:41

Early results from the trial are promising.

0:26:420:26:45

Before this treatment,

0:26:450:26:47

Linda struggled with carrying out even basic tasks,

0:26:470:26:50

but now she's able to manage most everyday activities.

0:26:500:26:54

I can't really put it into words, like,

0:26:550:26:57

how good it is to be improved as much as I am.

0:26:570:27:01

It's brought normality and independence back to me,

0:27:010:27:04

being a person,

0:27:040:27:06

and I don't need to rely on anybody now and I'm just me.

0:27:060:27:09

In the 17 or so years since I've become a doctor,

0:27:110:27:14

I've seen tonnes of patients with strokes who get to a certain point

0:27:140:27:18

in their recovery and then just don't get any better,

0:27:180:27:21

so to see this patient get such a dramatic result is really amazing.

0:27:210:27:27

A larger study is now planned to assess whether this treatment

0:27:270:27:31

should be made available to stroke survivors across the world.

0:27:310:27:34

We know that our traditional

0:27:340:27:36

techniques just don't get enough people better,

0:27:360:27:39

and there are tens of thousands of patients in the UK who could

0:27:390:27:42

benefit from this therapy and many more worldwide.

0:27:420:27:45

This truly could be a breakthrough

0:27:450:27:47

treatment for patients with upper limb problems after stroke.

0:27:470:27:50

Excellent.

0:27:500:27:52

Well done. OK...

0:27:520:27:53

What I've seen here today has

0:27:550:27:57

reminded me that stroke is incredibly common,

0:27:570:27:59

and can happen at any time in a patient's life.

0:27:590:28:03

Now, this research is in its very early stages,

0:28:030:28:06

but on the basis of what I've witnessed,

0:28:060:28:08

I think this device holds out real

0:28:080:28:11

hope to patients suffering from stroke

0:28:110:28:14

and the people who look after them.

0:28:140:28:16

That's it for this edition of Trust Me.

0:28:230:28:25

Next time, we're in Leeds,

0:28:250:28:28

finding out what type of exercise gives you the strongest bones.

0:28:280:28:33

# I've just made an appointment for a special rendezvous

0:28:330:28:37

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

0:28:370:28:43

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

0:28:430:28:47

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

0:28:470:28:52

# Doctor I want you

0:28:520:28:55

# Do what you want to do

0:28:550:28:57

# I can't get over you

0:28:570:28:59

# Doctor do anything that you want to do. #

0:28:590:29:02

Michael Mosley runs an experiment to test whether beetroot and leafy greens can give your body and brain a boost. GP Dr Zoe Williams investigates the new generation flu vaccine and gives advice on which health apps for your phone can be trusted. Surgeon Gabriel Weston discovers a new treatment that promises to improve the mobility of stroke survivors. And psychiatrist Dr Alain Gregoire reveals how to spot generalised anxiety disorder and what you can do about it.