Episode 5 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.

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

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

Also in the programme...

Health apps.

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

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

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

And can the flu vaccine make you ill?

But first...

As every mother knows, green

vegetables are incredibly good for you.

What is less well known is it's the

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

Now, that might sound surprising, because nitrates,

when added as a preservative to processed meats,

have been linked to an increased risk of certain cancers,

so they've had some bad press.

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

nitrates in vegetables like beetroot, rocket and spinach,

can improve both our physical health and our mental sharpness.

So, is that true?

Can eating nitrate-rich vegetables

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

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

We've recruited six volunteers of different ages to test

both the physical and mental effects of nitrates from veg.

Helping us run our study is

Professor Andy Jones from the University of Exeter.

So, what is new about this?

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

exercise performance, but also

cognitive function because that's something

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

But we're also interested in what

happens with healthy middle-aged people.

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

and we're interested to see to what

extent that can translate into a different population.

OK, so this is basically people

more like me and less like elite athletes.

Just like me, yeah.

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

our body converts it to nitric oxide,

which makes our blood vessels widen.

This in turn could produce some very interesting changes.

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

test their physical performance, and their mental sharpness.

We'll do all three of these tests

before and after three different meals -

a carefully weighed-out salad containing spinach and rocket,

both of which have naturally high levels of nitrates.

A portion of yummy beetroot juice,

which contains exactly the same levels of nitrates.

And a control,

a salad made from foods that

naturally contain almost no nitrates.

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

it does and if we get even a small effect,

that can give us some insight.

And presumably you'll also be

able to tell whether there is a difference

depending on whether you eat it

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

Same amount of nitrate in both cases.

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

After three days, our volunteers have tried all three meals

and completed the test before and after each.

Andy has crunched the data.

Time for the results.

Salads delicious?

-They were very large.

-Very big.

-Very large.

First, the blood pressure results.

When you consumed the high nitrate salad,

your blood pressure on average

was around three millimetres of mercury lower,

and what we also found is that those

of you that had the highest blood pressure at baseline

were those that benefited the most.

That was also true for the beetroot shot,

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

It's an impressive result with significant health implications.

Actually, you can calculate that if

that if that were reproduced across the entire population,

the incidents of adverse cardiovascular events

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

Next, what about physical performance?

We measured the oxygen demand

of cycling and that was reduced by about 5%.

It suggests that the effort required to exercise at that intensity

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

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

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

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

people ought to be able to do that

for longer or to do it without fatigue, really.

And it's legal, presumably?

-It is, absolutely.

-It's legal for now.

-Yeah.

So, positive results on both our physical health measures.

But what about our third test?

Did nitrates improve our volunteers' mental performance?

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

on their cognitive ability. What happened there?

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

their cognitive function pre- and

post the salad there was no difference.

-But?

-But...

-There's a but there.

Yeah, because they did the cognitive

function test again after they'd cycled.

In the control condition, their cognitive performance became worse,

but when they took the high nitrate salad,

their function was better preserved.

So, looking at mental performance,

our experiment took a surprising turn.

When our volunteers were well-rested,

taking in nitrates didn't make any difference.

But, after exercising,

the nitrates stopped their mental performance dropping off.

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

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

That was certainly offset when they were consuming nitrate.

I think that's fascinating.

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

could help me stay sharp when I get there.

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

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

containing nitrate that may be particularly important.

I must admit, I do find it incredibly interesting.

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

which I was completely unaware of.

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

and the exercise really genuinely felt easier.

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

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

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

could do all those things - reduce blood pressure,

have an effect on muscle efficiency,

and also prevent brain fade during exercise.

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

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

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

the over-65s and people at clinical risk,

less than two thirds of those eligible actually have it.

So, what's the problem?

One for GP Zoe Williams.

Over the winter months, like many GPS,

I see dozens of patients with flu,

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

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

The most common reason I hear from

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

Well, that's not possible because

there's absolutely no live virus in it.

It takes about 7-14 days for your

body to develop the protection after the vaccine,

so if you actually contract the flu during this time,

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

And that protection is important

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

and during a pandemic, this can escalate to millions.

The biggest challenge facing

the scientists developing the flu vaccine is

that the virus is always changing,

which makes it one of the most

difficult diseases to predict and control.

Imagine this gift box is a flu virus.

It infects a cell and then it multiplies...

But when viruses are copied, sometimes mistakes are made,

and the virus mutates. It's still flu,

but it looks slightly different.

Our immune system gets to work and

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

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

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

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

more people and the cycle goes all over again.

To keep up with these mutations

requires a massive ongoing research effort.

Scientists have to constantly

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

But this involves predicting

which strains will be most common each winter.

Some years that's more successful than others,

but it's always worth having

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

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

Researchers are working to create

a new broad spectrum or universal flu vaccine,

which will protect against more viruses and last longer.

The research takes place in a tightly controlled quarantine unit,

as it involves volunteers actually being infected with the flu.

The principle behind the new vaccine is to target particular

protein molecules that lie deep inside the virus.

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

..but if we look inside,

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

And this is similar with flu viruses.

Although the proteins on the outside mutate,

the proteins deep inside stay the same.

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

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

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

the vaccine will continue to work.

Kim Denney, CEO of one of the companies

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

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

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

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

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

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

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

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

So when that virus opens up

and exposes the internal proteins

that we're targeting for our vaccine,

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

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

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

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

Well, we don't know quite yet.

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

up to three years, potentially up to five years.

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

it's going to still be much better

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

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

-Yeah.

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

but with research facilities like this,

we're getting closer to better treatments for flu.

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

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

it'll help protect you and those

around you and it will not give you the flu.

Coming up - the new implant that's

helping rewire the brains of stroke survivors.

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

But first, in this series of Trust Me,

we are exploring some common mental health conditions.

In this programme, psychiatrist

Dr Alain Gregoire is looking at anxiety disorders.

For most of us,

anxiety is a perfectly normal reaction to many of the challenges

that everyday life throws at us.

But for some people, the anxious

feelings and thoughts become so intense,

so frequent and so disabling that it

becomes a condition known as generalised anxiety disorder.

It's called generalised because the

anxiety experienced by sufferers is not confined to specific issues.

Instead it spreads to almost every aspect of life.

Almost 6% of the UK population has experienced GAD.

Adele and Russell are among them.

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

Oh, I could just be walking down the street,

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

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

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

and the thoughts that you have

during that time period are just warped.

Really, really strange.

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

I'd worry about my husband driving to work,

whether he'd get involved

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

I would be in a highly anxious state,

and you can completely convince yourself that that has actually

taken place and then you feel almost

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

which is just a ridiculous reaction.

The thought's ridiculous and the

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

If you think you or someone else is

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

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

excessive concerns and anxious thoughts,

restlessness, and avoiding situations that make you anxious.

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

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

Some people get panic attacks

in which all of these features combine intensely.

The exact psychological and physical symptoms will vary from person

to person, and similarly research

has identified a wide range of factors

that can increase our vulnerability,

including current stresses and past adverse life experiences,

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

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

First, acknowledge that you have a problem,

and then start talking about it.

I suddenly realised that the

level of anxious feelings that I was having and the thoughts

that I was having weren't quite right,

and I didn't really want to admit that,

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

partly through the stigma of it, but

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

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

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

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

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

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

so it's really important

to recognise them and get help as quickly as possible.

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

Definitely find a support group if you can

to talk openly about this over a coffee.

And it doesn't matter whether

the people have got different conditions,

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

Treatment for GAD usually involves

a talking therapy such as cognitive behavioural therapy, CBT,

sometimes medication, or a combination of both.

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

that was the best thing for me.

We learned about mindfulness

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

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

such as exercising regularly,

stopping smoking and cutting down on

the amount of alcohol and caffeine you consume.

Generalised anxiety disorder does

not have to become a long-term disability

if you recognise it and you get the right treatment.

Understanding and support from other people and professional help

will maximise your chances of a good recovery.

Thousands of you have been sending

in questions to the Trust Me website,

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

Do the health apps on my phone really work?

Zoe has been investigating.

The market for health apps has exploded.

There are now more than a quarter of

a million to choose from for just about everything.

From measuring your heart rate to dieting,

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

For the consumer, harnessing the

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

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

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

people more control over their health and wellbeing and,

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

But do these apps actually do what they claim?

Surprisingly, the app market

is largely unregulated with very little policing.

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

without any quality or safety checks.

Research has shown that many health

apps are based on very little solid science.

The big app marketplaces found online do some basic checks

to make sure that the software will

work on your phone and to check for malware,

but they don't do any clinical

trialling to make sure that the health advice is sound.

And there's another snag, which I

can demonstrate using a selection of smartphones.

One of the most popular forms

of apps are those that use your phone's hardware

to take a physical body measure.

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

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

minuscule colour changes that happen each time the heart beats.

But look what happens when I use

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

..compared to this one...

..and compared to this one.

Same app, three different readings.

The problem is the quality

of the hardware varies widely from phone to phone.

So the readings can often be inaccurate,

which could be misleading

and potentially more dangerous for your health.

This inaccuracy combined with a lack

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

Well, the NHS is a good place to start.

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

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

Apps here have all been put through

their paces by clinical professionals

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

They don't depend on complex hardware,

so both simple and effective,

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

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

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

such as the British Heart Foundation or the NHS.

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

And look what the reviews say.

Read the comments carefully

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

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

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

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

But when it comes to diagnosis and managing disease,

they'll never replace a GP.

People who have had a stroke are

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

Surgeon Gabriel Weston has been

investigating a novel therapy that really could change their lives.

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

Most survivors face dramatic changes to their lives.

Almost two thirds leave hospital with a disability.

The most common form of stroke

is one that's caused by the blood supply to

the brain being cut off by a blocked artery.

Now, this can have bad effects throughout the body,

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

or loss of mobility in the arms and hands,

and this is the single biggest

reason why these patients need long-term care.

But a new form of therapy promises to transform the chances

of restoring movement and strength for patients like Linda.

She had a stroke four years ago.

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

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

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

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

He put the light on

and then discovered my face had been drooping.

Linda's stroke left her with severely impaired mobility.

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

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

Patients normally go through a

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

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

and patients are left with long-term problems.

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

But Linda is now taking part in an

innovative new trial at the Queen Elizabeth Hospital in Glasgow.

The aim is to compensate for the damage to the brain

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

Lovely wrist position there.

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

and has many functions throughout the body.

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

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

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

So, this is the implantable pulse generator,

so this is the electrical box, if you like,

and it sits just under the collarbone,

underneath the skin on the left-hand side.

During the operation, the surgeon will connect this lead,

which will be inserted into the device

and will take the electrical

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

Check to make sure it's simulated.

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

Once the device is in,

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

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

Linda had her device implanted over two years ago.

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

repeating physical actions

encourages the brain to bypass the areas damaged by stroke.

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

the therapist will press the push button,

and that will then activate the computer

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

which then stimulates the vagus nerve.

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

the brainstem, and by activating the brainstem,

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

of the brain and we think that it's

increasing the concentration of those chemicals at the same time

that somebody's training that

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

Early results from the trial are promising.

Before this treatment,

Linda struggled with carrying out even basic tasks,

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

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

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

It's brought normality and independence back to me,

being a person,

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

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

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

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

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

A larger study is now planned to assess whether this treatment

should be made available to stroke survivors across the world.

We know that our traditional

techniques just don't get enough people better,

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

benefit from this therapy and many more worldwide.

This truly could be a breakthrough

treatment for patients with upper limb problems after stroke.

Excellent.

Well done. OK...

What I've seen here today has

reminded me that stroke is incredibly common,

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

Now, this research is in its very early stages,

but on the basis of what I've witnessed,

I think this device holds out real

hope to patients suffering from stroke

and the people who look after them.

That's it for this edition of Trust Me.

Next time, we're in Leeds,

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

# I've 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. #