Trust Me I'm A Doctor (2013) s05e02 Episode Script

Series 5, Episode 2

1 When it comes to our health it seems everyone has an opinion and everyone has an agenda.
So what's the health advice you can really trust? We're here to weigh up the evidence and use our expertise to guide you Through the contradictions and the confusions.
We do the research no one else has done.
And put your health at the heart of what we do to ensure that you get the information that you need.
We're here when you want to know the latest findings, and not just the latest fads.
I'm Michael Mosley.
In this series I'm joined by a team of doctors.
Together, we'll cut through the hype, the headlines and the health claims.
This is Trust Me I'm A Doctor.
This time we're in Worcester, running a big experiment to find out, is going gluten-free really good for us? I get hypnotised to discover if this could be the next big thing in medicine.
We reveal the tiny implant which could switch off rheumatoid arthritis.
I have my life back.
For those of us unsteady on our feet, we reveal the secret to better balance.
And does stretching our muscles before exercise actually do any good? But first Welcome to the historic city of Worcester.
The British Medical Association was founded here over 180 years ago.
We're here, however, to do an experiment to find out what the effects of going gluten-free are.
Over to Dr Chris van Tulleken.
We now spend about £180 million a year avoiding gluten, with an estimated 8.
5 million of us is going gluten-free in the last year or so.
Gluten is a protein found in grains like wheat, rye and barley, and foods that many of us take for granted like bread and pasta are full of it.
Giving it up isn't straightforward.
So who exactly should consider making the sacrifice? Well, there are a small number of people who have to avoid gluten.
About 1% of people have a condition called coeliac disease.
When they eat gluten their immune system is stimulated in such a way that it ends up attacking their own bodies.
This damages the intestines and limits the body's ability Coeliac disease can be diagnosed with a biopsy from the intestines and then it is a lifetime of avoiding gluten for sufferers.
There are a few other people for whom gluten-free is a short cut to knowing something is free from wheat.
A tiny proportion of people, around a tenth of 1%, are allergic to wheat and going gluten-free is a good way of avoiding it.
Now, if these people eat wheat, within minutes, they have an immune response similar to hay fever, sneezing, itching and rashes.
In rare cases they can have a more severe anaphylactic reaction which can be fatal.
But apart from those who need to avoid these foods, there is a significant proportion of the population who have voluntarily gone gluten-free.
In fact, about 15% of people think it is healthier for them or they have some sort of intolerance to gluten, giving gut symptoms like bloating and wind.
But are they right? For some doctors, gluten intolerance is controversial.
Patients describe digestive symptoms after eating gluten.
But on testing they have no abnormality with their immune system or their guts.
So it doesn't appear to be an allergy or coeliac disease.
The question is, are these people hypochondriacs or are they suffering with something that science has yet to describe? To find out, we've come to Worcester to run an experiment.
We're going to see just what effect a gluten-free diet has an 60 people, some of whom think they might have a gluten intolerance, and others who don't believe it exists.
If I have a pizza I know about it the next day! So bloating, wind? More of a sicky feeling, as if you've eaten something dodgy.
Because I've had IBS for over 20 years, I thought this would be an opportunity to take part in a proper experiment and to see whether I could alleviate some of the bloating and noise Nausea.
And noise! Noisea! I joined up in the hope that I would be proven that cynicism rules.
Why? I think I'm allergic to nothing.
But they won't be gluten-free all the time.
Although they are being asked to cut out all gluten from their diet for the next six weeks, we are supplying them with some special pasta.
This is normal pasta, full of gluten.
And this is gluten-free pasta.
Each day of the trial, every volunteer will eat a pasta meal, but at no point will they know whether the pasta they are eating contains gluten or is gluten-free.
So all our volunteers will have weeks when they are gluten-free and weeks when they are eating gluten but they won't know when, nor will the scientists.
Before the trial starts, we check that none of the volunteers actually have coeliac disease or a wheat allergy because we know that they will have a reaction to the pasta.
We want to find out if gluten could affect other people without these conditions, so we will be asking everyone to record any symptoms they have every fortnight, and we will be taking regular blood samples to examine their immune system and look for markers of gut inflammation.
Do some people really suffer gut trouble when they eat gluten, and is there a blood test which could confirm if this intolerance is real? We don't really know what to expect from this trial.
First of all, we should be able to pin down whether the people who claim they get symptoms when they eat gluten really do, because of course they won't know when they are eating it and when they are not.
And secondly, we hope that our blood tests should be able to shed some light on what is going on in our volunteers' bodies.
Do those people who get symptoms also show a reaction on their blood tests for their immune system and their gut inflammation? And finally, could it be that gluten is affecting all of us badly? We'll find out the results later in the programme.
Like many of us, my vision has never been perfect.
As I get older, it's getting worse.
Now, most of us don't worry about our eyesight until things start to go wrong.
What can we all do to prevent problems and perhaps even improve our eyesight as we get older? I've come to Waterford in south-east Ireland to find out about some ground-breaking research which suggests what we eat could make a difference.
To discover why, I need to look right to the back of my eye as Professor John Nolan explains.
What we are looking at here, Michael, is an image at the back of your eye, an area known as the retina which is basically responsible for vision.
Now, the centre part of the retina is known as the macula.
And the macula is very important because it is where about 90% of our vision is mediated from.
The macula is protected by special coloured pigments.
These act as a sunscreen for the eyes to block harmful UV light.
It is thought they are a key part of good eyesight.
So the researchers here believe that if we boost our pigments, we might be able to boost our vision too.
Pigments in your macula which protect your eyes against sunlight come from food, in particular from leafy green spinach, kale, bright red peppers and from the yellow yolk of eggs.
If we eat enough of the right kinds of foods, the theory is we end up with three key chemicals in our blood.
Lutein, zeaxanthin and meso-zeaxanthin.
If the theory is right, these should make their way from our blood to our macula and improve our eyesight.
To find out if this theory is true, we got a group of ten volunteers here in Waterford, and me.
Every day for the next five weeks, our volunteers will drink a daily smoothie made of a special recipe.
It's not really long enough to expect any improvement in their eyesight, but we will be able to test a crucial first stage, whether their daily smoothie can boost the pigment compounds in their blood.
I hear the kiwi takes away the amount of kale! I want to take part in this experiment as well, but I'm going to test a different way to get these crucial chemicals.
One that is also the subject of research.
I'm going to be taking some supplements and see what effect that has.
The supplements have concentrated amounts of the three key pigment chemicals.
I'm testing whether these instant high levels will really make a difference to my eyesight.
I'm going to be taking the supplements for 12 weeks.
At the beginning and end I'm having my eyes tested.
They'll measure the levels of the pigment chemicals in my eye, and also test every aspect of my eyesight, from my perception of detail and colour, to my night vision.
Meanwhile, over in Ireland, our smoothie-sucking volunteers are having their blood tested to see if they now have high levels of the all-important chemicals.
So how did we all get on? Firstly, our volunteers.
After five weeks of the smoothie diet, the levels of one of the three key chemicals in their blood, lutein was significantly boosted.
It is not long enough to see the effects on their eyesight but research into this is ongoing.
More is already known about the effect of supplements which can deliver a controlled dose of chemicals into the blood.
So, how have I fared after my 12 week regime? After a thorough re-test of my eyes, it is results time.
The results are interesting, in fact we could significantly increase your macula pigment levels.
So the chemicals definitely went into my eyes and the pigment significantly increased.
But would that make any real difference to my eyesight? When we look at your contrast sensitivity measures, we can see at the end of the experiment your vision now is greatly enhanced.
So my levels of these vital pigments all went up? Yes.
And my vision improved pretty much across the board? Yes.
I can now see objects that are significantly smaller and fainter than I could before.
I also notice colours more vividly, particularly yellows and blues.
The most important change though is in my night vision.
I can see much finer detail in the dark.
It's an outstanding result, but that's not all.
John and his team have come across something unexpected that could have an even greater impact on our health.
It's recently been found in studies of people It's recently been found in studies of people with Alzheimer's disease that there is an unforeseen link to these compounds.
What is really striking is that the subjects that had the high amount of macula pigment have significantly better cognitive performance when compared to the subjects with low levels.
So the idea here is the macula pigment may in fact be a very important measure of the risk about sinus disease.
important measure of the risk of Alzheimer's disease.
It may be that detecting high levels of these chemicals means that people are getting a healthy diet, rich in fruit and vegetables which is as good for the brain as it is for the eyes.
So it seems, many of us could improve our eyesight simply by eating more of these colourful plant chemicals.
But although a healthy diet is important, the research suggests for once it is cheaper and more effective simply Check that they contain lutein, zeaxanthin and meso-zeaxanthin.
Now, on the whole, I'm not a fan of supplements.
I would much rather people got their nutrients from real food.
But in this example I can see that as well as eating lots more leafy green vegetables and red peppers, there might be a case for having supplements.
It utterly depends on your personal circumstances.
To find out more, do visit our website.
When we took about improving our health, the first things that spring to mind are normally diet and exercise.
But as Dr Saleyha Ahsan has been finding out, there is something which is equally as important.
Balance, it's one of the most underrated aspects of our health and fitness.
Balancing helps improve our core which acts as our body's inner stabiliser.
When you do that you improve your posture and coordination, and that helps us avoid injury.
But, like our muscle strength, if you don't use it, you will lose it.
Well done! So, what can we do to improve our own sense of balance? Well, the first thing is to work out how good or bad your own balance is, and there is a really easy way to test it.
Simply, close your eyes, lift one of your feet about six inches off the ground and time how long you can balance.
Our brain relies heavily on what our eyes see to keep us steady, but there are other parts of the body involved.
Our inner ear has a series of tubes and chambers containing fluid and works a bit like a spirit level.
While our muscles are constantly sending signals to the brain to help us orientate.
The average time you should be able to stand on one leg with your eyes closed declines with age.
If you're under 40, it's about 15 seconds.
If you're 65, it's around four.
But if you're struggling, there are some simple things you can do to help.
I've come to Dumfries to try a set of exercises that have been proven to help get any of us back into balance, with Professor Dawn Skelton, from Glasgow Caledonian University.
Push yourself up nice and slowly.
OK? Take a couple of steps backwards.
Only a couple.
Pull your bottom in, cos it's sticking out.
The idea is that by lessening the amount of contact you have with the floor or by looking away from where you normally would, you're making your brain work harder to keep you balanced, training it.
And the more you do this, the better your brain becomes at keeping you upright.
Curl your toes up towards your nose.
OK? Penguin walking.
Three little steps.
On your heels.
That wobbliness is good because that means that your brain is having to work at getting everything to work together, and that will improve your balance.
10-15 minutes a day and I guarantee, within three to four weeks, you'll feel a big difference in your balance.
It's that quick.
In Glasgow, these and similar exercises have been recommended for the over-65s and it's made a huge impact, helping reduce hospital admissions due to falls by a third.
But they can improve your balance at any age and they're easy to do at home.
Other activities known to help our balance, posture and core strength are dancing, tai chi and yoga.
Now, balance exercises are quite simple to do, but the key is to integrate them into our everyday lives.
You might never walk the tightrope, but you could soon be seeing improvements to your health.
You'll find the demonstrations of all the balance exercises on our website.
In Worcester, our 60 volunteers are back to have their bloods taken.
So far, half of them have been gluten-free for two weeks.
Half of them have been secretly given pasta containing gluten.
We're recording any symptoms they notice and analysing their blood to see whether these match changes in their immune system and gut.
They'll be back in a few weeks' time, after swapping to the opposite diet, when we'll retest them.
We're hoping to discover whether gluten is having a real and measurable effect on any of them.
Now, gluten, of course, isn't the only foodstuff that people worry about.
There are companies out there flogging tests that apparently will tell you if you're allergic or, at least, intolerant to a whole range of things -- from apples to yeast, from meat to tea.
They cost between £10 and £300.
And with allergies on the rise, we're buying a lot of them.
But do they really work? I'm going to try out a few and find out.
The tests you can buy on the High Street and online vary in what they claim to analyse.
And they'll use anything from a piece of hair to a drop of blood to diagnose your problem.
One tubeful of Mosley blood.
They promise a healthier you as a result, because the consumption of certain foods can have profound effects on the physical and mental health of susceptible individuals.
The results from the different tests tell me that I have an intolerance to -- amongst other things -- walnuts, durum wheat, maple syrup, eggs, Mountain Juniper, corn, even parsley and dill.
Another test tells me that I do have food intolerances, but I'd have to stump up another £284 to discover what they are.
So should I be worried and pay up? To find out, I'm meeting allergist Dr Adam Fox, from Guy's and St Thomas' Hospital.
First up, allergies.
I took one test that claimed to measure my immune system's antibodies and it said I had no allergies, although I was actually suffering from hayfever.
What was happening here? It's very easy to misinterpret the tests and that test only has value if it's done together with the medical history.
So doing it in isolation, as a screening test -- which is what lots of parents and patients do -- waste of time.
So if this isn't a useful test to do on its own, only if you have clear symptoms of analogy such as itching and sneezing would your doctor do a test, and for specific likely causes.
And as for the quite expensive allergy test that can apparently be done from a hair sample? We know that has no scientific validity.
You can actually hear the quacking coming out of the box with something like that! So a firm 'no' to any home testing for allergy.
They need proper medical interpretation.
How about the test kits for intolerances? These are, as we know from our big experiment, very difficult to diagnose.
Intolerances are different.
They don't involve the immune system.
They can be unpleasant, but they're never really dangerous.
For example, lactose intolerance is extremely common, so people don't have the enzyme in their gut that breaks down the lactose that you find in milk.
And as a result, when they drink milk, they'll get an upset tummy, they'll get diarrhoea and bloating.
One of the intolerance test kits I used claimed to measure an antibody in the blood called IgG.
It told me I had potential intolerances to wheat, rice and milk.
But Adam has me do the same test again to demonstrate a point.
IgG is one of the naturally occurring antibodies produced by our immune system.
In fact, they have a very, very important role in protecting us from infection.
They're also produced in response to any number of things that you take into your body.
So if you eat lots of food, your body will be recognising that it's food, it will be producing IgG antibodies to it.
And those IgG antibodies won't really be doing anything in particular.
OK, so it isn't an indication of sickness or disease? It's never been shown to be a useful indicator of disease in any way.
And to illustrate that, my results on this exact same test today are different from when I took it previously.
The levels of IgG in my blood simply indicate what I've been eating recently, not whether it was doing me any harm.
Eggs, it suggested quite strongly here, whereas eggs sort of, you know, are very weak according to this one here.
Yes, and I'm sure if you did this test every day, it would come up a little bit differently because your levels of any antibody are going to fluctuate from one day to the next.
So Adam's view on these home test kits is clear.
Across the world, the societies that represent allergists, gastroenterologists, are very clear that these tests do not have a place in diagnosis.
So although the kits may accurately measure IgG, that's of no use.
There is no scientifically valid home test for food intolerances.
Now, this isn't just about money.
Eliminating basics like eggs, wheat and dairy from your diet is not a good idea, particularly if you're a child.
It should only really be done if there's a proven need.
And ideally, under medical supervision.
If you suspect you or your child has a food allergy, then visit your GP to be properly tested for that specific foodstuff.
If you think you have an intolerance, then the best thing you can do is to try and eliminate it from your diet, to see whether or not that makes a difference.
Exactly as our volunteers at the university have been doing with gluten.
And we'll see what differences that made to them later in the programme.
Still to come: The device that can switch off rheumatoid arthritis.
And the results of our experiment.
Should we all go gluten-free? But first There are plenty of gadgets out there that are designed to help you monitor your health, but are they value for money, or do they simply generate unnecessary worry? We've invited GP Dr Zoe Williams to investigate.
One of the commonest things I do as a GP is take people's blood pressure using one of these.
But there are lots of problems with doing that here in the consultation room because no matter how unintimidating I try to be, sometimes, the patients may feel a bit stressed.
Now, my blood pressure reading is a bit on the high side just now.
That's because, frankly, I'm being intimidated by this lot.
So would we actually be better off measuring our own blood pressure at home? There's a wide variety of monitors available, anything from £10 to £150.
You'll all have slightly different machines, but this is what we use here in the surgery.
Our blood pressure is worth keeping an eye on.
If it's high, it can damage our blood vessels and put a strain on the heart and this can lead to heart failure, strokes and other problems as well.
The measurement is made up of two numbers, the highest and lowest pressure your blood exerts throughout every beat of your heart.
The higher one is known as systolic blood pressure and the lower number is the diastolic pressure, and that's the pressure between the heartbeats.
So we've got your reading now, Andre, and the result is pretty good.
So your systolic is 126.
We want that to be ideally between 80 and 130, so yours is fine.
And the diastolic should be between 70 and 90.
So yours is absolutely fine, which is great, especially in this slightly unusual environment.
Compared to the professional kit, then, how accurate are the sorts of home monitors that we can all buy? We've bought two common brands that fit on the upper arm and they both compared well against the professional equipment.
88 Mmm, quite close.
And two wrist monitors.
These are harder to use as the monitor needs to be held at the level of the heart, but one performed very well.
126 over 84, exactly the same! Wow! Whilst the other was inaccurate every time.
So the reading is 139 over 92, which actually means you've got abnormal blood pressure.
I'd feel worried if I was at home and I saw that.
Some monitors have been independently tested and deemed accurate, and we have details on our website.
Most of the machines that you can buy over-the-counter are actually quite good, but if you're buying from a pharmacist, it might be worth just asking them to check your machine against their calibrated machine so you know you can trust the results.
But if you're going to measure your own blood pressure, you have to know how to do it properly, so here's our Trust Me guide.
Whether you're sitting, standing or lying down will make a difference.
If you're talking or even if you have your legs crossed.
So you should be sitting, back supported, the pressure cuff at the height of your heart, legs crossed, breathing normally and not talking.
at the height of your heart, legs uncrossed, breathing normally and not talking.
Your blood pressure also varies throughout the day, so you should take it at the same time each day.
Take it twice, one minute apart, over four days to get an average reading.
After meals, it can be variable as your body sends blood to the gut for digestion.
And some food and drinks will also affect it, as some of our volunteers found through their day.
Around midday, it started to get really quite high.
That's, I think, because I had some coffee.
And if you don't want to buy a home monitor, doctors' surgeries and pharmacies often have monitors in public areas to use.
So measuring your blood pressure at home, then, is a good idea.
But remember, your blood pressure goes up and down all the time so if you get the occasional high reading, don't worry.
If your blood pressure is a bit high, there are lots of things that you can do to help bring it down.
So exercise is one of them.
Just 20 minutes a day of brisk walking really helps to bring it down.
And then dietary changes.
So reducing your alcohol intake and increasing the potassium intake by eating more vegetables.
And if that doesn't work, then please do go and see your doctor.
It seems like every day, we read about so-called 'alternative therapies' that claim to do things like relieve pain, cure addiction or improve our mental health.
In this series, we're asking -- can any of them really help us? This time, we're looking at hypnosis.
Now, hypnosis has a long and colourful history and its fans claim it can cure everything from depression through to phobias.
Critics, however, say it's nothing more than a cheap parlour trick.
I'm going to delve into the debate, try hypnosis for myself, and then speak to a world-renowned expert.
I want to get to the truth and decide -- should I try hypnosis? I'm not convinced that hypnosis is really a state of altered consciousness, or that people aren't just pretending, so I want to see if I can be hypnotised.
I'm about to give you some instructions that will help you to relax and gradually to enter a state of hypnosis.
Taking me through the procedure is Professor David Oakley, a clinical psychologist who uses hypnosis to help people with mental health conditions like depression and anxiety.
Your breathing is becoming slower and regular.
Not everyone can be hypnotised, so the first thing David is going to try and do is put me into a state of focused attention and then test how suggestible I am.
Pay attention only to my voice and only to such things as I may call to your attention.
Now he gives me a series of suggestions to see if I perceive them as real.
Please extend your left arm straight out in front of you.
Up in the air, just beginning to get very heavy.
Heavier and heavier, as though a weight were pulling the hand and arm down.
A little bit down.
More and more down.
It gets heavier and heavier and goes down more and more.
If I were here to give up smoking or lose weight, David would use hypnosis alongside other therapies to help me.
But today, it's just a test of how suggestible I am.
You haven't noticed that a fly has been buzzing around you and it's going round and round your head.
Go ahead and get rid of it if you want to.
It's a weird experience.
I still feel conscious, yet compelled to follow David's suggestions.
The power of these suggestions can be used to help a person tackle their fears or negative thoughts or behaviour.
You will not awaken until I ask you to do so.
To test how powerful the suggestions can be, David now suggests I write some sentences, as if I'm being controlled by someone else.
The sentence begins, "the woman.
" Now.
It's an eerie sensation.
Three, two, one, wide-awake and fully alert.
Blimey, I didn't even know I was writing this.
It was an involuntary movement.
It didn't feel directly it was something I was controlling.
It felt like something was being done to me, rather than I was doing which was quite strange.
To my surprise, hypnosis felt very real, but is there something going on in the brain that can be measured? Here at Kings College London, they have spent months repeating the writing test with volunteers in an MRI scanner.
As I count, you will feel yourself going down Like me, the volunteers are asked to write as if they were being controlled by someone else.
Their brain scans are then compared to scans taken when they are asked to pretend this is happening.
The study is overseen by Dr Eamonn Walsh.
When we asked our participants just to pretend that someone was controlling their right hand as they wrote, we see a classic signature of activation in the front and back of the brain.
This pattern is totally different from the activation we saw when it was suggested that someone else is controlling your hand movements as you write.
This would suggest that in the hypnotised state, your volunteers were absolutely convinced that someone had taken over their brain.
It's very striking! So the suggestion under hypnosis really does change the patterns of activity in your brain.
It proves hypnosis isn't a trick.
It's real.
That is, I must admit, very impressive, isn't it? Certainly, as a piece of evidence.
Seeing the power of hypnosis in the brain is fascinating, but does that mean it's useful? While it's used by trained experts to treat certain mental conditions, can it really help you lose weight or quit smoking? To find out, I'm going to speak to another member of the team, Dr Quinton Deeley, consultant psychiatrist at the Maudsley Hospital at Kings College London.
So what sort of conditions would you recommend or suggest to people that they might like to go and explore hypnosis for? The kind of conditios where it is being recommended is in conditions like irritable bowel syndrome.
There is some evidence and recommendation to augment weight loss and use for analgesia, pain relief, for example in labour.
There is a role for the use of suggestion in hypnosis in, for example, cognitive behavioural therapy for depression.
There are some studies and practitioners which relate to that.
The difficulty we have is there is likely to be a lot of individual variability to these types of interventions, so if we are making a general recommendation to the public as a whole, we still don't have a well conducted as a whole, we still don't have a well conducted large-scale trial.
So there is something real going on in the brain, potentially very useful, but it is slightly frustrating to be able to pin it down? I think it's a fair judgment.
Clearly, it is being advertised for smoking cessation, I found very little evidence at all that it works in those cases, and you could spend a lot of money and not get much result.
Is that broadly accurate? I think that's an accurate summary.
At the moment, we still don't have the evidence for the effectiveness of hypnotic intervention for smoking to make it And how do you go about finding somebody who is a decent hypnotist? Ideally, the practitioner should have training in a recognised health profession.
So, for example, they should be a qualified psychologist, or possibly another health profession.
And they are part of a professional organisation, regulatory body to which they are accountable and which exercises supervision over what they do.
So when is hypnosis useful? Well, there is some evidence it is useful for treating pain associated with irritable bowel and also with childbirth.
But in most other areas, the jury is still out.
So, should I have hypnosis? I think it utterly depends on your personal circumstances.
Are you suggestible? What sort of condition is it you are trying to get treated? And most of all, who is going to be doing the hypnosis.
To find out more, do visit our website.
There are a number of serious diseases like multiple sclerosis or rheumatoid arthritis, which happen when somebody's immune system begins to attack their own body.
These conditions are you hard to treat.
These conditions are really hard to treat.
But a chance discovery is helping to rewrite our understanding of how the immune system works and could help millions.
Surgeon Gabriel Weston has been investigating.
As a surgeon, I am always excited to find out about new medical developments, but this time it is particularly special.
It is a treatment that's come from a breakthrough in understanding how our bodies work.
When the body's damaged, the classic response is inflammation.
You'll know this from the redness and swelling you see when you hurt yourself.
But it also happens in hidden parts of the body.
In autoimmune disease, where the body's immune system goes wrong, and attacks your own cells, the damage this causes can trigger inflammation in all sorts of parts of the body, leading to disability, pain and illness.
The main treatment options for autoimmune diseases until now have either been anti-inflammatory drugs like steroids to deal with the symptoms of the damage, or severely dampening sufferers' entire immune system is to stop the attack.
But at New York's Feinstein Institute, Dr Kevin Tracey was studying the problem of inflammation and had a moment of breakthrough.
He realised that signals controlling the immune system were being carried by the nervous system which gave rise to a new idea.
What if we could use our nerves to control the immune system and treat disease? That was a real sort of eureka moment.
Nerves work by carrying electrical information to the end of the nerve.
At the end of the nerve, the nerve releases molecules, neurotransmitters, which then instruct the cells next to the nerve ending to change their behaviour.
And theoretically, you could have a device that targets the activity of that nerve to just work for a very short period of time, only in the place where the disease is.
That idea really for me, was the birth of bio-electronic medicine.
I think that some drugs that are used today, will be replaced by very small devices that will target nerves.
The result was a world first, a device that could be implanted beside a nerve that could send signals to control the immune system.
The only way to find out if it would work, was to try it in a handful of brave patients, and I've come to California to see what they were given.
An implant that could be attached along the vagus nerve in the neck which connects the brain to our major organs.
This device was implanted into patients as part of the very first trial to set out whether the basic concept would work.
This battery here is inserted under the skin a bit like a pacemaker, and it is connected to this lead with this electrode here which coils around the vagus.
The electrode stimulates the nerve for about a minute a day, at a level which is optimal for regulating the inflammatory response, but not so high that it interrupts the other really important functions of the vagus nerve.
Amongst the first people to test this implant were a group of patients in Amsterdam with severe rheumatoid arthritis.
In this disease, information is caused when the immune system produces too many inflammatory molecules, including one called TNF.
Researchers hope that by targeting specific fibres in the vagus nerve which control TNF production, they could lower levels and reduce inflammation.
One of the patients taking part in the trial was Monique.
I couldn't walk from one side of the room to the other side of the room.
It took a long time to go downstairs and put my clothes on, and take a shower.
I was the whole day at home.
I didn't work any more.
Monique, could you show me how you use the device? Yes, this is the magnet.
I do it on this way.
It is going now.
You will hear it maybe on my voice.
A little vibration on my voice.
I can hear it.
Yes! And now, now it's gone.
How big a difference has this made to your life? The first thing I recognised was my energy.
I had more energy to do more things.
So I can walk, I cycle more.
I have started with work again.
Dr Koopman, what do you make of Monique today, assessing her, how is she doing? For me there is nothing to detect, to show there is any sign of arthritis.
You can see in her hands there has been arthritis, but it has, at least for now, it has died down.
I don't see myself like a patient who has arthritis.
I don't think about it any more.
I have my life back as before I got arthritis.
Monique is now been using the device for three years but Dr Frieda Koopman has the results of the trial as a whole.
How many patients were there in the trial? In total there were 17.
What did you find? About two thirds of the patients had clinical response, so less swelling and also less painful joints.
You could see at the same time that TNF was going down, and during the study there was a moment that we would stop stimulations and then we saw the patients getting a little bit worse, but also the TNF was going up.
And also the anti-inflammatory effect of the stimulation was no longer there.
Of course, TNF is only one part of the problem in rheumatoid arthritis.
But the results of this trial are really promising, and what is even more exciting is that the technology involved is only going to get better.
Here in California, the company which developed Monique's implant are already working on a new model and it's tiny.
CEO Anthony Arnold explains how it works.
The device is a micro regulator we call it.
A surgeon would implant the device just above the collarbone.
Would that have any wires or batteries attached to it which would also be under the skin? Not at all.
It is entirely self-contained.
The battery is in it.
There are no wires.
The stimulating leads are built into the device so there is no need for multiple components.
How long do you think it might be before this device can actually be in necks doing the job it can do? Could be four years in Europe, five years in the US, assuming everything goes smoothly, and there are no unusual findings.
It's not just rheumatoid arthritis that could ultimately benefit from this technology.
The vagus nerve is like a transatlantic telephone wire, with maybe 100,000 individual telephone lines, and each of those has a specific job, and the challenge for bio-electronic medicine is to ask what is that fibre doing, and how can we control that fibre to the therapeutic benefit of that patient with this disease? That is the opportunity for the future of medicine.
What I've seen in the US and here in Amsterdam has absolutely blown me away, and it is clear that this rheumatoid arthritis trial is just the beginning.
I wouldn't be at all surprised if in the near future, we start seeing bioelectronics being used to treat a whole range of previously very difficult to manage medical conditions.
Most people think that stretching is important when we exercise.
Do you normally stretch before exercise? I do a little bit of stretching, yes.
Why do you do it? I do it because I feel it will stave off injury.
I feel like I can actually use all my muscles to the extent that I need to.
So the consensus is, we should stretch.
The idea is it will reduce your risk of injury and improve your performance.
People believe this, but is it actually true? Time for me to find out.
Agh! I'm going to do an experiment on myself under the guidance of biomechanist Dr Polly McGuigan.
Firstly, a baseline measure of my muscle power -- how high I can jump.
Then -- how flexible am I? Now, will stretching improve these measures? Ooh, blimey.
Am I supposed to experience pain there? You do expect to be able to feel it.
I can certainly feel it.
Now it's time to re-do exactly the same test to see if all those structures had any effect.
stretches had any effect.
Polly has the answer.
OK, so after all that strenuous and slightly painful stretching, what were the results? Starting with flexibility, you did become more flexible after the stretches.
For a given level of force, that muscle tension unit stretched a little bit more.
After the stretching, I was able to extend my knee by an extra 90 degrees.
by an extra 9 degrees.
My calves were almost 20% less stiff.
So how did stretching improve my flexibility? There is an argument that over a long period of time, if you stretch a muscle, you actually do physically make it longer.
But probably, the strongest argument for an immediate effect like we saw today is that you just become a little bit more tolerant to that degree of stretch and, therefore, you can push yourself a bit further.
So stretching did make me more flexible, but the key question is, does it actually make me a better athlete? Time for my jumping results.
What about power? Well, power had the opposite effect.
Your jump height went down after the stretching.
It didn't feel like it.
I mean, I actually felt more limber and I was shouting well! Yes! And I was jumping to the full extent of my strength.
In fact, my jump height was 20% lower.
So why does stretching actually harm my performance? If things become a bit more stretchy, a bit more compliant, the speed with which you can transmit force from the muscle which is generating the force to your skeleton, which is producing the movement, decreases a bit.
So stretching makes you less powerful, but what about protecting you from injury? The vast majority of the research suggests that there is no effect on injury risk of stretching before you exercise.
It's not going to reduce your risk of getting injured.
Because I imagine that when you stretch, you're going to warm up the muscles, and warming up the muscles is a good thing.
Warming up the muscles is a good thing, definitely.
A muscle will produce more force after it's warmed up a little bit.
But stretching is not the best way to warm up.
It's better just to do gentle light exercise.
So stretching is useful to stay flexible, especially as we get older, but not to help your exercise.
If you're doing any sort of exercise which involves power -- such as jumping or perhaps sprinting -- then doing this sort of stretching really isn't going to help.
Instead, if for example you want to go for a run, then what you should do beforehand is go for a stroll, speed it up, maybe do a little bit of jogging.
What this will do is, it will increase the blood flow to the muscles that will warm them up and also improve efficiencies.
In fact, if you do this sort of exercise, the evidence is that it will improve your performance.
When we talk about the signs and symptoms of ill-health, we often focus on the physical, but mental illness is also incredibly common.
So what should we be looking out for? Over to Saleyha.
One in four people in the UK will be affected by mental health problems, one of the most common of which is depression.
All too often, depression isn't recognised as a genuine health condition or is dismissed as trivial, but it's far more than feeling low or unhappy for a few days.
Depression is a real illness, with real symptoms and real dangers.
It's a medical condition which can creep up on any of us and its causes are many and varied.
But the most common trigger is a traumatic life event like losing a loved-one, going through a stressful situation at work, or experiencing a serious physical illness.
Many people find it difficult to be open about having the condition, for fear of seeming weak.
But Lol, Sarah, Richard and Cath -- who have all been diagnosed with depression -- are happy to talk about their experiences to help us all recognise the red-flag symptoms.
My moods were dropping.
My behaviours were erratic and quite unpredictable.
I eventually noticed that my normal behaviours, my normal character and personality, had gone.
I'd really start spiralling down and feeling like an impostor, you know? I never felt I was quite good enough.
I'd be waking up once or twice in the night.
I was having thoughts about, have I done this, have I done that? I need to get to work to sort this out.
I was questioning myself and being self-critical, which I wouldn't normally be.
I just shut myself away, just not interested in anything whatsoever, and just wanted to curl up in a ball and just stay in my own bubble, so to speak.
Although people can have very different experiences of depression, these are all common signs and symptoms, and there are others to look out for.
Among them, there's a constant flow of negative thoughts and low self-esteem.
People can also suffer from physiological symptoms like changes in their eating or sleeping pattern, or feeling like their energy levels are so low.
Sometimes, it's the people around us who notice the change in our behaviour.
My children actually pointed it out because they'd ask me for something and I'd bite their head off for it, not meaning to.
And it was at that point, I said, right, I've got to go to my GP I tried to mask it.
And then on this particular day, I was so emotional and my manager said, look, you're clearly not well.
We've seen this for a long time, we've been seeing the signs.
I think tomorrow, you need to go and see a doctor.
And that was almost like a weight had been lifted off my shoulder.
I know it's a cliche, but If you do experience some of these symptoms every day for two weeks or more, then visit your doctor, as there are many forms of treatment and therapy to help you recover.
One of the things that they might prescribe you is CBT, cognitive behavioural therapy.
CBT is a talking therapy.
It helps you to identify negative thoughts and gives you coping strategies on how to deal with them.
I found it I found it quite useful.
It kind of gave me a different outlook, to look at things in a different way.
It kind of shed a lot of light on different things.
Some people find self-help techniques effective.
Mindfulness is a big one for me, and meditation.
I do that every day and I swear by it.
Your GP may also suggest a course of antidepressant medication.
They've been a life-saver for me because they keep me buoyed up so that I'm able to function and able to get to the point where I can start to recover properly.
But whatever therapy is prescribed, it's important not to give up hope.
If you're a man in particular, or a young man, not to feel it's a sign of weakness and to not feel stigmatised by having depression.
Certainly, don't shy away from it.
And also, talk about it to either friends, family or go to your GP.
Ring up the NHS.
You know, I would say to them everyone's got their mental health as much as we have physical health, so why not talk about it in the same way that you would if you had a terrible cold? As an A doctor, one of the hardest parts of the job is losing a patient due to a preventable cause, and that includes mental health illnesses.
So if you or someone you know is suffering from depressive symptoms, don't ignore them.
Getting help and the right treatment can save lives.
Don't suffer in silence.
If you want more information, go to our website Back in Worcester, our trial into going gluten-free is coming to an end.
Our volunteers all cut out gluten for six weeks.
But we secretly slipped each of them gluten containing pasta for two weeks during that time.
Not even the researchers knew when each person had their gluten until the results were analysed.
But some of our volunteers thought they could tell which weeks they were eating gluten just from the way they felt, and they generally preferred being gluten-free.
Do you feel better off gluten or on gluten? I definitely felt a difference.
And my teenage son has noticed a difference in the digestive system.
In YOUR digestive system? Yes.
He said to me, "Mum, you're not gluten-free anymore, are you?" And the rest, I'll leave to your imagination! My eyes are clear and my skin is clear and my bloat has gone down.
It's been a really interesting experience, yeAH.
It's been a really interesting experience, yes.
Why? Well, I have to say, I was a cynic.
Yes, but I may convert now.
Yes, but I'm a convert now.
But anecdotes aren't scientific, so we asked people to record their symptoms each fortnight.
Once the experiment was over, we then looked up who'd been given gluten when and compared their symptoms on the different diets.
And actually, those that recorded gut symptoms like bloating and nausea reported fewer when they were truly gluten-free.
And they did suffer significantly more in the weeks we slipped them gluten.
We also recorded things like tiredness and skin health.
And here, there was no significant difference between gluten and gluten-free weeks.
So what do our volunteers and the scientific team make of these results? Over to Justine, from the University of Worcester.
First of all, thank you very much for taking part.
I'm now going to hand you to Justine, our expert, to give the results -- which are pretty interesting.
So the symptom questionnaire data that we've got is showing a statistically significant difference and a benefit for following a gluten-free diet.
So in a sense, from your point of view as a scientist, that is an important result? Yes.
So people are feeling better.
And we have anecdotally asked people if they're going to continue with the gluten-free diet and out of the 50 people who completed, we think seven are going to return to eating normally and the rest of the people have indicated that they will either restrict their gluten or follow a gluten-free diet, so that's quite significant.
So going gluten-free helped a lot of people's guts feel better, but was this mirrored by changes in their immune system or gut inflamation? Could there be a medical test to help classify gluten intolerance as a condition? Well, when we looked at their blood test results, there was no significant change in either their immune markers or information markers when they went gluten-free or when they had gluten secretly reintroduced into their diets.
Nor were there any differences between those who recorded suffering a lot of symptoms when eating gluten and those who didn't.
But that doesn't matter to those who feel better.
Bryony, what was your experience of the experiment like? Really good.
Was it? Yes, really good.
I'm going to stay gluten-free now.
You're going to stay gluten-free? Yes, 100%.
A lot more energy.
I'm exercising a lot more now.
The bloating's gone and I've lost some weight as well, so brilliant.
Now, it's possible that our volunteers could taste the difference in the pastas and that this influenced them.
Perhaps simply thinking they were cutting out the gluten was enough to make them feel better.
Or maybe gluten was doing something to their bodies that we just didn't pick up with the blood markers that we looked at.
It could be, for example, that gluten affected some people's gut bacteria badly.
Now, if you're going to exclude gluten from your diet, you should take the appropriate medical advice.
But the good news is that all the tools are readily and cheaply available for anyone to try this out on.
That's it from Worcester.
Next time: We're coming from Newcastle, where we're doing a big experiment to see whether turmeric can help protect us against cancer.
We'll also be revealing the secret behind glucosamine pills.
And investigating the current craze for mindfulness.
There's a brand-new way to stay on top of the Premier League action.
We look ahead to the weekend's fixtures,