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Teenage depression, Choir, Heart failure, Protein shakes

Duration:
28 minutes
First broadcast:
Tuesday 24 April 2012

In Inside Health, Mark Porter clarifies recent headlines claiming that researchers have found a "Blood test that identifies depression". It certainly isn't that simple.

GP Margaret McCartney reports from Paisley Abbey in Glasgow on the health benefits of joining a choir.

And do special muscle building drinks live up to the marketing hype? Max Pemberton looks at the science behind the recent explosion in sales of high protein sports drinks.

Plus a new treatment for helping people with fluid retention due to heart failure, that can transform a puffy face to a chiselled jaw bone overnight.

Producer: Erika Wright.

  • Programme Transcript - Inside Health

    Downloaded from www.bbc.co.uk/radio4
    THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.


    INSIDE HEALTH

    TX DATE: 24.04.12 2100-2130

    PRESENTER: MARK PORTER

    PRODUCER: ERIKA WRIGHT


    Porter
    Hello and welcome to Inside Health - in today's programme:

    "Blood test identifies depression" said the release from the Press Association, and several papers ran with the story, but is it really as simple as that? We delve behind the headlines.

    Do special muscle building drinks live up to the marketing hype? Max Pemberton looks at the science behind the recent explosion in sales of high protein sports drinks, and gets put through his paces in the process.

    Clip
    Get those little skinny legs going come on. Come on Max.

    People fall off the back of it?

    Probably today they will, I'm hoping, I've got some fresh mats behind anyway.

    Porter
    Well let's hope he doesn't.

    I visit the Heart Hospital in London to see how a new treatment for helping people with heart failure can transform them overnight.

    And GP Margaret McCartney reports on an unusual approach to improving your health and sense of well-being - joining a choir.

    Choir singing

    But first you may have seen reports that American researchers have come up with a blood test that can identify depression. The story made the headlines in a number of papers. The Daily Mail reported: "Scientists have devised the first blood test capable of diagnosing major depression in teenagers." Well, have they?

    Psychologist Claudia Hammond, presenter of Radio 4's All in the Mind is here, as is our resident psychiatrist Dr Max Pemberton. Max, the press reports have somewhat over simplified the story, haven't they?

    Pemberton
    Yeah that's right. I mean it sounded initially really exciting that you could have a blood test that would somehow be picking up some chemical or something that would give you a definitive diagnosis of depression and actually that's not really what's going on here, it's much more complex.

    Porter
    Claudia, where did this story come from?

    Hammond
    So it's from some research that's been published in a medical journal called translation or psychiatry and it was done by researchers in America at Northwestern University in Chicago and what they were doing was they did some research on rats and some research on people and they found that when they took their blood tests and looked at the genetic markers in their blood, so they looked at sections of DNA, there were 11 that were different in those who had depression from those who didn't. But there were only 14 people in each group.

    Porter
    So a tiny study.

    Hammond
    It's a really small study.

    Porter
    And they'd identified these markers and they're assuming - so they're associated with depression, it's not saying that you're depressed if you haven't had those markers?

    Hammond
    So they don't know that, you can't say that, all they can say is that 14 people who had depression had these markers and the 14 people who didn't have depression didn't have these markers. And in a sense that's as far as it goes at this moment.

    Porter
    So the headlines have rather taken the story on...

    Hammond
    It's not quite a blood test that you can go and get right now.

    Porter
    Max, let's put some perspective on this - how big a problem is depression in teenagers?

    Pemberton
    Well it's complicated by the fact that firstly teenagers tend not to seek help when perhaps adults might do so and also that part of being a teenager is to have mood swings, be a bit miserable one day and then sort of top of the world the next day and that sort of sometimes obscures depression and the fact that often there'll be - it's normal for teenagers to lock themselves in their bedroom and so often the parents don't even know really what's going on with them. I suspect it's something that's massively underdiagnosed.

    Porter
    I mean that's one of the attractions of having a blood test because it's a very difficult condition to diagnose in anybody but in this age group in particular.

    Pemberton
    Exactly but I mean this study is not really giving us a test that me as a doctor can sit there and go I've taken your blood and yes you do have that, it's not providing some kind of objective analysis of this, all it's really doing is it's an investigation into the genetics of depression.

    Porter
    The genetics is an interesting component, presumably if they've identified these 11 markers then that might give us some insight into why some people are more susceptible to depression possibly?

    Hammond
    I think the difficulty is that depression is so multi-faceted and so complicated that you'll still find plenty of people who are depressed who might not have these markers, I mean we don't know because they did it on so few people but there are so many different things that can cause depression that to say that it would be genetic in everybody is very unlikely to be the case.

    Pemberton
    From a clinicians perspective I always think well is this test or are these genetic investigations are they actually going to help change my practice in any way and I don't really think that understanding the genetic basis of this is really going to change how I would interact with the patient or indeed the kind of therapies that I'd use with them.

    Porter
    Do we have any objective measures at the moment for deciding whether someone's depressed or not, I mean obviously we don't have a blood test but do we have something that's black and white or is it purely subjective in the eyes of the psychologist or the doctor that's looking after them?

    Pemberton
    Well it's not entirely subjective, there's diagnostic categories, so there's kind of internationally recognised tools that can be used when you're talking to somebody, a bit like a tick box, sort of tick off...

    Porter
    Have they got these following symptoms?

    Pemberton
    Exactly. Obviously that is open to interpretation and - although it's supposed to be rigid, again there's some variation.

    Porter
    And do they work as well in teenagers do we think?

    Pemberton
    Well that would be my concern, lots of these are developed for use in adults and actually teenagers have got sort of different emotional responses to things.

    Hammond
    I think what's interesting about this is that theoretically it's very, very interesting, as Max says would it change his practice and I think even if you could develop a blood test there'd be the question of how were you going to use this - are you going to screen everybody before they're depressed and in which case you've then got quite serious ethical issues about how are you going to break the news to these teenagers that oh actually you're somebody who might well be susceptible to very serious depression, I mean how are you going to tell people this and unless you can actually do something really good about that, something to then prevent it, there'd be a big question mark over whether you should tell people this. I mean they've done, with pencil and paper tests, they've done a big screening programme in America that's been very controversial in teenagers because sometimes teenagers are suddenly told this diagnosis when they thought they felt fine.

    Pemberton
    And then what would you do? Do you put everybody on antidepressants or give everybody CBT even though actually they've got no symptoms?

    Porter
    It might become a self-fulfilling prophesy one worries. Well thank you very much both - Max more from you later. Claudio you're back with All in the Mind next week in this very slot.

    Hammond
    That's right same time, same place I'll be there.

    Porter
    Claudia Hammond, thank you very much.

    Choir music

    Singing may be about as far removed from blood tests and genetic markers as it's possible to get, but it too can play a role in helping boost mood and enhance well-being. GP Margaret McCartney certainly thinks so:

    McCartney
    Every Tuesday night I pitch up, with a hundred or so others, in a lecture hall, furnished with a piano and a choirmaster. This is the City of Glasgow Chorus in rehearsal. I cycle, I run, I eat my greens but actually, I suspect that sitting in the back row attempting that horribly high A in Szymanowski's Stabat Mater might be the healthiest thing I do all week.

    We're currently in final rehearsals for a concert at the voluptuously acoustic and ancient Paisley Abbey, just outside Glasgow. It's a joy. My fellow choir members think so too and get other things out of it.

    Chorister 1
    I love singing and have always loved singing since I was very young. I find it a really uplifting experience and I really, really enjoy it. I've also made a lot of friends through choir and so I wanted to keep coming because of that as well.

    McCartney
    So choir's been a good thing for you?

    Chorister 1
    Oh fabulous, a good hobby and good for de-stressing from work and taking my mind off things.

    Chorister 2
    I like having people around and it's kind of a social thing. When I joined my last choir was in an isolated time of my life and that was really important to me to be able to be with people for that period.

    Chorister 3
    I find it relaxing, you use up a lot of energy doing it but it sort of calms your mind I think, I think it's very useful.

    McCartney
    It often makes me feel good after a bad day as it were.

    Chorister 3
    That's how I feel.

    Chorister 4
    It is a complete escape from the horrors or the realities or whatever else meets you in life because you have to focus on the music and you can completely be overcome - overtaken by the music, not in a bad way but it gets a chance to wipe all the muck from your head at the time you're performing or rehearsing - it's great.

    McCartney
    There's an interesting thing called social capital and for me singing with the second soprano section delivers it bounteously. A hundred years ago the major threats to health were contagious diseases. Now the larger problems are chronic illnesses - like diabetes, chronic obstructive airways disease, dementia, mental illness. The best treatments - and preventions - might not always come in the form of tablets but through how we live our lives.

    The idea is that social networks have value: the better the quality and quantity of social interactions we have, the bigger the social capital. Epidemiological and economics research over the last couple of decades is beginning to point towards higher social capital being closely linked with better health. Of course, it would be possible to explain this by saying that healthy people are better able to make more social links. Yet the research points to a more circular relationship. More social links makes for better health and better health makes for more embedded social networks.

    Edward Caswell directs the Health and Wellbeing through Song course at Strathclyde University and is here at the abbey - what is there specifically about singing in a choir?

    Caswell
    Well it's fun, that's the main thing. A lot of people are retired and so they're looking for something to do which they're going to enjoy. Singing is something, in some cases, which they've been told they weren't any good at maybe 50 years ago, they've sung in a school choir and then auditioned for something at the age of nine and told to go away and not come back and they come to us at the age of maybe 59 and we teach them how to sing - of course they can sing, very, very few people can't sing. And once you're doing it and once you're really understanding the physicality of singing - all the muscles that need to be involved, the good posture that you need to adopt - then it makes you feel great, particularly if you're doing it with a room full of other likeminded people.

    McCartney
    Well-being's a word that I think has been used and sort of pulverised by quite a lot of people to mean all kinds of different things but in the context of a choir what does well-being mean to you?

    Caswell
    Well there's a physical side to it - well-being comes from standing up straight, good posture - so many things we do in life involve terrible posture - sitting at computers, sitting on the phone - singing something where we can actually insist on good posture, even when people are sitting down we can insist that they sit up in fact, well that makes you feel better for a start. So you're feeling better just because you're doing it, just because your throat is open and you're singing well and that's even before you get on to the fact that you're able then to sing wonderful music which is very inspiring and uplifting.

    McCartney
    There is more evidence to back this up. Small but detailed studies have examined the effects of choir singing with people with chronic mental illness or disability and described the effects beautifully as people "finding a voice". This isn't new, there's a paper from 1961 describing the formation of a choir in a psychiatric hospital in Germany. It describes a group of 30 patients who met weekly with their doctor and nurse, who also sang. They noted improved concentration and communication as well as a function of bringing people "pleasure and happiness" as well as "playfulness".

    Even for people who are well there are benefits. A famous study from 1996 in the British Medical Journal confirmed that Swedish people who attended cultural events, including choir singing, lived longer. And there is also research with a small number of patients showing that singing classes can improve quality of life scores and anxiety measures in people with chronic respiratory disease. Not bad, for turning up once a week to see your friends and get high on music.

    It all makes me wonder what the best things are we can do for our health. Is the push towards preventative medication in the form of statins for our cholesterol and blood pressure tablets the best we can be doing? Or should we be looking towards our human need for shared expression, our need to be part of a community fabric and of course our intrinsic capability and love for music and song.

    Porter
    Second soprano Margaret McCartney.

    You are listening to Inside Health, I am Dr Mark Porter, and if you want any more information on the subjects covered then do visit our website - go to bbc.co.uk/radio4 and follow the links to Inside Health.

    Nearly a million people in the UK live with some degree of heart failure - a condition where their heart struggles to pump blood efficiently enough to maintain a healthy circulation. Those affected tend to retain fluid resulting in swelling and breathlessness and the problem is typically managed using diuretics - drugs that encourage removal of excess fluid via the kidneys - but in extreme cases, more drastic action is required. The Heart Hospital in London is one of a handful of centres in the UK offering a new approach called aquapheresis - and the results can be spectacular.

    John Connolly
    The legs got fatter and fatter by the day, I wasn't walking at all, I was just laying in bed. And they were like elephants' legs because they were so big. All the top boxers and all that their legs were nowhere near as big as mine. There wasn't really pain, they just seemed to be getting bigger and bigger and getting nowhere.

    Maggie Connolly
    They were like tree trunks - his legs. They were so heavy he couldn't move them on his own, we used to have to lift them up, move them about on the bed and they were getting quite concerned about bedsores because he couldn't get out of bed because of the size of his legs. Then when he started having the treatment it was like a miracle.

    Thomas
    My name's Martin Thomas, I'm a consultant cardiologist at the Heart Hospital. This is predominantly for patients that have significant fluid overload, so we know that they have heart failure, they're building up fluid and despite our best attempts with simple diuretics - water tablets - the fluid is still accumulating.

    Porter
    And how would they know, as the patient, that they're accumulating fluid, what would they notice?

    Thomas
    Predominantly increasing swelling in their lower extremities, sometimes in their abdomen but also with worsening breathlessness and fatigue.

    Porter
    And that's literally fluid collecting in the lungs?

    Thomas
    Yeah, and the problem is that most patients will accumulate up to five kilos in weight before they actually are aware of any symptoms themselves.

    Porter
    So that translates to five litres of fluid?

    Thomas
    Yeah.

    Flett
    My name is Andrew Flett and I am a specialist registrar in cardiology. This is the Aquadex ultrafiltration machine. It's designed to be quite portable, so it stands on wheels and it's about the size of a kitchen - a large kitchen toaster or something and it's quite lightweight to push around and the patients can actually support themselves on the frame if they have trouble with mobility. And it's been designed with that in mind, so that the treatment can be given to patients that can walk around the ward and mobilise to the toilet themselves. And I can just switch it on now - it'll probably make some funny noises...

    Porter
    The basic principle is what - how does it work?

    Flett
    So what happens is blood comes out of the patient through a line that's put into their neck, like some people may have had lines in the back of their hands, it's very similar but just slightly larger and the blood comes into this circuitry which we have here and passes through a filter, which is like lots of Macdonald straws within a plastic container, the blood goes down the middle of the straws and water is pushed across the straw wall into the space between the straws, then it all just drips out into a bag which hangs on to the machine. This machine really just gets the blood from the patient, pushes it through the filter and collects it and actually weighs it - weighs the bag continuously so we know exactly how much fluid has been removed and you can just actually just set on the console here how much fluid you want to remove and at what rate.

    Porter
    What happens with the machine when you move on to the next patient, presumably the only bit that comes in contact with the patient's blood is all within this plastic tubing set, so you just throw that away?

    Flett
    Yeah so this - this bit gets thrown in the bin and we just get a brand new one out for the next patient.

    Porter
    So no blood is actually going into the machine, it's all held within the tubing?

    Flett
    No, exactly.

    Curl
    My name is Fiona Curl I am the ward sister on acute coronary ward.

    Porter
    You get to see this machine in operation a lot, what sort of difference does it make to the patients?

    Curl
    Quite a drastic change within a very short space of time. I'll go home from one shift, seen a patient quite round in the face, come in the next day and they've actually got a jawline and they've got a neck which they may have not seen for even possibly years. Also you'll find that they'll sort of reduce in girth size and also their ankles and their legs resulting from fluid retracts from those areas as well.

    Porter
    So as well as them feeling the difference, hopefully they'll be feeling a lot better as well, you can actually see it as someone who's looking after them?

    Curl
    Yeah definitely, there is a physical difference. Even the relatives who come in the next day will actually remark upon how the change has occurred.

    Thomas
    It's essentially a mechanical water tablet - it's a very simple system of connecting the patient's bloodstream to this machine which actually just filters off water. So it's a bit like dialysis but it doesn't take any impurities out of the blood, it's purely fluid.

    Porter
    So it gives them pretty rapid relief?

    Thomas
    Yes so with standard theory - with intravenous diuretics, intravenous water tablets - you would be aiming to get off a kilo of fluid per kilo of weight per day, any faster than that you tend to upset their renal function and their kidney function. With this system you can remove up to 500 mils of fluid an hour.

    Curl
    One of our patients actually commented the fact that she can actually get upstairs now which she'd never been able to do previously.

    Porter
    Because as well as the swelling their breathing improves I presume quite significantly?

    Curl
    Yes, yeah, that can actually happen within quite a few hours, that can actually markedly change, they feel a little more comfortable with their breathing. They are literally losing kilos.

    Thomas
    These are predominantly patients that we're seeing in outpatients who have been getting progressively worse over several weeks or several months. We bring them in, give them the treatment and the advantage of that is that it makes the patients more sensitive to their water tablets, so when you've got a lot of fluid in your gut because the gut wall is swollen the water tablet can't be absorbed, by getting rid of the fluid you can actually improve the absorption of the drug. And we know that the patients with this treatment spend much less time in hospital, which is fantastic for them, and stops their readmission to hospital with fluid overload.

    Porter
    Yes I'm thinking of managing patients of mine who've got heart failure who we lose control of and they end up in this situation where they've got a lot of fluid. How quickly can you put them right with this new technique?

    Thomas
    Well we know from our local figures that the average admission for someone with decompensated heart failure, so lots of fluid on board, with standard therapy is about 12 days, we would expect someone on the ultrafiltration system to be in the hospital for no more than five days.

    Maggie Connolly
    He was on the actual machine for three days altogether. A few hours, he started perking up. And then the following day when I went in he was sitting up in bed, which he was not doing beforehand. When he finished the actual treatment I went in there to see him and he jumped off the bed - I couldn't believe that he just walked to the toilet on his own - I mean he hadn't been out of bed for several days because he couldn't move his legs and then there he was walking about, jumping off the bed. It was fantastic.

    John Connolly
    Before I would never have been able to - with the size of those legs - I would never have been able to walk, I would never have been able to pick them up and walk.

    Porter
    Satisfied patient, 84 year old John Connolly and his wife Maggie.

    Now, on to a query from a listener - Simon Williams wants to know if drinking high protein supplements helps build bigger muscles. The burgeoning popularity of high protein sports drinks first caught my eye a few years ago, particularly among young men keen to bulk up. These days they seem to be everywhere. And with brand names like Extreme Mass, Body Fortress and Maximuscle, you can imagine the appeal. But, while they may help serious athletes, do they actually do anything for the majority of more recreational gym users?

    Max Pemberton went to meet personal trainer Dean Thorpe to investigate.

    Thorpe
    Max has just got on to the treadmill now, he's going to be on here for a few minutes just to warm himself up before I put him through his paces.

    Pemberton
    I'm feeling quite tired and I'd really like it to stop.

    So Dean we had a tweet from Simon Williams who's a listener and he asked us about protein shakes and protein supplements that are very popular amongst gym goers and how effective they are in muscle building. Phew, I'm glad to get my breath back. Is this something that people come to you and ask you a lot about?

    Thorpe
    I've been asked about protein shakes, probably twice maybe three times a day every single year that I've been doing this job.

    Pemberton
    I keep on seeing all these adverts and there's always these incredibly buff chiselled torsos on the adverts, if I take these drinks is that what I'm going to look like?

    Thorpe
    Afraid not Max. The thing that we don't see is their training routines, they've got fantastic physiques because they put a lot of work in, it is a full-time job to look like that. They take supplements to supplement their training routines but it doesn't necessarily mean that that is what is creating these amazing bodies.

    Pemberton
    So the drinks themselves aren't actually what makes them look like that?

    Thorpe
    There is nothing miracle in these drinks whatsoever.

    Pemberton
    So actually if you're not careful if you take some of these supplements and you don't exercise you're actually just going to get fat and nobody wants that do they?

    Thorpe
    No exactly.

    Stevenson
    If it was a sedentary person who wasn't exercising then taking on any extra calories in their diet would cause weight gain.

    Pemberton
    Dr Emma Stevenson from the Brain Performance and Nutrition Research Centre at Northumbria University has been looking into the benefits of using protein drinks after exercise and whether milk is a cheaper alternative.

    Stevenson
    Most of the good evidence is based around recovery and how protein can help the recovery process and particularly in elite athletes. So there's different aspects of recovery, so protein has been shown firstly through some research actually that we've done here at Northumbria University where we've looked at milk intake after exercise and other people have looked at recovery with protein shakes, rather than using milk but it's the same concept that if you provide protein in the recovery period after exercise that it can help to reduce the amount of soreness after exercise. So if you've done a really hard bout of exercise, and it's something that you're not accustomed to, then that's going to damage your muscles.

    Pemberton
    How about some abs?

    Thorpe
    Abs, brilliant. So I want your hands by the side of your head, I want to lie yourself down very slowly and I want you to come up about three quarters of the way...

    Pemberton
    Like that.

    Thorpe
    That's it and back down again, nice and slow, slow at the...that's horrific, you really should be coming here a lot more, you know that don't you?

    What you've just done now is broken down quite a few muscle fibres after that little workout, these need to be repaired. Protein repairs muscles, protein's main objective when it enters the body is to repair muscles.

    Pemberton
    So the purpose of going to the gym is that you work out, that damages the muscle fibres and then - so really all the body building bit actually happens after the gym with your diet and with having enough protein which then helps you build up the muscle, is that right?

    Thorpe
    Exactly that. Your body is only building when it's resting, not when you're training. You're breaking down muscle fibres only for the rest phase and that eating protein loading up phases - that is the only time that you're actually going to be building the muscle.

    Stevenson
    I'd say that you need to make sure that you're doing some quite vigorous exercise and it's just a convenience thing really - often people don't feel like sitting down to a big meal or they just don't have the opportunity to sit down to a meal. I would always recommend to eating a healthy balanced diet but if there are situations that you do quite a hard session and you know that you're not going to be able to eat for a few hours after that session then that's the time to take on a recovery drink. The research that we've done here has shown that milk is very, very good actually as a sport's drink, as a recovery product, milk actually is good for rehydration post exercise as well.

    Porter
    Dr Emma Stevenson highlighting the fact that protein based drinks can help after strenuous exercise, but pointing out that milk is as good a recovery product as specialist high protein shakes for recreational users. It is also a lot cheaper. It doesn't matter what type of milk you use but skimmed and semi-skimmed contain less fat and fewer calories if you are watching your weight. Aim to consume anything up to a pint within an hour of finishing a hard workout.

    Don't forget if there is anything that confuses you, that you would like us to look into, then you can get in touch via Twitter - send at tweet to @bbcradio4 including the hashtag insidehealth. Or you can e-mail us via insidehealth@bbc.co.uk.

    Which is what listener Paul Sutton did when he heard last week's item on extreme blushing.

    Sutton
    Your programme may just have solved a 40 year old mystery. As a teenager, at Southampton University in the late sixties, I became aware of having hot flushes whilst attending lectures. It was something that I was more conscious of feeling than was evidenced by any real effects and it was not triggered by any form of embarrassment for instance. It seemed to be brought on according to the time of day. I would wake up every day believing I was cured, only to be afflicted as usual by 11 o'clock. It devastated my life although it must have been invisible to others. Nobody ever mentioned my appearance to me, yet I was extremely self-conscious and imagined that I looked like a human Belisha beacon. My affliction had become the only thing I could think about. Suicide was certainly something I contemplated.

    I once gingerly consulted the resident student general practitioner, who said something witty about hot flushes normally being the preserve of old ladies. I was mortified and I never went back.

    In my subsequent life I was not much afflicted by the condition but I always speculated why my academic career was destroyed by this insignificant complaint. I had my theories concerning my illness and reckoned that in relating it it would seem trivial to anyone else. But after listening to your programme I realise that it might have been a recognised condition.

    Porter
    Thank you Paul for getting in touch. Jacqueline Deeks also wrote in after last week's programme, but this time to complain about Margaret McCartney's call for everyone to call a spade a spade when referring to their genitals. Jacqueline writes: "Personally I can't bear the word vulva - it sounds like a cross between Volvo and vulgar - or labia, for that matter, I call them little ears - and why shouldn't I if I want to?"

    That it is for the current series. As I mentioned earlier Claudia Hammond will be taking over this chair for a couple of months for another series of All in the Mind. We will be back in July - until then, goodbye.


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