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I’m proud Good Health STICKS ITS NECK OUT!

By Dr Michael Mosley, who charts some of the breakthroughs we’ve covered

By DR MICHAEL MOSLEY

FoR 30 years Good Health and I — sometimes together! — have covered some of the most extraordinary years in medicine, including, perhaps, the biggest health story of our lifetime, the Covid-19 pandemic.

From ever-shrinking surgery tools and minimally invasive procedures, to scanning machines that work in 3D and vaccines for a pandemic virus developed in under a year, it’s been an amazing period of breakthroughs big and small.

As the health section marks its 30th anniversary it’s a great time to look back at how medicine, and our health, have been transformed. Here is my very personal take on what I think are some of the most important changes of the past three decades, and the kind of medical advances we might see in the future.

GUT INSTINCT

PeRHAPS one of the most significant developments has been in our understanding — and appreciation — of the gut. The gut is not the most glamorous of organs and, for a long time, its problems were the butt of jokes, or simply taboo.

But along with its microscopic inhabitants (mainly bacteria), it has a huge impact on our health: research into gut health has exploded in recent times and, with it, has come the realisation that treating the gut could play a wider role in a range of conditions including those affecting the brain.

We now know that buried along the entire digestive tract is a very thin layer of brain, made up of the same cells (neurons) found in your main brain. There are more than 100million

neurons in your gut, as many as in a cat’s brain, which makes your guts pretty smart.

Your ‘gut’ brain keeps in touch with your main brain via the vagus nerve, which seems to be an important pathway for certain conditions. Recent research, for example, suggests that Parkinson’s disease starts in the gut and spreads to the brain via the vagus nerve.

And thanks to the Human Genome Project, a vast project which 20 years ago provided the first draft of the roughly 25,000 genes that make us human, not only have we been able to explore our own DNA, but also, for the first time, the trillions of microbes that live in and on us.

Scientists have shown that the balance of bacteria in our gut affects many things, including our appetite and weight and also our mental state (using the vagus nerve as a super highway to the brain).

It’s widely acknowledged that our microbiome can be affected by factors such as exercise, sleep and diet (we’re all now familiar with ‘prebiotics’ — foods rich in fibre that feed the ‘good’ bacteria in our gut — and ‘probiotics’, living bacteria which are found in fermented foods such as yoghurt and sauerkraut).

But we also know there are more radical ways of changing our gut bacteria, including with a faecal microbiota transplantation (FMT) — transplanting faeces from a healthy donor into the person you want to treat.

In January 2013 the first scientific trials were done, testing FMT for Clostridium difficile, a common gut infection that kills more than 1,600 Britons a year. Standard treatments, which include antibiotics, are often ineffectual.

But this study found that FMT cured more than 90 per cent of cases, which is astonishing, and it’s now being tried on other conditions such as type 2 diabetes and even autism.

TICKING TIMEBOMB

SOMETIMES the greatest changes are the result not of high-tech wizardry, but lowtech changes.

Heart disease is still the biggest overall killer in the UK. But the past three decades have been a good news story because rates have really plummeted, halving between 2005 and 2015, according to research from Imperial College London.

This was not because of brilliant medical advances but because of a simple bit of legislation.

In 2007, the UK government banned smoking in public places, leading to a huge drop in the number of people smoking and dying of heart disease.

Although we think of smoking causing lung cancer, in fact it kills far more people by making

blood more likely to clot and clogging up arteries with plaque.

Another reason for this big drop in deaths is the widespread use of statins. When I first reported on statins when they were launched in the 1990s, I was sceptical they would live up to the hype: lots of drugs that look promising early on disappoint in the long run.

Though they still have their critics, statins have stood the test of time — and I take one myself.

SEARCH FOR MIRACLE

LIKE heart disease, the story of cancer is largely one of good news. Thanks to better screening and treatments, almost twice as many people survive common forms, such as bowel, breast and prostate cancer, than 30 years ago.

One of the drugs that made a big difference is tamoxifen, which can improve survival rates from breast cancer by around 40 per cent. A promising approach to cancer generally is immunotherapy, where you galvanise the body’s immune system to attack the cancer.

Cancers can sometimes find ways to evade your defences and there are now a number of ways to try to get round this, including extracting immune cells, modifying them in the lab before reinjecting them.

In the early days the effects were unpredictable — but nonetheless, when it worked, the effect could be astonishing. Take the example of Helen Mayoh, who was diagnosed with terminal kidney cancer, butaft e rim mu no therapy made a recovery and went on to have her third child, as Good Health reported in 2006.

BEST BRAIN FOOD

THE brain is the most complex organism in the known universe, so perhaps it’s not surprising that when it comes to things such as dementia or mental health, we have made less progress over the past 30 years.

Despite billions spent on research, none of the drugs for dementia has made a significant difference and there have been few new drugs for depression.

But as with heart disease, breakthroughs aren’t all about high-tech — thanks to pioneering work done by bodies such as the Food & Mood Centre at Deakin University in Australia, we know that what we eat has a profound effect on our mental health — and if you swap junk food for a healthier, balanced diet, within weeks most people see big improvements in mood, even those on medication.

Lifestyle changes may also help with dementia, with numerous studies showing that exercising more and improving your diet can succeed where drugs have failed, significantly delaying the onset.

The link is so strong that some scientists believe Alzheimer’s should be called type 3 diabetes. That’s because insulin resistance, where your body has to produce ever larger amounts of insulin to bring your blood sugar levels down, common in diabetes, is also characteristic of this form of dementia — highlighted by Good Health as far back as 2012.

DIABETES SUCCESS

THE past 30 years have seen a major expansion in human waistlines. Rates of obesity have tripled, and in the Uk more than two-thirds of adults are now overweight or obese. This has been accompanied by a spectacular, fourfold increase in type 2 diabetes.

Until very recently this was seen as a progressive disease, almost inevitably meaning a lifetime of ever increasing medication.

But then two of my scientific heroes, Professor Roy Taylor of Newcastle University, and Professor Michael Lean of Glasgow University, made a true breakthrough when, in 2018, they showed that type 2 diabetes can actually be reversed with a rapid weightloss, 800-calories-a-day diet. Their results were so impressive that the NHS is currently rolling out a major pilot of this approach.

Another low-tech but genuinely revolutionary advance.

WHAT NEXT?

LAST, and by no means least, there is our ongoing battle with deadly microbes. Over the past 30 years we’ve seen increasing numbers of deadly new outbreaks, from swine flu to ebola, but they’ve been accompanied by some amazing developments.

Although Covid19 has had a devastating impact, it could have been worse. But thanks to genetic testing, which came out of the Human Genome Project, we can now track the progress of the virus and detect new variants when they arise.

And the creation of novel vaccines, such as those produced by Pfizer and AstraZeneca, has saved millions of lives.

These vaccines are based around a completely different approach to boosting our immune system. Instead of injecting us with dead or weakened viruses, they are based on short stretches of genetic material that instruct your body to produce harmless fragments of the Covid virus. enough to provoke your immune system, without making you sick.

So what about the future? Two of the most exciting technologies are 3D printing for everything from personalised drugs to new joints — and stem cells, where you can grow new blood vessels and even potentially a whole new heart.

The world has changed in so many extraordinary ways over the past 30 years, and the rate of change is accelerating. It can be hard to keep up. But you can count on Good Health to keep you informed of the latest developments, for many years to come...

30 YEARS OF GOOD HEALTH

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2021-09-25T07:00:00.0000000Z

2021-09-25T07:00:00.0000000Z

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