By Jerome Burne
Given this blog’s commitment to tackling chronic disease by helping people change their lifestyle, I was delighted to discover that the BBC 1 was devoting its prime time 9.00 slot to a three part series about passionate young GP, Dr Rangan Chatterjee, who goes to stay with patients and turns their unhealthy lifestyle around.
Dr Chatterjee is just the sort of doctor we all want – sympathetic and supportive, as well as knowledgeable and careful. He dissolves the barrier between drugs and complementary approaches. You don’t need a controlled trial to prove that replacing five fast-food take away meals a week with fresh ingredients is going to make a big difference. The first episode airs on Thursday. Watch it.
I talked to Dr Chatterjee for a paper which, for one of those frustrating reasons, was unable to run the article. So here it is, complete with various background tit-bits that don’t appear in the programs.
A home visit from a GP is an increasingly rare occurrence, but when Dr Rangan Chatterjee went to see Dotti Darcy and her family at their house in Shrewsbury, it was particularly notable.
For not only did Dr Chatterjee stay for dinner, but he then spent the night on a blow-up mattress in the living room.
The GP from Oldham is on a mission to put ‘lifestyle medicine’ on the map. As he explains: ‘Most of the patients I see have chronic problems – diabetes, obesity, gut issues and headaches – which are strongly affected by their lifestyle.
Treating the causes of chronic disease not the symptoms
This includes what they eat, how they handle stress and relationships,’ he says. ‘We doctors are very good at dealing with emergencies and diagnosing acute problems which is what’s needed to deal with things such as infectious diseases and trauma. But these chronic conditions need a different approach.’
When Dr Chatterjee goes to stay with the Darcys it’s immediately clear what’s wrong with their health. Dotti, 36, who works in the buffet service on trains, is 5ft 2in and weighed 19 stone 10, giving her a BMI of 50.5 (dangerously obese). Her husband Russ, 32, a fire station controller, and at 5ft 11, weighed 19st 13 (BMI 38.9. – obese). Their children, Deni, 17, and Brandon, 18, were both heavy.
The parents had given up on trying to control their weight and it was some time since anyone in the family had seen a doctor.
Dotti hated being so large. ‘My back, my ankles my heart, they all ache. I don’t want to die of a heart attack at 40,’ she said, adding through the tears: ‘I want to grow old.’
I look forward to it but afterwards I feel guilty
But their diet was making that unlikely. On the evening he arrived Dr Chatterjee and Russ went to collect a take-away, which consisted of four fried chicken meals, seven burgers, five large portions of chips and four large sugary drinks.
‘How often do you have this,’ asks Dr Chatterjee, amazed. ‘Five nights a week easy,’ Dotti admits. ‘I look forward to it but afterwards I feel guilty.’ The family’s diet for their other meals was not much healthier – essentially ready meals, breakfast cereals and crisps; almost no fruit or vegetables.
‘Every GP in the county has dozens of families like the Darcys,’ says Dr Chatterjee. ‘Lovely people but they are getting sicker and sicker. There is no way we can have any significant impact in a few 10 minute consultations, which is why the most common treatment is to prescribe drugs.’
‘This can help with symptoms but they rarely tackle the underlying cause. Our failure means they will cost the health service a fortune. More importantly our patients deserve much better.’
Every meal has to be freshly prepared
So after a night on the blow-up mattress Dr Chatterjee and the family go to work. Fridge and cupboards are emptied of junk food and the Darcys are made to go cold turkey on the take-aways.
From now on every meal is to be freshly prepared from whole foods such as fish, eggs and meat as well as lots of fruits, vegetables, nuts and seeds. ‘A big part of what I do is education,’ explains Chatterjee. ‘Most of my patients are worried about weight.
‘Most of them are following low fat diets that are loaded with added sugar. My role is to bust some myths and explain that increasing good quality healthy fat and reducing refined carbohydrates such as cereals and bread can be very beneficial.
‘The problem is you can’t explain all that and do everything else in ten minutes,’ says Dr Chatterjee. ‘That’s why briefly moving in with the families made such a big difference. They were really interested to discover how processed foods were driving their cravings because the sugar and refined carbohydrates kept pushing up their blood sugar for a few hours but then it dropped and they were hungry again.’
At the end comes the transformation
Delivering the message is helped by the speed with which the benefits show up. Three days after starting, the pains in Dotti’s back and ankles had gone. ‘That’s because persistent inflammation is at the root of most chronic diseases,’ explains Dr Chatterjee. ‘Junk and processed foods increase the amount of inflammation via the effect they have on the gut. Healthy food brings it down.’
Like all make-over programs, this one ends with a ‘reveal’ where we see the transformation. At the beginning Dotti had the blood glucose level of a diabetic but she had never been properly diagnosed.
Six weeks later by sticking to her new diet of unprocessed food Dotti’s blood sugar had fallen to a normal level and her weight had gone from 19st 10lb to 17st 8lb. Russ had lost a stone.
Dr Chatterjee’s interest in lifestyle medicine was triggered by a terrifying incident in his own life when his then six-month-old son, now five, was rushed to hospital after suffering a life-threatening seizure. It turned out that the baby wasn’t getting enough calcium to the brain because he had a serious vitamin D deficiency – IT’S NOT CLEAR WHY.
Repairing the guts with vegetables
‘The hospital doctors were great at diagnosing the problem and replacing the missing vitamin and mineral,’ he says ‘but they didn’t have much to say about what the long term effects of such low vitamin D very early in life might be. That’s when I realised the important difference between medicine for acute and chronic conditions.’
Through his own research he discovered that an immature immune system could be strengthened by encouraging certain “friendly” bacteria to grow in the gut. ‘You can do this with vegetables that contain the sort of fibre they need plus probiotic supplements,’ he says.
This information came in handy when as part of the BBC series Dr Chatterjee stayed with a family where a young boy called Lucas had several problems, the most obvious of which was eczema. ‘My son had also had eczema which I’d found was one of the many possible effects of an immature immune system, says Dr Chatterjee.
‘Lucas had two other supposedly unconnected problems – acid reflux and abdominal pains that often kept him off school.’ He was getting drugs for each from three different doctors but there had been little improvement.
Three chronic conditions vanished within a month
Dr Chatterjee suspected, however, that the root of Lucas’ problems were down to his gut health. About 70% of our immune system is found in and around our guts, so he focused his attention there.
‘I cut certain foods out of his diet that I felt might be making the situation worse and replaced them with foods rich in the vegetable fibre and specific probiotic supplements that had helped my son.’ Within a month all three of Lucas’ chronic conditions had almost entirely vanished.
Although many of Dr Chatterjee’s cases benefitted from a change of diet, he had plenty other equally safe non-drug options.
In another episode Ray, an impressively muscular body-builder who often worked out for 14 hours week, had suffered constant back pain for over ten years. The only treatment he’d been offered was painkillers and he taking such a huge amount it put him at high risk of liver damage and addiction.
First Dr Chatterjee spelt out the risks of the drugs and then he took Ray to see a musculo-skeletal therapist, who identified the root of the problem: a twisted spine that was the long term effect of having broken his jaw when he was young.
Behind the muscles there was still a frightened boy
The injury has subtly altered his posture and the way he walked. Teaching Ray exercises to help realign his body ‘dramatically stopped the pain within a few days so he no longer needed the painkillers.’
Then a cognitive-behavioural therapist helped Ray to deal with the distorted image he had of his own body that was driving him to spend hours in the gym. Despite being heavily muscled, he had still been seeing himself as a typical seven stone weakling.
In his own GP practice Dr Chatterjee has found ways to make more time to talk to patients about nutrition and lifestyle. ‘Rather than scheduling, say, six separate appointments, I’ve been making hour-long group appointments for ten people with similar issues. That lets me go into a lot more detail.’
A doctor in the house is clearly not a national strategy but it certainly makes a strong case for more support for patients and putting nutrition and lifestyle management back on the medical curriculum.
Doctor in the House: A three part series beginning at 9pm on 19 November on BBC One | www.drchatterjee.co.uk | @drchatterjeeuk