TONIGHT: AMA with Xand van Tulleken on wellness, supplements and health tech 7-8:30pm, post your Qs now!

[RayaMumsnet]

Hi there,

We’re delighted to announce an AMA with leading doctor, broadcaster and presenter Xand Van Tulleken, on Thursday 10 September, 7-8:30pm.

He’ll be discussing his new book Make Me Well: A Quest to Understand the Confusing World of Wellness

"There has never been a more confusing time to try to be healthy. In the past decade, the healthcare sector has witnessed a remarkable surge in innovation: drug design, genomics and diagnostic technology have all changed almost beyond recognition.

Simultaneously, there has been a significant expansion in consumer health services, including the supplement industry, blood testing, consumer genomics and wearable technology, which claim to improve “wellness” (emphasising physical and mental performance and longevity) rather than curing or preventing specific disease states.

For a typical consumer this is both confusing, as the health and wellness industries are almost indistinguishable, and expensive, as consumer health emphasises personalised products, often sold on a subscription basis. In Make Me Well, Xand van Tulleken investigates the new Wild West of the wellness industry, demystifying a landscape dominated by three products: supplements, blood testing, and wearable technology. In doing so, he shines a light on how people can take care of themselves better in this new and overwhelming world of wellness."

Please post your questions below and join Xand on the thread at 7pm on Thursday 10 Sept to hear the answers.

As always, please remember our guidelines - one question per user, follow-ups only if there’s time and most questions have been answered, and please keep it civil.

hi @PotatoNumber5 ! This is a great place to start! A lot of these wellness products are extremely expensive but the numbers creep up on you. Typically they can extract a pound a day but increasingly they can be a lot more. A typical collagen price on the high st is around £75/month so £900/year!!! That's a lot of money for a product which has two significant problems.

The first is that the scientific evidence says that it doesn't work. This is not easy to see for consumers as the studies that say it does work are very visible and promoted but paid for by industry. The independent studies tend not to find an effect.

The second is that collagen is a byproduct - really a waste product of the meat and fish industries and the mark-up is MASSIVE!!! If you buy collagen wholesale it's about £15/kg, on the high st it's £300/KG!!!

Finally, if you love your collagen then that's fine - I know loads of doctors who like it - but you're being ripped off. You can make it from boiling your chicken bones or beef bones!!! A stock is full of collagen!

What if any supplements do you and your family take?

PS LOVE love love the podcast.

Is stress really bad for our health, and what's the best way to tackle it (supplements, meditation, exercise etc)? Love your podcast btw

Hello Doctor,

AI is proving to be a double-edged sword, but the possible uses in healthcare are immense.
What excites you the most about its application in medicine?

Thank you.

Hello. I love your books. My question is about my thirteen year old boy who pretty much refuses to eat any kind of plant except for cucumber and apples (occasionally). Breakfast is four weetabix and a pint of milk. Goodness only knows what he eats at school and he appears to eat pretty much nothing at home in the evening, but chugs a ton more milk if I let him. As a family we eat pretty healthily, my other two eat anything, and I’ve been putting good home cooked food in front of him from six months old so it’s disappointing. How bad is this for his long term health and any tips for getting more plants into him? He’s the only one of my children who has skin issues and allergies so I’m worried that it’s connected. He also had to have a lot of antibiotics as a young child for various infections. Poor kid drives me mad!

thanks so much for this @Melarus When I was writing make me well the chapter on menopause supplements was the most upsetting for me. For the rest of the book I am the target of the marketing as much as anyone! I get sold collagen and testosterone and turmeric just like everyone else! I'm the victim too! But the menopause industry is far more aggressive and manipulative and none of it is marketed towards me at all.

worth saying for starters we spend around $6 BILLION on menopause supplements and we spend 100 times less than that on menopause research! I interviewed a range of experts about menopause supplements for the book and there were a couple of things that clearly emerged. The first is that some of the ingredients are dangerous including one of the most popular which is called black cohosh. Our medical regulator, the MHRA, which is one of the best medical regulators in the world has advised that black cohosh supplements should have a safety warning label on them warning consumers about liver damage, but because this is not legally required the supplements do not typically have this warning on them.

When the researchers I spoke to looked at 200 widely available menopause supplements they found that they had no ingredient that was common to all the supplements! In the book I go to a wide variety of different supplement manufacturers and I found the same cynicism over and over again: these companies that put powders en capsules to make profit and have absolutely no interest in the effectiveness of their products at all. Obviously, I cannot speak for all the brands, but this was an extremely common thread. The other thing that became very clear when I spoke to investors in the supplement industry was that they two had absolutely no interest in effectiveness and were simply investing in companies with brand loyalty and the ability to pivot rapidly to new trends. I really wanted all this stuff to work but I found the landscape extremely depressing.

I did also spend quite a lot of time writing about HRT which I think has been widely misunderstood. Thanks to very poor communication from the medical profession. Although as many of the people reading this will know it can be very nuanced and different for each person HRT is on the whole much safer than has been reported in recent years and is widely believed. Unfortunately, it is also a little overmarketed and confusingly under prescribed. All in all a very frustrating situation for women. Easy for me to say have a conversation with your GP but so few GPs are expert in it. I hope at least that the section on menopause does have some more optimistic discussion of menopause with some fantastic experts from. Some superb charities.

thanks so much @multigenliving I think this is a very good question to ask anyone who is commenting on this area. Since writing the book I take many fewer supplements and one of the things I hope the book will do is save people money. I also hope that it will save people a lot of confusion anxiety which I think are almost worse than the waste of money. In our house we follow the NHS guidelines pretty closely. I think these are extremely useful for anyone wondering about supplements. The vitamin D guidance is a great place to start depending on how much sun we are getting and the time of year we will take a small dose of vitamin D but all the evidence says that larger dose can be dangerous and confirm no benefit whatsoever! I found this as surprising as anyone else Wood. For my entire career I've assumed that beyond bone health vitamin D was valuable for a wide range of issues including mood immunity and brain health. But all the evidence suggests that the small supplement is all you need and it will do nothing other than preventing you getting the bone Problems of vitamin D deficiency. The NHS recommend some specific supplements for people trying to conceive and for pregnant women breastfeeding women and young children. If you're a vegan, it is worth taking B12 or at least thinking about this carefully! Beyond those things I could not find any evidence that any of the supplements did very much good. The multivitamins have been extremely well studied and gained. These are supplements that we would all expect to work! It seems totally reasonable to believe that our diet in the UK are not terribly good and it would be worth topping up a few of the essential ingredients. But very large studies have found no benefit whatsoever. You may have noticed recent headlines saying that multivitamins stay off cognitive decline in older age and can improve biological age and these findings were very widely reported but were from small studies attached to a much larger study whose central finding was that multivitamins do not improve our health. And even the authors did say that the small studies should not be used to make any decisions! Unfortunately fresh fruit and veg are extremely expensive. I do my best to grow my own but I am not a good Gardner! I know this is very difficult for many families but it does seem like fresh fruit and veg act on our bodies in extremely different ways and far more beneficial ways than supplements do! Thanks so much for your question. I would be fascinated to know what you think!

Apologies! I am getting to grips with the reply system. This is a repost of the earlier one but quoting the question!

Thanks so much *@multigenliving I think this is a very good question to ask anyone who is commenting on this area. Since writing the book I take many fewer supplements and one of the things I hope the book will do is save people money. I also hope that it will save people a lot of confusion and anxiety which I think are almost worse than the waste of money. In our house we follow the NHS guidelines pretty closely. I think these are extremely useful for anyone wondering about supplements. The vitamin D guidance is a great place to start depending on how much sun we are getting and the time of year we will take a small dose of vitamin D but all the evidence says that larger doses can be dangerous and confirm no benefit whatsoever! I found this as surprising as anyone else would. For my entire career I've assumed that beyond bone health vitamin D was valuable for a wide range of issues including mood, immunity, and brain health. But all the evidence suggests that the small supplement is all you need and it will do nothing other than prevent you getting the bone problems of vitamin D deficiency.

The NHS recommends some specific supplements for people trying to conceive and for pregnant women, breastfeeding women and young children. If you're a vegan, it is worth taking B12 or at least thinking about this carefully! Beyond those things I could not find any evidence that any of the supplements did very much good. The multivitamins have been extremely well studied and gained. These are supplements that we would all expect to work! It seems totally reasonable to believe that our diets in the UK are not terribly good and it would be worth topping up a few of the essential ingredients. But very large studies have found no benefit whatsoever.

You may have noticed recent headlines saying that multivitamins stay off cognitive decline in older age and can improve biological age and these findings were very widely reported but were from small studies attached to a much larger study whose central finding was that multivitamins do not improve our health. And even the authors did say that the small studies should not be used to make any decisions! Unfortunately fresh fruit and veg are extremely expensive. I do my best to grow my own but I am not a good gardener! I know this is very difficult for many families but it does seem like fresh fruit and veg act on our bodies in extremely different ways and far more beneficial ways than supplements do! Thanks so much for your question. I would be fascinated to know what you think!

Thanks so much! We love making it even if Chris and I do occasionally try to strangle each other! Please do let us know on the socials if you have any suggestions for topics you would like us to cover or email the team as we do read all the messages!

Any thoughts on Zu-vendis from Goode Supplements for seasonal affective disorder?

Thanks so much for this question @Ladyglittersparkleseriously one of my colleagues at University College London Professor Michael Marmot did the foundational work on this and I think the data is pretty clear that stress is genuinely bad for our health... Though it can be difficult to describe exactly what stress is! It seems like the combination of financial difficulties, anxiety and social isolation is physically damaging and that probably much of this damage comes from chronically elevated cortisol which is one of the hormones that we used to respond to stress.

It is worth saying though that there are beneficial forms of stress, exercise being perhaps the most important one. We talk about this issue a lot in my house because both my wife Dolly and I get quite anxious about work and our children and we are frequently short of sleep. I do not have a perfect cure for this, but I think that the wellness industry has very little to offer in this regard. When I was writing Make Me Well I was anxious to answer this question and found a couple of quite strange people to give me some wisdom. The first one is a rock musician from the band Guns N' Roses, a man called Duff McKagan who many readers will never have heard of. But if you like 1980s Glam rock, he is one of the rock gods. He wrote a fantastic book about recovery from drugs and alcohol that really described the role of creativity and family in leading a more meaningful life.

And pleasingly his advice was echoed very confidently by Daisy Fancourt who is a Professor of Psychobiology at University College London who talks about the value of having hobbies and undertaking crafts and engaging with culture and the arts. What I like about both of their advice is that there does seem to be very good reason to pick something that you enjoy and I think it could be anything like learning a language or a musical instrument or joining a choir or doing some martial arts or birdwatching and pursuing it with passion and enthusiasm! Many of these things are inexpensive or free and they will be good for your brain and your body and your social world.

Personally, this seems to be a far more enjoyable and meaningful way to engage with the world than just judging through the instructions from a personalised nutrition company or a fitness guru on Instagram! I do also rely pretty heavily on my exercise bike for stress relief and I have to say it makes me feel pretty good but I realise this is not for everyone and if you don't like exercise then I think finding something you do enjoy is probably more beneficial! I hope this is helpful, perhaps it is not terribly new advice but it was very thrilling in the book to get it from a wide range of people. The value of family friendship community and an outward looking approach to life rather than the naval gazing that is encouraged by the wellness industry! XX

This is such a great question! Thank you @VK456 ! Different doctors are very good at different things. I found the parts of the job that involved working closely with patients to decide on different treatments and making sure that patients and families understood what was happening enjoyable and rewarding.

I was quite good at looking at the big picture of a person's entire health and wellbeing and helping them through complex choices about drugs and procedures. But for whatever reason perhaps a touch of dyslexia or some other kind of neurodivergence! I found keeping track of the minute details of drug doses are very specific diagnosis of complex cancer is extremely challenging.

I think that there is a possibility for AI to help different doctors play to their strengths a bit more. And also to provide a safety net for patients: an AI system that listens in to clinic and perhaps reminds clinicians to ask about straightforward things like pregnancy or drug allergies or looks out for different drug interactions could be very valuable.

That said I'm very concerned about the increasing use of AI in healthcare as essentially an unregulated untested medical device. It seems to me that using AI is very similar to using a CT scanner or an MRI machine or any other kind of electronic assistance: it would be essential in all those cases to do detailed trials to understand what the role of these machines and this technology is in saving lives and whether or not indeed it does save lives.

At the moment most of the most exciting results in AI medicine are from trials that have been entirely paid for by artificial intelligence companies and often the details of the trial are not fully disclosed. This would not be acceptable with a drug or any other medical intervention and so it seems to me that we should be far more cautious about rolling these technologies out widely.

We're there any things you looked into that you found could be genuinely a good intervention beyond what normal NHS healthcare care that you would recommend? Ie step tracking seems to have given a lot of people and incentive to move a little bit more, or is that also an exaggerated idea?

hello @WutheringTights and thanks so much for this question! I have a 17-year-old, a two-year-old and an eight month old and I'm very sympathetic about the stresses of parenting!

Worth emphasising that I am not a paediatrician or a nutritionist so if you are really concerned of course discuss with your GP. But here are my thoughts:

The first thing is that this is definitely not your fault. You are doing all the things that are supposed to work and he has two siblings who are doing well so you can feel good about your parenting and this is just the frustrating variation between different children! Don't beat yourself up!

Second, I don't think this is as bad as you imagine it is. Four Weetabix and a pint of milk is quite good nutritionally and there is data to show that picky eaters end up doing just fine later in life.

I don't suspect that his skin or allergies are actually connected to his diet and so again my inclination is to reassure you that you are doing a good job and there may be less to worry about then you think.

My advice would be largely to stop worrying about this and not to make meal times a battle. This is common wisdom from nutritionists but it is also based on my personal experience. My own twin brother's concern about my weight - admittedly I had a different problem where I will eat absolutely anything in large quantities - but still, Chris was worried about my weight and would nag me constantly and I really found it difficult to take charge of my own diet and look after myself until he let it drop.

If the list of foods he is willing to eat is shrinking; then it is important to speak to his GP but otherwise I think a much more relaxed attitude might help. I do share your frustration and he would probably feel very much better from a gut health point of view and generally if he increased his fibre intake and perhaps just making things available for him could help: cucumber, apple sugar snaps, raw carrots and so on. Even a smoothie with bananas and frozen berries might be a slightly easier sell and would get him on the road to having a bit more fibre!

Frustratingly for you, he might well do what my son did and start to take an interest in food when he begins to take an interest in exercise. For example, when he gets a little bit older or as my son did when he got a girlfriend who was interested in healthy eating! Perhaps the one other thing you might try is teaching him to cook or getting him some cooking lessons. Putting him in charge of things and giving him some control might allow him to consider his choices a little bit more. As I say, this is not my area of expertise other than that I am a parent and human who has struggled with some of these things and I spend a lot of time thinking about our food system! Very good luck XX

Thanks so much for this question about such an important and confusing issue @onemoretimefromthetop when I was writing Make Me Well I found this perhaps the hardest issue to communicate. The problem is the same whether you are talking about expensive health scans or less expensive blood tests. When we use medical investigations to look for things, we tend to find things and then not know what to do about them! It seems so seductive and obvious that having a test to look for problems and then catching those problems early and treating them would save lives and save people a great deal of time and difficulty. But in fact what happens is the opposite.

I did my dissertation when I was at medical school in the MRI department and we used to routinely scan a lot of people’s heads just to test the machinery and try out different methods of scanning. Everyone that came into the department had to sign a form saying that they understood we would not tell them the results of the scans because we would find so many cysts and growths and other abnormalities in people's brains and because all these people had come in just to have a test scan they were usually just healthy medical students with no symptoms. So there is no clear helpful way of proceeding from there!

If you want to know what something abnormal inside someone's head is you really have to drill a hole in the head and biopsy it. All you have to tell them is that there is a growth inside their skull and you don't know what it is and you have to rescan them regularly and see what happens. All of that creates anxiety and can be risky!

Basically large studies have been done doing scanning to look for problems and doing blood tests to look for problems and with a small number of exceptions we find that they either don't save lives or that they kill more people than they save!

It is a hard issue to explain particularly as so many of us have health anxiety but these companies are preying on our anxiety and vulnerability. I'm sorry not to be able to offer you a safe inexpensive way of getting reassurance, but the best thing to do is keep an eye on yourself and how you're feeling and check yourself for symptoms and discuss any of those symptoms with your GP. And do make sure that you do the regular screening that is offered to everyone by the NHS, as that stuff is free and very evidence-based to save lives! I know many people who have not had their cholesterol or blood pressure checked or had their colonoscopy on the NHS who are paying out-of-pocket for expensive private testing that will endanger them or falsely reassure them!

Happy to try and answer more questions about this as it is so confusing. I do tackle it in detail in the book and I'm very sympathetic to how tempting it is to do this stuff.

What's your view on the blanket inclusion of Folic Acid in flour, given there are potential issues and Europe don't!

To what extent do you think our nature disconnectedness and our insistence on ignoring our basic biology more broadly (loss of community, blue light etc) is contributing to our health issues, alongside our poor diets (which represent a different facet of the above)? Do you feel social prescribing could play a more overt role and what is the attitude to this amongst medics?

Thanks so much @ElderFlour88 I wrote about this in Make Me Well as I was looking for an alternative to all the various products offered by the wellness industry! Finances and household income play a huge part in determining our health. But even within these constraints there is evidence that beyond diet and exercise, engaging with hobbies and the arts can be really beneficial to physical and mental health!

The advice I liked the most was from scientists who recommended picking something you enjoy and pursuing it with enthusiasm! They particularly talked about "mastery" with the idea that rather than simply doing something repetitively that you enjoy, we should be trying to improve and master something. That could be knitting, birdwatching, martial arts or joining a local choir and so it does not have to be expensive, but I found this advice personally really helpful and reassuring. I don't think it should feel very radical to say that it is great to have things that feel meaningful in our lives that we can pursue and improve but in the face of the wellness industry it does feel like it is worth saying! XX

Does collagen supplementation have any health benefits? Thank you

Thanks so much for this question @LemonJues I have tried to avoid saying "buy the book!" But in this case that might be the easiest way of getting the answer in detail. Let me try to help here: I spent a lot of money and time doing microbiome testing in the book, investing about £3,000 in personalised nutrition products. They give wildly inconsistent results and no serious microbiome scientist would ever use them to make any decision about their health or nutrition.

These tests are only useful to diagnose severe medical problems and I am amazed that there are prominent scientists and doctors making money out of them and promoting them as good for our health. Sorry to be so blunt but I spent a lot of time talking to a number of independent scientists and could not find anyone in favour of them who was not selling them!

Yes! Although lots of my answers about the supplement industry in this AMA are extremely negative. I really did approach the wellness industry with an open mind and there are many wellness practices that I think are valuable and important. You are probably the best judge of what works for you but I think anything that makes you look outwards rather than inwards and broadens your social world is good for you! I think joining a choir for instance is 1 million times better for you than any supplement or gadget! I hope that helps!

Sadly, I think that what you hint At in your question is exactly right @ThatBeachLyfe

I interviewed supplement lobbyists and manufacturers and marketers and investors and found an almost bottomless pit of cynicism and lack of interest in their customers. That said the list you have given me is quite diverse. I think there is little reason for most people to take magnesium but it can be useful in some healthcare situations, HRT is a prescription drug which has tremendous value for many people facing menopause although it is frustratingly difficult to get and hard to find expertise about it! There is good evidence that creatine can be beneficial for very particular Sports but I think it is wildly overhyped and far too expensive to make it worthwhile for most people and will not have any of the cognitive benefits or endurance benefits that I claimed for it. Collagen is a perfect example of the industry playing on women's insecurities and anxieties: it is inexpensive industrial waste which is sold at a huge huge premium with no good quality evidence to support its use in anyone. I hope this is helpful even if it is a little depressing XX

Thanks so much @GingerIsland unfortunately no serious medical organisation recommends multivitamins or any supplements for these problems. It is a shame as it would be wonderful to have an inexpensive safe way of treating these issues. Unless you have a diagnosed nutritional deficiency, it seems to be very unlikely from looking at the data that a multivitamin would be a helpful way of addressing the problem. I'm sorry about this and I know that mental health disorders can be extremely difficult to get help with on the NHS, but I think a conversation with your GP is a much better place to begin. Very good luck and best wishes X

A very common question and one we were frustrated by in our house! @BeardofHagrid the short answer is that this is standard medical advice and probably sensible even though it is extremely frustrating as we found when my wife was pregnant! Sorry about this