The Long Game | Dr Alex

You can be a completely normal weight and still be carrying the type of fat that does the most damage over time. Visceral fat sits deep around your liver and intestines rather than just under your skin, and it behaves very differently because of where it drains in your body.

In this episode I go through five things with proper evidence behind them for shifting visceral fat. Losing body fat overall, aerobic exercise that gets you out of breath, the quality of the food you eat, getting enough regular sleep, and cutting back on alcohol and chronic stress.

I also cover three things that get sold constantly but do very little. Ab exercises like crunches, fat burning supplements, and anything that makes you sweat around your middle like waist trainers or sauna belts.

A simple way to check where you stand is a tape measure. Measure around the widest point of your waist and aim for a number that is under half your height.

The full list of research references for this episode is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #visceralfat #preventativehealth

Your body makes a gas called nitric oxide inside the lining of your blood vessels every single day, and it only survives for about a second before it disappears. It is so powerful that a synthetic version of it is used in emergency medicine during a heart attack.

Nitric oxide tells the muscle in your artery walls to relax, which drops your blood pressure. But it also keeps the inner surface of your arteries smooth, so cholesterol and immune cells cannot stick and start building the plaques that lead to heart attacks and strokes.

In this episode I go through six ways to raise your nitric oxide, including what you eat, a habit that might be sitting in your bathroom cabinet right now, how movement changes things even when you are not exercising, what your nose and sunlight have to do with it, and the one factor that matters more than any of the others, which is not making more nitric oxide but destroying less of it.

The full list of research references is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #nitricoxide #heartheath

Bowel cancer usually gives warning signs long before it becomes serious, but those signs are easy to explain away as something you ate, stress, or just getting older.

In this video I go through six warning signs of bowel cancer in order, from the easiest to miss through to the most serious one of all, which needs an ambulance. For each one I explain what it actually means in your body and what you should do about it, whether that is a routine GP appointment, a same day appointment, or a trip to A&E.

The six signs covered are bloating that lasts three weeks or more, tiredness and breathlessness caused by hidden blood loss, a change in bowel habit that sticks around, losing weight without trying, bleeding from the back passage, and a blocked bowel.

If you are in the UK and aged between 50 and 74, the NHS will post you a screening kit every two years. Screening does not cover you for new symptoms though, so please do not wait for a kit to arrive if something feels off.

The full list of research references for this video is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #boweldisease #preventativehealth

A study following more than 90,000 people for around 20 years found that those eating a small handful of walnuts five or more times a week were about 14% less likely to have died by the end of the study than those who ate none at all.

What makes walnuts stand out is that this isn't just one observation. A proper randomised trial handed people the nuts directly and then tracked heart attacks and strokes, and found a lower rate of those events in the group eating nuts regularly.

In this episode I go through that large study, the trial behind it, what walnuts appear to be doing inside your blood vessels once eaten, and what this looks like in a normal week, including how much to eat and how to store them so they don't go off.

The full list of research references for this episode is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #walnuts #preventativehealth

Cortisol gets a bad reputation, but without it you would not survive the day. The real issue is that your stress system was built to handle a threat lasting a few minutes, while many of us are carrying pressure that lasts years.

In this episode I walk through what cortisol does when it is working properly, what changes when stress never switches off, the signs worth noticing, why sleep sits right at the centre of all this, how movement and food shape the picture, and the part that happens purely in your own head through rumination.

I also cover why adrenal fatigue is not a recognised diagnosis, what the evidence actually shows for supplements like ashwagandha, and why saliva cortisol tests are so hard to interpret.

The full list of research references for this episode is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #cortisol #stressmanagement

The PSA test that most men get offered is right about as often as a coin flip, and a newer blood test claims 94 percent accuracy. Both numbers need context before they mean anything.

In this episode I go through what PSA actually measures, why catching a prostate cancer early does not always help the man it is found in, how the biopsy pathway has quietly changed for the better, and what this new 94 percent test can and cannot tell you. I also cover a second test from Sweden called Stockholm3 that I think deserves a lot more attention than it gets, and the screening decision the UK made this June that most people have misunderstood.

The full list of research references is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #prostatecancer #psatest

Families often come into A&E convinced a parent is developing dementia, when forgetfulness, exhaustion and low mood can sometimes be traced back to something far simpler and far cheaper to check for.

As we move past our 50s, the stomach lining naturally becomes thinner and produces less acid, which makes it harder to release vitamin B12 from food and harder for the body to absorb it. Two very common prescriptions, metformin for type 2 diabetes and PPIs for acid reflux, can also quietly reduce how much B12 the body takes in, especially the longer they are used.

When B12 and other B vitamins like folate and B6 run low, a substance called homocysteine starts to build up, and higher levels have been linked to faster brain shrinkage and poorer memory. A small Oxford trial found that people with mild memory problems who took folic acid, B12 and B6 saw their brains shrink more slowly than those given a placebo over two years, particularly those who started with the highest homocysteine levels. It is an interesting result, though the study was small and larger trials have not shown the same clear benefit across the wider population.

The most reliable way to protect these levels is through whole foods rather than supplements. Fish, shellfish, eggs and dairy provide B12, leafy greens, beans and lentils provide folate, and fish, poultry, potatoes and bananas provide B6. Supplements have their place for people on a vegan or vegetarian diet, those on medication that affects absorption, or anyone with a confirmed deficiency, but they are not a substitute for eating well.

If you think this might apply to you or a relative, it is worth asking your doctor for a full blood count along with B12, folate, ferritin, thyroid function and HbA1c, since an underactive thyroid or rising blood sugar can cause very similar symptoms. Please do not stop any prescribed medication, including antidepressants, based on this video. Speak to your doctor first.

The full list of research references is in the description of the YouTube version of this video.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #B12deficiency #BrainHealth

Your kidneys can lose a huge amount of their working capacity before you ever feel anything wrong, which is exactly why kidney problems tend to get missed until they are much further along.

In this episode I go through the early signs that are genuinely worth paying attention to, including frothy urine that does not clear after a minute, puffiness around your eyes in the morning, swelling in your ankles or lower legs, and needing to get up at night to pee more than you used to.

I also cover the later signs that only appear once things are more advanced, the two tests that catch kidney problems long before any symptom does, and what actually protects your kidneys over the long run, including the role of blood sugar, blood pressure, certain painkillers, and diet.

The full list of research references is in the description of the YouTube version of this video.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #kidneyhealth #preventativehealth

One in four scans I used to see in A&E had the same quiet little note at the bottom: fatty infiltration of the liver, incidental finding. No pain, no symptoms, just sat there until we went looking for something else entirely.

The good news is that this is one of the most reversible things we talk about in lifestyle medicine. Studies show that meaningful weight loss and cutting back on added sugar can genuinely shrink liver fat, sometimes within weeks. Even swapping in resistant starch, the kind your gut bacteria feed on, seems to make a real difference.

In this video I share five meals we actually cook at home, from overnight oats to a cold potato and mackerel salad, that lean on fibre, olive oil, oily fish, beans and resistant starch rather than the fast sugar hit that so much processed food gives your liver.

The full list of research references for this video is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #liverhealth #guthealth

You cannot dissolve plaque like pouring a drain cleaner down a pipe. Plaque forms inside the wall of your artery, not on the surface, so there is nothing to simply rinse away.

But the research does show three real things we can aim for. You can stop plaque getting worse. You can stabilise it so the cap toughens and becomes far less likely to burst. And in some trials, plaque has genuinely gone backwards.

Two studies make this clear. The Ornish trial put patients with existing heart disease onto an intensive lifestyle programme and found most of that group showed some regression, while the group on standard care kept getting worse and had far more cardiac events over time. The ASTEROID trial took the opposite route, using a high dose statin, and used ultrasound scans to watch plaque actually shrink.

Diet and medication are not competing with each other. They work on the same root causes, mainly cholesterol and inflammation, just by different routes.

In this episode I walk through six practical steps that the evidence actually supports, covering your cholesterol numbers, the way you eat, how movement helps clean your arteries, calming chronic inflammation, managing stress properly, and which supplements are simply not worth your money.

The full list of research references is in the description of the YouTube version.

Disclaimer: This is not personal medical advice and does not override what your doctor says.

#dralex #hearthealth #preventativemedicine