The Long Game | Dr Alex

Bowel cancer in people under 50 is rising, and the numbers are genuinely striking. Someone born around 1990 has roughly double the risk of bowel cancer compared with someone born around 1950 at the same age, and the risk of rectal cancer specifically is even higher. At the same time, rates in older people are actually falling, which tells us something in the way we live has changed.

In this episode I go through what the research currently points to. That includes how inactivity affects insulin levels in a way that may encourage damaged cells to grow, how ultra processed food has pushed fibre out of our diets, and what that does to the good bacteria living in your gut. I also talk about a toxin called colibactin, made by certain strains of E. coli, which a 2025 study found far more often in bowel cancers diagnosed in people under 40 than in those diagnosed over 70.

I also cover alcohol, why the old idea that a glass of red wine is good for your heart doesn't hold up once you look closely at the research, and why regular drinking carries more risk than people often assume.

Most importantly, I talk through the warning signs you should never ignore, things like bleeding from your back passage, an unexplained change in bowel habit, weight loss you can't explain, or tummy pain that keeps coming back. If any of these apply to you, please get seen by a doctor.

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 #boweldcancer #guthealth

There is a process ticking away in your body right now that sits behind pretty much every condition Dr Alex has treated in A&E, from heart attacks and strokes to type 2 diabetes, dementia, arthritis, kidney disease and several cancers. That process is low grade inflammation, and what you eat has a real influence on whether it stays switched off or keeps simmering away for years.

In this episode Dr Alex explains what inflammation actually is, why it sometimes fails to switch off, and the nine foods that help bring it back under control. These include tinned oily fish for the omega 3 fats that help end an inflammatory response, blackberries for their pigments called anthocyanins, broccoli for a compound called sulforaphane that switches on your own cell defences, and extra virgin olive oil, which contains a polyphenol that works a bit like a mild natural ibuprofen.

He also covers hemp seeds, mushrooms and their compound ergothioneine, turmeric and why cooking it with black pepper and oil matters more than taking a supplement, fermented foods like yoghurt, kefir, sauerkraut and kimchi for gut bacteria diversity, and dark chocolate at 80 percent cocoa or above for its flavanols.

Finally, Dr Alex talks through the three everyday habits that push inflammation back up: ultra processed food, not eating enough fibre, and alcohol, including why the old idea that a glass of red wine protects your heart does not hold up once you look at the research properly.

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

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

#dralex #inflammation #guthealth

Big update today. I have been building something behind the scenes for months and I finally want to share where things are up to.

It is called The Long Game Kitchen, a recipe platform I have been working on with Steph. The idea came from so many of you after I first mentioned wanting to film cooking content. Rather than just show what we eat, we decided to build something bigger, a full database of the recipes we actually cook at home, alongside the reasoning behind why certain foods and combinations are good for you.

We are aiming for around 150 recipes at launch, a genuine mix of breakfasts, lunches, dinners and snacks. Nothing dogmatic, nothing restrictive. There is meat, there is chocolate, there are veggie and vegan options too. It is all whole food, cooked from scratch, with plenty of inspiration from the Mediterranean.

This has honestly been the hardest I have ever worked on anything, including medical school and ten years as a doctor. Early mornings, endless recipe testing, writing and photography, all in the hope of building something that genuinely helps people cook better and live longer.

We are planning to launch in the second half of November, with a discount for founding members and an extra discount for anyone who joins in the first week. If you want to be the first to hear when it goes live, the newsletter is the best place to find out, link in the description.

The full list of research references for my videos is always in the description of the YouTube version.

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

#dralex #thelonggame #longevity

Cardiovascular disease kills around 20 million people a year worldwide, about a third of all deaths on the planet. In the UK it accounts for more than a quarter of deaths, roughly 170,000 people a year, which works out to one person every three minutes. Someone is admitted to hospital with a heart attack roughly every five minutes. Up to 80 percent of heart attacks and strokes that happen before old age could be prevented.

In this episode I go through what heart disease actually is, how it starts in the lining of your arteries decades before any symptoms appear, and what the warning signs look like in A&E, including the ones that often get missed in women, older people and people with diabetes.

I also share my own dad's story. He had a heart attack at around 40, and it changed how my whole family thinks about prevention. Heart muscle that dies during a heart attack does not grow back, which is why the best treatment for a heart attack is never having one at all.

We also cover the habits that actually make a difference, eating mostly whole foods grown in the ground, cooking from scratch, walking more and checking your blood pressure, cholesterol and blood sugar regularly, since all three can quietly rise for years without causing any symptoms.

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 #heartdisease #preventativehealth

Visceral fat is the fat packed around your liver, gut and pancreas, and it behaves like a gland, pumping out inflammatory chemicals around the clock. The good news is it is often one of the first types of fat to shift when you change two specific habits, sometimes within weeks.

The first is eating plenty of colourful, polyphenol rich plants such as blueberries, red cabbage, tomatoes, leafy greens, extra virgin olive oil and dark chocolate above 80%. In trials using MRI scans, people on a Mediterranean style diet with extra polyphenols lost roughly twice as much visceral fat as those on a standard Mediterranean diet, even though overall weight barely changed. The colour on your plate tends to come with more fibre, more antioxidants and more home cooked meals, and that whole pattern seems to be what does the work.

The second habit is interval training, short bursts of hard effort followed by easier recovery. It is one of the quickest ways to improve your fitness, helps your body handle sugar better, and builds muscle in your legs and core, often in far less time than a steady cardio session. It will not suit everyone, so if you have heart disease, chest pain, high blood pressure or any other significant medical condition, speak to your doctor before trying 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 #visceralfat #inflammation

Four everyday foods sit in most weekly shops without a second thought, yet they are tied to some of the strongest links to cancer risk we have.

In this episode Dr Alex breaks down processed meat, sugary drinks, ultra processed snacks and alcohol, explaining why each one is so easy to overeat and what the research actually shows about the risk involved.

He also shares a simpler way to think about your plate, built around a rotation of meals you enjoy rather than restrictive dieting, and why the parts of the world with lower cancer rates tend to eat very differently.

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 #preventativehealth #nhsdoctor

A supplement claim going around says taking bergamot extract can lower LDL cholesterol by 41% and put it on a level with a prescription statin. I wanted to look at the study behind that number properly.

The research came from 2011, ran for about 30 days, and included a couple of hundred people in southern Italy, where nearly all commercial bergamot is grown. The participants weren't average healthy adults. They were recruited because their cholesterol was already high, and some also had type 2 diabetes. The reductions reported ranged from the low twenties up to the high thirties as a percentage, and the very biggest figures, the ones close to that 40% mark, came from people who were taking a statin at the same time.

A percentage on its own doesn't tell you much without the starting number attached. If your LDL starts at 4.2, a 41% drop takes you to around 2.5. If it starts at 3, that same percentage only brings you to around 1.8. The higher your starting point, the easier it is to produce an impressive looking percentage.

There is some genuine chemistry behind bergamot. It contains flavonoids that can block the same enzyme in the liver that statins target, and that effect has been shown in lab and computer modelling. What hasn't been settled is how much of that actually reaches the liver once it's been through your gut and broken down by your gut bacteria.

We also know from a huge amount of research, across statins, other cholesterol lowering medications and people with genetically lower cholesterol, that bringing LDL down over years tends to protect the arteries. But that evidence is built on long term outcome data, not on a single 30 day blood test. Nobody has followed people taking bergamot for years and counted how many went on to have a heart attack.

Even if it does nudge your cholesterol down a little, I wouldn't take it instead of or alongside a statin without speaking to your doctor first. Bergamot is a citrus fruit, and citrus fruits can interfere with how your body processes certain medications, including some statins. Supplements like this also aren't standardised, so what's in the bottle can vary a lot between brands and batches.

If you're on a statin, please don't stop it or swap it for a supplement without talking to your doctor, who knows your history and your actual risk. 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 #cholesterol #supplements

Can you bring your blood sugar down without cutting out carbs altogether? Yes, and the answer comes down to which carbs you are actually eating.

Broccoli, lentils, oats and berries are all carbohydrates too, so when someone says they are cutting carbs, the real question is which ones. That answer decides whether the whole approach works long term or quietly falls apart within a fortnight.

In this episode I go through what actually decides how much your blood sugar rises after a meal, why milling and juicing change things so much, and why your muscles play a bigger role in all of this than most of the advice out there gives credit for. I also talk through insulin, where fat sitting in your liver and pancreas fits into type 2 diabetes, and why a diet built around beans, whole grains, fruit and vegetables can lower HbA1c even while increasing total carbohydrate intake.

Towards the end I share a few simple habits that have genuinely helped me and Steph, like giving your body a longer overnight break between dinner and breakfast, not snacking constantly between meals, and moving after you eat.

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 #bloodsugar #guthealth

If you lined up two 60 year olds, one could have the heart, blood sugar and muscle of someone in their late 40s while the other is already heading towards the problems we see constantly in A&E.

The difference usually shows up years before anything actually goes wrong.

In this episode I talk through seven signs that tend to separate the two, starting with a couple of simple blood tests, then a scan of the heart, then how much you move and how fit you are, then your memory, and finally what actually happens in your kitchen.

A normal albumin level on a blood test is often one of the first things that tells you a lot about someone's overall health, reflecting muscle, nutrition and inflammation.

Staying physically active throughout most of the day, not just during one workout, matters because long unbroken stretches of sitting are linked with worse blood sugar and heart health even in people who exercise.

A normal echocardiogram in your sixties is a genuinely reassuring sign about how your heart muscle and valves have held up over the decades.

A healthy HbA1c shows how your blood sugar has behaved over the last few months and responds really well to lifestyle changes.

Good cardiovascular fitness for your age, something you can track with a simple watch or just by checking whether you can hold a conversation after climbing a couple of flights of stairs, is one of the strongest predictors we have of how long and how well someone lives.

Sharp conversational memory and the ability to multitask without slowing down a lot says a great deal about brain health as you get older.

And cooking most of your meals from scratch with plenty of colourful plants ties everything else together, supporting your blood sugar, your heart, your brain and your muscle all at once.

If you can say yes to all seven, you should feel genuinely proud. If you can't yet, remember these are patterns you can work on, not a verdict on your life.

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

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

#dralex #healthyageing #preventativehealth

Every heartbeat needs your arteries to widen slightly, and the molecule that lets that happen is nitric oxide. When your body makes less of it, your arteries gradually stiffen and blood pressure can creep up, often without you noticing for years.

In this episode I go through seven everyday things that quietly lower your nitric oxide, including one habit plenty of people do every morning thinking it helps them.

We cover sitting still for long stretches, poor sleep, antiseptic mouthwash, smoking and vaping, low oxygen levels during sleep, low fitness, and ultra processed food. I also answer questions from the last nitric oxide video, including beetroot, arginine and citrulline supplements, and whether people with naturally low blood pressure need to worry.

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 #preventativehealth

Once you pass 50, five everyday movements can tell a doctor a surprising amount about how your body is ageing and how long you are likely to stay independent. No equipment needed, you can try each one at home today.

The first is climbing two flights of stairs without stopping. It asks your heart, lungs and leg muscles to work together, and some doctors even use it as a rough guide before big operations like lung surgery.

The second is putting your shoes and socks on without sitting down or leaning on anything. This one is all about balance, standing on one leg while your ankles, core and brain coordinate to keep you upright.

The third is carrying heavy shopping from the car to the kitchen without putting the bags down. This is really testing your grip strength, which reflects how your muscles are functioning right across your whole body.

The fourth, and the one that catches people out the most, is getting down to the floor and standing back up again without using your hands or knees. It needs leg strength, hip flexibility and balance all at once, which is exactly why it is so hard.

The fifth is managing 10 press ups, testing the strength and stamina in your chest, shoulders, arms and core.

None of these are formal medical tests you would find in a hospital or a textbook, but they lean on the same things doctors do measure, strength, balance and coordination. If something specific like arthritis or a joint replacement stops you doing one of them, that is a completely different situation to simply being out of practice.

If you struggled with any of these, you are in very good company and it says far more about how modern life is set up than about you as a person. The encouraging part is that every one of these can be improved at any age, even starting later in life makes a real difference.

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 #longevity #healthyageing

Two 70 year olds, same town, same height, same starting point. One has trained for most of their adult life. One hasn't. Look inside their muscle cells and the difference is not small.

In this video I take you inside a muscle to show what actually happens as we age, why your energy producing machinery slows down, how fat sitting inside muscle messes with your blood sugar, and why your nerves start dropping fast muscle fibres from your 50s onwards.

I also look at what the research says about NAD boosting supplements, and whether it is ever too late to start training. Spoiler, it isn't. There is a study in this video involving people in their late 80s and even their 90s who improved their strength and walking speed with regular training.

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 #muscleaging #strengthtraining

I eat somewhere around 60 grams of fibre on a normal day. I never planned that number and I never tracked it, Steph and I just sat down one day and worked out what a typical day actually contained.

For context, the average person in Britain eats around 18 to 20 grams a day, and in the US it is closer to 15 or 16. The official guidance sits at 30 grams in the UK and between 25 and 38 grams in the US depending on sex. A lot of doctors working in this space, myself included, think those targets are set low on purpose, as a realistic starting point for a population eating far less, rather than as an actual goal for health.

In this video I go through why those numbers look the way they do, what a large review in the Lancet found when looking at fibre intake well above the official guidelines, and what groups like the Hadza in Tanzania and communities in the Bolivian Amazon eat on a daily basis without a second thought.

Then I walk through an entire ordinary day of eating in our house, meal by meal, showing exactly where that fibre comes from. Spoiler, tinned beans do a huge amount of the work.

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 #fibre #guthealth

Most health advice I give is about small, slow changes. But some of you have told me you prefer to go all in, so here is a full day built entirely around your health, from the moment you wake up to the moment you fall asleep.

It starts with getting outside into natural daylight as soon as you can after waking, which helps set your body clock for the whole day. Then comes a breakfast with proper protein and some colour on the plate, which keeps your blood sugar steady and your energy levels up for hours.

After that, a short walk, even just a few minutes, helps your muscles pull sugar out of your bloodstream before it causes any damage. Somewhere in the day you want to lift something properly heavy, because muscle is one of the biggest places your body stores sugar safely and it protects your bones as you age.

Add something fermented, aim for a wide variety of plants across the week, get outside again for a proper laugh with someone you care about, and protect the final hour before bed by dimming the lights and keeping your bedroom cool and dark.

You do not need to keep all of it going forever. Try the whole day once, then keep the two or three parts that felt easiest and build from there.

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 #preventativehealth #healthyhabits

What actually happens to your blood sugar if you did 30 squats every day for 30 days? In this episode I go through exactly that, from the first afternoon all the way through to a full year of doing this.

The short version is that using your muscles after a meal gives your blood sugar somewhere to go instead of sitting around in your bloodstream causing damage. Your muscles are the biggest user of the glucose you eat, and squeezing them opens up a way for sugar to get in that does not rely on insulin working properly, which matters a lot if your insulin signalling has already started to struggle.

Research looking at short bouts of movement every twenty minutes or so found noticeably less sugar in the blood afterwards and a real drop in the amount of insulin the body needed to deal with it. More recent work using small sets of squats scattered through the day found similar benefits, sometimes doing better than one longer walk.

I take you through what to expect at each stage. The effect on a single meal is immediate. Thirty days builds the habit and starts shifting insulin sensitivity under the surface, even if your bloods do not show much yet. Three months is where a blood test can actually reflect the change. A year of this puts you on a genuinely different trajectory for your long term health.

I also cover how to actually fit this into a normal busy day, how to do a squat safely, and why this only works as part of a wider picture that includes what you are eating, not as a replacement for 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 #bloodsugar #insulinresistance

Cooling your rice, pasta or potatoes after cooking turns some of that starch into something your body treats more like fibre than carbohydrate. The surprising part is that reheating it properly the next day does not undo that benefit. The type of starch responsible for most of the effect is incredibly heat stable, so warming your food back up barely touches it.

The food poisoning worry that comes up every time this topic is discussed is really about how quickly food is cooled, not about reheating it. Bacteria like Bacillus cereus can survive cooking by forming spores, and those spores wake up if food sits too long at room temperature. Getting food into the fridge promptly, rather than leaving it out for hours, is the part that actually matters for safety.

Freezing bread works on the same principle. A fresh slice gives the biggest blood sugar spike, but freezing and then toasting it brings that spike down noticeably, roughly half as much in the small study mentioned in the video. It also stops good quality loaves going to waste, which makes it one of those habits with no real downside.

None of this replaces eating more fibre in the first place or cutting back on refined carbohydrates generally. The numbers involved are fairly small on their own, an extra gram or two of resistant starch per portion, but repeated several times a week over many years, small shifts like this genuinely add up.

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 #guthealth #healthyeating

Five diet mistakes that are quietly undoing your health, and none of them require buying anything new or giving up the food you love.

The first is not getting enough antioxidants. These come from colourful plants and they protect the lining of your arteries from everyday wear and tear. Supplements will not do the job here, the food itself is what matters.

The second is eating the same few plants over and over. Variety matters just as much as quantity, since different coloured plants feed different parts of your body. Aiming for around 30 different plants a week is a good target, and herbs, spices, nuts and beans all count towards that.

The third is simply not eating enough fibre. The UK recommendation is 30 grams a day and the average person falls well short of that. Fibre lowers cholesterol, flattens blood sugar spikes and calms inflammation, all from one thing on your plate.

The fourth is reaching for sugar and refined carbs first thing in the morning. Many breakfast foods are dressed up desserts, and they send your blood sugar up and then crashing down, leaving you foggy and hungry again within hours.

The fifth is fearing fat itself rather than choosing the right type. Good fats from oily fish, nuts, seeds and olive oil actually help your liver clear cholesterol, while the low fat trend of past decades often just replaced fat with sugar and starch.

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 #nutrition #healthyeating

Aspirin sits in millions of kitchen cupboards, but whether it helps or harms you comes down to one question most people have never been asked properly.

In this episode I explain what aspirin is actually doing inside your body once you swallow it, why the dose matters so much, and why a tablet that works brilliantly for some people can quietly cause harm in others.

I walk through the difference between secondary prevention, for people who have already had a heart attack or stroke, and primary prevention, for people trying to stop a first event ever happening. These are two very different situations with very different evidence behind them.

I also cover the big studies that changed official guidance in the UK, the US, Canada and Australia, and why the advice for older adults without existing heart or artery disease has shifted so clearly away from routine daily aspirin.

Finally, I compare aspirin against simple lifestyle changes such as diet, walking and blood pressure control, and what the evidence actually shows when you put them side by side.

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 #aspirin #heartdisease

Your eyes can lose around a third of their function before you ever notice anything is wrong, because your brain quietly fills in the gaps and hides the problem from you.

In this episode I go through exactly how your eye works, why presbyopia from your mid forties onwards is normal ageing rather than a disease, and the difference between your eyes ageing at the pace they should and ageing faster than they should because of years of accumulated damage.

I also cover a simple fifteen second test you can do at home to pick up on early changes in your vision, the symptoms that mean you need to be seen the same day rather than waiting for a routine appointment, floaters and when they actually matter, glaucoma, cataracts, sunglasses and the best time of day to wear them, and why your yearly eye test checks for far more than just whether you need new glasses.

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 #eyehealth #preventativehealth

You can throw out your salt shaker completely and your blood pressure can still barely move three months later. That is not you doing something wrong. It usually means something underneath your diet has been pushing that number up for years.

In this episode I go through five things that keep blood pressure high even when someone's diet already looks fairly sensible: where most of your salt actually comes from and the mineral that is missing alongside it, the hormone problem that runs quietly for years before anyone mentions diabetes, what ultraprocessed food does to your vessels beyond the salt it contains, the type of exercise that moves the number more than people expect, and the stress and sleep side of things, which I personally find hardest.

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 #bloodpressure #preventativehealth