How To Use Food To Transform Your Health, Reverse Type 2 Diabetes & Improve Your Mood with Dr David Unwin #611

Only 1 in 8 of the population is metabolically healthy. 1 in 8. So in our practice, of all the people with diabetes, we know that if they go low carb, 50% of them will achieve drug free type 2 diabetes remission at three years. A further 48% have improved their blood sugar significantly. Or maybe they're on less medication. It's amazing because the average improvements are better than drugs for diabetes.

0:01

Hey guys, how you doing? Hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast Feel Better, Live More. If you have ever struggled with your weight, low energy, prediabetes or even type 2 diabetes, this is a conversation that could change your life. My guest this week is Dr. David Unwin, an NHS GP who not only puts his own type 2 diabetes into drug free remission, he's also helped over 150 patients do the same in a standard UK general practice with ordinary people on ordinary budgets using food and lifestyle. You see, right now it's estimated that around seven eighths of the adult population are metabolically unhealthy, which means that only a tiny minority of us are truly metabolically well. And this is a serious issue because poor metabolic health is one of the root cause drivers of insulin resistance, type 2 diabetes, cardiovascular disease, strokes, Alzheimer's and many forms of cancer. And as you may have heard me talk about recently in other podcast episodes and in my weekly newsletter, this is one of the main reasons why I co founded Do Health, a personalized health companion powered by your individual biology and lifestyle, as a way of helping people improve their metabolic health early, well before they get sick in the future. In our conversation, David explains the early signs of poor metabolic health and why symptoms like fatigue, belly fat and brain fog are often overlooked. Why many issues we see as normal aging are actually signs of insulin resistance. How David himself reversed his own type 2 diabetes and at the same time improved his mood, energy and cognition. How reducing starchy carbohydrates if you have metabolic dysregulation can dramatically improve your blood sugar control. Why so many of us struggle with bread, pasta and ultra processed foods, and how food addiction may be silently driving our behavior. The two women who helped David rethink everything he thought he knew about food, hope and healing, and why it's never too late to work on your metabolic health, and why doing so can change every aspect of your life. One of the things I love most about David is his passion. He really is someone who genuinely wants to improve the health and lives of his Patients. And our hope is that by the end of this conversation, you won't just understand type 2 diabetes differently, you'll also feel empowered to make small changes that improve your blood sugar, your weight, your energy, and ultimately your future. David, welcome to the podcast.

0:34

Ronggren. Thank you.

3:56

I have been so looking forward to this for a number of years. In fact, I can't believe we're only doing it now because I think we share quite a similar philosophy.

3:58

We do, we do.

4:05

Health and maybe life in general.

4:07

Yeah.

4:09

To start, I wanted to talk about the continuum of health. You're someone who has helped over 150 people in your practice put their type 2 diabetes into remission, which is amazing. I'm going to talk about how you've done that, but at the same time, I don't think there's an awareness out there that type 2 diabetes is the end process. Things have been going wrong with your metabolic health for a number of years. So what would you say are some of the signs that we can look for in our cells that might indicate our metabolic health is a little bit off and maybe we're on the road to getting type 2 diabetes.

4:11

That's a fabulous question. You're right. It starts years before you actually have type 2 diabetes. And the things I would say, the things I noticed in myself actually, because I have type 2 diabetes, so I know a bit about this. The first thing is I used to find myself tired, particularly after meals. So I remember after lunch, even in the practice, I'd have to have a little nap on my own doctor's couch. That terrible. And I was only 55 and I thought that was aging. So the first thing is tiredness, particularly after meals. And also I was always ready to lie down in the evening. I was always thinking I'd put my feet up instead of doing anything. That's one thing. Another one is your belly size. And I think loads of us have noticed that, that you, we call that just middle aged spread. But I think that is a euphemism really, because if your belly is more than half your height, you may have a problem. So all you have to do actually is get a piece of string as long as you are tall, cut it in half, and will it reach around the biggest bit of your belly. And in my case, it wouldn't have done. So belly size is another early thing that people might notice. What else might they notice?

4:58

Cognition.

6:31

That certainly happened to me. Yeah, they call it brain fog, don't they? Again, I thought this was normal aging. So I was 55, which I'm now 67, so it's kind of crazy. I just noticed that the younger partners in the practice seemed to have intellectually more horsepower. And that was another thing for me, sort of fogginess. But then another odd thing. I remember a thing at Christmas, I got sleepier and sleepier through Christmas and slightly depressed. And again, all of that turned out to be reversible. And all of it turned out to be those early signs that I was becoming insulin resistant and my insulin wasn't working properly. I mean, and then you have the various biochemical tests that doctors might do. So any sign of fatty liver, maybe we'll come on to that. A third of everybody in the world now has fatty liver. So I had that as well. And then in blood tests, a high triglyceride is a thing that people may have and not know why they've got that. So that's on the fasting lipid panel. If you do a triglyceride and it might be high. One final thing with me, I became fretty, so I would sort of chew on stuff for days and sort of circular thinking. It was funny because when I improved my diet, all of those things went away and my confidence increased. So that's my personal experience, actually.

6:33

Yeah, it's really interesting. You're talking about what, on the surface, seems to be quite a variety of different symptoms, right? Belly fat, a bit of brain fog, what you call frettiness, low mood, fatigue. There has been a tendency in medicine for many years to look at these things as separate. Okay, what's the cause of your tiredness? What's the cause of your brain fog? What's the cause of your low mood? But you found. Yeah, what I have also found in my career, that often the root cause is the same. The other thing that's really interesting, what you said is you were using the past tense in all of them, right? You, you used to be tired, you used to have belly fat, right. You used to struggle with sleepiness in the evening, whereas you don't anymore. So that's the empowering message that people are gonna get throughout this conversation. Those are things you had, but you no longer do.

8:19

I'm changed, really changed. So, yeah, I'm 67 now and I run regularly, which would have been impossible when I was a younger man. It didn't occur to me it was a thing I could do. So I can out sprint my grandchildren, and I'm 67, I've got eight amazing grandchildren. They think it's hilarious seeing an old guy Run. They say that I win because they laugh so much. Cause they think it's so funny to see an old guy actually sprinting. But I can't. And all of these things have changed. And I'm not on any medication. Oh, I didn't tell you I had high, significantly high blood pressure. And do you know, I didn't want to be a patient. Isn't that stupid of me? So I put my head in the sand. I knew it was high, wasn't that bad. It was like 160 over 94, 95. I never went to a doctor, but now my blood pressure's about 120 over 70. So that's another. Yet another thing. High blood pressure that I sorted out and all of these things. No medication. And I'm so lucky. So very, very lucky.

9:19

There's so much I want to cover with you today, David. So let's perhaps start off with your personal story.

10:35

Yeah.

10:41

Yes. You've helped, I think 153 patients now put their type 2 diabetes into remission. I want to hear how exactly you've done that, because I think that's going to be very helpful for everyone listening as to what they might be able to do in their own lives. But why don't we start off with you? Because you were the patients.

10:42

Yes.

11:02

You were skeptical of any kind of approach that could perhaps work. And I believe that there were two, what you call two very intelligent women who helped you see things differently.

11:03

There were two formidable women, I would say formidable. So, yeah, what a shock. A little bit more background before we come to that. Sure. So I was unhappy in practice. So I was the senior partner of a large practice, 10,000 patients. And I wasn't as dissatisfied somehow in my mid-50s with what I'd achieved. You know, we all become. Do you remember when you're young, you know, why do you become a doctor? And it's all like, you're all excited by the difference you're going to make, aren't you? And you can't wait to, you know, getting to practice. And I, in my mid-50s, I was disappointed because it didn't really feel that great. Because actually, the health of the population that I cared for got worse, not better. I mean, an example, we're talking about type 2 diabetes. So when I first joined the practice, which was in 1986, I've been there since 1986, we had just 57 people with type 2 diabetes. Fast forward. We've now got 600. So that's a tenfold increase. And it's the same population but along. So there's an epidemic for you, an epidemic of type 2 diabetes, but I'd also seen an epidemic of obesity. Really just astonishing. So back, we're going back now to 2012 and I'm aware of all these epidemics of lots of chronic ill health. And so how was I doing? The answer was poorly. And I had a sort of feeling, it felt depressing, all the prescribing. Don't know how you felt about that, but I was, you know, you add one drug and then people deteriorate and you add another drug and it feels sort of wrong somewhere. Also, they didn't look well, so nobody came in like they were amazingly well. And that's how we come to the first very formidable woman. Because part of the payment in general practice was to be sure that your patients are taking metformin for their type 2 diabetes. Metformin, I mean, it's the baseline treatment for type 2 diabetes. And I had a lady we knew, she wasn't cashing in her prescriptions for months. She was somebody I'd known for years. And so I wrote to her to say, please, can we have a chat because I'm a bit worried about your type 2 diabetes. Nothing prepared me for that woman marching in because she'd actually got her diabetes into drug free remission. So she wasn't taking any medication. She was a woman who'd had diabetes for a decade. And when we did the blood test, her blood sugars were normal. So I didn't know that could even be done after years of medication.

11:18

And this was in 2012?

14:26

This was 2012, towards the end of 2012. And she marched in. But the point was she was angry with me and she felt I had let her down. And she said, she explained, really, she said, I never told you, but the metformin you'd been giving me gave me diarrhea. But that was a bit embarrassing to mention. So I didn't, I carried on trying to take it. And if only you had told me that it wasn't just sugar I should be avoiding, but the starchy carbohydrates that break down into sugar. I could have had better health years ago. Cause I had to find out about bread and rice and potatoes as sugar all by myself. And you're my doctor, but you never mentioned that once and I wonder why you didn't, surely, Dr. Unwin, this is schoolboy physiology. You know bread, you should know from O level biology that bread is starch and starch is sugar molecules holding hands. So you know, I'm even wondering whether you're medically qualified. How could you not have mentioned this in 10 years?

14:28

How did you feel when Chi was starting to attack you like this?

15:44

Well, you know, as you get older, as a doctor, you fear complaints. You really do, because they can run on for years. So I was scared, mainly because she was right. It was a completely justified complaint. And I felt I had let her down. So we had to say, okay, I agree. I've got stuff to learn, you know, maybe I have. Perhaps I can do better. Will you help me to do better? And that helped deflect her anger. But I'm grateful to her because she pointed me. It turned out she was one of 40,000 people on a website all teaching themselves how to improve diabetic control. But being ridiculed by healthcare professionals. They were being ridiculed. So that was the beginning of my mind cracked wide open. Cause he was proof right in front of me that there was a different way. And it's funny, when you look back in life, it's really odd how things can come and change you. Sort of pivotal moments. And there was another one. The other formidable woman is my wife, Jen. She's a clinical health psychologist, and her expertise is behavior change and the use of hope in chronic disease. Wow. So that's really relevant. And she read a book which was Beat the diet trap by Dr. Brifa. Perhaps you remember Dr. Brifa.

15:48

John Briffa.

17:21

John Brifa. And he was talking about diet insulin resistance in this book. And she kept reading out to me, david, you have to listen to this. You've got to. And I was a bit resistant to that as well. Cause I was too tired, you know. Why is she going on at me like this?

17:22

It's a vicious cycle, isn't it? You're feeling frustrated at work.

17:42

Yes.

17:45

You know deep in your heart that you're not helping as many patients as you thought you were gonna help. When you were at medical school, there's this sort of evidence coming in front of you that there is a better way to do it, but you're probably too knackered to act on it. Plus, you've been doing it that way for 30 years.

17:46

Yes, well, my expertise lay in using medication. And I was really tired. I was really tired. And I was actually thinking of retiring anyway. I was thinking of going probably when I was 55. And many GPs do go when they're 55 now. So I'm now, I think I'm the oldest practicing gp maybe in a hundred mile Radius, they've all gone because they get fed up and tired. I was really tired. I wasn't actually.

18:02

Well, yeah, it's kind of interesting hearing that and putting it in the context of what you do today. You're very, very active on social media. You are constantly on X, sharing helpful information, showing you what you're able to do with your patients, publishing data. You're being, you know, you're traveling to different places, you're starting charities to help people improve their lives, you're talking at international conferences. So, you know, what does that feel like? If you reflect back and we compare the David Unwin of today with the David unwin of just 13 years ago. Right. Contrast that for me.

18:32

It's just weird and astonishing. There I was, sort of dumpy, middle aged, fed up, thinking of going, and now it's night and day. So I'm loving being a doctor now. Yesterday I was in clinic and I see somebody whose life's completely changed. It's oxygen to me. Isn't it odd? So I became a doctor wishing to make a difference, and then suddenly, right at the end, how ironic. Right at the end, I am. And now I can't give it up. And so I was somebody. I didn't believe in social media, I didn't believe in mobile phones, so I was a dinosaur. You know, the children just laughed at me because I, you know, I wouldn't have known anything about X or Twitter, I couldn't have published papers, I didn't understand the use of statistics or research. So I've become a very, very different animal so late in life.

19:15

Yeah, I think there's a very powerful lesson there, David, for all of us, which is it's never too late to change. Right. It is never too late. People would just regard, you know, you're 55, you've had your career, you're not enjoying it, time to hang up your boots. And I'm just imagining what the previous version of Dr. David Unwin would be doing now. You know, you might have retired, maybe you wouldn't have all this energy with your grandkids, you wouldn't be doing all the things you're doing. Your, your entire experience of life would be completely different. But now because you've regained that vitality, sorted out your mood, your weight, your blood sugar, your brain fog, your cognition, you're literally experiencing life in a different way. So this goes beyond just type 2 diabetes and blood sugar. Oh, yeah, that's just the kind of rocket launcher, you know, you sort that out, then your whole life starts to change. Right.

20:20

I'm sure I would have been quite ill by now. I would for certain. You know, I would have got heavier and heavier. I had type 2 diabetes. I have high blood pressure. Both my parents had suffered major heart attacks before the ages of 65. Right. Both of them. So I've seen both my parents in intensive care. I would have been there as well. This is how it begins.

21:16

Is this one of the reasons you're so passionate? Because the thing I get from you, David, and you're very kind and compassionate online, which I've always respected about you. And whenever I see you at a conference or when we were filming for this new TV show recently, there seems to be this really genuine desire to help people. I get the sense that you're really frustrated by how many people don't know the basics of good health.

21:40

Wow. Yeah. When I look around, what I see in society shocks and appalls me and makes me so sad. It really does. You know, everywhere you go, I see people who could feel better, who could look better. I see young people living half the life they could lead, and that drives me and drives me. I can't rest because I know there's a better way, and I see it with every patient. But then again, what about all the many, many people whose lives are deteriorating and they have no hope? And so that. Yeah, I just can't let it go. I can't let it go. And it's almost difficult to stay sane with it because the magnitude of what's going on in society. And I have a particular thought, and that is so. I remember a time when I was little when most people were fit. I didn't know anybody with type 2 diabetes or asthma. I didn't know any children or young people with depression. The world was so different. And I think we're beginning to normalize chronic ill health and the danger of that. So I know it is possible that kids don't have to be overweight or suffer with that. I know it's possible that most people wouldn't have type 2 diabetes, because I remember a world before all that. I am the last generation of doctors. When I am gone, will anybody remember that there was a life and society could lead a healthier life without the need for all these drugs. So that drives me because I know it's possible that all of these chronic diseases of modern life are not genetic. It's not inevitable that I grow up, I get sick, and I have type 2 diabetes and heart attacks like my mother and father. It's not inevitable at all. What we've got is we have a changed environment in the world, which I believe a lot of it is dietary. But there's other things as well, acting on possible genetic triggers. But those triggers don't have to go off. They don't have to go off. And so that you're right, it's huge. And the more of it you see, unfortunately, the worse you think it is, the harder we all have to try to do something better.

22:11

Yeah. I think you made such a key point that we are normalizing poor health.

24:52

Yeah.

24:58

You know, what people accept as normal these days is so far removed from how we can be and they accept that. I mean, as we were just chatting in my kitchen before we started recording, I was just sharing with you. I still to this day haven't seen a more powerful intervention with patients, no matter what you come in with, than trying to have a whole food diet exclusively for maybe two to four weeks. If you can do that and we can talk about what that actually means. It is amazing how many of the things that you thought were separate issues just start to disappear. So I got to the point about a decade ago thinking that, well, I actually don't know how many of these symptoms are related to nutrition until I sort their diet out. So why don't we go with the diet first? Understanding that everyone's able to and giving people help and support. And if you are able to stick to this, people would say, I've got more energy, I'm sleeping better, my joint pain has gone.

24:59

You know, that last one's a common one. Joint pain.

26:00

Joint pain, exactly. Think about to medical school, when were we ever taught that joint pain might be to do with your diet?

26:03

Never.

26:11

We're taught the joint, but, you know, if they're overweight is probably that. I've had overweight patients who it was thought that their weight was causing their joint ache. And when they went on a low carb diet, the joint pain goes. It's incredible.

26:11

I don't know where it's going to end. So, yeah, the journey for me started with type 2 diabetes. And of course the accent on that is sugariness and sugar and where it comes from, so that you end up going lower carb to avoid the sugar. But then I found people's eczema improved all their psoriasis, just as you said, particularly irritable bowel syndrome, depression, all sorts of things. And you're so right, joint pain. So I had people on maybe a waiting list to have a knee replacement or something, and then they'd said, you know what, I think it's a bit better. I think it's a bit better than they wouldn't need or sleep apnea, lots of. And I don't know where it's going to end because of the number of conditions that improving diet seems to bring about. And then we must mention exercise a bit as well. So I find a lot of my patients, they lose weight, they feel better and then they're interested in exercise. I used to tell people to exercise when they weren't really well enough and some of them would damage themselves. You know, if you, if you're quite heavy and then Dr. Oman tells you to start doing weights. But if you, if I did diet first, then they lose the weight, then they're metabolically stronger, then many of them add in exercise to this, which is very important.

26:27

I want to talk about what you actually did with yourself and what you do with patients once they're diagnosed with type 2 diabetes. But then I want to sort of backpedal and go, well, how can we apply that before we've got type 2 diabetes and you know, maybe even before we've got pre diabetes.

27:59

Yes, yeah, yeah.

28:16

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28:17

So it's somewhere, I'd say somewhere between 5 to 10% of the population, something like that. But we don't know because I'm finding people all the time who don't even know they are.

30:13

So they're not showing up on the research.

30:23

No, but it's going up. That's for sure. It's going up. So, yeah, let's start with. Do you want to start with, say, a person that's just been diagnosed?

30:25

Yeah. In fact, maybe the best way for the audience is to just imagine, you know, what would you say to a patient, right, a patient who's just been diagnosed with type 2 diabetes. What do you say to them?

30:34

Yeah, I can think of a good example. So, yeah, I had a guy who has given his permission called dan. He was 39 years old. And we did the hemoglobin A1C, which is the average sugariness of his blood. And if you have the result which is above 48, then that means you've got type 2 diabetes. So he came into me and his result was 96, which is sky high. That's really, really high. So what I'm saying to Dan is, okay, we've done this blood test, which is the average sugariness of your blood, and it's really, really high. It looks as if your insulin is not working properly. So your insulin is there to get rid of blood sugar, and you're not doing that properly. So the point for Dana, right, that day is you and I have alternatives today. I'd love to suggest a lifestyle change that could have you with much better health and change all sorts. Or it's lifelong medication. Which would you prefer? And the important thing, I think, is to give the patient the choice so that it becomes a collaborative approach. And so Dan was interested in avoiding lifelong medication. Cause he thought, well, I'm only 39, so I'd quite like not to be on drugs. And then we're talking about, okay, so if your problem is a high blood sugar, what are you eating that puts your blood sugar up? It's as simple as that. What are you eating? Because a high blood sugar for most people is what they've eaten in the few hours before. So we have to acknowledge the stress can put up blood sugar and sleep deprivation, illnesses, all various things. But really, in clinical practice, 95% of the people you see with a high blood sugar have eaten something that put it up, up. And I broke the rules for Dan. I actually gave him a continuous glucose monitor to say, well, why don't you find out? You need to know what you're eating. That Puts up your blood sugar. This is years ago. I did this five years ago. You need to know what puts up your blood sugar and eat something else. And he discovered it, for him, it was bread and breakfast cereals were really spiking his blood glucose. And then I'm teaching people about a nutrient dense diet. So I want you to get your nutrients of the macros and the micros.

30:45

You know, for people who don't know what macros and micros mean, the macros.

33:26

You'Ve got three macros. So that is carbohydrate, which is a problem for me, somebody with type 2 diabetes, because carbohydrates digest down into sugar. You've got fats and then you've got protein. So I'd be talking about increasing the protein in Dan's diet, avoiding the carbohydrates and whatever you think, healthy fats. But for me that would be butter and he'd be having dairy, full fat yogurt, that kind of thing, and loads of green veg, then the micros of vitamins. So for that patient it's, do you know what's putting your blood sugar up? Yes or no? If you do know, then could you eat differently? Could you base your meal on maybe protein and add in loads of green veg? If you were going to have, I don't know, steak and chips, do you have to have the chips? Could you not have lots of green veg? And that's what, that's what Dan did. The idea of trying to work out what is putting your blood sugar up, that brings me just a little segue into the teaspoon of sugar equivalents, please. So I had to find a way to help people like Dan understand the consequences in terms of blood sugar for what they ate. And so I looked at the glycemic index and the glycemic load of foods. Cause I had a hunch, I thought maybe if I could tell you in terms of teaspoons of sugar, this could help you understand what foods to avoid. For instance, so 150 grams of boiled rice is equivalent approximately to 10 teaspoons of sugar. So if you have a curry and you have a small bowl of rice, well, you've just added 10 teaspoons of sugar to your sugar load. Could you have your curry, I don't know, with frozen green beans or something else. So this turned out, this teaspoon of sugar idea that I had was valid. So I went to the experts on glycemic load, one famous one, Dr. Jeffrey Levsey. And we published a paper together looking at many commonly eaten foods and doing a teaspoon of sugar equivalent. So a big baked potato is about nine teaspoons of sugar. A portion of chips is eight or nine. A banana is five or six teaspoons of sugar.

33:30

Can I just pause you there, David, because I think there's a couple of things to tease out here. So first of all, many people believe rice, potatoes, bananas, for example, are healthy foods. Now, of course, what is healthy depends on the context. Right. So, and also, of course, table sugar itself, you know, is not particularly good for your teeth. Right. If consumed in excess.

36:04

Fair point. Yeah.

36:35

Whereas maybe white rice, you could argue. I guess what I'm trying to get to. You're talking about, I think, the impact of that food on your blood sugar levels.

36:37

Exactly. So because if you have type 2 diabetes, your insulin isn't working properly, you're insulin resistant, so that you can't deal with extra glucose, the sugar we're talking about.

36:48

Okay. So if you were metabolically healthy, so, you know, not only do you not have type 2 diabetes, but you have no insulin resistance, which is getting rarer and rarer these days.

37:05

Yeah.

37:17

Do you think that these kind of foods are also problematic in that category of people, or is it more in the ones as they get closer and closer to type 2 diabetes?

37:18

Great point. I think if we took children and fed them, perhaps like our great grandparents were fed from a child, they would be metabolically healthy as they used to be. As they used to be. And for them, bread was all right and rice was all right. The difficulty. Now, there's a wonderful paper from the States showing that in America now only one in eight of the population is metabolically healthy. I know one in eight. And that's approximately correct for the uk.

37:30

And let's just flip that for a minute. I mean, it's obvious, but let's just make it really explicit. That means seven eighths of the adult population are not metabolically healthy. And therefore. Yeah. The stuff that might have worked for our great grandparents.

38:06

Yeah.

38:21

Maybe doesn't work because I think we have to also, you know, square the circle in many ways to go, that there are populations like the Somali in South America who are having 70% carbs, whole food carbs in their diet and are very, very insulin sensitive. But I also believe they walk a ton every day, maybe 17 to 20,000 steps up and down lots of hilly terrain, and that their whole food carbs. So I think it's, to me at least, it feels like the low carb approach seems to have a, almost a unique benefit in the modern world.

38:22

Yeah. And I've worried just like you as well. And you think, how many people are metabolically healthy? It's very small. It's very, very small. And the thing is, it's getting worse because so many. I know now. Yeah. This is how it's changed. So when I went to university, you're younger than me, maybe not, but we called it maturity onset diabetes.

39:02

I remember that from med school.

39:24

Yeah, well, that was meant to indicate this is what old people get. Well, now, you know, I've got. My youngest patient with type 2 diabetes is 12 years old. So you see what is. We are sleepwalking into something so serious. And it's. Insulin resistance is not everywhere, but almost everywhere in so many people, how confident is anybody that they're metabolically healthy? Because it is becoming very, very rare.

39:25

So with that patient, you help to educate them on the sugar equivalent of bread, potatoes and rice. And you said to him, listen, you now you have type 2 diabetes. Currently you are very insulin resistant. So insulin is not working as well as we would want it to work.

39:57

Yes.

40:16

Therefore, I can offer you one or two options. Option one is I can put you on medication, which I can, I can do for you, but you have to take it for life. Or I can help you change your lifestyle.

40:17

Yes.

40:28

Which one would you like?

40:28

Exactly.

40:29

Now, what's really interesting to me, that is what I call proper informed consent.

40:30

Yes. Right.

40:34

You're giving the options. Whereas, unfortunately, I mean, there's a course that me and Dr. Panja teach called Prescribing Lifestyle Medicine. And we try and teach healthcare professionals the basics of lifestyle and how you can actually use the lifestyle interventions for a variety of different conditions, including type 2 diabetes, to help them. And when we used to do it live before COVID so we used to do it in person. At the end of the day, we would do two role play consultations on stage. And I'd love to get your perspective on this. And I would say to the, to the audience of healthcare professionals there, there are kind of two ways a consultation can go. The patient comes in, they maybe just done their blood test, and you discover that they've got type 2 diabetes. Patient comes in, you have 10 minutes with them. If you say, hey, Mr. Jones, you've got a condition called type 2 diabetes, but there's nothing to worry about. We've got loads of medication that can sort this out. Okay, so today I'm gonna start you on metformin. If over the next couple of years Your blood sugar keeps going up, as it probably will. I've got more medications that I can put on you, on. And then in a few years, if we really need to, you can start injecting insulin. But don't worry, we've got that. So you tell them that, give them a prescription, and as they leave the door, as they walk, walking out and say, oh, and if you can change your diet and move a little bit more, that would be helpful. Contrast that with the same consultation, same patient, where they come in and you say, hey, Mr. Jones, listen, there's a few things that have come up in your blood test today. One of the things is that your blood sugar is elevated. Now, it's elevated to a point that we would call this type 2 diabetes. But I'm not sure if you're aware there will be things going on in your life for many years now which have caused that. Would you like me to help you figure out what those are? You know, if you spend 90% of the consultation with that sort of messaging, guess what? The, you know, the patient goes out that they think two completely different things. Patient, the first consultation, they're walking out thinking, well, he did mention diet and exercise at the end, but really it's all about the medications versus the other way.

40:35

You're right.

42:49

And I would say on stage, I say, I know that sounds quite extreme, but that is literally how these consultations are going down.

42:49

Well. And my.

42:56

That's not informed consent, David, is it?

42:57

It isn't. And that's what. That's where I was so wrong, because I was. I've been the first doctor and now the second doctor, and I really want to pick up on the idea of informed consent. It's key. Isn't it odd? Isn't it odd that if, if we're doing, say, a minor surgical procedure, I don't know if you've got a wart in the middle of your head, but you would have to sign, before I took that wart off your head, that you understand the pros and the cons of that removal. And yet, as a British gp, I can start on you drugs for the rest of your life without any informed consent. And I believe there's something very peculiar about that. It's interesting because I lecture at Edge Hill University sometimes. I'm an honorary lecturer in ethics, medical ethics. And it is so odd that we're doing things to patients without explaining the pros and the cons. And how is it that we're exempt from giving people that vital information, like, say, metformin I know that approximately a third of people given metformin over 10 years will finally get diarrhea like that lady. And yet I didn't have to tell her. It's odd, isn't it? Why do you think that is so peculiar?

42:59

I think there's many. I think there's many factors that play into that. One of the sort of theories I've had for a number of years is that this is a consequence of almost this old school paternalistic model in medicine whereby doctor knows best.

44:19

Yeah.

44:37

So we don't question doctor. You know, the doctor knows everything. We just wait for the doctor to tell we should be doing. And I think that's actually. Whilst you could argue for acute problems, maybe there's a role for it. Although I never like that paternalistic approach. I think everything should be a collaboration for these chronic conditions that are largely driven by the way we're living our lives. I don't think there's any place for that. I think you're right. There's almost an arrogance to think that we don't need to explain ourselves, that this goes beyond type 2 diabetes.

44:38

Right.

45:13

Let's think about antidepressants for a minute. Okay. And there's currently, we think that 20% of the UK population, adults are on what would be called antidepressants. Okay. That's a fifth of the adult population taking SSRIs. There are question marks over the validity of the evidence. But just if you part that to the minute for a moment and say, just ignore that for just a second. Even if you're gonna put someone on an ssri, a selective serotonin reuptake inhibitor for what you think is depression, and you think it's gonna help. How many of those patients have been actually told the real risks? They're not. I mean, there's a. You know, I looked at the BNF literally two weeks ago as part of this TV show that I'm filming, and I've asked you to be a part of. And there are new things added over the last few years. You know, for example, there's something now saying that, you know, if you take these SSRIs, you can have persistent sexual dysfunction that continues even after you stop it. Now, would you not want to be told that before you're prescribed that you might still go, yeah, on balance, I'm so struggling. I'll take that risk. But people are not being told that. And so I don't think we do give informed consent, David. And I think it's a problem.

45:13

But isn't it weird? It's weird because, you know, how can I legally get away with that? I'm just, how can I do it? It shouldn't be right. Informed consent, surely that's a, that's the.

46:37

Bedrock of what we must be.

46:51

And yet it's very odd because it looks as if particularly repeat medications are exempt from that. So there's no going back to say, you never told me about sexual dysfunction.

46:53

Well, the argument is, well, some people will say, what are you gonna do? You're gonna tell everyone of all the possible side effects for every medications? And I'm sort of partly thinking, well, kind of, yeah. I mean, if I was gonna say something, I think I would want to know what the potential consequences might be.

47:05

I think what people would expect is that we use our expertise to say what's likely. So if I'm saying, you know, diarrhea is up to a third, that's likely, and then again, it's how serious. So there are two things. How serious is this potential side effect and how common? And it's a sort of factor of those two things. So even a small risk of sudden death isn't great. Do you see what I mean? I mean, that's coming out now in the fat loss jabs in a way, isn't it? Where, you know, there were 82 deaths so far with those. But, you know, my patients, when I say there have been 82 deaths, are astonished because they use, they've, they've gone online and got the fat loss jabs and nobody ever told them that we, there have been a few deaths or there are any risks at all. Yeah, I suppose we're off on the sideline there. But it's an important one, it's very important, the ethics of particularly repeat medications that you could be on for the rest, you need to understand it and maybe your family too.

47:23

Yeah. Let's go back to patients with type 2 diabetes. So just to make this really practical for people.

48:30

Yeah.

48:37

You recommended to this patient that, you know, he was very lucky to have you as a doctor. I'm sure you had to sort of bend the rules a little bit to give him a cgm, a continuous glucose monitor, because of course, those things, typically you only given certain instances.

48:39

Oh, yeah.

48:55

And we'll come to that in a minute. But he was able to see how these foods were affecting his blood sugar. So he was able to go, oh, wow, I'm going to change that now because I don't like that.

48:56

Yes.

49:07

But you've also helped many patients for years. Without access to CGMs. Right, so it's possible to do that?

49:08

Yes. Yeah. Now, the majority of what I've done was not with CGMs that's come recently, so you're right. Sorry.

49:15

No, no, it's fine. But when you say, you know, cut back on bread and pasta and potatoes.

49:22

And I always wonder, what shall I eat? Oh, my God.

49:29

So there will be listeners now going, well, what's left? Well, I'm gonna be hungry all the time, aren't I? So what have you found in your experience?

49:31

Right, so I think one of the main things is more protein. A lot of older people don't have enough protein because you're trying as you get older to maintain muscle mass, so it makes sense to eat more protein. So I'm basing meals on fish, on chicken, on eggs, on red meat, and then you're adding loads of green veg and some butter if you want, or some olive oil or full fat mayonnaise, that kind of thing. And there are loads and loads of recipe books, apps, everything online. So my family, so I've been low carb. My wife, my eight grandchildren, my three children, our entire extended family are low carb. And we do Christmas and birthdays by learning how to cook low carb. You can actually can use almond flour instead of wheat flour, so that doesn't have as much carbohydrate in hardly any. But you begin with having lots more protein, reducing the carbohydrate. Because how much you reduce the carbohydrate by varies depending on how sugary you are. Not everybody has to cut it out altogether. Some just reduce it. Some people are having when they actually admit to how many chocolate bars, how many sugary drinks they have, how many crisps, snacks through the day. They're having a lot of carbohydrates. So I just would encourage people to have less carbohydrate. And then how do you feel? How's it going?

49:39

Is there a transitional period where people, of course, are used to having the rice and the pasta and the potatoes. Right. So when you start to cut back on that, what do they complain of? Is it, I don't know. I don't feel full, Dr. Unwin. I feel like I need it. What are some of the common issues that come up?

51:17

Right, well, actually, most people who go low carb would say they feel a lot less hungry. Most of my patients tell you they're surprised not to be hungry. What some people get is what is called keto flu. That's a bit of a Strong word where they don't feel as good for a few days. And that is because it takes up to a week for the enzyme balance in your liver to change. Your body has to think, oh, so I'm gonna start burning fat. I think a point I'd like to make now is this idea. We are a dual fuel engineer, so we are, gosh, so clever, our design. We can burn sugar or we can burn fat, but what happens is. So if you have a high carbohydrate diet, then your levels of insulin are high and insulin prevents you from being able to burn your own fat. This is the basis of the keto diet. So the keto diet is people who are very low carb, under 50 grams of carbs a day, and because they're very low carb, their levels of insulin are very low, and then suddenly they're able to burn fat and fat is turned into ketones as a fuel. That's why it's called a keto diet. And the keto diet is a type of low carb diet which is becoming incredibly popular across the world. And that shows very well this transition from relying upon carbohydrates to burn, which is what I did until I was 55 years old, to a greater emphasis on burning fat, which now I am. Actually, I've been on the keto diet for about eight years and I burn fat.

51:34

Now, some people listening will have heard negative stories about the keto diets.

53:21

Yes.

53:27

Okay, so what is the pushback sometimes that comes when people hear about these ketogenic diets?

53:28

Well, I mean, I suffered from. I think there's a common confusion, particularly for healthcare professionals, between ketoacidosis, which you and I both remember, is something that is very serious. This is often people with type 1 diabetes who don't have insulin. Ketoacidosis is severe and you're ill. That's quite different. It sounds similar to ketosis, but it isn't. So ketosis can be a healthy state. I hope I'm healthy. I've done it for eight years. I think that's one of the confusions I had earlier on that a keto diet, is it healthy? But it seems extreme and yet for some people, it does work very, very well.

53:36

Do we know or do you know how many of our ancestors ate in a way that would be consistent with a ketogenic diet?

54:26

Well, I do, actually. Just a little aside. So years years ago, I was giving a speech in Tel Aviv and the dinner afterwards, I happened to sit next to Dr. Mickey Ben Doer. Who is a worldwide expert on what cavemen ate. And he spent his life scraping the tartar off caveman's teeth and also looking at the bone isotopes. So we do know what they ate. And his conclusion, he's published this is that our ancestors were eating about 70% meat, and the isotope scans were about the same as a wolf. So our ancestors were ate like wolves in terms of the amount of meat in the diet, and they were surprisingly healthy on that.

54:36

Cause that's the thing that people will say. They go, okay, well, maybe our ancestors ate that way because they had to. But do we know what that did to their coronary arteries? Do we know what that did to their longevity? That's the pushback that sometimes comes.

55:31

Yeah, it is. And so just to develop that a little bit, I asked him, actually, I said, well, didn't they all die when they were about 30? And the error in that is that if you do the arithmetical mean is about 35.

55:46

The average.

56:01

The average. But the average is skewed very badly by infections killing children. So if, as a caveman, you lived to be 12 to 15, you'd probably live to be 60 or even 70 if you once got over the childhood infection. They lived surprisingly long lives. And just going back to the distribution of what people ate or what the wolves ate, what wolves and people ate was more carbohydrate in the autumn, if they could, because they needed to put on fat. So insulin is fat fertilizer, so it makes you fatter, gives you a bigger tummy. But that actually is adaptive, because if you're going to get through the British winter, you've gotta get fat in the autumn, so you gotta scoff those berries down. So wolves and humans were eating all the carbohydrate, all the berries they could in autumn to survive the winter. And I think we should. Now, see, we're almost eating in a perpetual autumn now. You can go to the supermarket and buy whatever you like and have the bananas and the orange juice and the waffles and everything. We're eating in a perpetual autumn for a winter that never comes. Yeah.

56:02

Not only does the winter not come, certainly in this country, Christmas comes in the winter. So actually it's the opposite, isn't it? Whereby we probably get rather gluttonous and overeat in that time where we'd be fasting. We'd be fasting. Exactly.

57:25

We would. And you know, it's always, isn't it Father's Day, it's Mother's Day, it's Halloween, it's your holiday. It's, you know, we're eating so much more junk food, so much more sugar than we did when I was little. And what most of what I saw as a child at school was sweets, maybe once a week. That was all.

57:42

Can you talk about some of your data? Because I think your data, the way you've collected it, is so powerful because you're showing real world evidence in your NHS general practice that this, for some people at least, is working incredibly well.

58:08

Yeah.

58:27

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58:34

Data is so powerful and you're talking about real world data. That's the difference as well. This is the Brett sort of cash strapped British health service with 10 minute appointments. So in our practice, if you go low carb. So of all the people with diabetes, about 60% of them have, and it's increasing all the time, have gone low.

1:00:45

Carb in your practice.

1:01:09

In our NHS practice, so we've, as I say, It's a big practice, 10,000 patients. But if you have diabetes in my practice, 60% is likely that you'll have gone low carb. The people that go low carb, we know that if they go low carb, 50% of them will achieve drug free type 2 diabetes remission at three years. So it's not like in the first six months, they still have it three years later. And then you've got to ask, well, what happens? You know, are the other 50% dead? No, they're not. So we've got 50% improve to a point where they've got drug free remission. A further 48% have improved their blood.

1:01:10

Sugar significantly, but haven't quite hit the threshold for remission.

1:01:58

Or maybe they're on less medication.

1:02:02

Yeah. So it's still great.

1:02:04

It's amazing. Yeah, yeah. Because the Average improvements are 21 millimoles per mole in hemoglobin A1c, which to the doctors out there, that's better than metformin would achieve. So even the ones that don't get remission, they're still getting a significant improvement in blood sugar. And only at the end of three years, only 2% have worse diabetes than when they began. Whereas if you did nothing, of course, diabetes would tend to deteriorate for everybody.

1:02:05

What do we get taught? It's a progressive, chronic, irreversible condition.

1:02:38

So.

1:02:43

Which is just not true.

1:02:44

No, that's exactly. I just like you used to think, well, I'll add one drug and another. And I'm so proud of this data because it proves in the health service we have a different way. And another statistic is that we will. There is nationally collected data on what my practice spends on type 2 diabetes. And compared to 20 local practices, all the 20 local practices, we've spent £370,000 less on drugs for diabetes since 2018. So we've saved money. And there's more. There's more.

1:02:45

Well, I'm just imagining that £370,000 in one practice and over a thousand practices over the country. I mean, you're talking about a healthcare revolution.

1:03:23

Yes. Yeah.

1:03:34

Literally, yeah.

1:03:35

So in one of the papers we published, we looked at what would happen if every GP in the UK prescribed as we did, and you'd save about 270 million a year. You could build hospitals every year. And other practices have replicated what I've done. There are practices all over the uk. There are practices in New Zealand, in Australia, in Malaysia, in North America, in South America. It has been replicated all over the world. But just going into the detail first in my own practice, it's more exciting even than that because if we look at people with pre diabetes, so we've audited that. So the people who have pre diabetes, of those that go low carb, 93% achieve a normal blood sugar.

1:03:36

So they're.

1:04:33

Yeah.

1:04:34

So they've gone out of the pre diabetic range and gone back into inadvertently normal.

1:04:34

That's right. So it seems as if this is what we were saying earlier about it's not chronological age that matters, it's metabolic age because. So the people with pre diabetes, they have better multabolic health than me. Then if you offer low carb to people as they are diagnosed with diabetes, like the guy we were talking about, the 39 year old, 73% of those will get drug free remission, 73% get drug free remission. If I wait five years and you've had diabetes for five years, only 50% of you will get remission. So it seems to me like the longer we wait and the more serious or the worst is your metabolic health, the less likely you are to get remission. And that's the pressure to think, well, you know, stitching time. Why wouldn't you do it earlier? Why wait? Why wait till you're somebody like me who actually has type 2 diabetes? Wouldn't it be better if I'd done something earlier?

1:04:39

There's a couple of things I want to just sort of make sure we've covered.

1:05:40

Yes.

1:05:45

Mainly because I understand how confusing diets are these days for people and how divisive and controversial things often get. You know, people get, get quite stuck in their camps and start to throw metaphorical stones at people in other camps.

1:05:47

Right.

1:06:02

So you're saying, and please correct me if I've misinterpreted any of this, you're saying that you used to have type 2 diabetes and now your type 2 diabetes is in remission.

1:06:02

Yes.

1:06:14

You were unable to previously do much for your patients with type 2 diabetes apart from just keep them on medication and things would progressively just get worse.

1:06:15

Absolutely, that's what I saw.

1:06:26

And then over the last 13 years or so you have found a different way of approaching things. Right. You have found that for yourself and with many of your patients, if you have type 2 diabetes or pre diabetes, a low carb approach seems to be very, very effective for many, many people.

1:06:27

Absolutely. And it isn't just me as well, it's the nurses in my practice and the other day, it's now a practice wide approach because they didn't agree with what I did originally. They were worried and we had arguments. It was quite a difficult thing. But the value of collecting data is I've convinced all the partners in the practice and the nurses, and so now the entire team are doing this.

1:06:51

I don't want to talk about individuals necessarily, but even when you have the data, have you had pushback from people saying that this is ridiculous?

1:07:15

Yes, well, particularly in the early days. And some of it was understandable. The worst times were sort of 2013 to 2015. So I actually got hate mail, I got heckled in doctor's meetings, I was shouted at. And some of it was understandable because the point that worried other healthcare professionals was that if I'm saying it's okay, maybe to have more protein, what's that doing to your kidney function? If I'm saying it's okay to have full fat yogurt and full fat milk and use double cream, what's happening to the lipid profiles? And I think that was another reason that I kept such careful data. And what we saw, in fact what we published in our most recent paper, which is BMJ Nutrition 2023, was that every single marker of cardiovascular risk has improved for my patients. The cholesterol, the hdl, the triglyceride, the ratios, their blood pressure, all of those things, every single marker. And so I think people are less worried now by my approach because I've also gone ahead and said, fair point, let's have a look at cardiovascular risk. And then again, let's have a look at high protein. What has that done to the kidneys? Yeah, so I paired with Professor Wong, who's a local, he's a professor of nephrology, and we looked at my patients and actually their renal function, their kidney function improved.

1:07:24

If you really take a step back from that, it seems slightly illogical. That metabolism, which is such a fundamental part of the human experience and how we experience health, if that's getting better, you kind of think other things are likely to be getting better as well.

1:09:04

Well, that's what we looked at actually with Professor Wong when we were looking at kidney function. What is it in diabetes that causes kidney function to deteriorate? And the common denominator of so many things is blood sugar. And a single fact that really has burnt into my mind is that if you have high a spike of blood sugar, you damage the non stick lining of your arteries. The glycocalyx is damaged within six hours. And so for me, the common denominator is that high blood Sugars do damage, and they do damage to the microcirculation. That's your eyes and your kidneys, and they do damage to the macro. That's your big arteries. High blood sugar actually is aging you. It's aging you.

1:09:23

Talking about the sort of interconnectedness of the body again, for a moment. Cataracts are on the rise, aren't they? And again, cataracts. Well, that's my eyes. What's that got to do with my blood sugar?

1:10:17

You know, and actually on that fact, an ophthalmologist contacted me from Cumbria, and she said, weird things happened in our area. People's retinas started improving. People, she'd been screening the retinas every year, and in the end she said, what's going on? Cause they also were losing weight. They'd gone low carb. And the retina. So the retina becomes damaged with a high blood sugar. It's a very vascular, sensitive organ. And this was yet more proof, really. This lady contacted me saying, it's so weird. I've never seen retinas improve or peripheral neuropathy. I've seen improve as well.

1:10:28

Yeah. Another way I sort of would often talk to patients about this is to help them understand that your body will do whatever it can to keep your blood sugar in a very tightly controlled range.

1:11:12

Yes. Okay, that's a great point.

1:11:25

It's very important because it's dangerous. Because it's dangerous. So it will keep it there. And the problem is today is that because we abuse our metabolic system in so many ways, primarily through the food that we eat these days, is that that process stops working. And the end result of that process not working is your blood sugar can no longer be kept in that normal range. Your body's trying, it's pumping out more insulin, it's trying its best, and actually it's causing damage in those years before you get the diagnosis that chronically elevated insulin, as your body's trying, that's damaging you anyway. But we don't even get involved then until you've actually crossed the threshold. But I think it's, you know, it's the idea that when your blood sugar is persistently high, it is going around the body, doing damage in a lot of different places for every organ and.

1:11:27

Just going back to the diet again. What I had missed. So I would start the day with a big glass of fresh orange.

1:12:23

This is when you were.

1:12:29

Yeah, yeah. So if we just go back to how the assault on my body started, first thing with, you know, we had fresh orange by the Liter in the fridge. Cause I thought that was healthy. So that was then I'm thinking, right, muesli, that's healthy. So I had that. But I had loads of extra sultanas because that just made it so tasty.

1:12:30

It was delicious.

1:12:50

And a banana. So that's sugar with my sugar. Then I get to work and I'm having biscuits with my morning coffee. Cause people do. And then at lunchtime at sandwiches, that's more sugar. And then you might have a packet of crisps with your sandwiches. That's more sugar. You just ate. And then mid afternoon I'd have a bar of chocolate and more biscuits and go home to some. I used to love pasta, so my life was sugar with my sugar. With my sugar, my metabolism didn't stand a chance.

1:12:51

How many grams of carbs a day do you think you used to have in your heyday?

1:13:26

I know, I think it was about 300.

1:13:31

So you used to hang huge. 300 grams. And were you relatively sedentary then as well?

1:13:34

Yeah, because it didn't run. And you sit busy gp. So you sit behind your desk all day long. You press the buzzer for people to come in so you don't get up off your bum. And also people knew I love biscuits. So the patients used to hand over. Cause they're fond of me, so they would, oh, I don't know how. My drawers were full of biscuits that I ate. And they even knew the biscuits I liked. So I'm scoffing.

1:13:39

You stood no chance.

1:14:07

It's amazing. I was conscious. It's amazing. So, yeah, I used to have, I said before I used to have to have a little sleep on my own doctor's couch at lunchtime, after lunch, because I was so drowsy after lunch. And then I'd have to wake up. That's when I would wake up with a bar of chocolate and a strong coffee to get me through the afternoon.

1:14:08

So you used to have about 300 grams of carbs a day. A lot of them would be what we would regard as sort of not great carbs, like biscuits and chocolates and stuff. But some of them we would regard as healthy, like muesli and dried fruit, for example. Okay, we can come to that. But how many carbs do you think you currently have on most days now?

1:14:29

Yeah, fine. It's come down to probably about 40 grams.

1:14:51

About 40 grams a day. So that's for many people, that's quite low. And do you not experience times in the day where you're hungry, where you feel like, I've got an energy dip.

1:14:54

No, you see now I'm a fat burner. I'm burning my own fat. So actually I can eat once a day if I have to. I never eat more than twice a day. I haven't eaten breakfast for years.

1:15:04

So what time do you normally have your first meal these days?

1:15:20

Normally have probably lunch, maybe one o'. Clock. I wouldn't have eaten till then.

1:15:22

And are you open to sharing the sort of things that you eat?

1:15:27

Yeah, yeah, sure.

1:15:29

What might you have for lunch?

1:15:30

So a lunch might be something like. Maybe a three egg omelette. Something like. Like at least three eggs or it could. Trying to think what I had yesterday. Oh yeah. It was quite a lot of pork with loads of homemade coleslaw. So that was lunch yesterday. And then you'll have dinner when? Six o'. Clock. I try not to have it too late. And then again it would be a meal with protein and green veg. So what would it be yesterday? I think there was a couple of lamb chops and loads of broccoli with a bit of butter and some almonds on.

1:15:32

And what on the days.

1:16:18

And then raspberries and cream afterwards.

1:16:18

And on the days when you run.

1:16:20

Yes.

1:16:22

Do you change how you eat?

1:16:23

Not at all. No. Because now I can. So I used to run. I remember in my early days. Do you remember those little sachets that horrible. They had sugar in and salt in and that sort of. And in fact, when I first ran I carried jelly babies. Cause I thought I needed like I felt I was having a hypo. But now I don't run beyond about four miles. Is my. Now is it.

1:16:25

And is it relatively low intensity when you're running?

1:16:49

Yes.

1:16:51

Yeah.

1:16:51

Unless I'm sprinting with those grandchildren. Yeah.

1:16:52

But again, people don't realize if you train your body. Yeah. It's routine for me now if your heart rate is. You're not running too fast and pushing it high, you can. You don't need to eat. Your body will burn fat.

1:16:54

Yeah. Well, I usually run fasting because I usually run in the morning. So I won't have had breakfast and I don't eat when I get in. And I might do sprints. It just. Or I might do weights. Yeah. But I'd. Yeah. So I can burn fat. Now I am a fat burner because that's ketosis.

1:17:06

There's a lot of freedom when you, you know, there's many ways to get to burning fats. But I would say that in the modern world one of the things we struggle with is Temptation, Yeah. You're traveling, you're at a train station, you need to go on a train for work or a plane or whatever. And what are you surrounded by? You're tired, you're out of your routine. There's not often really good food choices. Whereas when you have trained your body to be able to burn fat, you actually are liberated because you just go, I just won't eat.

1:17:24

I can eat or not eat.

1:17:53

Yeah, I'm just not going to eat. Whereas if you're a trained sugar burner, you have to eat. So then you're in a real trouble because you're at the petrol pump or at the train, so you're like, damn it, I want to eat well, but I can't. So you went up with the chocolate or the crisps?

1:17:54

Well, that was really. I've noticed this with many of my patients. They go lower carb. And then I say to them, well, notice when you're at your best. And notice. Start noticing. And we all have to individualize our diet to suit us. So I go. I do about 50 speeches a year. So I go all over the world and is there food or not? Or very often the buff. It's ridiculous. I go to diabetes events and there's usually not anything I can eat at those events without putting my blood sugar up. Nothing. So I have to fast. Cause there is nothing for me to eat. So for me, a practical. It's just been practical to go lower carb. And many of my patients who've done this with me now for 13 years have come to the same conclusion that, well, it's just easier to, on the whole, try ketosis, because then you've got this flexibility now. You can break out of it, I suppose, if you go on holiday. But I actually find I just prefer to stick with it. It's just simpler. I like a simple, easy life.

1:18:06

Yeah. There are many different ways to put type 2 diabetes into remission after.

1:19:10

You should mention that. Yes.

1:19:17

One of the ways, the way that you view yourself and you recommend to many of your patients, is the low carb approach. But it's not the only way, is it?

1:19:18

No, not at all.

1:19:26

And I think it's an important point.

1:19:27

It's very, you know. So, I mean, we must mention the work of Professor Rob Taylor. He's a friend of mine and he was a senior author on my last paper.

1:19:28

And his work's great.

1:19:37

Yeah. So he's doing it a different way, which is just over 800 calories a day of the soups. And you can prescribe those. So he's giving people a low calorie diet, but actually it is low carb as well, of course, because if it's low calorie, if it's low food, if you're only having 800 calories, a diet a day, that has to be low carb, but that's actually on prescription. And what's interesting is bariatric surgery works really fast as well. Bariatric surgery can have people off insulin.

1:19:38

But of course, there is a consequence to bariatric surgery when you're talking about risk rewards or the pros and cons.

1:20:17

Yeah. It's major surgery and there's a mortality involved. So again, sharing with patients, which would you like to do? So bariatric surgery can't be reversed. And bariatric surgery for me doesn't very well address what your problem actually is. And I think one thing you and I haven't talked about is we're both passionate about why is this person suffering in this way? What's upstream and you know what's upstream of diabetes is like, why did you eat like that? And one of the reasons that I ate a lot of junk food was I was kind of addicted to it. So, you know, I could have had bariatric surgery, but would that have cured me? Would it have taught me to eat better? I wouldn't have learned. So the drawback of bariatric surgery is it's technically good, but have you learned how to care for yourself? Have you learned how to make it a long term success? And we know that people who have bariatric surgery, after about two years, a significant number of them are gaining weight again by their. Their blitzing Mars bars or that kind of thing. Or some of them are drinking.

1:20:24

Yeah.

1:21:42

And that's because bariatric surgery did not deal with their actual problem.

1:21:43

Yeah.

1:21:49

It sort of put them in low carb jail and then they find a way around that.

1:21:50

Yeah. I want to talk about food addiction in just a moment because I know you've got a lot of thoughts and I know your wife Jan has done loads of incredible work in this area. Before we move there, David, though, I just want to make sure we've covered something off. Okay. You mentioned your colleague and friend, Professor Roy Taylor, who's done some game changing work, type 2 diabetes. And he's shown, of course, that one of the central issues is this accumulation of a very small amount of liver fat.

1:21:54

Correct.

1:22:22

And we can accumulate liver fat in a variety of different ways. But let's assume that we've got the Liver fat and the pancreatic fat that then causes the type 2 diabetes.

1:22:23

Yes.

1:22:35

My understanding of Roy's work is that any mechanism by which you can get rid of that liver fat is, is a very successful way of reversing the type 2 diabetes or putting it into remission, which is the technically correct term. Although I, I want to, I want to talk about why we use that term actually in just a moment. If patients can lose significant amounts of weight, I think one of Roy's early papers showed that maybe it was 10, 12 kilos of weight loss.

1:22:36

I think that about 10%.

1:23:11

10%.

1:23:13

He would say losing 10% of your body weight is very likely to get you drug free remission. But you're right, what his work has shown, it's the liver fat has to go. And if I could just explain for listeners something about this. So the physiology here. Think back to me in my 50s as I ate the muesli and the bananas and the chocolate bars. What was happening was the excess sugar that you don't need for running around is being pushed inside cells by insulin. That's the work of insulin to protect me from the high blood sugar. So your body's left with no alternative but to turn that excess sugar, which is dangerous, into something that's less dangerous, fat, particularly in the liver. And so Roy Taylor talks about the long silent scream from the liver, which is the 10 years while I was overeating carbohydrates and my liver was filling with fat. And it is the fat in the liver is actually causing insulin resistance. So that then my insulin didn't work as well. And then my body has only got one alternative and that's to ramp up the supply of insulin. So if my insulin works less well, you need more of it to clear that miles bar. So then you have another state which is insulin resistant and hyperinsulinemia, which is a high level of insulin. Gradually though, as your liver fills with fat, the insulin resistance gets worse. But remember that insulin is produced by the pancreas gland. And unfortunately the double whammy is that my pancreas filled with fat also. And so the emergency response to the failing insulin is shut off because you can't produce enough insulin. And at that point the system collapses and I develop type 2 diabetes. All of this, the good news is all of this can be put into reverse with bariatric surgery, fasting, or low calorie diets or low carb. So that's just the physiology, because I like people to understand that. Because if you understand what's going on, you're in a much stronger position to individualize making choices yourself.

1:23:13

You know, now there's many people who listen to this podcast who prefer to eat plant based or vegan because of, you know, a whole variety of different reasons, including ethics and. Yeah, yeah, you know, animal compassion, etc. Etc. When you were mentioning the low carb approach that you have found successful with your patients, have any of them managed to do it in your experience whilst being vegan or plant based?

1:25:31

Yes, actually not many though, but it is possible.

1:26:02

This is.

1:26:06

Oh, yes, it is.

1:26:06

And I think that's a key point I wanted to make because a lot of people might be going, well, is that my only option? I don't want to eat answer. And I think, I think they can still do it if they're able to lose weight. Yes, A different way.

1:26:07

And at this point, I don't know whether I can mention D Life India.

1:26:17

Yeah, of course.

1:26:22

This is a wonderful website which has got lots and lots of really good vegan and vegetarian recipes, particularly for Asian people to enjoy the food with all the spice. And they're doing work in India helping people with type 2 diabetes get remission and with an eye to what might be culturally acceptable. And so they know far more than I do there. So, yes, I've got examples of people who've done it, but there's a website there that would make it easier for people if that's what they wanted to do. You have to be quite clever, but if you're motivated, of course, yes, it can be done.

1:26:23

Yeah. For someone who's listening, David, who perhaps is having a more conventional or what is more normal these days, you know, a moderate to high carb diet.

1:27:04

Yes.

1:27:15

So they are having cereal for breakfast and a sandwich for lunch and pasta for dinner. And I don't know, let's say they're in their 40s and they're feeling good, they've got energy, they're able to do what they want to do, they don't have any excess belly fat. What would you say to them?

1:27:16

Well, first of all, those people are quite rare.

1:27:34

Okay.

1:27:36

You know, in the British health service, they are rare and becoming rarer. So first of all, I'd say, congratulations, you're amazing. And I'd be curious how you did it. And I think curiosity has taught me a great deal. So if I find somebody who's successfully healthy, I'm fascinated. So I would be wanting to ask that. I'd be very interested to ask how you did it.

1:27:37

It could, of course, be that they are extremely active.

1:27:59

It may be. And some of them would say, well, you know, I'm a runner or whatever. So having said all that, because it's so rare, I would just want to check that the lipid profiles were okay. Things like the triglyceride, fasting triglyceride to be sure. And is your blood pressure fine? And if, I mean, if you're healthy, I'd be just celebrating that and well done and a bit curious. But I would say to you that, you know, the minute if your belly starts getting bigger or if your blood pressure goes up or if your triglyceride goes up, then perhaps you ought to cut back. I'd be a bit worried because, of course, that was me for many years, wasn't it?

1:28:02

Yeah.

1:28:44

So as a younger man, well, I was irresponsible with my body and what I ate. So I thought. So in my 30s, let's take me in my 30s, I wasn't particularly heavy, I didn't have a big belly. My body did what I wanted of it and I neglected it. I neglected it. And I got into some habits with the biscuits. That's where it began. I felt I was a bit stressed. So somehow I think that was a response to partnership and medicine. So, I mean, it brings danger when you take your body for granted. And if I could speak to my younger self, I wish I hadn't eaten as many biscuits. I wish I'd done differently because maybe my metabolic health could be better. Because now if I eat so much as a banana, my blood sugar is in double figures.

1:28:44

Well, some people will say critics of this kind of approach. I'm a fan of this approach. I used this approach on BBC1 back in 2015 and helped a lady, I think still to this day, from what I can tell, was the first time that I'd ever been done on television anywhere in the world, touched with IBC since remission.

1:29:42

To them, you were my hero. I was like, wow, yes, it's incredible.

1:30:00

That was 10 years ago. But I remember back then that was so controversial. That was 2015, I'm thinking, you know, I remember going back into my NHS practice after that aired and I actually can still remember a conversation with one of my colleagues who watched the show and said, you shouldn't have done that. I said, why not? Said, well, I've just been to the Diabetes conference in Cardiff and you shouldn't have put them on a low carb diet. That's not the recommended diets. And I remember saying, yeah, but did you see what happened did you see the results? Doesn't matter. She said, that's not the recommended diet. And I remember thinking, oh, wow, this is kind of crazy. This patient has had her health transformed. She's in remission. But such is the conditioning of our training that even a colleague. I just couldn't see through it. And you said curiosity before. I get. We all have different experiences. There was a point where you didn't know what you know today. There was a point where I didn't know what I know today. So we're all on earth, different part of our learning journey. But I don't get why there's not more curiosity from some of our colleagues. I would prefer to say, hey, listen, you know, I saw what you did. It's not what. I was recommended by the Diabetes association at the weekend, but can we get. Can we have a coffee and just talk about it? Because it's really interesting, or what research have you got to back that? Or whatever. I would love to have had a conversation when it was, you shouldn't have done that.

1:30:05

Yeah, you know, I've worried and worried about this exact point. And I think some of it is to do with the perception of guidelines. So they've brought nice guidelines. We're all now advised by nice guidelines. And I find young doctors are memorizing the nice guidelines, which is a lot of hard work. It's a lot of hard work. And I think for an inexperienced doctor, guidelines are very helpful. Cause you don't have experience of many.

1:31:37

Things or even that confidence, having done.

1:32:05

It for many years, it's kind of reassuring. It's a crutch, because it's reassuring because you're doing the guidelines. But I think we're confusing guidelines with. They are not rules that must be obeyed. They're not tram lines, they're guidelines. And one of the wonderful things about medicine is the ability to improve from experience as you get older. So there are compensations for being 67, because I've just seen so much medicine. But if you don't learn from that medicine, if you're not curious, and if I was to practice medicine exactly the same now as I did when I qualified with a bit, that's very sad, because otherwise we may as well just have AI learning and have machines do it all. Experience and expertise is key. I think patience, expertise of themselves is key. So for me, it's a collaborative approach. I supply information and experience, but the patient supplies what works for them. And so what's gone wrong with cura? I think doctors, we're not I know. I know what some of it is. Isn't it funny? We think we're scientists, don't we, doctors? But we're not scientists. We're scientists, have a hypothesis, and then we try and destroy the hypothesis. So you have something and you think, but is it true? Can you test the hypothesis? And in that way, science moves on by disproving things and doing it better. And yet medical trading is, memorize all this stuff, memorize all these drugs, memorize all of this. And there's not very much about scientific method. Then the other thing is we were taught very little about research and very little about how you would interpret a paper in terms of the quality of what that paper shows. And so we're not very well equipped for the adult world of medicine in terms of changing. And then you feel threatened, so you just do the same old stuff and you're tired. But the lack of curiosity makes me very sad. And I know on social media, people again and again are so disappointed because they say, I was so excited I went to see my doctor because my blood sugar's normal and I can't wait to tell him. And then the doctor's not a bit interested or even slightly defensive. Yeah, isn't that a worry?

1:32:08

And unfortunately, some of those doctors will also be knackered, burned out. They're not feeling good themselves, so they don't want to hear new stuff, they.

1:34:43

Don'T want to learn.

1:34:50

Tired by it all, which I get. But it's very hard for patients that I think when they're trying to. Because the way I look at it, sometimes I think, are we moving on? I think we are. We are making progress. Because back in that time period that you mentioned already, 2013, 2014, 2015, when you were discovering this, when I was showing this on tv, it was quite new, right? There was a bit of pushback. And I remember even being told that this idea that type 2 diabetes could be put into remission or is reversible, that's not true. I'm like, in my head, I was thinking, I know you're telling me it's not true, but I have seen it happen with multiple patients. So you can keep telling me it's not true. I'm like. But I'm seeing it, so I kind of trust what I'm seeing as opposed to what I was taught. And then I think, well, okay. And this is maybe tells us something about human nature. I think the fact now in 2025, that it is widely regarded as acceptable that type 2 diabetes can be put into remission. You can even read code on medical notes now in a way that you couldn't 10 years ago. This is well established. Instead of celebrating that now, I think people start fighting over what is the best way to get there. And I think, well, hold on a minute. We've made progress. We now understand that it's not chronic and irreversible. We can treat it successfully with diet and lifestyle. We can often put it into remission or reverse it. And there are a variety of different ways to do that. There's bariatric surgery, there's a low calorie diet from Roy Taylor, there's a low carb diet, and maybe for some people, there is a vegan diet that can do it if they're able to control their calories and, you know, get the weight off. With that approach, we should be celebrating that rather than fighting.

1:34:51

I agree. I mean, there's so many sick people. Crikey, you know, how's it going nationally? It's a disaster, in my opinion. It's getting worse and worse. So there's so many sick people. So I wish. Let's be curious, let's be interested in success. I found that in medicine to be a really good thing. Always be curious. If somebody improves their health, why do we always constantly. Medicine is all about noticing sickness, but actually you can learn a lot from people who surprise you with wellness. And that was from that very lady that began me to think. I think the other thing that's good now, I think social media is a phenomenon, really. A lot of this idea of lifestyle medicine is a grassroots revolution.

1:36:40

Yeah, exactly.

1:37:29

I learned from a patient and so did many other doctors, from clever people who've worked out how to get better health and celebrate that.

1:37:30

Have you noticed a difference, David, between men and women when it comes to this low carb approach for people who have got poor metabolic health?

1:37:37

I think with care, I'd say, I have. One thing I would like to say straight away is I remember I'm often asked, do men or women lose most weight low carb? And I'm very lucky because I have a medical statistician and you know, she's actually helped me for five years. Christine Dellon has helped me for five years for no payment, nothing. She just does helps me in her spare time. Look at my stats. So I asked Christine, okay, do men or women lose most weight with low carb? She said, well, if you look overall, men lose most weight, but if you look, remember that men are taller and heavier. If you look at as a proportion of their weight. Women do slightly better than men.

1:37:47

Wow.

1:38:39

Isn't that. And I had no idea.

1:38:39

That is super interesting.

1:38:41

And another interesting thing so is statistics is interesting. I used to hate statistics and audit like bar humbug, but it actually answers questions. So another interesting question is, do younger people or older people do better? And you know what? It's the older ones. The older people, she did all this very carefully with all my data. And the older people lost slightly more weight than the younger ones. I think it's because they're organized. I think they've the money and time to sort of sort themselves out. So but going back to your question, so actually women in terms of percentage weight loss do slightly better, but they are so men. I would say they like a message kind of straight somehow brief and straight, like how do you do it? Right. And some of them just go away and do it. My female patients like a bit more detail. Cause they're wondering, well, what recipes might work or they want a food plan. Not many men ask me for food plans or recipes.

1:38:42

That's interesting.

1:39:47

The blokes like it in a blokey way and they like it quite straight. The women have got more questions. You know, we're going to come on about food addiction because I think women have a slightly maybe different relationship with food. And it's quite complex sometimes.

1:39:49

What have you observed there?

1:40:08

I think so quite a lot of my female patients have told nobody that maybe they're addicted to bread or that they're secret eating or all sorts of things because they're ashamed or that, you know, maybe they have a weight problem and that they suffer with stigma because of that. And so they just think maybe they're weak willed or something. And nobody's ever said to them, you know, what if your problem was addiction, you know, because. So somebody with alcohol. Well, they're not an alcoholic to annoy me. People with cigarettes don't smoke cigarettes to annoy me. It's an addiction problem. They can't regulate it. And therefore moderation doesn't work very well with cigarettes and half a glass of whiskey. There's no doctor I know who would say half a glass of whiskey is okay if you're a dead set. Yeah. And so I started thinking about women in terms of carb addiction. This is my wife's work because she is a carb addict. I was married to one and didn't even realize. So I'd known her for so long. But then just to finish on that, I actually just, I thought it was women. And then I started asking the blokes and actually some of them were carb addicts as well. So I don't know where that's going.

1:40:10

But this topic of food addiction, again, it's also been quite controversial because for.

1:41:42

Many years it's said not to exist.

1:41:46

Yeah, they said it doesn't exist and you can't because of course you don't need alcohol, you don't need a cigarette to exist. People used to say, well, and I think many people still do that. Well, you know, you need food, so you, you know, you can't be addicted to food. Or that was one of the lines of thinking which I've always found a little bit problematic. Because if you look at the way people's behaviors are around foods, some people, and you compare it, you're like, well, whether you want to technically call it addiction or not, I think that looks like an addictive behavior for that individual.

1:41:49

Right. I have a few things to say on a few things to say on that. So, yes, we're told officially ultra processed food addiction doesn't exist. So that there are no clinical services for this problem. And what's interesting about this is, well, I've got clinics. I can refer you for nicotine, I can refer you for alcohol. But how about this? I can refer you for gambling addiction. And there is no substance even. There are clinics nh that is accepted gambling addiction and there is no substance even. And then if we come to, well, what is addiction? How would you diagnose addiction? As a doctor and you're diagnosing addiction when intelligent people do things they know harm their health and cannot stop. So somebody intelligent drinks when they know it will harm their health. Nicotine when they've had a heart attack. But isn't it the same as intelligent people? And I know so many people do this, cannot stop eating bread or pasta or whatever it is, they get cravings, there's secret eating. And I've got permission from a patient to give you a specific case that illustrates this so well. And I've seen this guy in the last week to check that we're fine. And he wants me to tell this story. So this is a successful business person, he runs a business and he has poorly controlled diabetes and he's overweight. He has a really severe orthopedic problem and he can't have the surgery on his orthopedic problem because his diabetes is so badly controlled. So he's been refused by the anesthetist for surgery. And the reason his blood sugar is high is because he can't stop eating bread. That's the reason. And he knows it's the reason because he's intelligent. His wife discovered that he was eating crusts of bread out of the bin that the rest of the family had eaten. So she loves him and she thought, right, I'll stop him. So she put detergent on the crusts. He still eats the bread, even with detergent on. Yes. His wife told me all this and he said it's right. She discovered the only way to stop her husband from eating bread, despite the fact it's threatening his life and despite the fact he can't have the surgery he so badly needs, was to spray bleach on bread and leave the bleach spray by the bin as a signal to her husband, don't even try. I've been there before you with the bleach. Is that not for you? That's addiction. So you have an intelligent person who's doing something he knows to harm his health and he's in agonies of pain and needs surgery that he cannot have. What's interesting is, so there are criteria for addiction. These are the criteria. You continue to take something that you know is harming your health and that if you don't have it, you get cravings.

1:42:23

Yeah.

1:45:30

It's the very basis of addiction, addiction. And you would not believe, if you never ask, you won't find it. So I never asked anybody about rice or bread or pasta as an addiction. And that's a great way never to find a food addict. So I never found one. I thought they don't exist in every clinic. I do, I find them. And, in fact, we now have research on this. We know that somewhere about 14% of the UK population are food addicts. We also know from Sweden, there's a wonderful paper there, that if you are an ultra processed food addict, you are 600% more likely to develop type 2 diabetes. So in the population with type 2 diabetes, there are a lot of food addicts. And in fact, we do group consultations at the practice, so we run this idea that you don't have to have an appointment, you can just come and the room fills with people that I know and we're caring for each other. It's the way to do it cheaply for all these years was to run group consultations. Anyway, we did an assessment of everybody in the room recently. Not one person in that room didn't screen positive for food addiction. Not one person. As we all sat there, we did the point system and at the end we all, you know, so that's my spiel really. And I think if we're caring for people, what matters is maintenance. So, okay, you did a great thing, you know, great, well done. But what happened a year later to those people, and if we can't, in the health service, if we can't maintain improvement, we are wasting our time and part of maintenance, the Holy Grail. Roy Taylor called, that's why he's interested in my work. He says, david, what's the magic source he calls it in your practice? Because we're curious, we're tenacious, we're trying so hard for maintenance. And if you don't address ultra processed food addiction, you will fail. Because if you are an ultra processed food addict, you can do good. But Christmas will come, the holiday will come, your birthday will come, and a little bit of cake can be your undoing. And that's why Jen's work, she's published on this, she's published out actual the first clinical outcomes in the world. She was the first person to do any studies and get clinical outcomes. She did a three center study. She did North America, Sweden and the uk three centers. And everybody that study was done for free because every single person that should have cost a million or a million and a half cost nothing. Cause everybody worked for free because they believed how important this is.

1:45:31

Are you and Jen, your wife, both food addicts, would you say?

1:48:23

Ah, now that's really interesting. So Jen is a serious addict. So to give you an example, when we went low carb at the beginning, it worked for her. And we thought, we'll have Christmas Day off, you know, it's Christmas Day, come on, we've got kids. And because of Christmas Day, she couldn't get a grip of her carbohydrate intake till May. So she gained weight from Christmas Day till May. Five months struggling. Yeah. And it was, I'll do it on Monday, tomorrow, tomorrow. So for her, she's a serious addict and she's a very intelligent woman. She's a consultant clinical psychologist and she couldn't stop it despite knowing it was harming her health. She says I'm a harmful user. So she's clever. She says, david, you're a harmful user. Which means I can really drift badly. But I'm better able than her to stop it. I'm better able to say on Monday I'll stop eating. But even for me, you know, if I was to eat milk chocolate, one cube of milk chocolate will make me hungry. And cravy. I tried it. Cause in the early days people would say, Dr. Amin, I've made you a birthday cake. Go on, just have a little piece. And out of courtesy, I would have a small piece. But then I'd get such cravings afterwards and such hunger. I learned it's just simpler for me not to break the rules.

1:48:26

You two don't do cheat days anymore, is that right?

1:49:53

No, never. I haven't. Never. And the reason is so I can give you an example. It was a big wedding anniversary and we went to Michelin starred. What? You know, kind of place, spent a fortune. And the chef did me a special lemon pudding. And you can't. What can you do if the Michelin starred. Ta da. I've made this for you. And it's got sparklers in it. And I remember it very well. He did it to look like a lemon and it just looked like a lemon. It's like a lemon sorbet that looked like a lemon. When I ate it, it was like little sparks were going off in my brain. I thought this, I've never eaten anything like it. Oh my God, this is so good. But, you know, I was over enjoying it. And afterwards, the rebound was a sort of weird mixture of anxiety and depression that went on for two days.

1:49:56

Wow.

1:50:46

So we were staying in a hotel and it completely ruined my little holiday because the next morning I woke with a sense of. Of doom and kind of worry. And that didn't leave me till the day after that. So the consequences of that marvelous half hour while I was eating that pudding, wow. But really my experience was like somebody having a drink who, you know, can you imagine? You hadn't drunk for five years and you have a whiskey. This whiskey is amazing. I feel terrific. I feel amazing. But oh my goodness, the next day. So, no, I could say, I never cheat now. It's simply not worth it.

1:50:47

But it's interesting for me that you've been on this journey for a little while now, right? So 10, 12 years. And throughout that process, you've learned things about yourself. You've tried to cheat or you've been caught in a position, right? You do what everyone does and you go, ah, Christmas Day. Or oh, it's the anniversary. But you figured out that for you, you can't do that without a serious consequence. You've got to the point where you've had enough of that to go, yeah, you know what? I'm better when I don't do that. Of course not everyone perhaps has to be that extreme, right?

1:51:21

Well, and they don't actually have type 2 diabetes like I do, so.

1:51:58

So Would you say Currently your type 2 diabetes is in remission?

1:52:03

Yeah, absolutely, it's in drug free remission. So my hemoglobin A1C, my average sugariness is 36, which is a very good result.

1:52:07

What do you say to people who say, listen, the low carb approach is not fully dealing with the root cause. Cause Some people will say that things have gone wrong in the body, therefore the blood sugar has started to rise. Of course, if you don't eat carbs, you're not gonna be spiking your blood sugar. But the underlying process of the accumulation of liver fat, for example, hasn't necessarily been addressed. What would you say to those people?

1:52:14

That's a fair point. I'd go back to the physiology and I'd be pointing out that this is about insulin. Yeah, this is about insulin. And then it's about insulin not working as well and insulin resistance. And why is it I, what's the reason for insulin resistance? What's the reason that that occurred? And I would say for me, I know how I ate and I know that it was sugar and carbohydrates and biscuits and that I believe the physiology whereby my body had no alternative really, it had to get rid of that sugar. And the only way to get rid of that sugar was turn it into fat in my liver. And the fatty liver was the beginning of insulin resistance and then hyperinsulinemia. And I do think I'm dealing with the cause, the root cause of it, which for most people I believe is too much carbohydrate over time. Now there are other things that I might just mention. One of them is seed oils that I don't know. There is a bit of suspicion that's new. We weren't using corn oil, were we, 150 years ago? So we have done some other things in society and I do have, that's why my patients, I'm advising them not to use seed oils because I do worry a little bit about the omega 6, omega 3 ratios. I do worry about them causing inflammation. So again, I could be wrong. So I have to be broad minded and say, well, I think what I'd say, you know, if you can go away and beat me and get better data with your patients, if you can do better than me, I'm fabulous. How did you do it? And I'd learn from you. That's what I'd say to any other doctor. Do your best, try collect data and beat me, Please get something. Let's do even better work and try and find out how. But until that happens, I'm fairly happy with.

1:52:46

I agree on it. Industrial seed oils. I don't see any. If you're a sick. Sick patients. Yeah. I for years have been telling. I think it's better to try and avoid them. Let's go with olive oil. Right.

1:54:54

Or if you. Butter. I think probably butter's okay. Yeah.

1:55:07

And it's like people will debate and get all sort of antsy over, you know, what does this trial say and what that trial I can just go on my clinical experience as well. I think generally I've seen it work really well and I don't. I can't find stuff that convinced me that there's really good benefits of having seed oils. Right. So why don't we stick to stuff that we're a bit more confident on than experimental is how I look at it.

1:55:09

Yes. And it's also more likely that butter or tallow or whatever will fit in. In terms of ancestral. What was our. How are we designed? How is our physiology designed? And I, you know, essentially you and I are cavemen.

1:55:32

Yeah.

1:55:50

Sitting ridiculously here in the modern world. And I believe we're adapted. We're highly adapted for a world that no longer exists. And we're doing our best in the modern world with a modern diet. But the modern diet is so recent in terms of evolution. It's so just seconds, as it were. I don't think we're very well adapted to the diet we're eating. And I'm struggling. I think I'm struggling to find out what's the nearest I can get to the diet that I'm adapted to eat in the modern world. And it's a struggle.

1:55:51

Your children have also gone low carb, I believe, even though they don't have type 2 diabetes.

1:56:28

Correct.

1:56:33

So what was the motivation for them?

1:56:33

That's right. So we struggled in the family. So Jen and I did it first and we annoyed the teenagers and you know. Cause they felt they had a right to the. So it was a real struggle for the first few years. So we. So we had to compromise. And I remember we used to have. First of all, we had carbohydrate corner. So that was. There it is. Okay, kids, that's your bit. And then we started thinking a bit. Well, that's a bit disappointing because don't we love our children more than ourselves? And is that okay to just let them ruin themselves as I ruined myself? So that was. It was a worry anyway. And then we adapted it slightly, which is we did meals so the protein was okay. The green veg was okay for everybody. If you wanted rice or oven chips, go and fix them yourself, okay? And they're dead lazy. Teenagers are dead lazy. And they, you know, so they made a farce and then they were just too. But we didn't, we didn't corner them, you know, we didn't corner them. We said, listen, we want to be fair, you know, we used to get. You can get rice and little things that you put in the microwave. So we bought those for them. Go and get it if you want it. And that was one approach that worked really well, just like you fix it yourself if you want. But the other thing was Jen really went. She majored on delicious low carb food. So she can make birthday cakes with almond flour. She can make pancakes using gram flour. So gram flour has got loads more protein. So much better in many ways. It's a far superior flour to wheat flour. So she's making pancakes, she's making batter.

1:56:35

So you're not depriving yourself.

1:58:22

So if you can have pancakes with fresh raspberries and double cream, well, isn't that okay? Or then I started doing a thing which is I was blending. I'd say, you know, I'll make you some ice cream. So I would blend double cream with frozen raspberries at the table, and they'd kind of think, that's fun and it's like, no pudding or that. So we were sneaky, really. We learned how to do really tasty, low carb cakes, if necessary, pancakes. We can do a low carb Christmas. We learned that. Now, the other thing was vanity. So the boys, two boys and a girl, the boys wanted to be. The word is hench, I believe, amongst young people. So they wanted girls, the boys wanted girls. They wanted to look hench. And they observed that even their dad was losing the dad board. And I could outrun them. I could outrun my sons. So far, I don't know whether they're even listening. None of my children have beat me in a sprint.

1:58:23

Really?

1:59:29

Yeah, really. And they tried. They've tried.

1:59:30

That's pretty cool. Well, cool for you.

1:59:33

And it's very annoying for them when old guys. So they think, bloody hell, you know, maybe he's onto something. And they wanted the girls. And one of them was slightly overweight and he wants to take his T shirt and often swim and stuff like that. So he came on. And of course, my daughter wanted to be attractive or maybe acne or, you know, skin condition matters. So gradually all three of them gave up bread. None of them would eat bread ever. I'd never seen them eat bread for years. They've gradually. And now I have eight grandchildren who are all low carb. Luckily they've gone away and found partners who also have chosen whole food approaches to health and then monitoring. And as it happens, of the grandchildren, three of them are quite ill with gluten. So as gluten is changing, as bread is changing, three of them, they're just ill if they have bread.

1:59:35

So there's a much higher concentration of gluten now in this modern bread.

2:00:34

Bread isn't what it was.

2:00:39

Loads of patients, I would say over the years, I found, have problems with gluten way more than the quoted weird numbers. I'm like, I don't know where those numbers are coming from because. But it is more, it's way more. So many people do well when they cut out gluten. But, you know. Yeah, particularly that's just what I've seen.

2:00:41

Time and time again, particularly patients with ibs, you know, that kind of bloating, discomfort, high proportion. I just say, can we. Can we just try going gluten?

2:00:58

Yeah, try it and see what happens. Free, you know, for some people, just.

2:01:08

Something about bread that I don't know. You are younger than me, but when you were little, did bread go moldy? I think it did, yeah. So my mother would say to me, and the mold, do you remember it was like all different colours of blue and green. And she would say, so we didn't have much money when we were little, so she would toast moldy bread and tell me it was penicillin, which was a mum's clever way of getting you to eat it. And I remember that so clearly. She'd say, okay, it's gone a bit. There's only bits of blue and green. It's just penicillin. I'll toast it for you and it'll be tasty, you'll love it. We tried with you try bread now. It never grows mold anymore, does it? We kept some. You can keep bread for weeks and weeks and it never goes. Something's changed.

2:01:11

Something has changed.

2:01:56

Something has changed in the bread. It doesn't go moldy.

2:01:57

You mentioned not having much money when growing up. And one of the things that people will often say when it comes to eating more whole foods or eating a low carb diet is the cost. Cost. How do you manage that in your practice?

2:02:00

I've learned a lot from my patients because we're north of Liverpool, so I'm not many of my patients are on benefit, so that is. It's a great. It's a great question.

2:02:13

And that's Social Security benefits.

2:02:23

Yeah, yeah, yeah. They're on benefit. So what they say, the patients tell me the first thing, is to be honest about what you're spending at baseline. Because they say if you're being honest, you're buying packets of crisps. People just do fizzy drinks in cans at a pound a can.

2:02:25

Yeah.

2:02:43

And a pizza Domino pizza at seven quid. So you should look at that budget. And if you include all of the money you spend on, essentially junk, you will be spending about the same when you go low carb, if you factor honestly in, when you bought petrol, what did you buy? You know, most patients are spending a couple of quid, they buy the petrol, but then there's about £2, maybe a drink and a chocolate bar. So they say if you factor that in, it's about the same when you go low carb, because, yes, the ingredients do cost a bit more, but they also say, if you're clever. So frozen raspberries are much cheaper. So frozen fish, for instance, is a fraction of the cost of fresh fish, frozen chicken thighs or go for mince. To make your own burgers takes moments to make your own burgers. Well, what's the price of a cabbage? Or even a pint of double cream isn't that much. Or eggs. So there are many nutritious, nutritionally dense foods specifically as well, I'd like to give a shout out to the Fresh well app. So the Fresh well app is a free app you can download on your phone. This is the Freshwell practice and they've taken my work, they're younger doctors and of course they've made a free app. And 200,000 people have downloaded that app. And in it is low carb on a budget. All done for you, all the recipes, all there, all for free. And the Freshwell app is approved for use within the British Health Service. It's approved by the nhs, it's kismet approved. So I think that, yeah, initially it's just working it out, it's planning, it requires more planning because you have to think in advance. You can't just, I don't know, just buy sandwiches. So it does require some planning.

2:02:44

That's why health does seem so difficult these days, doesn't it? But we used to live in a world where you didn't really have to think about health. Your daily life, your environment didn't drive you to poor health.

2:04:54

No.

2:05:06

And that's why I think health has, you know, has Blown up. These days, people want more health content, podcasts, books. They want to hear more from experts. And it's a kind of a reflection of the fact that we have become sick because of the state of the modern world. Fifty years ago, you didn't need all this information from people because people weren't overweight, the environment was dry, but you had to walk around to get stuff. You know, you couldn't just sit at home and order stuff on your smartphone. There's a certain irony there, isn't there?

2:05:07

There is. I mean, I remember the days before supermarkets. So people can't imagine, but there was a world with no supermarkets. I remember them coming in before supermarkets. My mother was forced to shop every day. We didn't have a freezer, you know, we had a fridge. But she was shopping every day.

2:05:36

You probably go to different shops, right? The butchers, the fishmonger, the grocers.

2:05:56

It was a chore. But she was walking around and I remember we had to help her carry it all in bags because she didn't have a car either. So it was a very different world.

2:06:00

And you were naturally healthy because of it.

2:06:10

The kids were walking around and then she had to. And make it and all the rest of it. And I remember ultra processed food coming in. I remember Arctic rolls were one of the first things. And we welcomed all these things. Cause it was tasty. But what we didn't realize, it was a trap. And we've moved, we're moving ever faster, away from the world that we're adapted to live in. Young people are struggling to be happy, whereas when I was little kids, we were just kids. You didn't struggle to, you just had your life, you didn't need experts. And now it's becoming very difficult not to become overweight. It's becoming very hard not to suffer with anxiety or depression. And it's a tragedy. And we got to do something.

2:06:12

I just want to finish off David talking to you about prevention.

2:07:03

Yes.

2:07:06

We started off talking about people who were already sick. Maybe they were type 2 diabetic or they were pre diabetic. They were just in that threshold just before. But this topic of prevention is really interesting to me. My sense is that the NHS doesn't really have prevention in its DNA. I agree, and I'm not saying that to be critical of anything. The NHS has been wonderful at so many things over the years, but I don't think we really. I think it's very hard to do prevention well, because I just think the whole model was developed around a different world and maybe more acute problems that people came in with. So this idea of prevention is not really there. So my question to you is, if you could redesign the healthcare system to be more focused on prevention, what are some of the things you would do? What are some of the tests that you would like to offer people that they don't currently get?

2:07:06

Fabulous. Why not make me Prime Minister for a few weeks?

2:08:23

Let's do it.

2:08:26

I think I'll do that because I think it's bigger than that. I think it's beyond medicine now. So with my new power, cause you did say I could be Prime Minister for a minute then the point you make is so good. The answer cannot be to drug everybody. The answer cannot be that we, what, we give the fat jabs to teenagers? Shall we do them all? Do we even know the long term consequences? We haven't a clue. It's becoming ridiculous how many sick people there are. And prevention must be. I think the problem has been that we live in a political system and each government has to get results within a few years.

2:08:27

Exactly.

2:09:06

So prevention doesn't sound quite as sexy. And yet it's the only way.

2:09:07

It's the only way.

2:09:13

The health service is breaking. The health service, all my friends are breaking through the amount of chronic disease getting worse and worse and worse. And so for me my big picture is just like cigarettes. Why don't we tax ultra processed food for the damage that it does? We know it affects all cause mortality. Yeah, we know that. But what should we do with the money? And I think should we not? This has been done in Brazil. There was a city in Brazil and what they did, they taxed. This was Coca Cola, which was the problem, ultra processed food. And then they subsidized locally produced food in farmer's markets. So that, you know, you think how is the food produced nearby that deals with your air miles. It also helps local farmers and shopkeepers or you know, the local economy benefits. Rather than flying avocados from Brazil, you know, subsidize locally produced foods and then also you have to help people learn how to cook again. So we'd use the money. I find actually most people are intelligent, most mothers want to feed their families. But could we subsidize quality food, quality whole foods produced locally? And that would mean that what you eat might depend on where you live. Yeah, but actually that's okay. And as part of that, and there was a really interesting experiment, I don't know whether you're aware of this, in Gateshead in the Northeast, they went through A period where there was a sort of moratorium on not allowing planning permission for any fast food outlets.

2:09:14

Wow.

2:10:58

And childhood obesity went down in those areas, neighboring areas where they. Every single time you allow a fast food outlet to produce ultra processed food and deliver it, it's an attack on the health of the local people. So in Gateshead it worked. So I would be doing those things, thinking about planning permission, thinking about. One other thing I do medically is why couldn't we give. If a GP is. If I'm going to give you any lifelong medication, why can't I have half an hour with you to do ethically the right thing and set before? Why shouldn't we make the choice together? I should be given half an hour paid, not for a 10 minute appointment, a half hour appointment so that we could explore the pros and cons of a potential lifelong medication and then you could be part of the decision making. And I believe that our practice has modeled this and you would save money against the standing, against the Treasury.

2:10:59

But the crazy thing is you're paying the money anyway, right? So if you don't give the time at the start and before you know it, the patient's on the prescription and they're on the repeat prescription, they're still on it five years later. And we both know how that goes, right? Once people are on these things, they.

2:12:07

Never come off them.

2:12:24

Very hard to come off them. Very, very hard.

2:12:25

Nobody has the energy to do it because it actually takes twice as long as to take you off it than it did to put you on them.

2:12:28

But the money you're gonna spend is huge. But if you could front end some of that money and go, not even like even 2% of that money to have a 30 minute consultation at the start, you may not need it at all.

2:12:34

And do you know, I have said that exact thing to two ministers of health. I won't tell you who they are, but I've said it twice.

2:12:47

I've programmed, I have a good idea who they might be.

2:12:55

Two of them I've spoken to to say every time a GP starts a lifelong medication, it's a standing order against the Treasury. And it's just like your own personal bank account. You're very careful with standing orders. I'm really careful with them because they just run invisibly and then where's all the money gone? And that's what we're dealing with now. Where's all the money gone? There's billions gone.

2:12:57

The reason it's not happening is that you said it's the politicians. Unfortunately, generally speaking, it's about getting voted in again. Prevention takes too long. You can't show that as easily for the next round of votes. Right. What about on an individual level? So are there any blood tests that you don't currently have access to in the National Health Service that you think would be great at identifying this problem? Years before they get type 2 diabetes?

2:13:20

I wish, I wish I could do fasting insulins, it's so obvious. But you know, even I cannot measure insulin at all, ever.

2:13:51

Yeah.

2:14:01

So that I've rung and I'm admitting people to hospital because I can't. So I can't die. You know, I can't deal with somebody. Maybe they need insulin and there's an emergency cause their own insulin, they're not producing enough. I cannot get, never mind a fasting insulin, I can't get any insulin or anything.

2:14:02

But a fasting insulin would be transformative because we might see this five years before you get type 2 diabetes. We may see your fasting insulin going up and we can go, wait a.

2:14:20

Minute, let me, for the people watching, just explain that and the reason. So if you're insulin resistant, your body is forced to increase the supply of insulin. So you're hyperinsulinemic. So one of the very first things you can measure is your, you're fasting insulin, you've not eaten anything, but your insulin levels are high. And if I'm sure my insulin levels would have been high 10 years before.

2:14:30

It'S an early warning sign.

2:14:53

And people in the States are astonished, Astonished. They absolutely. You can't, no. And so I have to use surrogates for that. So a surrogate, you know, if you look at a triglyceride level, that might give you an idea. Triglyceride and liver function might give me an idea. But yeah, give me the, give me the fasting insulin. Allow me to prescribe continuous glucose monitors for people who, you know, are not even diabetic because they might learn. They might learn information is power.

2:14:55

That's my sense. David, it's such a joy talking to you. You've done some incredible work over the last 12 years. The fact that you publish data on this, you publish articles on it, it's really given this whole movement so much more validity with many of our colleagues. I want to express gratitude and appreciation to you for that. If people want to learn more about you, I know you've also done loads of low carb recipe books with chefs in London, which is amazing. Where would you point them to? You Mentioned the Freshwell app as well. Of course.

2:15:27

Yeah. So there's the Freshwell app. Just. It's a free app. Download it, please. Please follow me on X.

2:15:59

Formerly Twitter.

2:16:06

I'm locarbgp and we have a really dynamic group of clever people around the world. We're learning from each other. Many, many clever people. Yes. Consider any of the Caldisi recipe books. So these are low carb chefs and I've written books with them. It includes the physiology in there, it includes the psychology. So Jen does the psychology, I do the physiology and they do the food. And there are eight of those. What else? I think that's mainly be curious, Be curious, be curious. Notice what works. Consider whether a continuous glucose monitor might be something that, that you could try to see how you're doing, because you can buy those on Amazon.

2:16:08

And right at the end of this conversation, David, if there's someone who's been listening to us, who has, throughout the conversation recognized that they haven't actually taken their health seriously, they've allowed the belly fat to accumulate year on year, they perhaps are noticing some of those signs and symptoms you mentioned right at the start. The brain fog, the fatigue, the lack of stamina, the low mood, whatever it might be. But there's been something in this conversation that's inspired them.

2:17:01

Yeah.

2:17:32

What would you final words to them be?

2:17:33

Two things, very important. Number one, if you're already on drugs for diabetes, before you make a massive change to your diet, consider how that might affect the medication and you might be wise to check with your doctor before you cut the carbs dramatically. I mean, imagine if you're on insulin and you just cut the carbs, your dose would have to be adjusted and that might apply for other drugs as well. So that's the first thing, if you're on drugs already. The second thing is there's one thing I mentioned, which was the teaspoon of sugar infographics that are now in 35 languages and they've been downloaded millions and millions of of times around the world and they're freely accessible and with a diet sheet, all free of copyright, on the Public Health Collaboration website. So this is a UK charity, of which you and I were both founder members, both of us started that and it's doing great work. And there are the teaspoon of sugar infographics, there is the diet sheet and many, many other resources. So it's the Public Health Collaboration website. But also check with your doctor if you're on drugs that are being prescribed.

2:17:35

David, thank you so much for all the work you've done. Thank you so much for making the journey to the studio to come on the podcast.

2:18:50

You're so welcome and I look forward.

2:18:56

To the next time we get together.

2:18:57

It's great fun. I'll do it again. Thank you very much. Thank you.

2:18:59

I really hope you enjoyed that conversation. Do take take a moment to think about one thing you can put into practice into your own life and one thing you could teach to somebody else. Remember, when you teach someone else, it not only helps them, it also helps you learn and retain the information. And of course, if you think this episode would be helpful for someone else in your life, please do consider sharing it with them. Also, if on on the back of hearing this episode you want to dive deeper into your own metabolic health, DO consider checking out DO Health, a personalised health companion that I co founded, powered by your individual biology and lifestyle that I believe is the future of health. With DO Health, you can regularly check what I consider to be 11 of the most important blood biomarkers in including fasting insulin, which of course David mentioned at the end of our conversation is one of the tests he wishes he had access to on the nhs. So if you want to be one of the first to join DO Health, you can see all details at doctorchatterjee.com. before you go, I just wanted to let you know about Friday 5. It is my free weekly email containing five simple ideas to improve your health and happiness. I share exclusive insights in it that I do not share anywhere else, including health advice, inspirational quotes, my comments on new research and so much more. And in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you you actively look forward to receiving. If that sounds like something you would like to receive each Friday, you can sign up for free@drchatterjee.com Friday 5. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the Episode Notes in your podcast app. And always remember, you are the architect of your own health. Making lifestyle change is always worth it because when you feel better, you live more.

2:19:06