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

35:54So 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. Can I just pause you there David? Yes. 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. It does. Right. So and also So of course, table sugar itself, you know, is not particularly good for your teeth, right? If consumed in excess. Fair point, yeah. 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.

36:48Exactly 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 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 yeah 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? 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.

37:43Yeah. As they used to be. And for them, bread was all right. Yeah. 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 and let's just flip that for a minute i mean it's 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, the stuff that might have worked for our great grandparents maybe doesn't work. Because I think we have to also square the circle in many ways to go that there are populations like the Somani in South America, who are having 70 % carbs, whole food carbs in their diet, and are very, very insulin sensitive.

38:38But I also believe they walk a ton every day, maybe 17 to 20 ,000 steps up and down, lots of hilly terrain and their whole food carbs. So I think it's, to me at least, it feels like the low carb approach seems to have almost a unique benefit in the modern world. Yeah. And I'm 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, 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.

39:24I remember that from high school, 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, we are sleepwalking into something so serious and 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. So with that patient, you helped 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.

40:11You are very insulin resistant. So insulin is not working as well as we would want it to work. Therefore, I can offer you one of two options. Option one is I can put you on medication, which I can do for you, but you have to take it for life. or I can help you change your lifestyle. Which one would you like? Exactly. Now, what's really interesting to me, that is what I call proper informed consent. Yes. 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.

40:56And 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 audience of healthcare professionals there, there are kind of two ways a consultation can go. The patient comes in, they've maybe just done the 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 so today I'm going to 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.

41:52So you tell them that, give them a prescription and as they leave the door, as they're walking out, 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.

42:25Would 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 patient goes out that they think two completely different things. The first consultation, they're walking out thinking, well, you did mention diet and exercise at the end, but really it's all about the medications versus the other way. You're right. And I would say on stage, I know that sounds quite extreme, but that is literally how these consultations are going down. That's not informed consent, David, is it? No, it isn't. And that's where I was so wrong, because I've been the first doctor and now the second doctor.

43:06And 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 we're doing, say, a minor surgical procedure, I don't know, if you've got a wart in the middle of your head, 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 Hedge Hill University sometimes. I'm an honorary lecturer. in ethics, medical ethics.

43:49And 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? 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.

44:38So we don't question doctor. The doctor knows everything, we just wait for the doctor to tell us what 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 liked 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 know, you're right. There's almost an arrogance to think that we don't need to explain ourselves. That, you know, this goes beyond type 2 diabetes.

45:12Antis, right? 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 going to put someone on an SSRI a selective serotonin reuptake inhibitor for what you think is depression and you think it's going to help how many of those patients have been actually told the real risks?

45:56They're not I looked at the BNF literally two weeks ago as part of this TV show that I'm filming and I invited you to be a part of and there are new things added over the last year 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 prescribe 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.

46:38Isn'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 bedrock of what we do. It must be. And yet it's very odd because it looks as if particularly repeat medications are exempt from that. Yeah. So there's no going back to say you never told me about sexual dysfunction. well the argument is well some people will say what are you going to do you're going to tell everyone of all the possible side effects for every medications and I'm sort of part of me is thinking well well kind of yeah I mean if I was going to say something I think I would want to know what the potential consequences might be 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 you know even a small risk of sudden death isn't great 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 have been 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 gone online and got the fat loss jabs and nobody ever told them that we have been a few deaths or there are any risks at all yeah i suppose we're off on a sideline there but it's an important 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.

48:30Yeah. Let's go back to patients with type 2 diabetes. So just to make this really practical for people, 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 give in certain in instances. Oh, yeah. 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. Yes. But you've also helped many patients for years without access to CGMs, right?

49:13So it's possible to do that. Yes, yeah. Now, the majority of what I've done was not with CGMs. That's come recently. So you're right. Sorry. No, no, it's fine. But when you say, you know, cut back on bread and pasta and potatoes and rice. They always wonder, what shall I eat? So there will be listeners now going, well, I'm going to be hungry all the time, aren't I? So what have you found in your experience? 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.

49:52so 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 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.

50:48because 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 carbohydrate. So I just would encourage people to have less carbohydrate and then how do you feel? How's it going? 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?

51:28Is it, I don't know, I don't feel full, Dr. Unwin. I feel like I need it. And what are some of the common issues that come up? 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 um 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 this i'm going to start burning fat i think a point i'd like to make now is is this idea we are a dual fuel engine so we are gosh, so clever our design, we can burn sugar or we can burn fat.

52:20But 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 burned fat.

53:21Now, some people listening will have heard negative stories about the keto diets. Yes. Okay. So what is the pushback sometimes that comes when people hear about these ketogenic diets? 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 8 years I think that's one of the confusions I had earlier on, that a keto diet, is it healthy?

54:19I mean, it seems extreme, and yet for some people it does work very, very well. Do we know, or do you know, how many of our ancestors ate in a way that would be consistent with a ketogenic diet? Well, I do actually. Just a little aside. So years ago, I was giving a speech in Tel Aviv. And the dinner afterwards, I happened to sit next to Dr. Mickey Bendour, 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.

55:22so our ancestors were ate like wolves in terms of the amount of meat in the diet and they were surprisingly healthy on that because that's the thing that will people will say they go okay well maybe our ancestors ate that way because they had to yeah but do we know what that did to their coronary arteries do we know what that did to their longevity that's that's the pushback that sometimes comes 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're about 30? And the error in that is that if you do the arithmetical mean, it is about 35.

56:01Yeah, the average. 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 infections 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 got to get fat in the autumn.

56:57So you've got to 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, 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...

57:40We'd be fasting. We'd be fasting, exactly. We would. And, you know, So it's always, isn't it, Father's Day, it's Mother's Day, it's Halloween, it's your holiday. We're eating so much more junk food, so much more sugar than we did when I was little. And what I saw as a child at school was sweets maybe once a week. That was all. 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.

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1:01:01Dr David Unwin. low carb in your practice 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 sugar significantly.

1:01:52But haven't quite hit the threshold for remission. or maybe they're on less medication. So it's still great. 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 significant improvements 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. What do we get taught? It's a progressive, chronic, irreversible condition.

1:02:36Which is just not true. 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 there's 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. Well, I'm just imagining that£370 ,000 in one practice, and you've put that over a thousand practices over the country.

1:03:23I mean, you're talking about a healthcare revolution. Yes. Literally. Yeah. 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 so they've gone out of the pre-diabetic range and gone back into normal 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 metabolic 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 5 years and you've had diabetes for 5 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.

1:05:17And that's the pressure to think, well, you know, stitch in 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? There's a couple of things I want to just sort of make sure we've covered. Yes. mainly because I understand how confusing diets are these days for people and how divisive and controversial things often get you know people get quite stuck in their camps and start to throw metaphorical stones at people in other camps right 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.

1:06:07Yes. 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. Absolutely, that's what I saw. 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 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 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 yes but well particularly in the early days and some of it was understandable the worst times were sort of 2013 to 2015.

1:07:27So 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, you know, 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 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.

1:08:18the cholesterol the hdl the triglyceride the ratios the blood pressure but 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. 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.

1:09:15Well, 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 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 your big arteries blood high blood sugar actually is aging you it's aging you talking about the the sort of interconnectedness of the body again for a moment cataracts are on the rise yes aren't they and again cataracts well that's my eyes what's that got to do with my blood sugar you know and actually on that fact i um an ophthalmologist contacted me from cumbria and she said that weird things happened in our area people's retina has started improving people she'd been screening the retinas every year and she in the end she said what's going on because 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 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.

1:11:18Yes. That's a great point. 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.

1:12:04But I think it's 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. To every organ. And just going back to the diet again, what I had missed. So I would start the day with a big glass of fresh orange. This is when you were... 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 because 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 in because that just made it so tasty it was delicious banana so that's sugar with my sugar then I get to work and I'm having biscuits with my morning coffee because people do and then at lunchtime at sandwiches that's more sugar and then you might have a package of crisps with your sandwiches, that's more sugar you just ate.

1:13:04And 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. How many grams of carbs a day do you think you used to have in your heyday? I know, I think it was about 300. So you used to weigh huge 300 grams easily and were you relatively sedentary then as well yeah because it didn't run and you sit a 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 because 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.

1:13:58So I'm scoffing biscuits. You stood no chance, did you? 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. 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.

1:14:37Okay, we can come to that. But how many carbs do you think you currently have on most days now? Yeah, fine. It's come down to probably about 40 grams. About 40 grams a day. So for many people, that's quite low. And do you not experience times in the day where you're hungry, where you feel like, oh, I've got an energy dip? 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. So what times do you normally have your first meal these days? I normally have probably lunch, maybe one o 'clock.

1:15:18I won't have eaten until then. And are you open to sharing the sort of things that you eat? Yeah, yeah, sure. What might you have for lunch? So a lunch might be something like maybe a three egg omelette, something 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 when I... 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.

1:16:10And then raspberries and cream afterwards. And on the days when you run, do you change how you eat? 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, those horrible, they had sugar in and salt in and that. So, and in fact, when I first ran, I carried jelly babies because 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? And is it relative low intensity when you're running? Yes. Yeah. Unless I'm sprinting with those grandchildren. Yeah, but again, people don't realise if you train your body and if your heart rate is you're not running too fast and pushing it high you don't need to eat sometimes before you run your body will burn fat 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 or I might do weights but yeah so I can burn fat now I am a fat burner because that's ketosis there's a lot of freedom when you, you know, there's many ways to get to burning fats.

1:17:21But I would say that in the modern world, one of the things we struggle with is temptation. 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 won't eat. I can eat or not eat. 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 real trouble because you're at the petrol pump or at the train.

1:17:55So you're like, damn it, I want to eat well, but I can't. So you went up with the chocolate or the crisps. 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 is 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 because 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 you know 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 like a simple easy life yeah there are many different ways to put type 2 diabetes into remission aren't there.

1:19:09We should mention that, yes. One of the ways, the way that you've used yourself and you recommend to many of your patients is the low carb approach, but it's not the only way, is it? No, not at all. I think it's an important point. It's very, you know, so I mean, we must mention the work of Professor Roy Taylor, who's a friend of mine and he was a senior author on my last paper. And his work's great. Yeah, so he's doing it a different way, which is just over 800 calories a day are 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.

1:19:50Because, you know, 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 but of course there is a consequence to bariatric surgery when you're talking about risk rewards or the pros and cons yeah it's major surgery and there's a mortality involved so again sharing with patients which would you like to do so your bariatric surgery can't be reversed And bariatric surgery, for me, doesn't very well address what your problem actually is.

1:20:35And 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 you 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 yeah and that's because bariatric surgery did not deal with their actual problem yeah it sort of put them in low-carb jail and then they find a way around that 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 Jen has done loads of incredible work in this area before we move there David I just want to make sure we've covered something off okay you mentioned um your colleague and friend Professor Roy Taylor who's done some game-changing work and he's shown of course that you know one of the central issues is this accumulation of a very small amount of liver fat.

1:22:15Correct. 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. My understanding of Roy's work is that any mechanism by which you can get rid of that liver fat is a very successful way of reversing the type 2 diabetes or putting it into remission, which is the technically correct term. Although I want to talk about why we use that term actually in just a moment.

1:22:54If 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, I think. About 10%. 10%. 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 is 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.

1:23:41That'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. Yeah. 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.

1:24:22So if my insulin works less well, you need more of it to clear that Mars bar. Yeah. 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 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.

1:25:14So 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, you know. Now there's many people who listen to this podcast who prefer to eat plant-based or vegan because of a whole variety of different reasons, including ethics and 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? Yes, actually. Not many though.

1:25:57But it is possible, isn't it? Oh, yes. It is possible. 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 animals. And I think they can still do it if they're able to lose weight. Yes, they can. A different way. And at this point, I don't know whether I can mention D-Life India. Yeah, of course. So 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.

1:26:39And 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. So you have to be quite clever, but if you're motivated, of course, yes, it can be done. 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. Yes. 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.

1:27:19they've got energy, they're able to do what they want to do, they don't have any excess belly fats, what would you say to them? Well, first of all, those people are quite rare. Okay. 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 it could of course be that they are extremely active 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 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 yeah so as a younger man well I was irresponsible with my body and what I ate so I thought I so in my 30s let's take me in my 30s I wasn't particularly heavy I didn't have a big belly um my dog my body did what I wanted of it and I neglected it yeah I neglected it and I got into some habits with the biscuits that's where it began, I felt I was a bit stressed.

1:29:08So somehow I think that was a response to partnership and medicine. So I mean, it brings danger when you know, you take your body for granted. And if I could speak to my younger self, I, you know, I, 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 well some people will say critics of this kind of approach you know i'm a fan of this approach i yeah 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 in 30 days yeah put type two diabetes into remission yeah i mean it's you were my hero i was like wow yes it's incredible that was 10 years ago, but I remember back then that was so controversial.

1:30:01It was. 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? He 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 diet. And I remember saying, yeah, but did you see what happened? Did you see the results? It doesn't matter. She said, you know, that's not the recommended diet. And I remember thinking, oh, wow, this is kind of crazy.

1:30:39Like this patient has had a health transform. 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. what I get we all have different experiences you know there was a point where you didn't know what you know today there's a point where I didn't know what I know today so we're all on a 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 there or whatever i would be i would love to have had a conversation when it was you shouldn't have done that yeah 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 guidelines 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 yeah it's a lot of hard work and i think for an inexperienced doctor guidelines are very helpful because you don't have experience of many things so or even that confidence yes having done 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 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.

1:32:25So 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, 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 patients' 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 what some of it is.

1:33:18Isn't it funny? We think we're scientists, don't we, doctors? But we're not scientists. 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.

1:34:04And 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 check's normal and I can't wait to tell him. And then the doctor's not a bit interested or even slightly defensive. Isn't that a worry? And unfortunately, some of those doctors will also be knackered, burnt out. They're not feeling good themselves.

1:34:40So they don't want to hear new stuff. They don't want to learn a new thing. They're like 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 yes 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 can i'm seeing it so i i I kind of trust what I'm seeing as opposed to what I was taught.

1:35:36And then I think, well, okay. And this is maybe tells us something about human nature. Either 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.

1:36:13And 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 get the weight off with that approach. We should be celebrating that rather than fighting. I agree. I mean, there's so many sick people. Yeah. Crikey. You know, how's it going nationally? It's a disaster, in my opinion. It's getting 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.

1:36:51Always 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 uh that's 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 it makes a lot of this idea of lifestyle medicine is a grassroots revolution yeah exactly you know i I learned from a patient and so did many other doctors, from clever people who worked out how to get better health and celebrate that. 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?

1:37:39I 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 Dallon 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 a proportion of their weight, women do slightly better than men.

1:38:31Wow. And I had no idea. That is super interesting. And another interesting thing, so statistics is interesting. I used to hate statistics and audit, like bar humbug. 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. But going back to your question, so actually women in terms of percentage weight loss do slightly better.

1:39:13but they are so men i would say it's they like a message kind of straight somehow brief and straight like oh how do you do it right and some of them just go away and do it um my female patients like a bit more detail because they're they're wondering well what recipes might work they want a food plan not many men ask me for food plans or recipes that's interesting 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 what have you observed there?

1:40:02I think so quite a lot of my female patients have told nobody that maybe they're addicted to bread or that their secret eating or all sorts of things because they're ashamed or they, you know, maybe they have a weight problem and that they suffer with stigma because of that. and so they you know they they just think maybe they're weak-willed or something and nobody's ever said to them you know what if if your problem was addiction you know because so somebody with alcohol well then they're not an alcoholic to annoy me they don't 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 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 but this topic of food addiction again it's also been quite controversial because for many years said not to exist 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.

1:41:49People used to say, well, and I think many people still do that, well, you know, you need food. So you can't be addicted to food. 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 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 and that is accepted gambling addiction and 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 they 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 um i've seen this guy in the last week to check that we're 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 a 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 anaesthetist 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 she thought right i'll stop him so she put detergent on the crusts he still eats the bread even with Yes.

1:44:30His wife told me all this and he's said he'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 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 that's 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 it's the very basis of addiction and it absolutely you would not believe the no if you are you won't 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 a wonderful paper there, that if you are an ultra-processed food addict, you are 600 % more likely to develop type 2 diabetes.

1:46:05So 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 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.

1:46:46And I think if we're caring for people, what matters is maintenance. So he's, 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 sauce, 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 the first clinical outcomes in the world.

1:47:52She was the first person to do any studies and get clinical outcomes. She did a three-centre study. She did North America, Sweden and the UK, three centres. And everybody, that study was done for free because every single person, that should have cost a million or a million and a half, it cost nothing because everybody worked for free because they believed how important this is. Are you and Jen, your wife, both food addicts, would you say? Ah, now that's really interesting. 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.

1:48:31You 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. Yeah, and it was, I'll do it on Monday, tomorrow, tomorrow. And 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.

1:49:16I'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 would make me hungry and cravey. I tried it because in the early days people would say, Dr. I mean, 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 learnt it's just simpler for me not to break the rules you two don't do cheat days anymore is that right? 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 it was, I remember it very well.

1:50:13It was, 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. Wow. So we were staying in a hotel and it completely ruined my little holiday because the next morning I woke with a sense of doom and kind of worry. And that didn't leave me till the day after that.

1:50:51So the consequences of that marvellous 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. 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?

1:51:32You do what everyone does and you go, ah, Christmas Day or oh, it's the anniversary. but you've 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? Well, and they don't actually have type 2 diabetes like I do. So would you say currently your type 2 diabetes is in remission? Yeah, absolutely. It's in drug-free remission. So my hemoglobin A1c, my average sugariness is 36, which is a very good result.

1:52:06What do you say to people who say, listen, the low-carb approach is not fully dealing with the root cause? Because 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 going to 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 it'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 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 that the 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 is too much carbohydrate over time now there are other things 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 yeah because i do worry a little bit about the omega-6 omega-3 ratios i do worry uh about them causing inflammation so i 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 why 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 what I'm doing I agree on it industrial seed oils I don't see any if you're a sick patient yeah I for years I've been having I think it's better to try and avoid them.

1:54:56Let's go with olive oil, right? Yeah, I would. Or even butter, I think probably butter's okay. Yeah, 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 say. I can just go on my clinical experience as well. I think generally I've seen it work really well and 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. And it's also more likely that butter or tallow or whatever will fit in in terms of ancestral.

1:55:35What was our, how are we designed? How is our physiology designed? And I, you know, essentially you and I are cavemen. Yeah. Sitting ridiculously here in the modern world. And I believe we're adapted. We're highly adapted for a world that no longer exists. Yeah. 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.

1:56:19And it's a struggle. Your children have also gone low carb, I believe. even though they don't have type 2 diabetes. Correct. So what was the motivation for them? That's right. So we struggled in the family. So Jen and I did it first and we annoyed the teenagers. And, you know, because they felt they had a right to the... So it was a real struggle for the first few years. 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?

1:56:58And is that okay to just let them ruin themselves as I ruined myself? So that was, it was a worry. 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.

1:57:38So we bought those for them. Go and get it if you want it. And that was one approach that worked really well. Wow. 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. It's a much better in many ways. It's a far superior flour to wheat flour. So she's making pancakes. She's making batter. So you're not depriving yourself. So if you can have pancakes with fresh raspberries and double cream, well, isn't that okay?

1:58:22Or then I started doing the 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.

1:59:05And they observed that even their dad was losing the dad bod 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 really yeah really and they tried they've tried that's pretty cool yeah so cool for you and it it's very annoying for them when old guys so they think bloody hell you know maybe he's on to something and they wanted the girls and and one of them is slightly overweight and he wants to take his t-shirt and often swim and stuff like that so he he came on and 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-carbon luckily they've gone away and found partners who also have chosen whole food approaches to health and then monitoring.

2:00:13And 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. There's a much higher concentration of gluten now. There's modern bread. Bread isn't what it was. No, no. Loads of patients, I would say, over the years, I found, have problems with gluten, way more than the quoted numbers. I'm like, I don't know where those numbers are coming from. But it is more. It's way more. So many people do well when they cut out gluten. But, you know, that's just what I've seen time and time again.

2:00:52Particularly patients with IBS. You know that kind of bloating discomfort? High proportion, I just say, can we just try going gluten? Yeah, try it and see what happens. free you know for some people just 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 you would say to me i and the mold do you remember it was like all different colors 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 mom's clever way of getting you to eat it and i remember that so clearly she said 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'd 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 something has changed in the bread it doesn't go moldy 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 how do you manage that in your practice i've learned a lot from my patients because we're north of liverpool so i'm not uh many of my patients are on benefit so that is uh it's a great it's a great question and that's social security benefits 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.

2:02:28Because 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, and a pizza, a Domino pizza at seven quid. So, 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 two pounds, 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 so make your own burgers it takes moments to make your own burgers.

2:03:41Well, what's the price of a cabbage? Or even a pint of double cream isn't that much, or eggs. So there are many 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 Fresh Well 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 fresh well app is approved for use within the british health service it's approved by the nhs it's kismet approved so uh 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 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 yeah your daily life your environment didn't drive you to poor health No.

2:05:00And that's why I think health 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. 50 years ago, you didn't need all this information from people because people weren't overweight. The environment was dry. You had to walk around to get stuff. You couldn't just sit at home and order stuff on your smartphone. There's a certain irony there, isn't there? There is. I mean, I remember the days before supermarkets. So people can't imagine, but there was a world with no supermarkets.

2:05:37I 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. You probably go to different shops, right? The butchers, the fishmonger, the grocers. 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. And you were naturally healthy because of it. Yeah, because we were walking around and then she had to peel it and make it and all the rest of it. And I remember ultra-processed food coming in.

2:06:13I remember Arctic rolls were one of the first things. And we welcomed all these things because it was tasty, but what we didn't realise, 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've got to do something. I just want to finish off, David, talking to you about prevention.

2:06:58Yes. 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. Yes. But this topic of prevention is really interesting to me.

2:07:19my 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?

2:08:15Fabulous. why not make me prime minister for a few weeks let's do it 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 because you did say i could be prime minister then um 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 should 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.

2:08:59Yeah, exactly. So prevention doesn't sound quite as sexy and yet it's the only way to survive. The health service is breaking. The health service, all my friends are breaking through the amount of chronic disease is 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 farmers markets.

2:09:51So that you think, how is the food produced nearby? That deals with your air miles. It also helps local farmers and shopkeepers or 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.

2:10:40I 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. And childhood obesity went down in those areas. Neighbouring areas where every single time you allow a fast food outlet to produce ultra-processed food and delivery, 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?

2:11:31Why shouldn't we make the choice together? Yeah. 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. 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.

2:12:12And we both know how that goes, right? Once people are on these things, it's very hard to come off them. Very, very hard. Nobody has the energy to do it because it actually takes twice as long to take you off it than it did to put you on them. But the money you're going to spend is huge. But if you could front end some of that money and go, like even 2 % of that money to have a 30-minute consultation at the start, you may not need it at all. 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. I've proven... I've got a good idea who they might be.

2:12:49Two 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 going the reason it's not happening is that you said the politicians unfortunately generally speaking it's about getting voted in again and so 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 I wish I wish I could do fasting insulin it's so obvious but you know even I cannot measure insulin at all ever so that I've rung and I end up admitting people to hospital because I can't.

2:14:00So I can't deal with somebody. Maybe they need insulin and there's an emergency because they're not producing enough. I cannot get, nevermind a fasting insulin, I can't get any insulin or anything. But a fasting insulin would be transformative because we might see this five years before you get type 2 diabetes, we may see a fasting insulin going up and we can go, wait a minute. Let me, for the people watching, just explain that. 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 fasting insulin.

2:14:40You're not eating anything, but your insulin levels are high. And I'm sure my insulin levels would have been high 10 years before. It's an early warning sign. 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 you an idea. But yeah, give me a 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.

2:15:18Information is power. 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 local recipe books with chefs in London, which is amazing. Where would you point them to? You mentioned the Freshwell app as well, of course. So there's the Freshwell app. It's a free app.

2:15:55Download it. Please, please follow me on X. Formerly Twitter. I'm Low Carb GP. 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 Chaldezi 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. Notice what works. Consider whether a continuous glucose monitor might be something that you could try to see how you're doing because you can buy those on amazon 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.

2:17:21But there's been something in this conversation that's inspired them. What would your final words to them be? 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. That's the first thing, if you're on drugs already. The second thing is 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 times around the world.

2:18:10And 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. 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.

2:18:49You're so welcome. And I look forward to the next time we get together. Great fun. I'll do it again. Thank you very much. Thank you.

2:18:58I really hope you enjoyed that conversation. do 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 the back of hearing this episode, you want to dive deeper into your own metabolic health, do consider checking out Do Health, a personalized health companion that I co-founded, powered by your individual biology and lifestyle that I believe is the future of health.

2:19:45With Do Health, you can regularly check what I consider to be 11 of the most important blood biomarkers, 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 drchatterjee.com forward slash do. Now before you go, I just wanted to let you know about Friday Five. 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.

2:20:36And 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 actively look forward to receiving. If that sounds like something you would like to receive each Friday, you can sign up for free at drchatterjee.com forward slash Friday Five. 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