THE £10 BILLION FAILURE: Is The System Lying About Type 2 Diabetes? with Natalie Louise Burrows

0:00Welcome to Catching Up With The Royals, a brand new show with me Richard Coles. And me, Emily Andrews. Every week we'll be going beyond the headlines, lifting the lid, and what life is really like behind the palace walls. Hello, sir. Good morning. I'm The Sun's new royal correspondent. Oh, he said, look at me up and down. Things are looking up. We'll be diving into the moments everyone's talking about. What does the world owe you if all of a sudden you've handed back your crown? Meghan and Harry can't keep hold of their staff. We'll reveal the secrets of an organisation usually shrouded in mystery and explore defining moments of royal history to see how the past still shapes the monarchy today.

0:38Now, you actually knew Princess Diana. I think one of the ways she acquired power was through that relationship with the president. But before that interview, no-one had really spoken and been so open. Was that a game-changer? So join us every week wherever you get your podcasts, on YouTube and on Saturdays on 5 as we catch up with the royals. Today we're joined by Natalie Louise Burrows and she is a woman on a mission. She wants to help prevent and treat 100 ,000 people with type 2 diabetes and this is a huge problem that is growing more and more each year. Natalie is famous for setting up Integral Wellness which is a nutrition and a functional medicine integrated business that helps people on their health journey.

1:28She's been quoted in the press and featured on many radio and TV shows about her approach to nutrition and how a differing standard of the food we eat can lead to much better metabolic health and blood sugar control. We even get into her recommendations for the Eat Well Guide and how she would change fundamentally what our base diet is. So this is a must listen. Welcome to the Unprocessed Truth. Natalie, it's great to have you. You are on a well-stated mission to help 100 ,000 people reduce their risk of type 2 diabetes, which is phenomenal. Love that kind of mission. But before we get into that detail, just give our listeners a bit of your story, what got you into health, what you do today.

2:13Thank you for inviting me so that we can talk about blood sugars in a bit more detail. A lot of people sort of say they come into health and nutrition because they've experienced something themselves. I've never been diagnosed with type 2 diabetes or anything like that so mine was a bit of a collision of factors. I do have a family history of type 2 diabetes, of high blood pressure, of high cholesterol, of atrial fibrillation which is a very common heart condition and of autoimmune conditions. A lot? A lot so I've really got to look after myself but at the same time when I was going through my 20s all of that wasn't really...

2:44You're invincible in your time. Nothing I really cared about. I was as invincible as anybody else. And I was very much climbing the ladder in the city, working very hard, working quite a demanding role, over-exercising, under-eating, under-nourishing. And I felt awful. I lived my 20s really as a bit of a blur of too much alcohol, too much sugar, not enough sleep. And I felt absolutely dreadful. and it was a bit of a sort of outer body moment where it was another Wednesday night where we're outside a pub all of us as work colleagues and everybody's drinking again middle of the week I don't know how the Friday became the Thursday became the Wednesday Wednesday was a great night out but I suddenly was looking around and thinking I think everybody is looking how I feel I feel really awful and I think everybody is looking quite unwell we're all talking about the fact like we're struggling with weight, we're seeing redness in the face, we're getting prescriptions, we're popping blister packs of painkillers, you know, there's vitamin C drops going in water, like all sorts of things are happening on the regular and yet we're still keeping up with this cycle of working really hard, drinking is a form of recovery, not sleeping particularly well, then going back and doing it all over again.

4:00And I just had this sort of out-of-body experience of looking at the scenario and then also appreciating what the NHS had been saying about the rise in metabolic illnesses, the budget that's needed for type 2 diabetes. Knowing my family history, it all just collided for me. And I just thought, we can't keep living like this. This is not living. I'm not living in my 20s. I'm really just surviving and I'm managing because I'm young. But I'm looking around me at the other colleagues and I'm thinking, this can't be my future, not with my risk factors. And this is all so preventable. If we just looked after ourselves a little bit better and prioritised our health and wellbeing over work, we would just turn the tide on the state of the health in the nation and our quality of life would soar.

4:48And so I thought, fine. I couldn't imagine being in that industry. I was in financial technology. It was fun. It was exciting. I entered when mobile banking apps were new and just being created. It was so exciting. But I couldn't imagine myself staying there when suddenly my values were not aligning with the pace of work that I had to keep up with. Well, so you took a bold move then and left that industry. Yeah. Totally changed your career path. Yeah, very bold move. So you went back to uni? Went back to studying, yeah. Qualified, took three, three and a half years because the pandemic sort of interrupted it partway through.

5:24Qualified and set up practice and after five months called it a day in fintech and I've never looked back. and now you run integral wellness now i run integral wellness a little bit what you do there yes i set up integral wellness as an online nutrition and health clinic specializing in cardio metabolic health with this mission of helping a hundred thousand people avoid and reverse type 2 diabetes and it is very much a north star mission but i've got to put my mark somewhere i've got to be out of focus and the team that work with me have got to be out of focus and we're really there to help people from a holistic health perspective to see the person as the individual that they are with the life experience that's going to be different to the next person with diabetes or the next person with blood sugar issues or blood pressure issues or cholesterol issues we're trying to see that individual for exactly who they are what's brought them to this place and how do we meet them where they're at in order to help them to make the right steps that are right for them you can't tell everybody the same advice and they won't all be able to go away and take it we see that in the way that public health isn't working the advice for public health is not working you can't give everybody blanket advice you've got to see where they're at and you've got to help them make the steps to change so it's about that personal approach it's about behavioral change it's about realistic manageable expectations all right so where are we today then with diabetes in the uk because i always say to people 63 % of the uk is overweight or obese but what's the number on diabetes and what's going on because there's obviously people who are clinically diagnosed but there's also pre-diabetes right Yeah, there is.

6:56Suspicions are around one in nine people have pre-diabetes, whether they do or don't know about it. I hope that was higher in the US. In the US, it will generally be higher. The US are generally a little bit ahead of where we are. And I think that's an important thing to, one, distinguish against, but also to watch out for, because we tend to just follow just a bit behind. It's the same, I think, with ultra-processed foods in the diet. The US are around 60, 65 percent of the overall diet, and we're sitting around 50. So it's the same with diabetes, pre-diabetes, and pre-diabetes is very much about before type 2 diabetes.

7:29This is not about type 1 diabetes. That's a very different circumstance. That's an autoimmune condition. Really, the only thing that's similar is the blood sugar part because the mechanisms to get there are very different. So we'll definitely keep that separate. Type 2 diabetes, I understand at the moment it's just under 5 million for type 2 diabetes or 5 million for overall type of diabetes, of which 90 % is type 2. Yeah. And it's a big number. It's a lot of people. Come on. Like something's going on here. And it's growing, right? It's not just, oh, that's how many people normally get it, so it's fine.

8:05It's how we have to deal with it. It's not genetics. It's what we're putting in our body. Yeah. We know now it's very much a diet and lifestyle-driven condition. NICE have updated their guidelines finally this year to agree that it can be put into remission. Just who are nice for... Nice of the body that is governing really a lot of our medical guidance and advice. So it's a lot of where you'd go to... National Institute for Clinical Excellence. I think that's the acronym. If I remember the name. But OK, carry on, sorry. No, no, not at all. So yeah, they've finally updated their guidelines to say that you can put it into remission, which at least helps support the narrative.

8:44Because when I enter clinical practice, you would have arguments with people that you couldn't put type 2 diabetes into remission and yet I was doing it I was doing it within my clinic and yet you would genuinely I would go to medical conferences and have conversations with delegates or people at the stands and you'd have a lot of really connecting conversations but you'd have some conversations where people were really pushing back and still calling type 2 diabetes a progressive disease it's only progressive if we don't intervene and do something about it and i was in a situation where my clinical practice was proving otherwise with even type 2 diabetes client who had had type 2 diabetes for 20 years and it is still considered that once you've done 5 10 years the chances are very slim that you can put it into remission but he did absolutely he did and i think it's important to see that this narrative is beginning to change because at the very heart of it you give someone hope The moment you say that someone's condition is only progressive from where they currently sit today, that can feel really disheartening.

9:47When you say that there's a possibility for you to put this into a mission, to reverse where you're currently at, to increase your quality of life, that can bring somebody back to life. That can bring somebody's ability to make change so much easier. They've got more motivation to do it because they know the art of what's possible. And I think that's really important in medical language that we give hope. Oh, for sure. I mean, you know, we need to understand that there's a possibility of a brighter future, right? Otherwise, what do you do? You give up, sit at home, depressed, eat more crap and watch TV.

10:19When you look at the statistics, it paints a pretty dark picture of our future. But why are we failing so bad? If the nice understand now you can reverse it, why is everything getting worse? Yeah, it's a really good question. I think it's a question that in health care we have to sit with. And we have to keep asking these really uncomfortable questions. Why, when we know this information, why is it still getting worse? Why is the trajectory still only accelerating? I think there's, as with all things nutrition and health, there's several layers to this. I think there's an element of the fact that we don't have great education at the very grassroots of this.

10:58So we aren't really teaching our children and our teenagers, and I've got a teenager, We aren't really teaching them in schools about good nutrition, about what it means for not just, you know, you can't tell my 16 year old that you need to eat well. Otherwise you'll have heart disease when you're 50. He can't connect to that. But just the ability to talk about it, the very fundamentals of how you could feel happier. You know, your mental health can improve if you if you improve your diet, you can sleep better. You'll have more energy. You'll be better at your performance in sports. your tummy might not hurt so much if you find you're having digestive discomforts things like this if we actually enter it with a language that our kids can understand and teach them good nutrition I think that will really help them to understand as I do even with the adults that I see in clinical practice why should I bother why should I spend an hour cooking a meal from scratch when I could just buy something that's convenient when yeah people are really busy and they're really push for time.

11:56So I think education is a really key one of trying to help to get that in at all levels, but grassroots specifically. I think as well, we've got a challenge here where if we were to look at blood sugars, a lot of things can go missed. So if we were to just look at your HbA1c score on your blood test, which is, it should be listed as HbA1c, it's glycated hemoglobin, how sticky is your blood cells? And your blood cells replenish and renew every 90 to 120 days. As you get older, that process slows down because you're older. If maybe you're fighting infection, that process might slow down or speed up.

12:30So there's some variations, but it gives you a really good gold standard of testing. However, there's a lot that can happen before those blood sugars rise. There's a lot of reasons why actually on that blood sugar marker, you might say, well, your blood sugars are fine, but actually there might be insulin resistance happening and hyperinsulinemia happening that's still driving a wave of inflammation and issues that are just predisposing to what's potentially going to come 10, 15, 20 years down the line. Because this doesn't, type 2 diabetes doesn't happen overnight. That's a couple of decades of progression.

13:06And it will take time to then pull back. Obviously, the quicker you act, the better. But I think there's potentially a misunderstanding of the fact that if we only jump on it when there's a diagnosis, we then got this massive gap of the preventative stage of how do we help people to understand what might be going on in their bodies and how do we catch it a little bit earlier to turn the tide well we love sugar and there's an element of body needs sugar right so where are we going wrong well you're right we do need sugar we shouldn't it's when i talk about blood sugars for people it's exactly the same as we talk about heart rate and blood pressure this isn't about having a flat line that's not a positive thing we need it it needs to ebb and flow the body should be doing a really good job of keeping it in balance because it's a natural process absolutely and homeostasis is the body's preferred state it's about a balance and that balance is about keeping things within ranges and blood sugars is one of them having about four milliliters per litre of sugar within your blood at any one time is pretty expected for you to be able to then go about your day and that can go up and down a little bit and that shouldn't be an issue whatsoever but the problem that we've got with the sugars is that there is so much sugar coming into the diet for some people that these blood sugars rather than being able to sit and manage the balance fairly easily we can sometimes get this flood intake of sugar that can elevate blood sugars to a high amount and that means that we then have a massive influx of need of insulin a hormone to help to bring that blood sugar down back into range now doing that on the one-off you and I go out for pizza tonight we cannot worry about it yes pizza is going to do that it's a lovely doughy base hopefully sourdough it'll be delicious we'll have a great time and we cannot worry about it but doing this frequently doing this daily across the course of the day across the course of the week this is the accumulative effect that we don't really seem to talk about in a medical setting until we get to a pre-diabetes status and it's this I think that we're missing that will help us to turn the tide on those statistics that we're concerned are going to be our future.

15:09I mean, this might be an impossible question to answer, but where is the tipping point on that journey? Because obviously everyone talks about the 80-20 and we're all going to eat ice cream and pizza sometimes and that's fine. But do you have a view on where it tips into, do you know what, that's probably a bit too much? It's going to be so specific for the individual. It's going to be very dependent on other factors as well. So your blood sugars is very much, yes, strongly managed by the nutrition that you eat but your blood sugars are also managed by your quality of sleep so actually if you have a really bad night's sleep you could eat the same meal on Monday and Tuesday if a really bad night's sleep on Monday night and your blood sugars can be as much as 30 percent different on the Tuesday morning even with the same food intake that's crazy so sleep can have a really big impact particularly on that morning sort of blood sugar response exercise is going to be another one how much are you moving because actually if you're moving a lot to make use of the glucose and that could be quite different so athletes are seen through a slightly different lens when we think about this it does come down to an accumulation of things the volume of muscle mass that you've got on you versus not got on you that are going to make a difference but i think when i try and put it in sort of everyday language for people to feel and take a bit of a tangible takeaway i always seem i talk about your reliance if you were going to look at if you were going to put everything that you ate across the week on the table and really look at it what colors can you see how many things are in packages versus not what reliance have you got you know are we seeing quite an overwhelming amount of bread to pasta to you know sugary drinks to pizzas that are stacked in the freezer or are we actually seeing a volume of colorful fruits and vegetables and i think it's about looking at that as a whole and it's not about getting rid of certain things it's about appreciating that the balance might need to change change and that's often how I enter that conversation particularly if I'm doing presentations to groups of people is to have a think about and I present my well-being plate rather than the current guideline one I tend to present both and we talk about the difference but have a think about how can you just start making that shift if you can really see that your diet is mainly beige and you are really eating a lot and relying a lot on those traditional beige carbohydrates where can you make some subtle changes and subtle shifts to make tomorrow look a little bit better okay but why why are carbohydrates so bad because we know sugar's better what does what happens when you eat pizza or bread what's going on yeah so good question so i think and i think this is really important that you've got sugar as you would buy it classic cane sugar you've then got carbohydrates as a massive macronutrient and we've got to break it down i actually don't like it as a name i think it's too vague so well it's funny because i always say like yeah I don't really eat carbs but vegetables are carbs so I do eat carbs I love vegetables thank you you've absolutely just proven my point that actually for me this idea of talking about carbs in the way that we do I think the reason that people end up in conflict about it is because we've not actually broken down what we really mean so yeah you cannot so for me fiber is what I want okay and that's in a carbohydrate so I can't eat fiber I can't eat my daily amount of fiber to feed my gut bugs to keep me full and satiated to manage and reduce my risk of type 2 diabetes without consuming carbohydrates but when I'm looking at reaching my daily fiber intake I'm looking at it from really whole food sources rather than from the flip side of it where we've got much more refined white carbohydrates like a pizza base or a white pasta or anything like that and the difference here is that we've got when we have a simple sugar like a sugar we can see it's sugar grain when we have something like a bread or a pasta we are digesting that digestion starts in the mouth we should be chewing really well which a lot of us quite fail to do because we're busy we're in a rush and eating is inconvenient guilty so we should be chewing really well that will kick up some enzymes just by our very saliva to start breaking it down it will then go through to our stomach which is the main focus of breakdown where stomach acid and other enzymes come into play as that breaks down that structure of carbohydrate and it depends on the structure that it is will be breaking down into their single forms of sugars and it just depends on how quickly that process can happen so if we've got a carbohydrate that has got simple sugars if it's refined it'll break down quite quickly into single sugars that can then be absorbed into the blood stream if you've got a slice of white bread can be the same as a teaspoon of sugar in regards to the speed it breaks down you're going to have other nutrients that get in the way but you're going to have a similarity there compared to if you're going to eat broccoli or something like that you're going to have much slower release with broccoli it's much more fibrous you've got a much longer chain of sugar molecules tied together that the body's then got to break down so it's really about appreciating that structure of the carbohydrate that we're talking about rather than you know no carbs before marbs it's the thing that haunts me for the rest of my life because it just doesn't give me context as to what i should eat and i think that's where the conversation really has to switch on i really like to talk to people about fiber and we talk about getting your fiber in so we can just leave carbohydrate that term carbs to the side and actually just focus on where you're going to get that because the health benefits of that are huge and undeniable yeah okay so what does fiber do to protect your blood sugar yeah so we see actually fibers role across health as a whole.

20:31We've got really important roles in thinking about breakdown of sugar slowly. So that slow release into your blood sugar means that you haven't got this instant spike and therefore huge demand on insulin and then potentially a drop and a crash which leads to cravings and additional hunger and need for more food. You've also got the fact that fibre really feeds our gut microbiome. So our microbiome eats what we eat and I think that's a really important part of nutrition conversations. If we want a healthy gut, we have to feed the microbiome in the way that would encourage health. And fibre really does that.

21:06And there's a lot of evidence to say that actually certain elements of our microbiome can have a real play into our metabolic function, particularly our blood sugars. So we want to be looking after it from that perspective too. It's very satiating. So we can tend to go for longer without food, which is an important part of managing blood sugars. We really should be able to go from one meal to the next without multiple snacks in between and fiber really helps us to do that too because it's been pitched as a wellness hack blood sugar has got very trendy with the glucose goddess and everything she's put out there with those beautiful videos showing you the different you know blood sugar response but you know is it really that important does it affect is it just important if you have type 2 diabetes or you know does it affect people every day like should we be monitoring it because you well you've had people wearing the blood glucose monitors and like testing their own thing when they haven't got type 2 diabetes like what's your view on that do you think people should be doing that yeah really good question a really important question as well i think if you are going to test your blood sugars i think you need to be doing it with somebody who can help you understand the data i think that's really important and that's very much what we would do in clinic is support people to understand what these cgms these continuous glucose monitors are saying so that we can add some nuance and context around it because it's really important that not only do you understand what your data means but also that we don't create the opposite effect which is scare people scare people from eating food put people into a state of health anxiety and orthorexia we really want to avoid that so that we don't swing the other way i do like cgms i found them very beneficial for improving my metabolic function i find them incredibly helpful in clinic for people that are type 2 pre-diabetic, pre-diabetic and not.

22:54Because what we know, although it's not telling us about insulin, it is telling us about blood sugar. What we know is that somebody, even if the HbA1c is showing as not pre-diabetic, from blood sugar highs and lows, we can take a picture of what insulin might be doing. If insulin is constantly being elevated and triggered, we are going to end up in a state of sugar burning only. So we don't, while insulin ends up being high, we don't enter a fat burning mode and that can be an issue from a metabolic perspective we don't gain metabolic flexibility if somebody was to come to me without type 2 diabetes or pre-diabetes and actually i was thinking a lot of your energy highs and lows a lot of your sleep problems maybe actually sometimes management of menopause if we've got poor metabolic function menopause can feel a lot harder blood pressure if we've got elevated blood pressure sometimes that can be driven from inflammation that's often linked to blood sugars if we have a look at somebody's blood sugar trends across the day we don't need to take the data as black and white and exact we need to layer an element of grey over it that's nutritional science it's got to come with an element of grey and we've got to be able to say right okay what are you feeling at say 10 o 'clock 11 o 'clock every morning i'm just feeling exhausted and like i need that other coffee interesting because i can also see that your blood sugars have taken a bit of a dive at that time so why don't we have a look at what you're eating for breakfast and why don't we start playing around with actually having something that's going to be a little bit more serving for you the important thing here for behavioral change which i think is potentially one of the most beneficial things that can come out of good cgm use with guidance is that the individual can see oh my gosh i feel like that and this is what's happening so i'm going to tomorrow i'm going to change my breakfast and he goes my god i didn't i didn't need my coffee at 11 o 'clock i actually went to get one and i realized i didn't need it when i checked my blood sugars i'd not spiked from my morning i'd actually stayed really stable and i was really feeling the benefit that immediate feedback of data feeds into our psyche as good behavior positive behavior and it reinforces us to keep doing these actions that is what i think is really beneficial from a preventative perspective you can see the instant results you can see the instant results as i say we can appreciate we're not testing insulin here but the better we get blood sugars in line the better insulin will come in line as well without having to go off and test it.

25:16So in the medical world, we test for blood pressure, but we're not testing for blood sugar stability. Why not? Yeah. And I think this is where the insulin resistant piece is really important and testing for hyperinsulinemia is missed. It's not, they're not the easiest test to do. They're not the cheapest test to do, whether that's why only someone in the NHS who makes the rules is probably going to be able to tell me. Blood pressure is really instant to be able to You can monitor it at home. And again, monitoring every sort of monitoring you have to do in a healthy way because it can make you quite nervous and anxious.

25:52But you can monitor blood pressure at home. You can pop into the doctors and monitor it, sometimes in sports centres. Nowadays, the closest thing we've got for blood sugars is wearing the CGMs. But I think we're still lacking behind on a lot of education. and I've been really fortunate to be able to provide educational lectures to other health professionals to teach them how to use this in clinical settings but I do think we're missing that in the doctor's office I think from a blood test perspective I think we're missing checking for hyperinsulinemia checking for insulin resistance but I query if the reason that they don't test it is because they wouldn't have anything to give you for it and I've had this open conversation with GPs.

26:32There's no drug to fix it you have to get involved in diet. Right and that's not a GP's forte we have to appreciate that the GP has gone training for six plus years to be a general practitioner and the wealth of information they've got to hold is beyond my mind so they've got a really important job to do is to try and diagnose you with something or at least do a you know a differential diagnosis and try and work out what's going on. Their end game is hopefully I can diagnose something I can give you a prescription and I can send you away that's their job that's their goal they're not being trained on diet and lifestyle medicine unless they go off and do that separately afterwards so it's not if they were to test and say oh yeah actually you are looking a little bit insulin resistant your insulin is really elevated which tells me you're sort of struggling with your blood sugar control in 10 to 20 years time this could potentially lead to type 2 diabetes what are they meant to do at that point unless they've got nutrition and lifestyle advice to be able to provide the doctor's role sort of comes to a bit of an end right but that's where you come in please let us come in let us help the nhs well what do you mean by that let us come in so from a nutritional therapist perspective we're really eager from our perspective and we should probably talk about the difference between the different nutrition professionals but nutritional therapists are coming at it from a preventative lifestyle perspective we want quality of life and we want to try and be proactive at preventing illnesses occurring by picking things up early things where a diagnosis isn't happening we can start to see things that potentially trek in in a direction we don't want them to go in because a diagnosis could then potentially be inevitable so what's the difference between a nutritionist dietitian like how does that whole system work yeah so there's three different qualifications i think it's really important to appreciate that we all have a role and i i really respect each profession and I'd like to see that each profession does the same and respects back.

28:22So you have got dieticians who are regulated. So regulated would mean there's a lot of red tape. There's guidelines that they've got to abide to. You'll generally find dieticians in hospital settings. They've been trained as clinical professionals and practitioners and they can do diagnosis. So they can diagnose people with conditions. They'd also do things like tube feeding, end of life care, liquid drinks as well for people that can't then take solids. That's a dietician's role. Very much sometimes supporting those diagnoses that are quite tricky and challenging and upsetting in hospital settings.

28:59Medical. Medical, really important jobs. Critical issues. Yeah, really important jobs. Then you've got AFN nutritionists who are not clinical trained but are public health facing. so they're thinking about government guidelines public health on a whole if we were to think about how we support giving details out to everybody what would that look like and then you've got nutritional therapists and we are clinical trained like dieticians are but we are not diagnosticians so we don't diagnose we don't do end-of-life care we don't do tube feeding we do about the foods you can buy in the supermarket we do about quality of life and And we use food and lifestyle advice to help prevent what could potentially happen in the future.

29:44Okay, interesting. I think it's really curious. But I'm going to change pace a little bit. Okay. I want to understand your Eat Well plate. Because you talked about it already, touched on it, and you said, I have the government's plate and you have your plate. What's your plate? I think my plate's better. Obviously. But what is it? So... Well, tell the people, for those who don't know, what is the Eat Well Plate, what's the typical makeup, and then go into yours. Yeah, sure. So I think that's a good place to start. So the Eat Well Plate was last updated in 2016. That's a long time ago. Yeah. Nine years, not quite double figures, but with the pace of change that we've seen in nutrition knowledge and nutrition science, it is a long time ago.

30:24So the Eat Well Plate has about the top two thirds on either side. One side is fruits and vegetables and the other side is grains. So you see a classic green colour on one side and a beige colour on the other side and they take up the majority of the plate. And then we've got another two-thirds of the plate with carbohydrates, grains, the more beige foods, the cereals. That then leaves actually quite a small part of the plate left, which they've then divided up into proteins, dairies, and a tiny sliver that they call oils and spreads. there is no mentioning of nuts and seeds and avocados and things like that and i appreciate for some people they are slightly out of reach due to budget perspective and i want to be really sensitive to the fact that everybody shops to the budget that they've got and we do the best we can with what we have but this portion spread of food is not working for the metabolic wave that we've got ahead of us the data is really clear that if we continue on this trend it's not going to work they've also kept they do talk about water but they've also kept a side portion off for ultra processed foods and snacks now they do state in writing that this should be limited however for the mindset of the human which we all are even nutritionists and you we're not immune to this are we if we see on an eat well plate that you can have chocolate and crisps and ice creams and things visually those images exist and in writing it says but not too much we still accept it as it becomes part of our diet it's an acceptable part of our diet that we can have everybody eats crisps and chocolate it's so ubiquitous right it's part of it yeah and i don't begrudge anyone who wants to do that you're not going to catch me in the supermarket probably without a bar of chocolate in my in my trolley but it's not about the fact that those things are bad and we need to demonize them it's about the fact that we know they're going to exist anyway so we don't need to put it on an eat well plate yeah fair enough you know definitely there's nothing eating well about that junk no we know it's going to exist it's going to naturally come into the diet like we said you and i could go out and have you know a couple of spicy margaritas and a pizza and we just we'll leave it at that it'll be a meal and call it a day i've just told everyone that you drink spicy margaritas and maybe you don't definitely don't no there you go I don't think I've ever had one.

32:40There you go. I'm missing out on the trend. But, you know, and it's the same. If you go into a supermarket, if you think about the Eat Well plate, you want to think about this is what I'm going to purchase the majority of the time. But for me, it's about the fact that there's the focus on it. The fact that it's even mentioned. I don't think, considering the tidal wave of what's to come, I don't personally think it's helpful. Not because we have to demonise it. So what's on your plate? So on my plate, slice the plate in half. half of it half and half half and half very simple there's one half is very simple the other half i'll divide up a little bit more but one half is salads and veggies and a whole half of it think about spending a little bit longer in the fruit and veg aisle for thinking about more salad items so your leaves your tomatoes your cucumbers classic salad items and your vegetables your aubergines your cabbages your broccolis your cauliflowers all that good stuff half your plate or bowl with that then absolutely there's a place for fruit and I tend to use ham portions from this perspective of thinking about the fact that we might want to make sure we've got a fist of something so is there an apple is there an orange is there a banana what's going to come into your life and that again might be dependent on the person in front of me some people don't do well with all fruits it's quite individual on the other half of the plate we have got two-thirds of it as protein there is not one biochemical process that happens in our bodies that does not involve protein to support that process taking place so it's not just for hair skin nails muscle it's for everything it's for the creation of antibodies for our immune system it's the creation of digestive enzymes it is literally everything in our body that needs protein so two-thirds of one half of a plate protein yeah protein good division and then the other portion i've just kept it in three the other portion to be fiber to think about more carbohydrates but in a really fiber centric way so dark grains whole grains root vegetables things like that interesting so the refined carbs aren't there or you you've ditched you've lived your no carbs before marbs philosophy I have.

34:53I have in the fact that we've still got carbohydrates. They're all over the plate. Well, they're the vegetables, right? They're the vegetables and they're that smaller portion. Smaller portion. But this is what we're seeing is really working from a metabolic perspective. And then we talk about healthy fats and they often come as an extra because they don't tend to take up a particular portion on a plate. It's often a drizzle of olive oil. It's often, you know, a portion of olives. But most people, you know, they base their meal around the carbohydrate, right? You get your big plate of pasta and then your sauce or your rice or your bread, whatever.

35:28That's the foundation of the meal. So you're saying that's wrong. I'm saying that's not helping the trajectory of where we're heading. And again, I want to be sensitive to understanding that for some people, three or four meals a week are pasta based because of budget reasons. And I want to really appreciate that. It is cheap. It's accessible. It fills people's bellies. I get it. if we just put that to one side for a moment and appreciate the trajectory that we're on from a health perspective that volume of carbohydrates which are pasta dishes it's a huge volume of carbohydrates with maybe it's a really good quality tomato sauce maybe some other veggies in there could be a positive but then where's the protein but the the italians eat pizza and pasta all the time they're fine they've got the blue zones in sicily what's going on there in some parts of italy they have got the blue zones i think this is where nutrition get gets really nuanced not all of italy is particularly healthy healthy it's the same with the mediterranean diet actually my grandparents lived in spain for 20 years not a lot of healthy mediterraneans necessarily happening there is a lot of this western diet that's sweeping across and infiltrating some of those countries as well there are areas where they will eat more carbohydrates and be okay there is so much else happening there as well calmer way of life less stress more community walking up hills and go to switzerland and everyone's eating trees drinking red wine meats you know breads but on a sunday everyone walks up a mountain yeah everyone walks up a hill if an 80 year old is living up on top of a hill which is quite common then they'll walk down the hill to go to the shop and then they'll walk back up the hill i'm not even joking i've had them walk past me it's incredible to see actually what other areas of lifestyle actually influence the health of that nation it's beyond nutrition but nutrition is key yeah that's really interesting yeah i've seen the studies where they've looked at all the blue zones and the commonalities and of the 10 commonalities diet is only one or two and then a lot of it is community exercise psychological factors stress it all plays a role and we have to look at the whole system right and i think that's what's massive here and i think that's probably one of the biggest and probably hardest things to get on top of here if we take the fact that we say well Italians will eat that pasta dish four times in a you know we can be absolutely fine we're going to do the same but actually a lot of us are sitting down for eight hours a day at a desk a lot of us are deeply stressed a lot of us are not managing our muscle mass so that we can manage our blood sugars better you know that even in the crux of that maybe me eating a pasta dish versus somebody else my blood sugars could look very different because of muscle mass might mean that the response is different there's so much else feeding into it did you have a good night's sleep last night or not so many people don't sleep well now i want to put something on your plate okay we're going to make it interesting and uh give you a snack and talk about a little food company that has actually sponsored today's episode but the idea of this is to show people that there are possibilities of healthier food because ultimately we're in this food environment where so many people feel stuck they don't know what to do they don't know what choices to make and we're stuck in this trap of sandwiches and meal deals and picking the wrong things through sheer unfortunate the unfortunate nature of our food environment that means we've got no time we can't cook yada yada yada we do all those things and then we make the wrong choices but there are healthier choices so let's try one.

38:59So this is Vilgain, grab a spoon, because these guys are an online food business that are trying to make food accessible, they're trying to make it nutritious and do it without the additives. People might think I'm weird for talking about this but I think this is a fantastic product because it's grass-fed pulled beef but fundamentally it is beef with some flavouring but all natural nothing bad in here and I would put this in my bag as a snack now I'm curious if I'm just the crazy guy that would do this or you would do it as well it's interesting you say you put it in your bag as a snack because I think that's where most people would think that's mad would you not why would you have beef in this way as a snack but I guess the likes of beef jerky and things like that have become a lot more popular I mean the ingredients impressive you've got 97 beef here tomato base and as you say a lot of herbs and spices we have appreciate in order for to create shelf life yet we've got salt and a bit of sugar in here too but if we go to the actual volume of it it is pretty small so now i've just got to try it do you like it i won't give my opinion i'll wait until you give yours because i'm maybe the crazy guy that's a bit of a nerd on stuff like this and how would you eat this like this with a just like this yeah love it and i haven't had lunch so i'm proper hungry credit for the fact that it is tasty right it is tasty i think you could potentially use this in something like your regular pasta meal but i'm thinking of how do you make this accessible to people right and they say i have to feed the family on pasta three four times a week it's just the way fundamentally i can budget and do it if something like this can become an option that you can then mix into the tomato sauce to make it easy and it's quick because it's already pre-cooked then actually you could start to suddenly elevate what your current dish is and that can be a stepping stone towards feeding a much more nutritious meal.

40:53Nice. That is good. OK, so you're in charge of the medical system, doctors, nutritionists, dieticians. How are you structuring it so that we give optimal care for people's health? What a question. I don't think anybody who picks up that gauntlet has an easy job to where the NHS currently stands. Any progression into a better place is going to be really tough going. I think first and foremost, if I can speak to it from the nutrition side, because that's the side I'm most connected to, is to actually make sure that dietitians, nutritionists and nutritional therapists are all utilised and all integrated, but for their really core skill sets.

41:39that if we can respect that everybody in that profession has a great skill to offer, how do we actually put them in the system at the point of which they are of most benefit and use to the individuals who need help? So if somebody is in a bed in hospital, you wouldn't call me. You'd call a dietician. But if somebody is saying, I don't feel well, and the blood tests keep coming back as normal, you'd call me. And if we can integrate in that way, as a nutrition profession team I think we've got much better reach of supporting people. GP side of things I would love to see that GPs are also able to integrate into the nutrition space more so they don't have to go out and get another qualification to be the nutritionist but to bring a nutritional therapist into GP surgeries so that when GP say you're pre-diabetic I'd like you to make some changes so we can avoid medication we've got Natalie who's in house today this nutritional therapist who's in house today pop along and make an appointment and book in four sessions with them so that you can start understanding what you can do.

42:49I'm interested with your patients that do come to you do you have a compliance issue because right on one hand it's easy for a doctor to write a prescription and then you're basically going to take it but when say someone comes to in that scenario and you're like okay well let's look at your diet you've got to change this you've got to change that like are they actually going to do it there's this i think this is the important point as to why public health often doesn't work or falls on deaf ears and i say that from people who've said to me i pick up the leaflets and they just go in the bin or i get handed leaflet and they go in the bin our job is very different as nutritional therapists we get to sit down and really spend a long time with somebody so i know where somebody wants to make change i know the types of foods they like and they dislike.

43:30I know the setup of their day. So when I'm recommending that we maybe add a little bit more protein into breakfast and maybe pump up the fiber a little bit more, I'm doing it in a way that's within arm's reach for them. So I'm not taking them from zero to hero. I'm taking them just one step forward. I'm using foods that I know they like. I'm explaining to them how they can do that so that either because they've got time in the morning, they can play around and do this, or if they've got no time in the morning, how they can make the prep of it work and it's about meeting that person where they're at and giving them recommendations in a way that fits into their lifestyle that is the joy of the work that we get to do as nutritional therapists at the moment it does mean it's in private practice but this model can move into the national health system if it would be accepted to do so and that means actually compliance goes up because i've heard them i've heard where they say i've got no time and say that's fine where do you think we can carve out 10 minutes 10 minutes on a sunday make yourself a package of egg muffins and also if you want keep up with your regular breakfast then they make that egg muffins become they have it they pair it with their current breakfast anyway so they ease into that transition and they've actually proved to themselves they do have 10 minutes when they find for it and they feel good for it and then they're motivated to do it again and it's about finding that in road to get them feeling good to get them feeling like they can and anything's possible and then they become more and more compliant being cynical though you know nhs budgets are pretty tight and the model you're talking about is see them once make an adjustment see them again in a month make another adjustment and like take it gradually but time is money that's expensive because you're not just you know i mean gps are put under immense pressure to have like what 10 minute appointments Yeah.

45:20Like what are you doing in 10 minutes? Absolutely. It's really hard, right? It's really, really hard. Time is money, but this is why I think we're looking at it in the wrong lens from a finance perspective. That top line for diabetes care, I don't have off the top of my head, but it's astronomical, it's huge, it's billions I think. Oh yeah, yeah. Annual spend. That top line is only going to keep growing unless we find funds, redirect funds into the grassroots level. I know GPs who have ventured into the space because of the absolute care and drive they have a bit like me to reverse and avoid type 2 diabetes.

45:56I know GPs who have entered this space and they are saving on their annual prescription budget because they're not medicating type 2 diabetes anymore. They're helping clients put it into remission, helping patients put it into remission. I know one GP who knocked£60 ,000 off of his NHS prescription budget in one year. What, just through lifestyle and education rather than prescribing drugs? Rather than just blindly prescribing. Wow. Yeah. Possible. It is possible. It doesn't, I mean, you might need to find money up front, but let's be fair, as a government, when they need to find money, they find money.

46:31They print it, don't they? So we can find money up front to know that the aim of the game is our return on investment is that top line number is coming down. Okay. That's how I would look at it. Well, and that's the win-win, right, where actually the cost of the NHS can go down. Our taxes might go down, maybe not, but who knows? We can dream. But then everybody's getting healthier and it's less of a burden on the NHS. Yeah, it's really concerning. And things like the thing with type 2 diabetes and the blood sugar and metabolic dysfunction trajectory that worries me the most is the additional health concerns that come with it.