Insulin Expert: Bread, Rice, Fruit, Potatoes - The Foods Spiking Your Blood Sugar Without You Knowing | Dr David Unwin

0:00I'm seeing a catastrophe unfold in front of me. When I was a young doctor 40 years ago, I never ever saw anybody under 50 with type 2 diabetes. And now I'm seeing it in every clinic. I'm supposed to wait until you are so sick that no matter how young you are, I am not allowed to give you a continuous glucose monitor, the thing that would teach you. So I'm breaking the rules. For the average person at home looking right now at their bellies and thinking, I do think I have a little bit of a belly. Does that mean to an extent that they can be insulin resistant? Dr. David Unwin is the low-carb GP, a globally leading doctor in insulin resistance and diabetes, recognized for his award-winning work in pioneering diet-based treatment to reverse type 2 diabetes.

0:47From his GP practice in England, he has helped hundreds of patients to achieve diabetes type 2 remission, saving the NHS just under 70 ,000 pounds. Every slice of toast is three or four teaspoons of sugar. Even if it's a brown toast or sourdough. Yes, it's still sugar. Breaks down into sugar. Turn the white stuff green. So instead of chips or rice, why don't you have loads of green veg? What has been the most painful failure, either in your professional or personal life? I blame myself for a long time. Things got so bad, so bad. Death would have been a release for me. And I see now, and I often say it, I often say it, the, when you...

1:38Dr. Unwin, as a doctor, what is your main area of focus? That's a great question.

1:49I think it's like this. every person like has a range of of different futures and i think as a as a doctor medically i'm trying to get you to pick the healthiest future and live the best life you can as a doctor so this is just um medically i've become obsessed really with when i look around in the north of England, so many people look unhealthy. So many people, even young people look unhealthy. And I think this can't be right. So my focus is what can we do without medication, without drugs, what can we do to improve people's health? So I think a great example is the States. it's even worse there in the states only seven percent of the population are metabolically healthy only seven percent so the great majority of people are not really healthy what do i mean by metabolically healthy well that's to do with obesity high blood pressure it's to do with we You might cover it, fatty liver disease, diabetes, all of these things.

3:15And even here in the UK, people's health span, the amount of time they can expect to be healthy is dropping. So health is getting worse. I might illustrate this further. So I'm a GP, a family doctor. and I've worked just north of Liverpool, I've looked after the same population for nearly 40 years. It'll be 40 years this September. I've looked after those folks. During that time, I've seen a tenfold increase in the number of people with type 2 diabetes. Ten times more. So this is an epidemic. It's really serious. I'm seeing more and more people with obesity more and more people with high blood pressure ten times more people with diabetes I'm seeing a catastrophe unfold in front of me in my patients, in my lifetime and I'm very determined to try and find out why this is and to improve their future and their health but at the same time i don't think i can just rest with that because that leaves all the other people in the uk whose health is deteriorating and around the world because i know that the the epidemic i am seeing is not an epidemic it's actually a pandemic because wherever i go in the world, diabetes, fatty liver, obesity and cancer are all rising, whether it's Malaysia, whether it's New Zealand, anywhere.

5:08It's something is happening worldwide. This is, it's a pandemic. And we made a lot of fuss, perhaps correctly about COVID. But I think this is far more important. and it's not talked about enough. And I suppose that's why I'm here. Thank you. Let's unpack some of those definitions of those problems. Yes. In very simple terms, what is diabetes? Well, so we need to begin not with diabetes, which, by the way, comes in type 1 and type 2, so we need to split those apart. But we need to begin with insulin. so it's not generally known but a high blood sugar damages the sensitive linings of your arteries in about six hours wow you're very sensitive to a high blood sugar and in fact if it goes up and up you will lose consciousness so nature regulates something as important as blood sugar very carefully.

6:16And this is done with the hormone insulin. Insulin has a special job. It's there to regulate your blood sugar and my blood sugar. And it does this. So if, I don't know, if I have five teaspoons of sugar in that coffee, then that's a big load of sugar in my bloodstream. Sugar in your bloodstream is sugar that you need for energy, but if there's too much sugar there, it's damaging your arteries. So insulin has a special job. It pushes that sugar out of the bloodstream and inside your cells where it can do less damage. And in that way, brings blood sugar down. I think you've really got to ask what happens to that extra sugar in the blood cells and it actually becomes fat and it becomes a specific fat called triglyceride which is a very known risk factor for cardiovascular disease so the first thing there is a diet with a lot of sugar in it is easily going to make you fat and that fat tends to be in your belly and in your liver so you get um a liver full of fat and in fact it's called non-alcoholic fatty liver disease and it's a third of everybody in the developed world a third of everybody you know a third of your friends and including we now have children with non-alcoholic fatty liver disease.

8:00But we need to just go another step. Fat in your liver unfortunately interferes with the work that insulin does. So your insulin gradually doesn't work as well. So it's becoming harder for you to regulate blood sugar, which is important. The only thing you can do about that, so you're insulin resistant now, insulin resistant, your insulin isn't working as well. So you have to ramp up the production of insulin. You have to produce more insulin. And that is another condition called hyperinsulinemia, which means producing more insulin. So your insulin doesn't work as well, and you're producing more insulin to compensate.

8:51That goes on for about 10 years. Unfortunately, the fat that's building up in your belly, and if you look around, look at all the young people with central obesity. Very many people. And the further north in the UK you go, the more you'll see. So the fat is building up in the liver, but it's also building up in the pancreas gland, the gland that produces insulin. and eventually you are quite unable to produce enough insulin to compensate for the insulin resistance and at that point you're losing control over your blood sugar and that takes about 10 years and you now have type 2 diabetes because you can't regulate your blood sugar.

9:39Type 1 diabetes is quite different. These are very, it's a completely different condition, they can't produce insulin at all and they need to inject insulin to stay alive. But I'm fascinated by type 2 diabetes and the point there is there's a 10 to 15 year window of opportunity before you have type 2 diabetes when you can do something about it by changing your diet. But we can't finish with insulin yet. Insulin does a lot of other things. it's the one of the master hormones it controls many of your other hormones and many of your other many of your other physiology so insulin makes you hungry all right so i um i i have let's say a huge bowl of ice cream or i go to who hasn't been to an indian buffet and eaten loads and loads and then when you get home you're really hungry again aren't you do you remember that you get home and you think i could just murder something else what has happened is the insulin has of course you responded to the high blood sugar so you you eat all this food your blood sugar is high.

11:06Insulin comes in and rapidly drops your blood sugar. And then if the blood sugar falls, then you're hungry again. And back you go for another bowl of ice cream. Or with me, it was biscuits. So I'd eat loads of biscuits, blood sugar high. Insulin comes in, blood sugar low, I'm hungry again. And back I go to the cookie jar, round and round and round, getting gradually fatter and fatter, bigger belly. So hunger, insulin, you could think of it as fat fertilizer, is key to obesity, but so much else. Insulin also puts up your blood pressure. So how does it do this? well do you know we've known since 1923 that insulin causes your kidneys to hoard salt so a high sugar or a high carb diet is a high insulin diet and a high level of insulin causes you so instead of just weeing out the salt your body hoards it where it the salt then causes you to retain fluid and that puts people a pressure why is high blood pressure bad for us right so think of it like a steam engine where the pipes you need pressure in the pipes to run the engine but too much pressure starts damaging the pipes and they can spring a leak which could be a stroke or very often at the juncture of arteries that pressure spurting on the walls damages the walls and then the response to that is the development of atheroma where the arteries are narrowed so high blood pressure is actually probably one of the world's biggest killers and insulin and hyperinsulinemia is an important part of that that we never talk about and in fact i wasn't taught that at medical school it wasn't until uh it wasn't until i started um helping my patients eat better, that a weird thing started happening.

13:43It happened with me first. I discovered I was dizzy when I stood up. For 10 to 15 years, I'd had high blood pressure. And weirdly, my blood pressure was low. And I was having to hang on to the desk if I stood up too quickly. And many of my patients were noticing the same when they started the low-carb diet. so I was having to stop their blood pressure medication. So we'd stop one drug and then another, and still the blood pressure would improve, and I couldn't understand what was happening. I was absolutely fascinated. And so if you're fascinated, you collect data. And I started making sure that we had everybody's baseline, lipid profiles, blood pressure, blood sugars, and then look at the latest follow-up.

14:38And that was the beginning of publishing. I'd published maybe about 30 peer-reviewed papers now. But back to the blood pressure story. So I didn't know what was going on. So what do you do? You find a clever man. So I found Professor Brady, a professor of cardiology at Glasgow University. And I contacted him to say, this data is so interesting. I don't know what's going on. but the blood pressure is definitely improving significantly and he knew why he said right well in 1923 we you know they did the experiments actually on dogs and they found out that insulin causes the kidneys to hoard salt and david partly this is what's going on and we published uh a paper on that so i didn't know it took me two years to find out this link between insulin and blood pressure and it made me think what else don't i know how you know you come out of medical school full of arrogance and and and you think right well i've passed all my exams you know and And you have the idea that modern medicine, we know it all.

15:58And so it's a shock when you discover at the age of 57, as I was then, that there was big stuff I had no idea, absolutely no idea about. And what else don't doctors know? I was senior partner. I saw myself as a knowledgeable, up-to-date person. And to discover there was something a hundred years had been known that I was not taught at medical school made me think all over again and made me very curious about the causes of all the illnesses that I saw in every clinic I do. Talk to him about those causes. Yeah. So I think before I lacked curiosity. And it's funny, I think a lot of doctors are not curious.

16:56And by thinking about why are people ill? So if we think about type 2 diabetes, well, the commonest drug we use is called metformin.

17:10so am i using metformin to treat type 2 diabetes because your metformin gland has packed up obviously that's nonsense you don't have a metformin gland so it's not hormone replacement we're doing so how do we know that metformin is the best treatment surely we should begin with what is the cause of each illness? Are we certain about the cause? Because then we're more confident of our treatments. And this led me to the personal discovery that insulin resistance and hyperinsulinemia were the actual causes of so many of the illnesses that I was seeing. So not just type 2 diabetes, but blood pressure, but cardiovascular disease, but dementia.

18:12And then cancer. I was really surprised to learn there's a very close relationship between insulin resistance, central obesity, a big belly, and eight forms of cancer. so really you can see now that whatever listeners are worrying about in terms of you know i'm worried about cancer i'm worried about blood pressure or whatever their insulin resistance is most important as a possible cause of these things on top of skin disease and acne polycystic ovarian disease, infertility. So think about how astonishing that was for me to see this common cause. And at the same time, I look in the streets of Liverpool, just look at the people, young people with big bellies, young people who look unhappy, young people struggling with health and in every clinic i do now i see people in their 20s with type 2 diabetes this is entirely new so when i was a young doctor 40 years ago i never ever saw anybody under 50 with type 2 diabetes and now i'm seeing it in every clinic how can we be so sleepy why are people not more worried why are they not fascinated with insulin resistance and hyperinsulinemia because it may define your future and i was talking before about what can you do about your medical future so for most people finding out about insulin resistance and what to do about it, it could be most, most important.

20:11And I just cannot believe the things I see on the news that I'm told are important. And yet, look, open your eyes, look. When you buy petrol or maybe diesel or whatever, just have a look at what's for sale. What is it? Is there anything in that shop that's healthy? No. Look around you. Look at all the bars of chocolate. Look at the biscuits. Somebody's buying those so-called foods and somebody's eating them. Look in the supermarkets. Row upon row of sugary cereals and biscuits and cakes. somebody's eating all of those. I believe the food supply is corrupted and is affecting people's lives and that using drugs will not solve the problem of obesity and the problem of dementia and the problem of type 2 diabetes and even the problem of cancer.

21:19We need to look to the food supply and we need to do it urgently for the average person at home looking right now at their babies and thinking i do think i have a little bit of a belly does that mean to an extent that they can be insulin resistant so yeah how would you know that's an excellent question how would you know you're insulin resistant and now you're worried because i've just told you it's really important so i suppose some aspects of it are so a tendency to insulin resistance can be inherited so if it runs in the family but that can't be the whole story can it because i've just told you that i've i've seen a tenfold increase in type 2 diabetes in 40 years so genetics cannot be the whole story because that's one generation so something else is changing it's the it's the food supply act acting on a genetic susceptibility so genes are part of it then the other thing is yes if your belly is getting larger that might be a cause of concern particularly for younger people because you're not you're supposed to be perfect when you're 25 or even 35 you know you're at the peak of your performance and yet when i look around for many people that is not the case people are struggling really really struggling which is why we have everybody desperate for the fat jabs they're looking for a solution uh to this so a bigger belly is definitely something to think about.

23:00For me, another one was sleepiness after meals. So I actually have type 2 diabetes, but I didn't know for years. But I do remember after lunch, I was so tired. And I actually would have a 20-minute little nap. I'd lie down on my own doctor's couch and have a little nap because i couldn't face the afternoon without a little sleep so sleepiness is is another one another one is when i actually developed type 2 diabetes you tend to wee more so that was another one another one is you know is your blood pressure rising Have you got high blood pressure? That's another one. I'm fascinated by the work of Dr.

23:54Georgia Ede. She is a world famous psychiatrist who specializes in the effect of nutrition and particularly sugar on mental health. and i've seen so many of my patients whose mental health has improved when they've reduced the carbohydrates in their diet how does that work that also works through insulin because insulin affects your your brain as well your brain needs a great deal of energy and if your brain becomes insulin resistant that's a problem you need to get georgia reed on this show if you possibly can but she's written a brilliant book a really uh good book and i would definitely say that when i first went low carb which was in 2013 and i did it with my patients i didn't know what would happen so we had an adventure with 18 patients who volunteered and we thought let's see what happens the first thing i noticed was the ability to concentrate better and i needed less sleep and hours less sleep but it was the power of concentration it was like having a young mind again and that is why i continue with the diet to this day because my ability to concentrate is far far better so that you see what's not to love in all of this you know if you could concentrate better what if you could live longer what if you could be healthier for longer and then your skin would look better as well so it's like how many patients don't fit into something i've just said in general practice in my clinics most of them are anxious um or tired or they're worried about their skin or fertility or blood pressure so you see i've fallen across something fundamental to many people's health we started talking about sugar and how sugar has severe impact over your blood sugar levels yes it can create high blood pressure it can also make you insulin resistant so i'm assuming that a lot of people at home are thinking well i'm going to stay away from sugar but what you did was not necessarily stop eating the sugary things but you stopped having carbohydrates.

26:21You've just made an excellent point. This was the thing that I had missed. This was the thing. So I didn't actually see myself as having a lot of sugar. I'd cut sugar out in tea and coffee because I wasn't a foolish person. The thing I had missed until I was 55 years old was that starchy foods like bread, rice, potatoes are actually soon to be sugar because digestion, the enzymes in your digestion break starchy foods down into glucose. So that, if you think about somebody's day, you start with orange juice. Well, that's sugar, isn't it and then you'll have some toast but toast is every slice of toast is three or four teaspoons of sugar even if it's a brown toast or sourdough yes yes it's still sugar breaks down into sugar and then you might have a banana a banana is roughly equivalent to five or six teaspoons of sugar depending on how ripe it is and then you might have a yogurt but probably they put sugar in that as well.

27:40And then on the way to work, I don't know, you might have some sort of some crisps or a bar of chocolate, that's sugar. Then at lunchtime, you're going to have sandwiches with bread, sugar. And then, I don't know, you might be a very healthy person. You might think, well, I'll just eat the sandwiches. But mid-afternoon, you're probably going to have a biscuit with your coffee, more sugar. Then at tea time, maybe pizza, sugar, or chips, sugar. So all day long, you've had sugar with your sugar, with your sugar, with your sugar. And I missed that. How did I miss that? Because it's schoolboy biology that bread and starch is sugar molecules holding hands and digestion breaks it down so suddenly a diet looks so different because you can see how easily it would be having healthy fruits and wholemeal bread and i don't know what did i used to have um yes alpen what was that alpen thing with healthy oats in it and sultanas and raisins and I ate my way into high blood pressure and type 2 diabetes as a doctor without realizing sugar with your sugar with your sugar and I was asleep I didn't see that at all and there I was quietly with type 2 diabetes

29:16is there a place for carbohydrates in our lives What an interesting question. What an interesting question. So, a little bit of nutrition now. There are three macronutrients. There is protein. You need protein for making muscle for growth. And then there are fats. Now, fats are vital for life. The fat-soluble vitamins like vitamin D, you need fats for life. you don't actually need carbohydrate to live it's nice to have but you don't need it to live it comes in many forms and some of them are more harmful than others so i actually think table sugar is particularly harmful and it would be the thing i would eliminate first because it's just empty, pointless calories.

30:17But there's carbohydrate in green vegetables. There's carbohydrate in cauliflower. There is carbohydrate in many healthy things that you might have. So what my patients do is they would tend to turn the white stuff green. So you can have your steak, have your fish, or have your protein, but what are you going to have with it? So instead of chips or rice why don't you have loads of green veg and have some healthy fat on there as well there's nothing wrong with butter and that's the basis of the low carb diet that you avoid carbohydrates but you have to major on protein and loads of green veg and some healthy fats what about fruits fruits now this is really interesting they vary according to how much sunshine they get so if you think about sunshine is about photosynthesis isn't it so what's happening is sunshine helps a plant fix carbon dioxide and turn it into sugar so the longer the fruit sits in hot sunshine, the more sugar it produces.

31:33So on one hand, you've got Scottish raspberries sulking in the mists of Scotland, struggling. They're not very sweet. There isn't much sugar. But then you have tropical fruits at the other end, like a banana, like a mango, like pineapple, absolutely saturated with sugar. So people, my patients on a low-carb diet are having berries, That's blackberries, blueberries, or strawberries, because they're not as sweet. Also, to answer your question, how low do you have to go with the carbs? And that depends on how good is your insulin. So, unfortunately, I've got type 2 diabetes, so my insulin is tired, exhausted.

32:19I'm insulin resistant, so I have to be very careful. so even half a banana would double my blood sugar and made me feel drowsy right even half an apple makes me feel unwell so i can't eat apples or bananas at all but i can have a few raspberries if you took one of my kids who are insulin sensitive and very healthy and exercise a lot, they can eat fruit because they've looked at, they're so far metabolically healthy, but they avoid large amounts of bananas and they certainly wouldn't have fruit juice because fruit comes in what's called a matrix, which delays the absorption of the sugar. So if you blitz fruit to make a smoothie, you're getting a really fast, rapid hit of sugar.

33:19would be much better to eat the fruit whole and give it as nature intended. So how low people go absolutely depends on their metabolic health and the state of their insulin. I mean, but the other thing is, you could just experiment, couldn't you? So I would say, now, this depends. If you're on medication, before you start experimenting with diet, you have to check with your doctor. For instance, if you're taking insulin for type 1 diabetes and then you cut out all the carbs, you're going to have a hypo, aren't you? So that makes no sense. If you're on drugs for diabetes, you probably have to check with your doctor before you start randomly cutting out all your carbs.

34:10but how about somebody who isn't on medication why don't you see your life as some an interesting experiment and you could try different diets and see how you feel that's what i did i didn't know how i'd feel on low carb i had no idea but i was curious and that's how we began with 18 volunteers let's learn together let's learn to cook let's do it together we used to meet every monday night and then notice it's key is noticing how you feel what i will tell you is if your diet is full of junk you can't notice anything because your system is so polluted you have to cut out the junk food first and then you will notice today i feel a bit better and do more of what works and probably probably you've done this already in your life.

35:10You know, you notice. You look like you care for yourself. That's good. So you notice, well, I feel better on that diet than that diet. Notice and experiment. And don't assume you know everything, but just go with it. And I'd say to people, well, try going low carb, but cut out the ultra-processed food, please, first. It's been manufactured to be super delicious. Who can eat one Pringle or a Dorito? Nobody. They've made those foods. They're making mugs of you. They're making mugs of you because they're selling you poor quality food to make money. Food with a long shelf life. Food that can be put in a packet and stored forever.

35:58They've done that even with bread. you're a very young person but when i was young bread would go moldy and green and blue in about three days wow right my mother used to tell me that was penicillin and she should she would toast it and i had to eat it anyway isn't that funny because we were short of money um but bread now you can keep it for ages and ages and you probably i don't know do you ever see bread go moldy it takes a long time a long time so even bread something even brown bread something you think is a pure food is not because it's been changed and just look at the lists of ingredients if things have molded about five ingredients why were they put in there generally it's so that food lasts a long time can stay on the shelf um but does that mean it's healthy so i would really say to people think about basing your diet on whole foods and see how you feel and see how you look i want to play devil's advocate there's a school of thought that says that we can eat carbohydrates on a daily basis as long as we eat enough fiber what do you think nonsense i'm sorry the thing is so how would fiber helps slow down the absorption of sugar but it's still there and it doesn't unless you're pouring with diarrhea you know you eat so much fiber you're actually pouring with diarrhea that would reduce the absorption of the sugar so it does help so high fiber foods do do help but it only reduces your sugar by about a third so even wholemeal bread or brown rice it's still got two thirds of the sugar in it and i'll give you a fact to help you understand this so 150 grams of boiled white rice is approximately equivalent to 10 teaspoons of sugar.

38:12So whether you had a small bowl of white rice with your tea, or you had 10 teaspoons of sugar, it's about the same. This is the basis of my teaspoons of sugar equivalents that are downloaded millions of times around the world and translated into 39 languages. Can you give me a few other food examples and convert them into sugar? Yeah, yeah. So 150 grams of boiled potato is the same as nine teaspoons of sugar. So whether you had that or the rice, a single slice, a thin slice of brown bread is three teaspoons of sugar. So if you made a sandwich with two thin slices of brown bread, that would be six teaspoons of sugar.

39:05And I'm going to go off on a diversion now because I can't resist it. So let's think about how much sugar there is in me. Right? So bleed me out into a bucket. Yeah. And there would be five liters of blood. I'd be dead by then, but there's five liters of blood in the bucket. If you could extract all the glucose from that bucket of five liters of blood, And guess for me, how much sugar do you think there would be in my entire bloodstream? Considering that you don't eat sugar regularly. Let's say, that's right, or in an average person. Let's say just an average person. We take them off the street, we bleed them out.

39:47And how much sugar is there in their entire bloodstream? How much? 10%, 5%. Give me, so a teaspoon is four grams. Okay. So talk to me in grams. In grams? Yeah. Just think of a figure. How much in a whole body? Three to 500 grams. Right. The truth, the actual truth is four grams. A single teaspoon of glucose in your entire bloodstream. So you can see that for me to have a banana that has six teaspoons of sugar, it's a hell of a lot. That's why my blood sugar goes up. I'm overwhelmed because my insulin doesn't work. I'm rapidly overwhelmed by the glucose load in that banana. And suddenly the world looks different to you.

40:37Because glucose has to be finely maintained. Somebody young like you will have amazing insulin. And you can abuse your body. And you can eat bread and carbs and you remain well. But your pancreas gland is slaving away. Shovelling, shovelling, produce the insulin, produce the insulin to deal with all that sugar. And suddenly you see the teaspoons of sugar completely differently. Because those equivalents... Now, but if you talk... I don't know if you could have... You could have steak and a massive salad, and it would have hardly any sugar in it. You could have a three-egg omelette with cheese.

41:21Hardly any sugar. So you can eat nutrient-dense, healthy whole foods with hardly any sugar in. So back to the teaspoon of sugar equivalents. I was a founder member of a UK charity. 16 clinicians got together horrified by the state of public health in the UK. And so our charity is called the Public Health Collaboration, the PHC. And in it are a lot of free resources. things that I've produced and other doctors they're all free of copyright so you can steal them you can use them so you can go on to the if you google phc and sugar and unwin there are seven different infograms in 39 languages showing you breakfast cereals fruits vegetables everything that I could think of to be helpful for people to understand their diet in a different way but to circle around to your original question.

42:29Do you remember that bowl of rice? The 150 grams was 10 teaspoons of sugar. Let's say it was brown rice. It would still be about six or seven teaspoons of sugar. So yeah, that's an improvement, but that's no good to me. With type 2 diabetes, I can't eat brown rice because my blood sugar will go up and I don't feel well. And it's contributing to the fat in my liver because it's carbohydrate I don't need. For someone right now making their lunch or dinner choice, would you tell them categorically to not eat carbohydrates? No, I wouldn't tell them anything at all. I think I'd say, I would say cut out junk food, wise up about ultra processed food.

43:18I would say start making your meals yourself if you possibly can then the question is what are you hoping for in your health yeah do you want is it that you don't like your skin condition is it that you feel you're tired is it that you're not happy with your belly and then it may be that reducing carbohydrate would make sense are you having enough protein in your diet are you having enough green veg and then i would say experiment. So let's look at what my patients eat through the day so that people can imagine, well, so they would normally start the day with something like full fat plain yogurt with a few raspberries.

44:06That's not difficult, is it? Why full fat? Full fat because why, first of all, why take stuff out? That's the first thing. And also So the fat helps satisfy you because what's going to fill you up? So if you take out the fat of the yogurt, how will you remain full? And in fact, the most recent research on dairy fat has decided it's not necessarily harmful after all. There are plenty of publications on that. So full fat, plain yogurt is fine. Have it with some raspberries, buy frozen raspberries and just put a few in if you think they're expensive. if that makes them cheaper. You could add some flaked almonds to that if you wanted.

44:51Or you could have scrambled eggs, that's very quick, with smoked salmon. Or just scrambled eggs with some pepper on it. Or you could make yourself an omelette. Or you could have bacon and eggs. So that's your breakfast. But you're not going to drink fruit juice with it. You'll drink sparkling water or you'll have tea or coffee. For people with diabetes, there's quite a lot of sugar in milk. So if I have a latte, that will double my blood sugar. And in fact, I've taken, I haven't got one on now, but I've taken to wearing a continuous glucose monitor because you learn really fast what puts up your blood sugar.

45:30Should we all wear those? I think we should all try one. For how long? I really do. Just two weeks. You'd learn a lot. You can buy them on Amazon, put them on your arm. It tells your phone about your blood sugar. We'll come back to that. Let's get back on with the day um that's that and you're not going to snack you don't need to eat people the more often you eat the hungrier you will become i didn't used to understand that because i was somebody who had breakfast then biscuits through the morning then lunch then chocolate in the afternoon i was always eating always hungry i ate because i was hungry people eat because they're hungry.

46:11But I mentioned already that insulin makes you hungry. The more you eat, the hungrier you will be. So normally, actually, I only eat twice a day and sometimes just once, but have a big meal because I find, well, I'm lazy, number one, and also very busy. So I don't always have breakfast. That's the meal I tend to skip. Right, lunch. So what's your source of protein? We've said protein is important so you could have a piece of fish or you you could have smoked salmon couldn't you we could have a couple of hard-boiled eggs and you could have some coleslaw because you want you're wanting to eat it quickly then dinner you've got a bit more time maybe that's when I'm going to have my steak with broccoli, with butter, with garlic.

47:03Have loads. And then you could have some cheese after that because cheese is low carb. I wouldn't have the biscuits, but I might have it with celery would be all right. But that's very low carb. So that's one of my patients whose type, that's how they would eat. But actually you can mainly eat in, So fine dining, which is kind of your business, isn't it? So fine dining on the whole is reasonably low carb because you're not loading up with chips. You're enjoying the quality of what you eat. And there isn't usually masses of carbohydrate on the plate.

47:47What do you think about the ketogenic diet? That's a really good question. so we've been talking about insulin right so let's go back to insulin so here's the thing we're so fabulous we're a dual fuel engine you can burn two fuels you can burn glucose or you can burn fat so you're dual fuel but insulin has a trick up its sleeve Insulin prevents you from burning your own fat Okay So if you're eating carbohydrates Your insulin levels are high And you cannot burn your belly fat So it's like it's been food that's locked away in a freezer You can't touch it And that's why some very heavy people can be genuinely very hungry Why are they even hungry?

48:47They've got a year's worth of calories right in their body. They're hungry because they are having carbohydrate. Even a small amount generates insulin, and insulin prevents you from burning your own fat. So in order to burn fat, you have to get the insulin levels low, and you have to go below about 50 grams of carbohydrate a day. Below 50 grams. It's the magic figure. 50 to 30. And at that point, the insulin level is so low, you start burning fat as ketones. And that's why it's called the keto diet, because you're burning ketones and your brain loves ketones. What are ketones? Ketones are a form of fat that your mitochondria can burn.

49:35so it's fat reduced down into its essential there so that your little batteries in every cell the mitochondria can burn ketones and that's why it's called the keto diet and that's why people love it because they become fat burners and all of a sudden you're much less hungry and if there's one thing my patients tell me it's they're separate why am i not hungry do i have to eat breakfast No, you don't. But I'm not hungry. I know. It's because you've gone keto. And that's why the keto diet is so big. Because people are not resisting hunger the whole time. Is it a diet that we can stick to long term?

50:21Well, so I've been in nutritional ketosis for 12 years. Every day? Yes. I haven't eaten bread. I haven't eaten an apple. Occasionally I've experimented for the purpose to have quite a large following on Twitter. So sometimes I will wear a continuous glucose monitor and eat bread just to show them what happens. But I wouldn't routinely. And I know people who've been keto for 20 years. And there's fascinating work going on in Edinburgh University. Dr. Ian Campbell there is researching the improvements that ketosis makes in severe mental illness, particularly bipolar disorder, and that's being published.

51:07So it's really interesting. But for me, keto gives me a sharper mind and the ability to concentrate. It also has some advantages for some forms of sport. So I'm old, I'm 67 now, but I still run. I love running. And when I was younger, I would run longer distances. so I might do a marathon. The trouble with a marathon is you, do you run? Yeah. Right. Have you ever done a marathon? Half marathon. Half marathon. But you'll know about the term of hitting the wall. Yeah. What's happened then is you've used up all the glucose in your body. But if you're a fat burner, you don't hit the wall. You don't need the little, you know, I used to have little horrid sweet gels and jelly babies.

51:57You don't need any of that nonsense. you can just run the freedom you just run and burn your fat so for someone that either runs regularly or exercises on a daily basis that doesn't mean that they've either earned the right in inverted commas to eat more carbs than a person that is physically less active not really i mean there are so carbs are useful if you're sprinting so fat is good for endurance so it's good. So it's a very, it's nature, fat has got more calories per gram than any other substance, you see. So it's, it's nature always designs things cleverly. So you've got that fat as dense calories to use on a long run.

52:42So you were designed to do that. You should, your body keeps its carbs for sprinting, or maybe for lifting very heavy weights. This, there's a real science behind nutrition and you um professor tim noakes is the world expert on the keto diet for endurance and sports athletes and he's written books he's famous tim noakes look him up you'd learn a great deal um for most the other thing is is most this is really important right so an ordinary bloke goes low carb, but all your enzymes are not ready. They take two to three weeks because all your enzymes are to do with carbohydrate. And it takes about three weeks to become fat adapted because your body has to learn.

53:38It's forgotten how to burn fat. So it has to learn and it takes about three weeks. And that's when you may be vulnerable to keto flu. And during the adaption, you either can reduce the carbs gradually or you need more fluid and more salt and you might need more magnesium while you adjust to being keto and it can take three weeks and again you wouldn't do this if you're on medication because you're doing an extreme thing if for somebody on medication you discuss it with your doctor first to find out whether would keto be safe for me but for people who are not on medication as long as they make sure that they're drinking plenty of fluid and maybe they have more um more salt in the diet uh people in their millions are trying keto now that's why you asked me because you've heard of it what are your views on intermittent fasting well i do it so what do we mean by intermittent fasting and i think so the king the person to read on this is dr jason fung he's a personal friend of mine have you read any of his books well he he's a world expert on fasting and he's a very good communicator so look him up the first thing is what's the difference between starvation and fasting.

55:02And the difference is, so in starvation, your body is stressed because it never gets the nutrients it needs. And stress is bad for you. So I'm not advocating that people should starve themselves. Fasting is a different thing. Fasting is something you do for a while, but when you finish, you eat nutrient-dense foods. So it's not starvation because you are going to have a good meal. We don't know when it is. And then the question is, what do I mean by intermittent fasting? Well, one of the benefits is if you don't eat for a few hours, the insulin is naturally low. And so your body gets a break. And insulin is also linked with inflammation.

55:50So your body is getting a break. So for me, I wouldn't tend to eat. I haven't eaten yet today, and it's probably mid-morning now. I won't eat till lunchtime. So I eat in a window between probably about 12.30 and maybe 7pm. So that for me is intermittent fasting because I eat within a window and I get the break all the way from 7 o 'clock till 12.30 the next day. But some days I might have one meal. I experimented once and didn't eat for seven days because it interested me. because I'd always thought, you know, you think, how do hunger strikers do it? How do they stay sane? So I thought, well, I'll try.

56:39And what I discovered was the longer I fasted, the less hungry I became. And by day seven, I was reluctant to eat. And that's why it's almost dangerous. I didn't need to eat. I could have carried on, which was slightly scary and weird. my wife has done even longer just out of curiosity how long she's gone to eight or nine days and aside from low insulin levels what are other benefits that people would feel you now let's talk about ramadan um so i've got some really good muslim friends and they say the prophet meant you to benefit from fasting because of the mental clarity. And it's actually ancient wisdom.

57:28And there is no religion that doesn't have some fasting somewhere in it. Christianity does. Think of Lent. Religions nearly always somewhere have fasting. And one of the benefits is mental clarity. And you think in a way you don't in others. And so to go into the desert and fast, as long as you don't, you've got to drink water um is an interesting thing but um for me it had dangers because i just wasn't hungry isn't that weird uh so i like the idea of resting my system and the rest from insulin um and you could also usefully look up the subject of autophagy which is you seem to know about that which is where your body is scavenging dying and dead cells having a cleanup using up spare resources while you're fasting so for me i've discovered i might sometimes do a full 24 hour fast occasionally often on a monday because i'm busy but normally i might eat once or twice a day in a window and many of my patients it's interesting they will often as the years go by drift lower carb and maybe just eat twice a day or many of them just one meal a day.

58:46After how many hours of not eating do we start getting all these benefits? That's a good question. I don't know the answer to that personally. I think you'd have to go four or five hours I think. I mean that's the idea of overnight fasting that's why it's a good thing but really serious carb addicts often get up in the night at four in the morning and eat carbs they can't even manage overnight so intermittent fasting i think it has a place it's very interesting just worries me a little bit you know for what about people with eating disorders would that open up would that make it a lot worse now interestingly there's some early published work on this where you know the question is do people who go very low carb and start intermittent fasting does that worsen anorexia or eating disorders and there are three papers out on this at the moment that would say probably it doesn't make it worse but we don't know so i would just put a little question mark over eating disorders there an amazing guest she's a a hormonal expert from Yale University, Dr.

1:00:02Florence Comity, shared on this show that women that are either looking to get pregnant or women that are pregnant should not do intermittent fasting because it can affect their hormonal balance. Well, I think here we have the difference between starving and fasting. So if you, I think there the two terms may have been confused. If you starve yourself, that's a very powerful stress signal to a woman's body, and your body will protect itself. so if you starve yourself the body will protect itself by lowered fertility because that's the signal now's a really bad time to get pregnant everything about our design from evolution is adaptive and clever everything's super super clever um and fertility evolution's really thought about fertility because it matters so much.

1:01:08I don't think eating within a window of intermittent fasting, I believe that might improve fertility. And there's a lot of work on low carb improving fertility because insulin resistance is linked to polycystic ovarian disease, which is a very common cause of low fertility. So I think the answer to that is nuanced and complex and very important to differentiate between starving and intermittent fasting. I think intermittent fasting, like me, I think, I'm guessing that would improve fertility, eating between 12.30 and 7 at night and being healthy and having plenty of protein and healthy fats. What is your relationship with alcohol?

1:01:54That's a great question. well it tends to call to me alcohol it calls to me and i'm i'm careful i'm careful with it i've seen so many people with alcohol problems so many and um so the first thing is you can enjoy some alcohol on a low-carb diet um because there is a spectrum of sugariness in alcohol just like the fruits so beer unfortunately is very carby my son robert calls it liquid toast hence the the beer belly um so beer is out but dry white wine and dry red wine are fine and actually shots of alcohol like a whiskey or a brandy are very low carb but liver health is key to insulin resistance so if you keep doing that you will damage your liver and it doesn't end well so i only allow myself to drink alcohol once or twice a week partly because it for me it can become too much of a habit and i will allow myself a couple of glasses of some i spend more money so i drink more expensive stuff but less often and on a very good day.

1:03:17Bollinger champagne is my favorite and it's very low carb, but I don't allow myself to indulge that often. I think, you know, just thinking about people listening, it depends where you are. What's your starting point? So I've had people who actually have achieved, so my, The thing I really go for is drug-free type 2 diabetes remission. I didn't know it was possible to put diabetes into remission until I was 55 years old. Can you define remission in simple terms for me? So we're talking about type 2 diabetes. We're talking about achieving a normal blood sugar without using drugs and having it sustainable.

1:04:07so until i was 55 years old i believed that type 2 diabetes was a chronic deteriorating condition that would inevitably mean i'd give you more drugs and that's what i did that's exactly what i did you know people gradually got fatter and i'd give more drugs and then the blood sugar starts rising and i oh now we have to add this so imagine when i discover there is this thing drug-free type 2 diabetes remission which i'd but i'd never seen it not once but now i've seen it i saw my 159th case of drug-free type 2 diabetes remission yesterday afternoon at half past three in a lady and i'm going cheering like imagine what a high for a doctor she comes in and i've got the results you know what's my result i said you've done it you've done it you're number 159 The prescription for all of them was the same, low-carb diet.

1:05:08Yes, I published it. It's a low-carb diet. And I've seen that miracle 159 times. And it's now about 24 % of our entire NHS diabetic register at Norwood Avenue in my practice. So 24 % of everybody with type 2 diabetes in my practice now has achieved drug-free type 2 diabetes remission. And because of that, we're making substantial drug savings on the NHS budget. So at the moment, the savings, this is money I haven't spent on drugs for diabetes. I started totting it up in 2018, and we're up to about£350 ,000 saved now. So this can be funded. And that's another thing that makes me angry, because I don't get those savings to spend on my patients.

1:06:04So I haven't spent the money, but it just goes back to central government. And these results were attributed not necessarily to a weight loss, but to a low carbohydrate. Right. Now we have another. You and I could go on for days like this, days and days. How much strength have you got? We'll find out. So there's a big debate. I agree that weight loss really helps with type 2 diabetes. It really helps. Weight loss. And whether it's bariatric surgery or whether it's the GLP-1 fat jabs, that really helps. But here's a funny thing. Bariatric surgery will improve your diabetes within three days. But you haven't lost any weight.

1:07:00So how can it be weight loss? so it's not simple and i've got patients who haven't lost weight who've got their diabetes into remission but they have reduced the carbohydrates so i'm not saying i know but i'm saying it just makes fundamental sense to me why would you eat stuff that puts up your blood sugar if you can't deal with sugar is that not reasonable and if you're going to lose weight well wouldn't it make sense to cut out the empty calories and the food you don't need um but i wouldn't say i know everything i would say that low carb if so on average documented published i'm getting 10 weight loss on low carb at about three years duration average.

1:07:55So we have patients who've lost. So I have people who come in, I can't weigh them. We have no machinery that can weigh them. This is young people in their twenties who I cannot weigh. This is the tragedy. Imagine their lives. They can't breathe. They can't move around. Their self-esteem. And so I have people who've lost lots of weight, but I don't even know how much weight they've lost somewhere over 10 stone but the average weight loss is 10 documented because every person i know the baseline and i know latest follow-up and 10 weight loss is what you get with low carb on average and 10 weight loss is also approximately what you need to achieve drug-free type 2 diabetes remission

1:08:54I want to talk about sleep. What role does it play in this conversation? Now, sleep is a really complicated thing. And we've got to be careful because you can really worry about your sleep, but then you won't sleep because you're worried about your sleep. So it's quite a tricky, clinically, it's quite a tricky thing to sort out because you must have laying there at three in the morning thinking, it's really important I go to sleep. I need to go to sleep and you have to try and stop the noise don't you so I don't want people to worry about sleep too much but it does matter because sleep and relaxation is part of how we deal with stress and actually eating heavy meals in the few hours before you go to bed means it's far less likely you'll have a good night's sleep and actually drinking alcohol and you'll notice this as you get older you're far too young now but you will notice it later on that you know alcohol can really spoil a night's sleep so slim i'm afraid it is very important one thing that isn't talked about is and we could go on to the subject of magnesium which is just a snatcher thing an awful lot of people are magnesium deficient because so that's an interesting question isn't it i'll ask Why do you think, have you heard of magnesium deficiency?

1:10:22Why is it then? Because perhaps we don't eat it enough within our regular diet. So, okay. So if I told you that for many people, no matter what I feed them, they can't get enough of magnesium, why is that then? Because they're not absorbing it, what? Very good. Partly that. But here's the fact. If you look at the magnesium content of green vegetables from the year 1906 to now, there's about 20 % of the magnesium in our crops now that there was in 1906. Wow. Because the food supply is affected by agriculture. if for a hundred well yes if for a hundred years you just add nitrogen fertilizer to the soil and you grow crops and harvest the crops what do you suppose happens to the quality of the soil yeah and crops yes of course and when i say that to you it makes sense doesn't it yeah if you stop adding animal poo which is what all our ancestors did to soil if you stop adding that to soil what do you think happens to the worms and the humus in the soil and it deteriorates our soil is deteriorating and the quality of what you eat and so it's getting harder and harder to get a nutrient-dense diet and magnesium is such a problem should we supplement it most people need supplements yeah i do and if i what happens to me i get muscle cramps if i don't have enough magnesium and if i'm stressed i need a lot more magnesium so as i'm older i absorb magnesium less well but a lot of younger people don't get magnesium what is the relationship between magnesium and stress so magnesium there's a wonderful book to take this further called the magnesium miracle written by a doctor who has devoted her life to magnesium as i have devoted my life to insulin resistance.

1:12:30Anyway, magnesium is involved in 400, at least 400 different enzymic reactions in your body. And in particular, it helps. So calcium is involved in contraction. Magnesium is involved in relaxation. So calcium, magnesium. And so if you think about this smooth muscles in the walls of your arteries calcium constricts the magnesium helps them relax so magnesium helps with blood pressure dumb question then why are we giving a baby milk before they go to sleep is that not going to impact their sleep because actually um that's a very good question i don't know the answer i'm going to say i don't know um yeah how do they is the magnesium in milk?

1:13:26We'd have to look it up, wouldn't we? Maybe the mother puts magnesium in milk. I don't know. There's definitely calcium. So it's keeping them away. But nature usually supplies calcium and magnesium both because they're a yin and yang thing. So I don't know, but they would normally. But you can see one of the dangers in modern life is that we tend to take a calcium supplement and vitamin D and forget about the magnesium. So magnesium helps relax muscles, but magnesium helps you sleep. Magnesium helps blood pressure. Magnesium helps insulin resistance. 400 different enzymic reactions. And it's really worth thinking about magnesium.

1:14:12And then there are different forms of magnesium. Some of them are laxative and some of them are not. So depending on your bowels, you're going to go for a laxative one like magnesium citrate. or you're going to go, if your bowels are pretty good, you don't want the laxative effect, go for magnesium glycinate, which doesn't cause loose bowels and is particularly good for sleep and then take it at night. Any other supplements that you would recommend the average person to take? Most people, a lot of people are deficient in vitamin D because they don't get either enough fat in their diet or enough sunshine.

1:14:49And particularly in the winter in the UK, you're not able to manufacture any vitamin D from about October till March. And that's even if you take your shirt off. Particularly problematic for people of colour because your skin is an actual vitamin D factory. It takes cholesterol and sunshine and makes vitamin D. One of the most important things. Isn't that brilliant? Nature designs us brilliantly. the thing is to work with nature and understand your physiology because then so sunshine is very important cholesterol is very important but most people don't get enough vitamin d would need to supplement in the winter and i supplement with a vitamin d spray between about october and march and i get sunshine when i can i want to revisit the topic that we briefly discussed earlier continuous glucose monitors oh that's right continuous glucose monitors so if you're going to change things in your life you need feedback you need to know how you're doing so you want to change something in your life you've got to measure something and see how it's doing.

1:16:14Historically, doctors look at blood sugar as a thing called the hemoglobin A1c, which the average blood sugar for you over three months. It's a blood test I can do, and it's really useful because people used to think, right, on the day of my blood test, I won't eat a Mars bar. But that doesn't help with the hemoglobin A1c because it's telling me how sugary you've been in the preceding three months. So it's really good. However, the feedback you're getting is old. The most potent feedback is feedback that comes hard after the behavior. So my wife is a specialist in behavior change. She's a consultant psychologist.

1:16:59And she knows that the more rapid the feedback after the behavior, so if I slap you hard when you eat a biscuit, you'll soon stop eating biscuits. Do you see? so continuous glucose monitor is brilliant this is a new thing so i wear a sensor on my arm and it's telling my mobile phone 24 7 my blood sugar so i will see an increase in blood sugar 10 minutes after i've eaten a biscuit so in real time i'm getting feedback on how i'm eating and if i wish to avoid a high blood sugar, well, the whole thing, suddenly no guessing. It's brilliant, because I know. Of course, it depends how your insulin's working.

1:17:46So for me, because my insulin works badly, I get very big spikes in blood sugar. But even most people, if you have a lot of sugary stuff, you'll see your blood sugar going up on a continuous glucose monitor. I believe they can be world changing. I believe they can be world changing. There is a conflict of interest that I must declare at this point. I think it's important to think about people's conflicts of interest in case I'm being paid to say this. So I am a scientific advisor to Abbott Laboratories on the subject of continuous glucose monitors. The reason I have done that is because I believe they are world changing.

1:18:30I believe knowing what your blood sugar is. Well, maybe a doctor woman's lying. You know, maybe you can eat rice and nothing happens. Well, why don't you try it? Because seeing is believing and it changes behavior. I've discovered with the help of a continuous glucose monitor, the average time it takes me to get drug-free type 2 diabetes remission the commonest time is eight weeks eight weeks so if you give me your life for eight weeks in my practice the commonest time is eight weeks and that is astonishing that will be in my next paper that's astonishing and so technology it doesn't matter where you're starting from no though i've got people with very poor diabetes what does predict it though is how long you've been diabetic so it's harder to get drug-free remission if you've been diabetic for 20 years but i have done it i have done it for people an interesting fact for those who have been diagnosed with type 2 diabetes in the previous year 74 of them will achieve drug-free remission so those are pretty good odds in my practice and one of the sources of massive pride for me is we're achieving in the british health service some of the best results of any clinic in the world anywhere in the world we're right up there norwood avenue we're getting results as good as rich people all over the world in the british health service with no money and no staff and that's my utter, I am driven, committed to how good can we do.

1:20:16And it's not just me. There are nine doctors. There are three nurses. I have a whole team doing this. And we're beginning to break the rules. The rules say that I will not prescribe a continuous glucose monitor for you because you're not a diabetic on insulin. I'm supposed to wait till you are so sick. This makes me mad yeah i'm supposed to wait until you are so sick that no matter how young you are i am not allowed to give you a continuous glucose monitor the thing that would teach you so i'm breaking the rules week after week and i'm not ashamed of that because i believe that waiting until young people are sick and then oh you're on insulin and your reward is now a continuous glucose monitor it's a scandal it's an absolute scandal only rich people can have continuous glucose monitors it's just so wrong uh so i'm prescribing them on the health service call how does our response to glucose evolve as we get older well you right this is another concept it's really not that much about chronological age it's about metabolic age so you're born metabolically young but how fast your metabolism ages depending depends upon to an extent your genetics but also how you are fed what is the metabolism in very simple terms right i think you could pretty well in simple terms why don't we just talk how how insulin resistant are you so as as you age metabolically so my son age 32 is has he's not he's insulin sensitive and i'm insulin resistant but there's a there is of course a continuum of that and so i have fed him and we have avoided carbs for years so he's in metabolically absolutely great shape.

1:22:22But you could start off age 20 and by the age of 30 have type 2 diabetes like so many of my patients just by cramming the carbs and abusing your body because it's new. So I think it's more useful the concept of metabolic age. Do you exercise? Do you eat whole foods? Do you sleep well? As against chronological, you can't do anything about chronological age. I'm 67, that's a fact but how metabolically healthy i am at least i have some control and exercise can make a difference too any particular type of exercise yes muscles are fabulous at soaking up sugar they're fabulous and so straining to lift weights it develops bigger muscles but also it soaks up glucose and it stimulates insulin sensitivity.

1:23:23So I get even older people to do power squats in the brain. I'll just get up, up, up, up you go. Two bricks. You don't have to buy weights. Two bricks up and down or do it slowly or go up and down stairs carrying bags of shopping. so muscular activity can really help i usually start with diet because it's i need to get results fast so people trust me but then i'm finessing afterwards and we're talking about some gentle weights if we can i mean but you exercise for other reasons as well it's good for mental health so i run because it brings me joy you know i like nature very much so i run and i enjoy that i don't i don't ask particularly whether that's doing my metabolic you know whatever but you ask the question and some weight work even for older people because one of the commonest reasons we die is we fall over and break your hip and muscle strength um in fact grip strength predicts survival and mortality really yes a muscle strength and this is women and men work on your muscles what is the relationship between the grip strength and our well because you can you can measure it how powerful is the grip and then you can see how long they live and and there's a very clear link between muscle strength age 70 and how long you're going to live interesting so it's worth uh doing the exercise but young people they never think they're not very in they're more interested in other things than how long they'll live you and your wife jen pioneered the model called the green model we did what is it right and we shouldn't use the word we because this is not my work i pioneered it but it's the work of my so i've got i'm married to one of the cleverest women in the world in the world my wife she's very very clever woman she's a consultant psychologist she is fascinated by the difference that hope makes to chronic disease can you say that again in a different way she's fascinated she's interested in if you've got hope if you're a more cheerful person does that mean you'll live longer and the answer is yes what's the correlation even it so her her her phd was on can you predict after traumatic amputation how people will do so at the point if you see them the day after a tractor has ripped their arm off so she worked in a trauma unit as a psychologist so she was assessing who are the people that are going to be badly affected how will they do and she discovered the attitude the day after they've when she interviewed them she could predict who's going to do well who's going to need more help what does it mean to do well is it as in happiness levels or performance measures there's there are measures of mental well-being okay there are clinical measures of mental well-being and so that some people could be surprisingly cheerful when they lost an arm you would imagine that they're you know a young person losing an arm their life is finished but not always some people are able to make the best of that they have a way of of coping and that they have more hope they're more optimistic more hopeful so she became fascinated by the difference that being hopeful makes to outcomes and then the next question is can you change that so then she moved on have you heard of cbt as a form of therapy no right it's a complicated form of therapy that's available on the national health service is a cognitive behavioral therapy yes that's cbt well done that's exactly it yeah but it's complicated and so she spent two years thinking but it works but why can we can we because we haven't all got ages can what is the fundamental the important point of cbt and she reduced the whole thing down to grin which we will do together now she reduced it down to grin g r i n spells grin g stands for goals so this is what are you hoping for for each of us what in that better life that you would want, what are you hoping for?

1:28:18So I think I usually use the example of weight loss because we're talking a lot about that. So maybe you'd hope to lose some weight, but that isn't really a goal. We've got to make the goal realistic. So you have to explain to me how would weight loss, how would that improve your life? Help me understand how weight loss would improve your life. Well, help me understand if you had the most successful podcast in the world, why is your life better? How is it better? I want to understand if a miracle happens and you have the best podcast in the world overnight, is your life actually better and how?

1:29:03And that helps you detect a false goal because if you can imagine it, you can then think, well, is that really what I want. If you really want it and you could imagine being the host of the most successful podcast in the world, it's going to feel great. And you say, I feel, you know, what are the reasons? So having goals in life is really important. But there's a problem. Loads of people have goals, don't they? To write a book. But do they ever write that book? No. So we need to go beyond your goal. so the next question is what resources do you have as a human being that might be relevant to your goal so why would you be a good podcast host what are the skills and experience that you bring to this and also you might think well what's worked for you so far so you said to me that You've changed your podcast from one type to another.

1:30:10So presumably you learned something from that. What resources? Your resources also are people that work with you, the team that's out there. Those are your resources. Are you properly thinking about your resources? Have you learned from experience? Are you thinking about your resources? R also stands for resilience. Are you a quitter? Or will you try and try and try? right that's r i stands for increments so you've got your big hairy goal your big brave goal the thing you want to do what's the first step that would be towards you being the most successful podcast hoster in the world what's the thing that you would think well actually i think you know over the next few weeks i need to do this and you commit to that and focus on that change so that's g r i and then n is the most important one it's noticing what works and do more of it and then round you go again it's a cycle so you do one thing and i've done that we run our family like this our kids do it on their friends the grin model i hear them on the phone talking and talking about their friend yeah but what is your goal and and you can see then i've done it for hundreds and i was doing this way before low carb this started 20 years ago and i do it in 10 minute appointments but noticing in your life what's working it's a good day i wonder why and taking a moment to think, why not?

1:32:00Maybe you just noticed your CGM. I find noticing really powerful. It drives me because then if you observe something, then you think, oh, I think this is true. And then maybe you experiment and do it again. There's one thing we haven't finished with. so that's the grin model published open access so you can you can google grin and jen and david on win and there's a paper on that to describe that because when we do things jen and i publish it and then have it open access so entrepreneurs pay for our papers to be free so that you can all read it so that's what we do so there's a paper on that but we haven't dealt with failure and it's really important to deal with failure because not everybody loses weight do they so you've got to find how do we reframe failure to become something useful so let's go back now to weight loss and all the people i see in january who say oh dr mwyn you're going to be so disappointed oh god i've lost i'm sorry i've gained so much weight now that's not a good start for a consultation is it somebody who feels like a failure what the first thing to do is dissect away the emotion of guilt because it's pointless it's so pointless feeling guilty what you have to do is think think right let's think about christmas at what point did you go wrong specifically really and the more specific the better oh it was eating chocolates off the christmas tree and then i lost control and then the next question is well what could you learn from that specific point what you're going to do differently next christmas well maybe i shouldn't have chocolate um ornaments on the christmas tree do it differently and so and the same applies to medical errors well of course am i going to go 40 years without making a mistake is that likely it's impossible isn't it if i make an error am i just going to kill myself am i going to have a nervous breakdown that's no use to anybody is it I have to think, truly wind back through that error.

1:34:33At what point could I have done something different and what is it? And next time I'll recognize that scenario and I will do it differently. And in that way, it helps me cope with failure because failure in medicine is a very, my father, I remember my father saying to me, I wanted to be a doctor. and he said, David, I'm not sure you're emotionally robust enough. He said, think this through. He said, you know, my father was an industrialist and he did well, but he said, I make an error and maybe people lose jobs or I lose money. You make an error, people die. How are you going to cope with that, David?

1:35:16I'm not sure you're tough enough. But he did me a massive favor because if there's one thing that made me so determined that I was tough enough and I had to learn how to cope with errors I had to find a way and it's to do with reframing and doing things differently so aged 55 I was making errors wasn't I I was I was using drugs what's about all those people who I was using drugs for type 2 diabetes was you know my least favorite patients were people who were overweight. And do you know why? Least favourite patient was because as a doctor, you want success. But the people with weight problems, they never seemed to get any thinner.

1:36:06Well, this is really interesting. So what was the common denominator between all those people not losing any weight? Me. the advice i was giving was poor and the results were poor and who did i blame the patients because it's i wanted to feel i'm so you know it's their fault how terrible is that how terrible and so i woke up and determined the only thing to do with that is do better and now I am I'm sorry very sorry imagine if I could have known all this when I was 25 I wonder what I would have achieved but we have to deal with what we know and how we are and I started when I was 55 and it brings me now joy and the people my preferred patients are overweight people with type 2 diabetes because I love to work with them because I believe together with a collaborative approach, the results can be astonishing.

1:37:15And I see them in every clinic I do. What has been the most painful failure, either in your professional or personal life? Loads of them. You're talking to an old man now. Loads of them. Oh gosh. My first wife was an alcoholic and a drug addict. And eventually she killed herself. So where do you begin?

1:37:48She couldn't help herself. She killed herself and she forged prescriptions. The fraud squad were involved. It was huge and terrible. And I blamed myself for a long time. I thought for 12 years, I thought I should be able to save her. You know, I thought therapy or whatever. And one of the lessons to learn, what do I learn from that? I learn that until somebody with an addiction wishes to change, you cannot change them. I failed. You cannot change. But now I'm a little bit easier on myself because the model is, well, she didn't want to change and she didn't. And I'm not responsible for what happened.

1:38:31But you do feel so that for a while was quite bad. And we had two children who were now in their 30s. And so that meant we had a very complex domestic situation, very, very difficult to cope with. and i i classify myself as a trier i am a trier and um i've tried i've done my best i've done my best and we're very close uh and i married a second time so jen is my second wife and we did a lot better the second time around patients um i had a patient who was before that yes um before we started recording we were speaking and it was very obvious and clear to me that you're a very optimistic person yes during those very tough years with your first wife yes were you as optimistic do you know it's a really good question isn't it how do you cope how do any of us cope And one thing I would say is adversity can teach you.

1:39:51You know, I did survive and those times. So we used to work in those days. I worked through the night as well. So I had young children. I was working through the night as a GP. So we did our own. Saw my own patients in the night. So I didn't get sleep. I used to work every third day. I would work through the day and then not sleep. work through the night every so every third night i lost a night's sleep on top of children and in my life i've been actively suicidal a few times actively wanted to die and that taught me a lot and why didn't i kill myself i didn't kill myself for the children I remember things got so bad, so bad, that life was so hard, the chaos and the pain and the police and the courts, it was very complicated.

1:40:51And I, just bad, bad, bad. So I, death would have been a release for me, such a release. And I remember driving along and thinking I could accelerate the car and drive into a wall. And I had to stop myself because just for the pain to stop would have been a release. But that taught me so much. So sometimes the worst times in your life teach you such a lot. So I didn't die. and because of my love for the kids stopped me. Just stopped me. I remember another time I used to be really frightened of flying and I suddenly realised I didn't care if a plane dropped out of the sky. It didn't matter anymore.

1:41:47It cured me forever of being frightened of flying. But my love for the kids kept me going and I learnt you can take joy, if you can just shut your mind, you can take joy in brushing your teeth. I learnt mindfulness. So you could have, you could take 10 minutes of your life and I could worry about my life situation in that 10 minutes and have a horrible 10 minutes or I could find a way to be mindful and see the sunshine and hear the birds and notice the flowers just for 10 minutes. and I started to cope in that way because it gave me a little break from the pain and it's a discipline that I learned to cope.

1:42:36I also learned and I think somewhere in your 30s you have to learn about where your limits are of your strength and I learned to read myself accurately to I need to leave work or I need to take a day off because I'm going to break down. I could feel I'd become brittle. And in the early days I wasn't self-caring and I didn't realize when I was becoming brittle. I remember one shouting at a nurse. I was overtired, it was three in the morning, and I started shouting and couldn't stop. and that's because i was a doctor who didn't realize my boundaries and you have to learn and i think it takes place in your 30s you have to know these boundaries and i recognize in myself the signs of exhaustion and i must it's imperative i stop and and do mindfulness or go a walk or a run or that sort of thing so i developed in those 12 years and you know i told nobody.

1:43:49I told not a living soul because I thought that would be disloyal. And I was trying to pretend we had a perfect life. I didn't tell anybody. So I had to learn all totally alone for 12 years how to cope. And it stood me in very good stead because who has the perfect life? I have a brilliant life but in it difficult things happen and the tools of survival are so necessary and mindfulness can be a can be a real help exercise and a sort of i don't accept i'm a I don't accept it's all hopeless I just can't accept I remember I've had some brilliant patients that have taught me a lot I had one lady if you can imagine her she's an upper middle class lady wearing a lovely a beautiful hat and it was it was amethyst color and she used to she used to coordinate her jewelry so she comes in so beautifully dressed with an amethyst hat wearing huge amethysts she was in her 80s what a clever clever woman and one day she she said are you all right dr umwin and i wasn't really and she said be careful don't the more you look in the abyss the more it will claim you is it time you stopped looking in the abyss and she meant that I was chewing too much on unhappiness.

1:45:31And she said, Dr. Ramin, I'm an old lady. I know I must die, but I'm cheerful and I'm enjoying today. I've never forgotten that lady. She wrote me a letter on it as well. Beautiful handwriting. If you could talk to the version of yourself that was driving on that car, that wanted to end it all. Yes. And you would talk to him with the version of yourself you are today, with all your learnings. what would you tell him? Oh, God, that's a good question, isn't it? Be kinder to yourself. Be kinder to yourself. Because it isn't, you know, life's a long run. And you will make errors and they're fine.

1:46:23And you've got to run that long run. so don't burn out because I so nearly did and I think the power of love the power of loving somebody else more than yourself is a wonderful gift a wonderful gift and I see now and I often say it I often say it the

1:46:56when you love other people more than yourself it can save you so you see my children saved me they absolutely saved me because I didn't kill myself did I and so when things in life are very tough rearing of children is very very hard is actually a privilege and a gift and it can save you and they saved me and i wish i didn't would have helped of course to know that i would have a happy marriage and all would be well and the other thing is there's a couple of other things but you know time and old people say this is very tedious isn't it time heals and it actually it really does things now that were so painful that i couldn't have talked about things that were so painful do over time become less painful if you can bear with it and get on with life and do something useful while while you adjust.

1:48:09My final point is most things in life are relative.

1:48:16So my point is at that time when I could have driven the car off the road, that was probably the worst time in my life where I actually had to not do that. But that makes other things look pretty unimportant. If you've been that near to killing yourself are you going to worry about the tax problem are you going to worry about the dreadful boss are you going to worry about litter or you know loads of nonsense nonsense nonsense and it's a it's a good leveler so having had something really tough in your life well then maybe other things won't seem as bad and the tough things my mother she's 90 another very clever woman she says what doesn't break you leaves you stronger and i've had a great many difficult things in my life a great many and most of them i'd say left me stronger and i i think that's i think that's enough old guy wisdom really thank you for opening up because i got to know not only the brilliant doctor that you are yeah but the beautiful human that you are my final question to you is the following yes if you had to compress all your knowledge all of it into one essential piece of advice that we all must implement in our daily lives, what would it be?

1:49:53I'm only allowed one. Right, well, I think it's the noticing. We're all variable. And that's the beginning of every experiment, isn't it? What's fundamental to this variability? You're happier some days than others. You feel more energetic some days than others. And some days you're closer to your better self. So, you know, if life is essentially a journey, but you'd be hoping to become your best self. And this forms the basis of many, many small experiments of noticing, what was it, do you think? And then you're guessing, well, I think it was that. I think exercise suits me. and in this way by noticing you can move incrementally towards a better expression of yourself a better expression of what is it to be human and what matters to you, so that would be it noticing it's my wife's thing but I've really begun to focus more and more on that, thank you, that'll do Dr.

1:51:11Anwin, David thank you from every corner of my brain and from the bottom of my heart, this has been one of the most beautiful and stimulating and educational conversations that I've had in my life and I'm blessed to get to have these conversations and I'm even more blessed to be able to share them with now a growing audience that I know will learn so much from you, not only as a doctor, but as an incredible human. Thank you so much Thank you.