Feel Better, Live More with Dr Rangan Chatterjee - How To Use Food To Transform Your Health, Reverse Type 2 Diabetes & Improve Your Mood with Dr David Unwin #611

Episode Date: January 14, 2026

If you have ever struggled with your weight, low energy, pre-diabetes or even type 2 diabetes, this is a conversation that could change your life. Dr David Unwin is an NHS GP who not only put his own type 2 diabetes into drug free remission, he has also helped over 150 patients do the same in a standard UK general practice – with ordinary people, on ordinary budgets, using food and lifestyle. It’s estimated that around 7/8ths of the adult population are metabolically unhealthy, which means that only a tiny minority of us are truly metabolically well. And this is a serious issue because poor metabolic health is one of the root cause drivers of insulin resistance, type 2 diabetes, cardiovascular disease, strokes, Alzheimer’s and many forms of cancer. In fact, this is one of the main reasons why I co-founded Do Health https://drchatterjee.com/do-health/ - a personalised health companion, powered by your individual biology and lifestyle - as a way of helping people improve their metabolic health early, well before they get sick in the future. In this week’s episode, we cover: The early signs of poor metabolic health, and why symptoms like fatigue, belly fat and brain fog are often overlooked. Why many issues we see as ‘normal ageing’ are actually signs of insulin resistance. How David himself reversed his own type 2 diabetes and, at the same time, improved his mood, energy and cognition. How reducing starchy carbohydrates if you have metabolic dys-regulation can dramatically improve blood sugar control Why so many of us struggle with bread, pasta, and ultra processed foods – and how food addiction may be silently driving our behaviour. The two women who helped David rethink everything he thought he knew about food, hope and healing And why it’s never too late to work on your metabolic health and why doing so can change every aspect of your life. One of the things I love most about David is his passion. He really is someone who genuinely wants to improve the health and lives of his patients and our hope is this conversation empowers you to make small changes that will improve your blood sugar, weight, energy, and ultimately, your future.   Support the podcast and enjoy Ad-Free episodes. Try FREE for 7 days on Apple Podcasts https://apple.co/feelbetterlivemore. For other podcast platforms go to https://fblm.supercast.com.   Thanks to our sponsors: https://boncharge.com/livemore https://thewayapp.com/livemore   Show notes https://drchatterjee.com/611⁠   DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

Only one in eight of the population is metabolically healthy. One in eight. So in our practice, of all the people with diabetes, we know that if they go low carb, 50% of them will achieve drug-free type 2 diabetes remission at three years. A further 48% have improved their blood sugar significantly, or maybe they're on less medication. It's amazing because the average improvement

are better than drugs for diabetes. Hey guys, how you doing? Hope you having a good week so far. My name is Dr. Rongan Chatterjee, and this is my podcast, Feel Better, Live More. If you have ever struggled with your weight, low energy, pre-diabetes,

or even type 2 diabetes, this is a conversation that could change your life. My guest this week is Dr. David Unwin, an NHS GP who not only puts his own type 2 diabetes into drug-free remission, he's also helped over 150 patients do the same in a standard UK general practice with ordinary people on ordinary budgets using food and lifestyle. You see, right now, it's estimated that around 7-8 of the adult population are metabolically unhealthy, which means

that only a tiny minority of us are truly metabolically well. And this is a serious issue because poor metabolic health is one of the root cause drivers of insulin resistance, type 2 diabetes, cardiovascular disease, strokes, Alzheimer's, and many forms of cancer. And as you may have heard me talk about recently in other podcast episodes and in my weekly newsletter, This is one of the main reasons why I co-founded Do Health, a personalized health companion powered by your individual biology and lifestyle

as a way of helping people improve their metabolic health early well before they get sick in the future. In our conversation, David explains the early signs of poor metabolic health and why symptoms like fatigue, belly fats and brain fog are often overlooked. Why many issues we see as normal ageing are actually signs of insulin resistance, how David himself reversed his own type to diabetes, and at the same time improved his mood, energy and cognition. How reducing starchy carbohydrates if you have metabolic dysregulation can dramatically improve your blood sugar control. Why so many of a struggle with bread,

pastor and ultra-processed foods, and how food addiction may be silently driving our behavior. The two women who helped David rethink everything he thought he knew about food, hope and healing, and why it's never too late to work on your metabolic health, and why doing so can change every aspect of your life. One of the things I love most about David is his passion. He really is someone who genuinely wants to be. to improve the health and lives of his patients. And our hope is that by the end of this conversation,

you won't just understand type 2 diabetes differently. You'll also feel empowered to make small changes that improve your blood sugar, your weight, your energy, and ultimately, your future. David, welcome to the podcast. Brongren, thank you. I have been so looking forward to this for a number of years. In fact, I can't believe we're only doing it now

because I think we share quite a similar philosophy about health and maybe life in general. To start, I wanted to talk about the continuum of health. You're someone who has helped over 150 people in your practice put their talk to diabetes into remission, which is amazing. I'm going to talk about how you've done that. But at the same time, I don't think there's an awareness out there

that type 2 diabetes is the end process. Things have been going wrong with your metabolic health for a number of years. So what would you say are some of the signs that we can look for in our cells that might indicate our metabolic health is a little bit off? And maybe we're on the road to getting type 2 diabetes. That's a fabulous question.

You're right, it starts years before you actually have type 2 diabetes. And the things I would say, the things I noticed in myself actually, because I have type 2 diabetes, so I know a bit about this. The first thing is I used to find myself tired, particularly after meals. So I remember after lunch, even in the practice, I'd have to have a little nap on my own doctor's couch. Isn't that terrible? and I was only 55 and I thought that was aging.

So the first thing is tiredness, particularly after meals, and also I was always ready to lie down in the evening. I was always thinking I'd put my feet up instead of doing anything. That's one thing. Another one is your belly size. And I think loads of us have noticed that. We call that just middle-aged spread, but I think that is, that's a euphemism really,

because if your belly is more than half your height, you may have a problem. So all you have to do actually is get a piece of string as long as you are tall, cut it in half and will it reach around the biggest bit of your belly. And in my case, it wouldn't have done. So belly size is another early thing that people, might notice. What else might they notice?

Cognition? That certainly happened to me. Yeah, they call it brain fog, don't they? Again, I thought this was normal aging, so I was 55, which I'm now 67, so it's kind of crazy. I just noticed that the younger partners in the practice seemed to have intellectually more horsepower. And that was another thing for me, sort of fogginess. But then another odd thing, I remember a thing at Christmas, I got sleepier and sleepier through Christmas and slightly depressed. And again, all of that turned out to be reversible and all of it turned out to be those early signs

that I was becoming insulin resistant. Yeah. And my insulin wasn't working. properly. I mean, and then you have the various biochemical tests that doctors might do. So any sign of fatty liver, maybe we'll come on to that. A third of everybody in the world now has fatty liver. So I had that as well. And then in blood tests, a high triglyceride is a thing that people may have and not know why they've got that. So that's on the lipid, panel if you do a triglyceride and it might be high.

One final thing with me, I became fretty. So I would sort of chew on stuff for days and sort of circular thinking. It was funny because when I improved my diet, all of those things went away and my confidence increased. So that's my personal experience actually. Yeah, it's really interesting. You're talking about what on the surface seems to be quite a variety of different symptoms. Yeah. Right? Belly fat, a bit of brain fog, what you

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

I'm 67 now and I run regularly, which would have been impossible when I was a younger man. It didn't occur to me. It was a thing I could do so I can out-sprint my grandchildren. I'm 67. I've got eight amazing grandchildren. They think it's hilarious seeing an old guy run. They say that I win because they laugh so much because they think it's so funny to see an old guy actually sprinting. But I can't. And all of these things have changed and I'm not on any medication.

Oh, I didn't tell you, I had significantly high blood pressure. And do you know, I didn't want to be a patient. Isn't that stupid of me? So I put my head in the sand. I knew it was high. It wasn't that bad. It was like 160 over 94, 95. I never went to a doctor. But now my blood pressure is about 1.20. 20 over 70. Wow. So that's another, yet another thing, high blood pressure that I sorted out. All of these things, no medication. And I'm so lucky.

So very, very lucky. There's so much I want to cover with you today, David. So let's perhaps start off with your personal story. Yeah. Yes, you've helped, I think, 153 patients now put their type to diabetes into remission. I want to hear how exactly you've done that, because I think that's going to be very helpful for everyone listening as to what they might be able to do in their own lives.

But why don't we start off with you? Because you were the patients. Yes. You were skeptical of any kind of approach that could perhaps work. And I believe that there were two, what you call two very intelligent women who helped you see things differently. There were two formidable women, I would say formidable.

So, yeah, what's a shock. A little bit more background before we come to that. So I was unhappy in practice. So I was the senior partner of a large practice, 10,000 patients. And I wasn't as dissatisfied somehow in my mid-50s with what I'd achieved. You know, we all become, you, when you're young, you know, why do you become a doctor and it's all like you're all excited by the difference you're going to make, aren't you?

Yeah. And you can't wait to, you know, get into practice. And I, in my mid-50s, I was disappointed because it didn't really feel that great. Because actually, the health of the population that I cared for got worse, not better. I mean, an example, we're talking about type 2 diabetes. So when I first joined the practice, which was in 1986, so I've been there since 1986, we had just 57 people with type 2 diabetes. Fast forward we've now got 600.

So that's a 10-fold increase and it's the same population. So there's an epidemic for you, an epidemic of type 2 diabetes, but I'd also seen an epidemic of obesity. Really just astonishing. So back, we're going back now to 2012 and I'm aware of all these epidemics of lots of chronic ill health. And so how was I doing?

The answer was poorly. So, and I had a sort of feeling, it felt depressing, all the prescribing. I don't know how you felt about that, but I was, you know, you add one drug and then people deteriorate and you add another drug and it feels sort of wrong somewhere. Also, they didn't look well. so nobody came in like they were amazingly well and that's how we come to the first very formidable woman because part of the payment in general practice

was to be sure that your patients are taking metformin for their type 2 diabetes. Metformin, I mean it's the baseline treatment for type 2 diabetes and I had a lady we knew she wasn't cashing in her prescriptions for months. She was somebody I'd known for years. And so I wrote to her to say, please, can we have a chat?

Because I'm a bit worried about your type 2 diabetes. Nothing prepared me for that woman marching in because she'd actually got her diabetes into drug-free remission. So she wasn't taking any medication. She was a woman who'd had diabetes for a decade. And when we did the blood test, her blood sugars were normal. So I didn't know that could even be done after years of medication.

And this was in 2012. This was 2012 towards the end of 2012. And she marched in. But the point was she was angry with me. And she felt I had let her down. And she said, she explained really, she said, I never told you, but the metformin you'd been giving me gave me diarrhea. But that was a bit embarrassing to mention, so I didn't.

I carried on trying to take it. And if only you had told me that it wasn't just sugar I should be avoiding, but the starchy carbohydrates that break down into sugar, I could have had better health years ago. Because I had to find out about bread and rice and potatoes as sugar or by myself. And you're my doctor, but you never mentioned that once. And I wonder why you didn't.

Surely, Dr. I mean, this is schoolboy physiology. You know, bread you should know from O-level biology that bread is starch and starch is sugar molecules holding hands. So, you know, I'm even wondering whether you're medically qualified. How could you not have mentioned this in 10 years? How did you feel when she was starting to attack you like this? Well, you know, as you get older as a doctor, you fear complaints. You really do because they can run on for years.

So I was scared mainly because she was right. It was a completely justified complaint. And I felt I had letter down. So we had to say, okay, I agree I've got stuff to learn. you know, maybe I have. Perhaps I can do better. Will you help me to do better? And that helped deflect her anger,

but I'm grateful to her because she pointed me, it turned out she was one of 40,000 people on a website, all teaching themselves how to improve diabetic control, but being ridiculed by healthcare professionals. They were being ridiculed. So that was the beginning of my mind,

cracked wide open because he was proof right in front of me that there was a different way. And it's funny, when you look back in life, it's really odd how things can come and change you such a pivotal moment. And there was another one. The other formidable woman is my wife, Jen. She's a clinical health psychologist. And her expertise is behavior change and the use of hope in chronic disease. Wow.

So that's really relevant. And she read a book which was Beat the Diet Trap by Dr. Briffer. Perhaps you remember Dr. Briffer. John Briffer. And he was talking about diet, insulin resistance in this book. And she kept reading it out to me, David, you have to listen to this. You've got to. And I was a bit resistant to that as well because I was too tired.

You know, why is she going on at me like this? It's a vicious cycle, isn't it? You're feeling frustrated at work. Yes. You know deep in your heart that you're not helping as many patients as you thought you were going to help when you were at medical school. There's this sort of evidence coming in front of you that there is a better way to do it, but you're probably too nacker to act on it.

Plus, you're doing it that way for 30 years. Yes. Well, my expertise lay in using medication. and I was really tired. I was really tired and I was actually thinking of retiring anyway. I was thinking of going probably when it was 55 and many GPs do go when they're 55 now.

So I'm now, I think I'm the oldest practicing GP maybe in a hundred mile radius. They've all gone because they get fed up and tired. I was really tired. I wasn't actually well. Yeah, it's kind of interesting hearing that and putting it in the context of what you do today, you're very, very active on social media.

You are constantly on X, sharing helpful information, showing you what you're able to do with your patients, publishing data, you're being, you know, you're traveling to different places, you're starting charities to help people improve their lives, you're talking at international conferences. So, you know, what does that feel like? If you reflect back and we compare the David Unwin

of today with the David Unwin of just 13 years ago right contrast that for me it's just weird and astonishing there I was sort of dumpy middle-aged fed up

thinking of going and now guys it's night and day so I'm loving being a doctor now yesterday I was in clinic and I see somebody whose life's completely changed. It's oxygen to me.

Isn't it odd? So I became a doctor wishing to make a difference. And then suddenly, right at the end, how ironic, right at the end, I am. And now I can't give it up. And so I was somebody I didn't believe in social media. I didn't believe in mobile phones. So I was a dinosaur. You know, the children just laughed at me because I, you know,

I wouldn't have known anything about X or Twitter. I couldn't have published papers. I didn't understand the use of statistics or research. So I've become a very, very different animal so late in life. Yeah. I think there's a very powerful lesson there, David, for all of us, which is it's never too late to change. Right?

It is never too late. People would just regard, you know, you're 55, you've had you've actually You're not enjoying it, time to hang up your boots. And I'm just imagining what the previous version of Dr. David Unwin would be doing now. You might have retired. Maybe you wouldn't have all this energy with your grandkids. You wouldn't be doing all the things you're doing.

Your entire experience of life would be completely different. But now because you've regained that vitality, sort out your mood, your weight, your blood sugar, your brain fog, your cognition, you're literally experienced a lot of your body, life in a different way. So this goes beyond just type two diabetes and blood sugar.

That's just the kind of rocket launcher. You know, you sort of that's out, then your whole life starts to change, right? I'm sure I would have been quite ill by now. I would for certain, you know, I would have got heavier and heavier. I had type two diabetes. I have high blood pressure.

Both my parents had suffered major heart attacks before the ages of 65. Right. Both of them. I've seen both my parents in intensive care. I would have been there as well. This is how it begins. Is this one of the reasons you're so passionate?

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

Yeah. When I look around, what I see in society shocks and appalls me and makes me so sad. It really does. You know, everywhere you go, I see people who could feel better, who could look better. I see young people living half the life. they could lead. And that drives me and drives me. I can't rest because I know there's a better way. And every, you know, I see it with every patient. But then again, what about all the many, many people whose lives are deteriorating and they have no hope? And so that, yeah, I just can't let it go. I can't let it go. And it's almost difficult to stay sane with it because the magnitude

of what's going on in society, and I have a particular thought, and that is. So I remember a time when I was little, when most people were fit, I didn't know anybody with type 2 diabetes or asthma. I didn't know any children or young people with depression. The world was so different. And I think we're beginning to normalize chronic ill health.

Yeah. And the danger of that. So I know it is possible that kids don't have to have, be overweight or suffer with that. I know it's possible that most people wouldn't have type 2 diabetes because I remember a world before all that. I am the last generation of doctors when I am gone. Will anybody remember that there was a life

and the society could lead a healthier life without the need for all these drugs? So that drives me because I know it's possible that all of these chronic diseases of modern life are not genetic. It's not inevitable that I grow up, I get sick, and I have type 2 diabetes and heart attacks like my mother and father. It's not inevitable at all.

What we've got is we have a changed environment in the world, which I believe a lot of it is dietary, but there's other things as well, acting on possible genetic triggers. But those triggers don't have to go off. They don't have to go off. And so you're right, it's huge. And the more of it you see, unfortunately, the worse you think it is,

the harder we all have to try to do something better. Yeah. I think you made such a key point that we are normalizing poor health. Yeah. You know, what people accept as normal these days is so far removed from how we can be, and they accept that. I mean, as we were just chatting in my kitchen before we started recording, I was just sharing with you, I still, to this day, haven't seen a more powerful intervention with patients, no matter what you come in with, then trying to have a whole food diet exclusively for maybe two to four weeks.

If you can do that, and we can talk about what that actually means, it is amazing how many of the things that you thought were separate issues just start to disappear. So I got to the point about a decade ago thinking that, well, I actually don't know how many of these symptoms are related to nutrition until I sort their diet out. So why don't we go with the diet first, understanding that everyone's able to

and giving people help and support. and if you are able to stick to this, people would say, I've got more energy, I'm sleeping better. My joint pain has gone, you know. That last one's a common one, joint pain. Joint pain, exactly. Think back to medical school. When were we ever taught that joint pain

might be to do with your diet? Never. We're taught that joint, you know, after they're overweight is probably that. I've had overweight patients who, it was thought that their weight was causing their joint take. And when they went on a low-carb diet, Yeah. The joint pain goes. It's incredible.

I don't know where it's going to end. So yeah, the journey for me started with type 2 diabetes. And of course, the accent on that is sugariness and sugar and where it comes from so that you end up going lower carb to avoid the sugar. But then I found people's eczema improved all their psoriasis, just as you said, particularly irritable bowel sin. depression, all sorts of things. And you're so right, joint pain. So I had people on maybe a waiting list to have a knee replacement or something. And then they'd say, you know what, I think it's a bit better. I think it's a bit better.

And they wouldn't need, or sleep apnea. Lots of, and I don't know where it's going to end because of the number of conditions that improving diet seems to be. bring about. And then we must mention exercise a bit as well. And so I find a lot of my patients, they lose weight, they feel better, and then they're interested in exercise. I used to tell people to exercise when they weren't really well enough, and some of them would damage themselves. You know, if you're quite heavy, and then Dr. Roman tells you to start doing weights. But if I did diet first, then they lose the weight, then they're metabolically stronger,

than many of them adding exercise to this, which is very important. I want to talk about what you actually did with yourself and what you do with patients once they're diagnosed with type 2 diabetes. But then I want to sort of backpedal and go, well, how can we apply that before we've got type to diabetes? Yes. And maybe even before we've got pre-diabetes. Yes. But let's start off with people who do have type-to-dibabetes, which is, you know, do you know the latest stats in the UK? I mean, how common is this now? Today's episode is sponsored by BonChage. Now, I've been using Bond Charge wellness products for over five years now. And their mission is to simplify wellness by uniting the world's most trusted science-backed technologies on one intuitive platform.

From red light therapy to infrared sauna blankets to blue light glasses, Bond Charge make it really easy to get healthy while staying at home. One of my favorites is their demi-redlight therapy device. I absolutely love it and personally have this device on when doing my morning meditation, and I also tend to read in front of it in the evening before I go to bed. and I've noticed some quite significant changes, improved relaxation, enhanced focus and deeper sleep.

And there are so many studies now showing the potential wide-ranging benefits of red-line therapy, including better eye health, pain relief, reduced inflammation, enhanced recovery, improve sleep and even better skin. So if you're looking to take charge of your health at home, I highly recommend you consider adding the Demi red light therapy device

into your daily routine and Bon Charge are giving my audience 20% off all of their products on their website. Just go to bondcharge.com forward slash live more and use coupon codes Live More to save 20%.

So it's somewhere, I'd say somewhere between 5% to 10% of the population, something like that. But we don't know because I'm finding people all the time who don't even know they're not showing up on the research. No.

But it's going up. That's for sure. It's going up. So yeah, let's start with what, do you want to start with, say, a person that's just been diagnosed? Yeah, in fact, maybe the best way for the audience is

to just imagine, you know, what would you say to a patient? Perfect. A patient who's just been diagnosed with heart to diabetes, what do you say to them? Yeah, I can think of a good example. So, yeah, I had a guy

who, who has given his permission called Dan, he was 39 years old. And we did the hemoglobin A1C, which is the average sugaryness of his blood. And if you have the result, which is above 48, then that means you've got type 2 diabetes. So he came into me and his result was 96,

which is sky high. That's really, really high. So what I'm saying to Dan is, okay, we've done this blood test, which is the average sugar. of your blood and it's really, really high. It looks as if your insulin is not working properly. So your insulin is there to get rid of blood sugar

and you're not doing that properly. So the point for Dana, right that day is we've got, you and I have alternatives today. I'd love to suggest a lifestyle change that could have you with much better health and change all sorts. Or it's lifelong medication, which would you prefer? And the important thing I think is to give the patient the choice so that it becomes a collaborative approach.

And so Dan was interested in avoiding lifelong medication because he thought, oh, I'm only 39, so I'd quite like not to be on drugs. and then we're talking about okay so if your problem is a high blood sugar what are you eating that puts your blood sugar up it's as simple as that what are you eating because a high blood sugar for most people is what they've eaten in a few hours before so we have to acknowledge the stress can put up blood sugar and sick deprivation illnesses all various things but really in clinical practice 95% of the people you see with high blood sugar have eaten something that put it up.

And I broke the rules for Dan. I actually gave him a continuous glucose monitor to say, well, why don't you find out? You need to know what you're eating that puts up your blood sugar. This is years ago I did this, five years ago. You need to know what puts up your blood sugar and eat something else. And he discovered it for him, it was bread and breakfast cereals. were really spiking his blood glucose and then I'm teaching people

about a nutrient-dense diet so I want you to get your nutrients of the macros and the micros you know for people who don't know what macros and micros mean the macros you've got three macros so that is carbohydrate which is a problem for me somebody with type 2 diabetes

because carbohydrates digest down into sugar you've got fats and then you've got protein. So I'd be talking about increasing the protein in Dan's diet, avoiding the carbohydrates and whatever you think, healthy fats. But for me, that would be butter and he'd be having dairy, full fat, yogurt, that kind of thing, and loads of green veg. Then the micros are vitamins. So for that patient, it's, do you know what's putting your blood sugar up? Yes or no. If you do know,

then could you eat differently? Could you base your meal on maybe protein and add in loads of green veg? If you were going to have, I don't know, steak and chips. Do you have to have the chips? Could you not have lots of green veg? And that's what, that's what Dan did. The idea of trying to work out what is putting your blood sugar up. And that brings me just a little segue into the teaspoon of sugar equivalence. Please. So I had to find a way to help people like Dan understand the consequences in terms of blood sugar for what they ate. And so I looked at the glycemic index and the glycemic load of foods because I had a hunch. I thought maybe if I could tell you in terms of teaspoons of sugar, this could help you.

you understand what foods to avoid. For instance, so 150 grams of boiled rice is equivalent approximately to 10 teaspoons of sugar. So if you have a curry and you have a small bowl of rice, well, you've just added 10 teaspoons of sugar to your sugar load. Could you have your curry? I don't know, with frozen green beans or something else. So this turned out, this teaspoon of sugar idea that I had, was valid. So I went to the experts on glycemic load,

a famous one, Dr. Jeffrey Levesy, and we published a paper together looking at many commonly eaten foods and doing a teaspoon of sugar equivalent. So a big baked potato is about nine teaspoons of sugar, a portion of chips is eight or nine, a banana is five or six teaspoons of sugar. Can I just pause you that, David? Yes. Because I think there's a couple of things to tease out here. So, first of all, many people believe rice, potatoes, bananas, for example, are healthy foods. Now, of course, what is healthy depends on the context.

It does. Right. So, and also, of course, table sugar itself, you know, is not particularly good for your teeth, right? Yes, yeah. If consumed in excess. Fair point. Whereas maybe white rice, you could argue, I guess what I'm trying to get to, you're talking about, I think, the impact of that food

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

if you were metabolically healthy, so not only do you not have type two diabetes, but you have no insulin resistance, which is getting rarer and rarer these days, do you think that these kind of foods are also problematic in that category of people, or is it more in the ones as they get closer and closer to type two diabetes?

Great point. I think if we took children and fed them perhaps like, our great-grandparents were fed from a child, they would be metabolically healthy as they used to be. Yeah. As they used to be. And for them, bread was all right. Yeah.

And rice was all right. The difficulty now, there's a wonderful paper from the States showing that in America now, only one in eight of the population is metabolically healthy. I know. One in eight. And that's approximately correct for the UK.

And let's just flip that for a minute. I mean, it's obvious, well, let's just make it really explicit. That means seven-eighths of the adult population are not metabolically healthy. And therefore, the stuff that might have worked for our great-grandparents maybe doesn't work. Because I think we have to also square the circle in many ways to go that there are populations like the Samarney in South America, who are having 70% carbs, whole-food carbs. Whole food carbs in their diet and are very, very insolentative. But I also believe they walk a ton every day,

maybe 17 to 20,000 steps, up and down, lots of hilly terrain, and their whole food carbs. So I think it's, to me at least, it feels like the low carb approach seems to have almost a unique benefit in the modern world. Yeah. And I've worried just like you as well. and you think how many people are metabolically healthy? It's very small.

It's very, very small. And the thing is it's getting worse because so many, I know now, yeah, this is how it's changed. So when I went to university, you're younger than me, maybe not, but we called it maturity onset diabetes. I remember that from that school, yeah. Well, that was meant to indicate. This is what old people get.

Well, now, you know, I've got my youngest patient with type G diabetes is 12 years old. So you see, we are sleepwalking into something so serious and insulin resistance is not everywhere, but almost everywhere, in so many people, how confident is anybody that they're metabolically healthy? Because it is becoming very, very rare. So without patients, you helped to educate them on the sugar equivalent of bread, potatoes and rice. And you said to him,

listen, you now, you have tight to your diabetes currently. You are very insulin resistant, so insulin is not working as well as we would want it to work. Therefore, I can offer you one or two options. Option one is I can put your medication, which I can do for you, but you have to take it for life. Or I can help you change your lifestyle.

Yes. Which one would you like? Exactly. Now, what's really interesting to me, that is what I call proper. informed consent. Yes. Right, you're giving the options. Whereas unfortunately, I mean, there's a course that me and Dr. Panja teach called prescribing lifestyle medicine. And we try and teach healthcare professionals the basics of lifestyle and how you can actually use the lifestyle

interventions for a variety of different conditions, including types of diabetes to help them. And when we used to do it live before COVID, so we used to do it in person, at the end, of the day, we would do two role play consultations on stage. And I'd love to get your perspective on this. And I would say to the audience of healthcare professionals there, there are kind of two ways a consultation can go. The patient comes in, they may be just in their blood test, and you discover that they've got tightly diabetes. The patient comes in, you have 10 minutes with them. If you say, hey, Mr. Jones, you've got a condition called tightly diabetes, but there's nothing to worry about. We've got loads of medication that can sort this out. So today I'm going

to start you on metformin. If over the next couple of years, your blood sugar keeps going up, as it probably will. I've got more medications that I can put on you on. And then in a few years, if we really need to, you can start injecting insulin. But don't worry, we've got that. So you tell them that, give them a prescription. And as they leave the door, as they're walking out and say, Oh, and if you can change your diet and move a little bit more, that would be helpful. Contrast that with the same consultation, same patient, where they come in and you say,

hey, Mr. Jones, listen, there's a few things that have come up in your blood test today. One of the things is that your blood sugar is elevated. Now, it's elevated to a point that we would call this type 2 diabetes, but I'm not sure if you're aware. There will be things going on in your life for many years now, which have caused that. would you like me to help you figure out what those are? You know, if you spend 90% of the consultation

with that sort of messaging, guess what the patient, you know, the patient goes out that they think two completely different things. The first consultation, they're walking out thinking, well, he did mention diet and exercise at the end, but really it's all about the medications versus the other way. You're right. And I would say on stage, I know that sounds quite extreme,

but that is literally how these consultations are going down. Well, and my... That's not informed consent, David, is it? It isn't. And that's where I was so wrong because I've been the first doctor and now the second doctor. And I really want to pick up on the idea of informed consent.

It's key. Isn't it odd? Isn't it odd that if we're doing, say, a minor surgical procedure, I don't know, if you've got a wart in the middle of your head, you would have to sign before I took that war, off your head, that you understand the pros and the cons of that removal. And yet, as a British

GP, I can start on you drugs for the rest of your life without any informed consent. And I believe there's something very peculiar about that. Yeah. It's interesting because I lecture at Hedge Hill University sometimes. I'm an honorary lecture in ethics, medical ethics. And it is so odd that we're doing things to patients without explaining the pros and the cons. And how is it that we're exempt from giving people that vital information? Like, say metformin, I know that approximately a third of people given metformin over 10 years will find they get diarrhea like that lady. And yet I didn't have to tell her.

It's odd, isn't it? Why do you think that is so peculiar? I think there's many... I think there's many factors that play in. into that, one of the sort of theories I've had for a number of years is that this is a consequence of almost this old school paternalistic model in medicine whereby doctor knows best. So we don't question doctor. You know, the doctor knows everything. We just wait for the doctor to tell us what we should be doing. And I think that's actually, while she could argue for acute problems,

maybe there's a role for it, although I don't, you know, I never like that paternalistic approach. I think everything should be a collaboration. For these chronic conditions that are largely driven by the way we're living our lives, I don't think there's any place for that. I think, you know, you're right. There's almost an arrogance to think that we don't need to explain ourselves.

That, you know, this goes beyond types of diabetes. Let's think about antidepressants for a minute. Okay, and there's currently, we think that 20% of the UK population, adults are on what would be called antidepressants. That's the fifth of the adult population taking SSRIs. There are question marks over the validity of the evidence, but just if you part that to the minute for a moment and say, just ignore that for just a second,

even if you're going to put someone on an SSRI, a selected serotonin re-uptake inhibitor for what you think is depression and you think it's going to help, How many of those patients have been actually told the real risks? They're not. I mean, I looked at the BNF literally two weeks ago as part of this TV show that I'm filming

and I invited you to be a part of. And there are new things added over the last years. You know, for example, there's something now saying that, you know, if you take these SSRIs, you can have persistent sexual dysfunction. that continues even after you stop it. Now, would you not want to be told that before you prescribe that? You might still go, yeah, on balance, I'm so struggling, I'll take that risk.

But people are not being told that. And so I don't think we do give informed consent, David, and I think it's a problem. Isn't it weird? It's weird. Because, you know, how can I legally get away with that? I'm just, how can I do it? It shouldn't be right. informed consent, surely that's a...

That's the bedrock of what we do. It must be. And yet it's very odd because it looks as if particularly repeat medications are exempt from that. So there's no going back to say you never told me

about sexual dysfunction. Well, the argument is, well, some people will say, what are you going to do? You're going to tell everyone of all the possible side effects for every medications. And I'm sort of part of me is thinking,

well, kind of, yeah. I mean, if I was going to say something, I think I would want to know what the potential consequences might be. I think what people would expect is that we use our expertise to say what's likely. Yeah. So if I'm saying, you know, diarrhea is up to a third, that's likely. And then again, it's how serious.

So there are two things. How serious is this potential side effect and how common? And it's a sort of factor of those two things. So, you know, even a small risk of sudden death isn't great. You see what I mean? I mean, that's coming out now in the fat loss jabs in a way, isn't it? Yeah. Yeah.

Yeah. Yeah. There were 82 deaths so far with those. But, you know, my patients, when I say there have been 82 deaths are astonished because they've gone online and got the fat lost jabs and nobody ever told them that there have been a few deaths or there are any risk. at all. Yeah.

I suppose we're off on a sideline there, but it's an important one. It's very important. The ethics of particularly repeat medications that you could be on for the rest. You need to understand it and maybe your family too. Yeah. Let's go back to patients with tight-to-diabetes. So just to make this really practical for people, you recommended to this patient that, you know, he was very lucky to have you as a doctor, I'm sure.

you had to sort of bend the rules a little bit to give him a CGM a continuous glucose monitor because of course those things typically you only give in certain instances. Oh yeah. And we'll come to that in a minute, but he was able to see how these foods were affecting his blood sugar.

So he was able to go, oh wow, I'm going to change that now because I don't like that. Yes. But you've also helped many patients for years without access to CGMs, right? So it's possible to do. do that. Yes, yeah. Now, when you... The majority of what I've done was not with CGMs. That's come

recently. So you're right, sorry. No, no, it's fine. But when you say, you know, cut back on bread and pasta and potatoes and rice. They always wonder, what shall I eat? Oh my God. So there will be listeners now going, well... Well, what's left? Well, I'm going to be hungry all the time, aren't I? So what have you found in your experience? Right. So I think one of the main things is more protein. A lot of older people don't have enough protein because you're trying as you get older to maintain muscle mass. So it makes sense to eat more protein. So I'm basing meals on fish, on chicken, on eggs, on red meat.

And then you're adding loads of green veg and some butter if you want or some olive oil or full fat mayonnaise, that kind of thing. And there are loads and loads of recipe books. apps, everything online. So my family, so I've been low carb, my wife, my eight grandchildren, my three children, our entire extended family are low carb. And we do Christmas and birthdays by learning how to cook low carb. You can actually, you can use almond flour instead of wheat flour. So that doesn't have as much carbohydrate in hardly any. But you begin to begin. with having lots more protein, reducing the carbohydrate,

because how much you reduce the carbohydrate by varies depending on how sugary you are. Not everybody has to cut it out altogether. Some just reduce it. Some people are having, when they actually admit to how many chocolate bars, how many sugary drinks they have, how many crisps snacks through the day, they're having a lot of carbohydrate. So I just would encourage people to have less carbohydrate and then how do you feel? How's it going?

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

Well, actually, most people who go low carb would say they feel a lot less hungry. Most of my patients tell you they're surprised. not to be hungry. What some people get is what is called keto flu. That's a bit of a strong word, where they don't feel as good for a few days. And that is because it takes up to a week

for the enzyme balance in your liver to change. Your body has to think, oh, so this, I'm going to start burning fat. I think a point I'd like to make now is this idea we are a dual fuel engine. So we are, gosh, so clever our design, we can burn sugar or we can burn fat. But what happens is, so if you have a high carbohydrate diet, then your levels of insulin are high. And insulin prevents you from being able to burn your own fat.

This is the basis of the keto diet. So the keto diet is people who are very low carb, under 50 grams of carb, a day. And because they're very low carb, their levels of insulin are very low, and then suddenly they're able to burn fat. And fat is turned into ketones as the fuel, that's why it's called a keto diet. And the keto diet is a type of low carb diet, which is becoming incredibly popular across the world. And that shows very well this transition from relying upon carbohydrates to burn, which is what I did until I was 55 years. old, to a greater emphasis on burning fat, which now I am actually, I've been on the keto

diet for about eight years, and I burn fat. Now, some people listening will have heard negative stories about the keto diets. Yes. Okay. So what is the pushback sometimes that comes when people hear about these ketogenic diets? Yeah. Well, I mean, I suffered from, I think there's a common confusion, particularly for healthcare professionals, between ketoacidosis, which you and I both remember, is something that is very serious. This is often people with type 1 diabetes who don't have insulin. Ketoacidosis is severe and you're ill. That's quite different. It sounds similar to ketosis, but it isn't. So ketosis can be a healthy state. I hope I'm healthy. I've done it for eight years. I think that's one of, that's one of the confusions I had earlier on that a keto diet,

is it, is it healthy? I mean, we've, but it, it seems extreme and yet for some people it does work very, very well. Do we know, or do you know, how many if our ancestors ate in a way that would be consistent with a ketogenic diet? Well, I do actually. Just a little aside. So years ago, I was giving a speech in Tel Aviv. And the dinner afterwards, I happened to sit next to Dr. Mickey Bendur, who is a worldwide expert on what cavemen ate. And he spent his life scraping the tartar off caveman's teeth

and also looking at the bone isotopes. So we do know what they ate. And his conclusion, and he's published this, is that our ancestors were eating about 70% meat. And the isotope scans were about the same as a wolf. So our ancestors were eight like wolves in terms of the amount of meat in the diet. And they were surprisingly healthy on that. Because that's the thing that people will say, they go, okay, well, maybe our ancestors ate that way because they had to.

Yeah. But do we know what that did to their coronary arteries? Do we know what that did to their longevity? That's the pushback that sometimes comes.

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

is about 35. Yeah, the average. The average. But the average is skewed very badly. by infections killing children. So if as a cave man, you lived to be 12 to 15,

you'd probably live to be 60 or even 70. If you once got over the childhood infections, they lived surprisingly long lives. And just going back to the distribution of what people ate or what the wolves ate, What wolves and people ate was more carbohydrate in the autumn if they could because they needed to put on fat. So insulin is fat fertiliser, so it makes you fat, it gives you a bigger tummy.

But that actually is adaptive because if you're going to get through the British winter, you've got to get fat in the autumn. So you've got to scoff those berries down. So wolves and humans were eating all the carbohydrate, all the berries they could in autumn to survive. the winter. And I think we should now see where we're almost eating in a perpetual autumn now. You can go to the supermarket and buy whatever you like and have the bananas and the orange juice and the waffles and everything. We're eating in a perpetual autumn for a winter that never comes.

Yeah, not only does the winter not come. Certainly in this country, Christmas comes in the winter. So actually it's the opposite, isn't it? whereby we probably get rather the gluttonous and over-eat in that time where we'd be fasting we'd be fasted exactly we would and you know i it's always isn't it's father's day it's mother's day it's Halloween it's your holiday it's you know we're eating so much more junk food so much more sugar than we did when i was little and what most of what what what i saw uh as a child at school was sweets maybe once a week. That was all. Can you talk about some of your data?

Because I think your data, the way you've collected it, is so powerful because you're showing real-world evidence in your NHS general practice. Yes. This, for some people, at least, is working incredibly well. Yeah. Today's episode is sponsored by the Way Meditation app. Now, you probably heard me talk about this app. over the past few months, and that is because I absolutely love it. Meditation has so many benefits

for our physical health and mental well-being, but only if we do it. And that's one of the reasons I love the way so much. It makes it really easy to establish a meditation practice that sticks. One of the most unique things about the way is that it is a meditation app with no choice. They understand that too much choice is stressful and can lead to procrastination and indecision. And so with the way, you only ever have one choice, which makes things really easy. Just open the app, follow the path, and your transformation will unfold. Now, there's no question that for me, using the way, has helped me feel calmer, more relaxed. And I would say it's also broadened my perspective on life and what is truly important. The creator of the app is Henry Shuckman,

a Zen Master, with a most wonderful, relaxing voice, who actually was a guest on this podcast a few months ago on episode 590. So if you think 2026 is finally going to be the year when you start and stick to a meditation practice, I'd highly encourage you to check out the way. And to give you, And to give you a little extra motivation, The Way is offering my podcast listeners 30 free sessions to get you started with your practice. That is a fantastic offer. What have you got to lose? To take advantage, all you have to do is go to thewayapp.com forward slash live more to get started and begin your journey towards peace, calm and purpose. Data is so powerful and you're talking about real world data. That's the difference as well. This is the sort of cash strap British health service with 10 minute appointments.

So in our practice, if you go low carb, so of all the people with diabetes, about 60% of them have, and it's increasing all the time, have gone low carb. In your practice? In our NHS practice. So we've, as I say, it's a big practice, 10,000 patients. but if you have diabetes in my practice, 60% is likely that you'll have gone low carb. The people that go low carb, we know that if they go low carb, 50% of them will achieve drug-free type 2 diabetes remission at three years.

So it's not like in the first six months, they still have it three years later. And then you've got to ask, well, what happens, you know, are the other? 50% dead. No, they're not. So we've got 50% improve to a point where they've got drug-free remission. A further 48% have improved their blood sugar significantly. But haven't quite hit the threshold for remission. Or maybe they're on less medication. Yeah. So it's still great. It's amazing. Yeah, yeah. Because the average improvements are 21 millimals per mole in hemoglobin A1C, which to the doctors out there, that's better than metformin would achieve. So even the ones that don't get remission,

they're still getting significant improvements in blood sugar. And only at the end of three years, only 2% have worse diabetes than when they began. Whereas if you did nothing, of course, diabetes would tend to deteriorate for everybody. What do we get taught? It's a progressive, chronic, irreversible condition. Which is just not true. No, that's exactly. I just like you used to think, well, I'll add one drug and another.

And I'm so proud of this data because it proves in the health service we have a different way. And another statistic is that there is nationally collected data on what my practice spends on type 2 diabetes. And compared to 20 local practices, all the 20 local practices, we've spent 370,000 pounds less on drugs for diabetes since 2018. So we've saved money. And there's more. There's more. Well, I'm just imagining that $370,000 in one practice.

And you've put that over a thousand practices over the country. I mean, you're talking about a healthcare revolution. Yes. Literally. Yeah. So in one of the papers we published, we looked at what would happen if every GP, in the UK prescribed as we did. And you'd save about 270 million a year.

You could build hospitals every year. And other practices have replicated what I've done. There are practices all over the UK. There are practices in New Zealand, in Australia, in Malaysia, in North America, in South America. It has been replicated all over the world. But just going into the detail first in my own practice, it's more exciting even than that

because if we look at people with pre-diabetes, so we've audited that, so the people who have pre-diabetes, of those that go low-carb, 93% achieve a normal blood sugar. So they've gone out of the pre-diabetic range and gone back into... Completely normal.

That's right. So it seems as if this is what we were saying earlier, about it's not chronological age that matters, it's metabolic age because, so the people with pre-diabetes, they have better metabolic health than me. Then, if you offer low carb to people as they are diagnosed with diabetes,

like the guy we were talking about, the 39-year-old, 73% of those will get drug-free remission. 73% get drug-free remission. If I wait five years, and you've had diabetes, had diabetes for five years, only 50% of you will get remission. So it seems to me like the longer we wait and the more serious, or the worst is your metabolic health, the less likely you are to get remission. And that's the pressure to think, well, you know, stitch in time, why wouldn't you do it earlier? Why wait? Yeah. Why wait until you somebody like me who actually has type two diabetes,

wouldn't it be better if I'd done something earlier? There's a couple of things I want to just sort of make sure we've covered. Yes. Mainly because I understand how confusing diets are these days for people. Yes. And how divisive and controversial things often get. You know, people get quite stuck in their camps and start to throw metaphorical stones at people in other camps, right?

So you're saying, and please correct me if I've misinterpreted any of this, you're saying that you used to have tarty diabetes. and now your type of diabetes is in remission. Yes. You were unable to previously do much for your patients with type two diabetes apart from just keep them on medication and things would progressively just get worse. Absolutely, that's what I saw.

And then over the last 13 years or so, you have found a different way of approaching things, right? You have found that for yourself and with many of your patients, if you have type 2 diabetes or pre-diabetes, a low-carb approach seems to be very, very effective for many, many people. Absolutely. And it isn't just me as well. It's the nurses in my practice and the other day. It's now a practice-wide approach.

Yeah. Because they didn't agree with what I did originally. They were worried and we had arguments. It was quite a difficult thing. but the value of collecting data is I've convinced all the partners in the practice and the nurses and so now the entire team are doing this. I don't want to talk about individuals necessarily, but even when you have the data, have you had pushback from people saying that this is ridiculous?

Yes. Well, particularly in the early days, and some of it was understandable. The worst times were sort of 2013 to 2015, so I actually got hate men, I got heckled in doctors' meetings. I was shouted at. And some of it was understandable because the point that worried other healthcare professionals was that if I'm saying it's okay maybe to have more protein,

what's that doing to your kidney function? If I'm saying it's okay to have full fat yogurt and full fat milk and use double cream, what's happening to the lipid profiles? and I think that was another reason that I kept such careful data and what we saw and in fact what we published

in our most recent paper which is BMJ Nutrition 2023 was that every single marker of cardiovascular risk has improved for my patients the cholesterol the HDL, the triglyceride

the ratios, their blood pressure but all of those things, every single marker and so I think people are less worried now by my approach because I've also gone ahead and said, fair point, let's have a look at cardiovascular risk. And then again, let's have a look at high protein. What has that done? To the kidneys. Yeah. So I paired with Professor Wong, who's a local, he's a professor of nephrology, and we looked at my patients and actually their renal function, their kidney function improved. If you really take a step back from that,

it seems slightly illogical that metabolism, which is such a fundamental part of the human experience and how we experience health. If that's getting better, you kind of think other things are likely to be getting better as well. Well, that's what we looked at actually with Professor Wong when we were looking at kidney function. What is it in diabetes that causes kidney function to deteriorate?

and the common denominator of so many things is blood sugar. And a single fact that really has burnt into my mind is that if you have a spike of blood sugar, you damage the non-stick lining of your arteries. The glyco-calyx is damaged within six hours. And so for me, the common denominator is that high blood sugars do damage and they do damage to the micro-circulation, that's your eyes and your kidneys,

and they do damage to the macro. That's your big arteries. High blood sugar actually is aging you. It's aging you. Talking about the sort of interconnectedness of the body again for a moment, cataracts are on the rise, aren't they? And again, cataracts are on the rise, what's that I've got to do with my blood sugar, you know?

And actually on that fact, an ophthalmologist contacted me from Cumbria and she said that weird things happened in our area people's retina has started improving people she'd been screening the retinas every year and she in the end she said what's going on because they also were losing weight they'd gone low carb

and the retina so the retina becomes damaged with a high blood sugar it's a very vascular sensitive organ And this was yet more proof, really. This lady contacted me saying, it's so weird, I've never seen retinas improve, or peripheral neuropathy I've seen improve as well. Yeah, another way I sort of would often talk to patients about this is to help them understand that your body will do whatever it can

to keep your blood sugar in a very tightly controlled range. Yes, that's a great point. It's very important. Because it's dangerous. Because it's dangerous. So it will keep it there. And the problem is today is that because we abuse our metabolic system in so many ways, primarily through the food that we eat these days,

is that that process stops working. And the end result of that process not working is your blood sugar can no longer be kept on that normal age. Your body's trying. It's pumping out more insulin. It's trying its best. and actually it's causing damage in those years before you get the diagnosis that chronically elevated insulin as your body is trying, that's damaging you anyway

but we don't even get involved then until you've actually crossed the threshold but I think it's the idea that when your blood sugar is persistently high it is going around the body doing damage in a lot of different places. To every organ and just going back to the diet again

what I had missed. So I would start the day with a big glass of fresh orange. This is when you were... Yeah, yeah. So if we just go back to how the assault on my body started first thing with, you know, we had fresh orange by the liter in the fridge because I thought that was healthy. So that was... Then I'm thinking, right, musli, that's healthy, so I had that.

But I had loads of extra sultanas in... Because that just made it so tasty. It was delicious. And a banana. So that's sugar with my sugar. then I get to work and I'm having biscuits with my morning coffee because people do and then at lunchtime at sandwiches that's more sugar and then you might have a pack of crisps with your sandwiches that's more sugar you just ate

and then mid-afternoon I'd have a bar of chocolate and more biscuits and go home to some I used to love pasta so my life was sugar with my sugar with my sugar with my sugar my metabolism didn't stand a chance. How many grams of carbs a day do you think you used to have in your heyday? I know. I think it was about 300. So you used to have... Way, huge.

300 grams. And were you relatively sedentary then as well? Yeah, because it didn't run. And you sit... A busy GP? Yeah. So you sit behind your desk all day long. You press the buzzer for people to come in so you don't get up off your bum.

And also, people knew I love, biscuits so the patients used to hand over because they're fond of me so they would oh i don't know how my drawers were full of biscuits that i ate and they even knew the biscuits i liked so i'm scoffing biscuits although it's amazing i was conscious it's amazing so yeah i used to have i said before i used to have a little sleep on my own doctor's couch at lunchtime after lunch because i was so drowsy after lunch and then i have to wake up that's when I would wake up with a bar of chocolate and a strong coffee to get me through the afternoon.

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

It's come down to probably about my own. 40 grams. About 40 grams a day. So that's, for many people, that's quite low. And do you not experience times in the day where you're hungry, where you feel like, oh, I've got an energy dip? No. You see, now I'm a fat burner. I'm burning my own fat. So actually, I can eat once a day if I have to. I never eat more than twice a day. I haven't eaten breakfast for years. So what times do you normally have your first meal these days? I normally have probably lunch, maybe one o'clock. I won't have eaten until then.

Are you open to sharing the sort of things that you eat? Yeah, yeah, sure. What might you have for lunch? So a lunch might be something like maybe a three-eg omelet, something like at least three eggs. Or it could, trying to think what I had yesterday. Oh, yeah, it was quite a lot of pork with loads of homemade coal slough. So that was lunch yesterday.

And then... You'll have dinner when? Six o'clock. I try not to have it too late because... And then, again, it would be a meal with protein and cream veg. So what would it be yesterday? I think there was a couple of lamb chops and loads of broccoli with a bit of butter and some almonds on.

And then raspberries and cream afterwards. And on the days when you run, Yes. Do you change how you eat? Not at all, no. Because now I can... So I used to run, I remember in my early days, do you remember those little sachets that horrible...

They had sugar in and salt in and that. So, and in fact, when I first ran, I carried jelly babies because I thought I needed, like, I felt I was having a hypo. But now, I don't run beyond about four miles is my now. Is it? And is it relatively low intensity when you're running? Yes.

Yeah. Unless I'm sprinting with those grandchildren. Yeah, but again, people don't realize if you're, if you train your body. Yeah, it's routine for me now. If your heart rate is you're not running too fast and pushing it high, you can, you don't need to eat since before you run. Your body will burn fat. Yeah. Well, I usually run fasting because I usually run in the morning.

So I won't have had breakfast and I don't eat when I get in. And I might do sprints. It just, or I might do weights. Yeah. But yeah, so I can burn fat now. I am a fat burner because that's ketosis. There's a lot of freedom when you, you know, there's many ways to get to burning fats,

but I would say that in the modern world, one of the things we struggle with is temptation. Yeah. You're traveling. You're at a train station. You know, you need to go on a train for work or a plane or whatever. And what are you surrounded by? You're tired.

You're out of your routine. There's not often really good food choices. Whereas when you have trained your body to be able to burn fat, you're actually liberated because you just go, I just won't eat. I can eat or not eat. Yeah, I'm just not going to eat. Whereas if you're a trained sugar burner, you have to eat. So then you're in real trouble because you're at the petrol pump

or at the trains and you're like, damn it, I want to eat well, but I can't. So you went up with the chocolate or the crisps. Well, that was really, I've noticed this with many of my patients. They go lower carb. And then I say to them, we'll notice when you're at your best. And start noticing. And we all have to individualize. our diet to suit us. So I go, I do about 50 speeches a year. So I go all over the world and

is the food or not or very often the buff, it's ridiculous. I go to diabetes events and there's usually not anything I can eat at those events without putting my blood sugar up, nothing. So I have to fast because there is nothing for me to eat. So for me a practical, it's just been practical to go lower carb and many of my patients who've done this with me now for, you know, 13 years have come to the same conclusion that, well, it's just easier to, on the whole, try ketosis because then you've got this flexibility. Now, you can break out of it, I suppose, if you go on holiday, but I actually find, I just prefer to stick with it. It's just simpler, I like a simple, easy life. Yeah. There are many different ways to put type to diabetes into remission,

aren't there? You should mention that, yes. One of the ways, the way that you, you've used yourself and you recommend to many of your patients is the low-carb approach. But it's not the only way, is it? No, not at all. I think it's an important point. It's very, you know, so I mean, we must mention the work of Professor Roy Taylor, who's a friend of mine, and he was a senior author on my last paper. And his work's great.

Yeah, so he's doing it a different way, which is just over 800 calories a day as the soups. and you can prescribe those. So he's giving people a low-calorie diet, but actually it is low-carb as well, of course. Because if it's low-calorie, if it's low food, if you're only having 800 calories a diet a day, that has to be low-carb. But that's actually on prescription,

and what's interesting is bariatric surgery works really fast as well. Bariatric surgery can have people off insulin. But of course there is a consequence to bariatric surgery. When you're talking about risk rewards or the pros and cons. Yeah, it's major surgery and there's a mortality involved. So again, sharing with patients, which would you like to do? So bariatric surgery can't be reversed. And bariatric surgery, for me, doesn't very well address what your problem actually is.

And I think one thing you and I haven't talked about is we're both passionate about, why is this person suffering in this way? What's upstream and, you know, what's upstream of diabetes is like, why did you eat like that? Yeah. And one of the reasons that I ate a lot of junk food

was I was kind of addicted to it. So, you know, I could have had bariatric surgery, but would that have cured me? Would it have taught me to eat better? I wouldn't have learned. So the drawback of bariatric surgeries, it's technically good, but have you learned how to care for yourself, have you learned how to make it a long-term success?

And we know that people have bariatric surgery, after about two years, a significant number of them are gaining weight again by their blitzing, Mars bars or that kind of thing, or some of them are drinking. And that's because bariatric surgery, surgery did not deal with their actual problem. Yeah. It sort of put them in low carb jail and then they'd find a way around that.

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

assume that we've got the liver fat and the pancreatic fat that then causes the type two diabetes. Yes. My understanding of Roy's work is that any mechanism by which you can get rid of that liver fat is is a very successful way of reversing the type of diabetes or putting it into remission, which is the technically correct term. Although I want to talk about why we use that term actually in just a moment.

If patients can lose significant amounts of weight, I think one of Roy's early papers showed that maybe it was 10, 12 kilos of weight loss, I think. About 10%. 10%. He would say losing 10% of your body weight is very likely to get you drug-free remission. But you're right.

His work has shown is the liver fat has to go. And if I could just explain for listeners something about this. So the physiology here, think back to me in my 50s. As I ate the musli and the bananas and the chocolate bars, what was happening was the excess sugar that you don't need for running around is being pushed. inside cells by insulin. That's the work of insulin

to protect me from the high blood sugar. So your body's left with no alternative but to turn that excess sugar which is dangerous into something that's less dangerous, fat, particularly in the liver. And so Roy Taylor talks about the long, silent scream from the liver

which is the 10 years while I was overeating carbohydrates and my liver was filling with fat. And it is the fat in the liver is actually causing insulin resistance. So that then my insulin didn't work as well. And then my body has only got one alternative and that's to ramp up the supply of insulin.

So if my insulin works less well, you need more of it to clear that miles bar. So then you have another state which is insulin resistant and hyper-insulinemia, which is a high level of insulin. gradually though as your liver fills with fat the insulin resistance gets worse but remember that insulin is produced by the pancreas gland and unfortunately the double whammy

is that my pancreas filled with fat also and so the emergency response to the failing insulin is shut off because you can't produce enough insulin and at that point the system collapses and I developed type 2 diabetes all of this the good news is all of this can be put into reverse with bariatric surgery, fasting or low calorie diets or low carb.

So that's just the physiology because I like people to understand that because if you understand what's going on, you're in a much stronger position to individualise making choices yourself, you know? Now there's many people who listen to this podcast who prefer to eat plant-based or vegan. Yeah, yeah. Because of, you know, a whole variety of different reasons, including ethics and, you know, animal, compassion, etc., etc. When you were mentioning the low-carb approach that you have found successful with your patients, have any of them managed to do it in your experience whilst being vegan or plant-based? Yes, actually. Not many, though. But it is possible, isn't it?

Oh, yes, it is possible. And I think that's a key point I wanted to make, because a lot of people might be going, well, Is that my only option? I don't want to eat out. And I think they can still do it if they're able to lose weight. Yes, they can. A different way. And at this point, I don't know whether I can mention D-Life India.

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

to do. You have to be quite clever, but if you're motivated, of course, yes, it can be done. Yeah. For someone who's listening, David, who perhaps is having a, more conventional or what is more normal these days, you know, a moderate to high carb diet. Yes. So they are having cereal for breakfast and a sandwich for lunch and pasta for dinner. And I don't know, let's say they're in their 40s and they're feeling good, they've got energy,

they're able to do what they want to do, they don't have any excess belly fats. What would you say to them? Well, first of all, those people are quite rare. Okay. You know, in the British Health Service, they are rare and become. becoming rarer. So first of all, I'd say congratulations, you're amazing, and I'd be curious how you did it. And I think curiosity has taught me a great deal. So if I find somebody who's successfully healthy, I'm fascinated. So I would be wanting to ask that, I'd be very interested to ask how

you did it. It could, of course, be that they are extremely active. It may be. And some of them would say, well, you know, I'm a runner or whatever. So having said all that, because it's so rare, I would just want to check that the lipid profiles were okay, things like the triglyceride fasting triglyceride, to be sure, and is your blood pressure fine. And if, I mean, if you're healthy, I'd be just celebrating that and well done and a bit curious. But I would say to you that, you know, the minute if your belly starts getting bigger, or if your blood pressure goes up, or if your triglyceride goes up, then perhaps you ought to cut back. I'd be a bit worried

because of course that was me for many years wasn't it? Yeah. So as a younger man well, I was irresponsible with my body

and what I ate so I thought I, so in my 30s let's take me in my 30s I wasn't particularly heavy I didn't have a big belly my body did what I wanted of it

and I neglected it I neglected it. And I got into some habits with the biscuits. That's where it began. I felt I was a bit stressed. So somehow I think that was a response to partnership and medicine. So, I mean, it brings danger when you know, you take your body for granted. And if I could speak to my younger self, you know, I wish I hadn't eaten as many biscuits.

I wish I'd done differently because maybe my metabolic health could be better. Because now, if I eat so much as a banana, my blood sugar is in double figures. Well, some people will say critics of this kind of approach. You know, I'm a fan of this approach. I used this approach on BBC 1 back in 2015 and helped a lady. I think still to this day from what I can tell was the first time that I'd ever be done on television anywhere in the world in 30 days. I was tired of diabetes since remission.

I was cheering to that. Yeah. You were my hero. I was like, wow, yes. It's incredible. That was 10 years ago. years ago, but I remember back then, that was so controversial. That was 2015, and I'm thinking, you know, I remember going back into my NHS practice after

that aired. And I actually can still remember a conversation with one of my colleagues who watched the show and said, you shouldn't have done that. I said, why not? It said, well, I've just been to the Diabetes Conference in Cardiff, and you shouldn't have put them on a low-carb diet. that's not the recommended diets. I remember, I was saying, yeah, but did you see what happened? Did you see the results? It doesn't matter. She said, you know, that's not the recommended diet.

And I remember thinking, oh, wow, this is kind of crazy. Like, this patient has had her health transform. She's in remission. But such is the conditioning of our training that even a colleague, I just couldn't see through it. And you said curiosity before. what I get we all have different experiences there was a point where you didn't know what you know today

there was a point where I didn't know what I know today so we're all on a different part of our learning journey but I don't get why there's not more curiosity from some of our colleagues I would prefer her to say hey listen you know I saw what you did it's not what I was recommended by the Diabetes Association at the weekend but can we have a coffee and just talk about it

because it's really interesting or what research have you got to back there or whatever. I would have loved to have had a conversation when it was, you shouldn't have done that. Yeah. Yeah, you know, I've worried and worried about this exact point. And I think some of it is to do with the perception of guidelines. So they've brought guidelines, nice guidelines.

We're all now advised by nice guidelines. And I find young doctors are memorizing the nice guidelines, which is a lot of hard work. It's a lot of hard work. And I think for an inexperienced, doctor, guidelines are very helpful. Yeah. You don't have experience of many things. Or even that confidence from having done it for many years.

It's kind of reassuring. It's a crutch because it's reassuring because you're doing the guidelines. But I think we're confusing guidelines with they are not rules that must be obeyed. They're not tram lines. They're guidelines. And one of the wonderful things about medicine is the ability. to improve from experience as you get older. So there are compensations for being 67

because I've just seen so much medicine. Yeah. But if you don't learn from that medicine, if you're not curious, and if I was to practice medicine exactly the same now as I did when I qualified with a bit, that's very sad. Because otherwise we may as well

just have AI learning and have machines to it all. Yeah. Experience and expertise is key. I think patients' expertise of themselves is key. So for me, it's a collaborative approach. I supply information and experience,

but the patient supplies what works for them. And so what's gone wrong with cure it? I think doctors, we're not, I know what some of it is. Isn't it funny? We think we're scientists, don't we? doctors, but we're not scientists. Scientists have a hypothesis and then we try and destroy the hypothesis. So you have something and you think, but is it true? Can you test the hypothesis? And in that way, science moves on by disproving things and doing it better. And yet medical

trading is memorize all this stuff. Memorize all these drugs. Memorize all of this. And there's not very much about scientific method, then the other thing is we were taught very little about research and very little about how you would interpret a paper in terms of the quality of what that paper shows. And so we're not very well equipped for the adult world of medicine in terms of changing. And then you feel threatened,

so you just do the same old stuff and you're tired. But the lack of curiosity makes me very very, sad. And I know on social media, people again and again are so disappointed because they say, I was so excited, I went to see my doctor because my blood check is normal and I can't wait to tell them. And then the doctor's not a bit interested or even slightly defensive. Isn't that a worry and sad? And unfortunately, some of those doctors will also be knackered, burned out. They're not feeling good themselves, so they don't want to hear new stuff. They don't want to learn a new thing. They're tired by it all, which I get. But it's very hard for patients.

that, I think, when they're trying to make a shit, the way I look at it sometimes, I think, are we moving on? I think we are. We are making progress because back in that time period that you mentioned already, 2013, 2014, 2015, when you were discovering this, when I was showing this on TV, it was quite new, right? There was a bit of pushback. And I remember even being told that this idea that type 2 diabetes could be put into remission or is reversible, that's not I'm like, in my head I was thinking, I know you're telling me it's not true, but I have seen it happen with multiple patients. So you can keep telling me it's not true. I'm like, but I can, I'm seeing it. So I kind of trust what I'm seeing as opposed to what I was taught. And then I think,

well, okay, we've, it's, and this is maybe he tells us something about human nature, either in the fact now in 2025 that it is widely regarded as acceptable, that types of diabetes is, can be put into remission. You can even read code it on medical notes now in a way that you couldn't 10 years ago. This is well established. Instead of celebrating that now, I think people start fighting over what is the best way to get there. And I think, well, hold on a minute. We've made progress. We now understand that it's not chronic and irreversible. We can treat it successfully with diet and lifestyle. We can often put it into remission or reverse it. And there are a variety of different ways to do that. There's bariatric surgery. There's a low calorie diet from

Roy Taylor, there's a low-carb diet. And maybe for some people, there is a vegan diet that can do it if they're able to control their calories and, you know, get the weight off with that approach. We should be celebrating that rather than fighting. I agree. I mean, there's so many sick people. Yeah. Cricky. You know, how's it going? Nationally, it's a disaster, in my opinion. It's getting worse. So there's so many sick people. So I wish, let's be curious. Let's be interested in success. I found that in medicine to be a really good thing. Always be curious. If somebody improves their health, why do we always constantly,

medicine is all about noticing sickness. But actually you can learn a lot from people who surprise you with wellness. And that was from that very lady. That began me to think. I think the other thing that's good now, I think social media is a phenomenon, really. makes a lot of this idea of lifestyle medicine is a grassroots revolution.

Yeah, exactly. You know, I learned from a patient and so did many other doctors from clever people who worked out how to get better health and celebrate that. Have you noticed a difference, David, between men and women when it comes to this low-carb approach

for people who have got poor metabolic health? I think with care, I'd say I have. One thing I would like to say straight away is I remember, I'm often asked, do men or women lose most weight, low carb? And I'm very lucky because I have a medical statistician. And, you know, she's actually helped me for five years. Christine Dallon has helped me for five years for no payment, nothing.

She just helps me in her spare time look at my stats. So I asked Christine, okay, do men or women lose most weight with low carb? she said, well, if you look overall, men lose most weight. But if you look, remember that men are taller and heavier. If you look at us a proportion of their weight, women do slightly better than men. Wow. Isn't that? And I had no idea.

That is super interesting. And another interesting thing, so statistics is interesting. I used to hate statistics and audit like bar humbug. It actually answers questions. So another interesting question is do younger people or older people do? better. And you know what? It's the older ones. The older people, she did all this very carefully with all my data and the older people lost slightly more weight than the younger ones. I think it's because they're organized. I think they have the money and time to sort of sort themselves out.

So, but going back to your question, so actually women in terms of percentage weight loss do slightly better, but they are, so men, I would say, they like a message kind of straight somehow, brief and straight, like, oh, how do you do it, right? And some of them just go away and do it. My female patients like a bit more detail, because they're wondering, well, what recipes might work or what they want a food plan. Not many men ask me for food plans or recipes. That's interesting. The blocs like it in a blokey way and they like it quite straight. The women have got more questions. You know, we're going to come on about food addiction

because I think women have a slightly maybe different relationship with food and it's quite complex sometimes. What have you observed that? I think so quite a lot of my female patients have, have told nobody that maybe they're addicted to bread or that their secret eating are all sorts of things because they're ashamed or maybe they have a weight problem and that they suffer with stigma because of that

and so they just think maybe they're weak-willed or something and nobody's ever said to them you know what if your problem was addiction you know because so somebody with alcohol well then they're not an alcoholic to annoy me people with cigarettes don't smoke cigarettes to annoy me it's an addiction problem they they can't regulate it and therefore moderation doesn't work very well with cigarettes and half a glass of whiskey there's no doctor i know who would say half a glass of whiskey is okay if you're a dead said

yeah and so I started thinking about women in terms of carb addiction this is my wife's work because she is a carb addict I was married to one and didn't even realize so I'd known her for so long but then just to finish on that

I actually thought it was women and then I started asking the blokes and actually some of them were carb addicts as well. So I don't know where that's going. But this topic of food addiction, again, it's also been quite controversial because for many years. It said not to exist. Yeah, they said it doesn't exist. And you can't, because of course you don't need alcohol. You don't need a cigarette to exist. People used to say, well, and I think many people still do, that, well, you know, you need food. So you can't be addicted to food. That was one of the lines of thinking, which I've always found

a little bit problematic. Because if you look at the way, you know, you know, you can't be addicted to food. That's, you know, you know, you know, you can't be addicted to food. That was one of the lines of thinking. Which I've always found, which I've always found a people's behaviours are around foods, some people, and you compare it, you're like, well, whether you want to technically call it addiction or not, I think that looks like an addictive behavior for that individual. Right, I have a few things to say on, a few things to say on that. So, yes, we're told officially ultra-processed food addiction doesn't exist, so that there are no clinical services for this problem.

And what's interesting about this is, well, I've got clinics, I can refer you for nicotine, I can refer you for alcohol. But how about this? I can refer you for gambling addiction and there is no substance even. There are clinics, that is accepted gambling addiction and there is no substance even. And then if we come to a what is addiction? How would you diagnose addiction as a doctor? And you're diagnosing addiction when intelligent people do things they need.

know harm their health and cannot stop. So somebody intelligent drinks when they know it will harm their health. They nicotine when they've had a heart attack. But isn't it the same as intelligent people and I know so many people do this? Cannot stop eating bread or pastor or whatever it is. They get cravings. There's secret eating. And I've got permission from a patient to give you a specific case that illustrates this so well.

And I've seen this guy in the last week to check that we're fine. And he wants me to tell this story. So this is a successful business person. He runs a business. And he has poorly controlled diabetes and he's overweight. He has a really severe orthopedic problem and he can't have the surgery on his orthopedic problem because his diabetes is so badly controlled.

So he's been refused by the anesthetist, for surgery. And the reason his blood sugar is high is because he can't stop eating bread. That's the reason. And he knows it's the reason because he's intelligent. His wife discovered that he was eating crusts of bread out of the bin that the rest of the family had eaten. So she loves him and she thought, right, I'll stop him.

So she put detergent on the crusts. He still eats the bread. Even with detergent on. Yes. His wife told me all this. And he's, say it's right, she discovered the only way to stop her husband from eating bread, despite the fact it's threatening his life, and despite the fact he can't have the surgery he so badly needs,

was to spray bleach on bread and leave the bleach bleach spray by the bin as a signal to a husband, don't even try, I've been there before you with the bleach. Is that not, is that not for you, that's addiction. So you have an intelligent person. who's doing something, he knows to harm his health, and he's in agonies of pain and needs surgery that he cannot have. What's interesting is, so there are criteria for addiction. These are the criteria.

You continue to take something that you know is harming your health and that if you don't have it, you get cravings. It's the very basis of addiction. And you would not believe the, if you never ask, you won't find it. So I never asked anybody about rice or bread or pasta as an addiction. And that's a great way never to find a food addict. So I never found one. I thought they don't exist.

In every clinic I do, I find them. And in fact, we now have research on this. We know that somewhere about 14% of the UK population are food addicts. We also know from Sweden there's a wonderful paper there that if you are an ultra-processed food addict, you are 600% more likely to develop type 2 diabetes. So in the population with type 2 diabetes, there are a lot of food addicts. And in fact, we do group consultations at the practice.

So we run this idea that you don't have to have an appointment. You can just come and the room fills with people I know and we're caring for each other. It's the way to do it cheaply for all these years was to run group consultations. Anyway, we did an assessment of everybody in the room, room recently, not one person in that room didn't screen positive for food addiction, not one person. Right.

As we all sat there, we did the point system and at the end we all, you know, so that's my spiel really. And I think if we're caring for people, what matters is maintenance. So, okay, you did a great thing, you know, great, well done. But what happened a year later to those people? And if we can't, in the health service, if we can't maintain improvement, we are wasting our time. And part of maintenance, the Holy Grail, Roy Taylor called, that's why he's interested in my work. He says, David, what's the magic source, he calls it, in your practice?

Because we're curious, we're tenacious. We're trying so hard for maintenance. And if you don't address ultra-processed food addiction, you will fail because if you are, are an ultra-processed food addict, you can do good, but Christmas will come, the holiday will come, your birthday will come, and a little bit of cake can be your undoing. And that's why Jen's work. She's published on this. She's published actual, the first clinical outcomes in the world. She was the first person to do any studies and get clinical outcomes. She did a three-centre study. she did North America, Sweden and the UK, three centres

and everybody, that study was done for free because every single person, that should have cost a million or a million and a half, cost nothing because everybody worked for free because they believed how important this is. Are you and Jen, your wife, both food addicts, would you say? Ah, now that's really interesting. Jen is a serious addict. So to give you an example, when we went low carb at the beginning,

it worked for her. And we thought we'll have Christmas Day off. You know, it's Christmas Day. Come on, we've got kids. And because of Christmas Day, she couldn't get a grip of her carbohydrate intake till May. So she gained weight from Christmas Day till May.

Five months. Yeah, and it was, I'll do it on Monday, tomorrow, tomorrow. And so for her, she's a serious addict. And she's a very intelligent woman. she's a consultant clinical psychologist and she couldn't stop it despite knowing it was harming her health she says I'm a harmful user

so she's clever she says David you're a harmful user which means I can really drift badly but I'm better able than her to stop it I'm better able to say on Monday I'll stop eating but even for me you know if I was to eat milk chocolate

one cube of milk chocolate will make me hungry and gravy. I tried it because in the early days people would say, Dr. I mean, I've made you a birthday cake. Go on,

just have a little piece and out of courtesy I would have a small piece but then I'd get such cravings afterwards and such hunger I learned it's just simpler for me not to break the rules.

You two don't do cheat days anymore, is that right? No. Never. I haven't, never. And the reason is so I can give you an example.

It was a big wedding anniversary and we went to Michelin starred, what kind of place, spent a fortune and the chef did me a special lemon pudding and you can't, what can you do if the Michelin Star said, da-da, I've made this for you

and it's got sparklers in it and I remember it very well. It was, he did it to look like a lemon and it just looked like a lemon. It's like a lemon sorbet that looked like a lemon. When I ate it, it was like little sparks were going off in my brain. I thought, this, I've never eaten anything.

like it. Oh my God, this is so good. But you know, I was over enjoying it. And afterwards, the rebound was a sort of weird mixture of anxiety and depression that went on for two days. So we were staying in hotel and it completely ruined my little holiday because the next morning I worked with a sense of doom and kind of worry. And that didn't leave me till the day after that. So the consequences of that marvelous half hour while I was eating that pudding wow but really my experience was like somebody having a drink who you know can imagine you haven't drunk for five years and you have a whiskey this whiskey is amazing I feel terrific I feel amazing but oh my goodness the next day so no I could say I never cheat now it's simply not worth it but it's interesting for me that you've been on this

journey for a little while now, right? So 10, 12 years. And throughout that process, you've learned things about yourself. You try to cheat or you've been caught in a position, right? You do what everyone does and you go, ah, Christmas Day or, oh, it's the anniversary. But you've figured out that for you, you can't do that without a serious consequence. So you've got to the point where you've, you've had enough of that to go, yeah, you know what, I'm better when I don't do that. That's exactly. Of course, not everyone perhaps has to be that extreme, right? Well, and they don't actually have type 2 diabetes like I do.

So would you say currently your type 2 diabetes is in remission? Yeah, absolutely. It's in drug-free remission. So my hemoglobin A1C, my average sugar in this is 36, which is a very good result. What do you say to people who say, listen, the low-carb approach is not fully dealing with the root cause? Because some people will say that things have gone wrong in the body, therefore the blood sugar has started to rise. Of course if you don't eat carbs, you're not going to be spiking your blood sugar,

but the underlying process of the accumulation of liver fat, for example, hasn't necessarily been addressed. What would you say to those people? It's a fair point. I'd go back to the physiology, and I'd be pointing out that this is about insulin. Yeah. This is about insulin, and then it's about insulin not working as well, and insulin resistance.

And why is it? I, what's the reason for insulin resistance? What's the reason that that occurred? And I would say for me, I know how I ate, and I know that it was sugar and carbohydrates and biscuits, and that I believe the physiology whereby my body had no alternative, really. It had to get rid of that sugar. And the only way to get rid of that sugar was turn it into fat in my liver. And the fatty liver was the beginning of insulin resistance

and then hyperinsulinemia. And I do think I'm dealing with the cause, the root cause of it, which for most people, I believe, is too much carbohydrate over time. Now there are other things that I might just mention. One of them is seed oils that I don't know, there is a bit of suspicion. That's new. We weren't using corn oil, were we 150 years ago? So we have done some other things in society. And I do have, that's why my patients, I'm advising

them not to use seed oils. Because I do worry a little bit about the omega-6, omega-3 ratios. I do worry about them causing inflammation. So again, I could be wrong. So I have to be broad-minded and say, well, I think what I'd say, you know, if you can go away and beat me and get better data with your patients, if you can do better than me, I'm fabulous. How did you do it? Yeah. And I'd learn from you. That's why I'd say to any other doctor, do your best.

Try. Collect data and beat me. Please get something. Let's do even better work and try and find out how. But until that happens, I'm fairly happy with what I'm doing. on industrial seed oils, I don't see any way. If you're a sick patient, yeah, for years I'd be seven,

I think it's better to try and avoid them. Let's go with olive oil, right? Yeah, I would. Or even butter, I think probably butter's okay. Yeah, and it's like people will debate and get all sort of antsy over, you know, what does this trial say and what that try to? I can just go on my clinical experience as well.

I think generally I've seen it work really well. And I don't, I can't find stuff that convinced me that there's really good benefits, of having seed oils. Yeah. Right? So why don't we stick to stuff that we're a bit more confident on

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

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

that I'm adapted to eat in the modern world and it's a struggle. Your children have also gone low carb, I believe, even though they don't have type to diabetes. Correct. So what was the motivation for them? That's right. So we struggled in the family. So Jen and I did it first and we annoyed the teenagers.

And, you know, because they felt they had a right to the, so it was a real struggle for the first few years. So we had to compromise. And I remember we used to have, first of all, we had carbohydrate corner. So that was, there it is, okay kids, that's your bit. And then we started thinking a bit, well, that's a bit disappointing because don't we love our children more than ourselves? And is that okay to just let them ruin themselves as I ruined myself?

So that was, it was a worry. And then we adapted it slightly, which is we did meals, so the protein was okay, the green veg was okay for everybody. if you wanted rice or oven chips, go and fix them yourself. Okay. And they're dead lazy. Teenagers are dead lazy. And they, you know, so they made a farce. And then they were just two, but we didn't, we didn't corner them.

You know, we didn't corner them. We said, listen, we want to be fair. You know, we used to get, you can get rice and little things that you put in the microwave. So we bought those for them. Go on get it if you want it. and that was one approach that worked really well just like you fix it yourself if you want but the other thing was Jen really went

she majored on delicious low-carb food so she can make birthday cakes with almond flour she can make pancakes using gram flour so gram flour has got loads more protein so much better in many ways it's a far superior flour to wheat flour so she's making pancakes who's making batter. So you're not depriving yourself.

So if you can have pancakes with fresh raspberries and double cream, well, isn't that okay? Or then I started doing a thing, which is I was blending, I'd say, you know, I'll make you some ice cream. So I would blend double cream with frozen raspberries at the table. And they'd kind of think that's fun. And it's like no pudding or that. So we were sneaky really.

We learned how to do really tasty low-carb, cakes if necessary, pancakes. We can do a low-carb Christmas. We learned that. Now, the other thing was vanity. So the boys, two boys and a girl, the boys wanted to be, the word is hench, I believe, among young people. So they wanted girls. The boys wanted girls.

They wanted to look hench. And they observed that even their dad, was losing the dad bod, and I could outrun them. I could outrun my sons. So far, I don't know whether they're even listening, none of my children have beat me in a sprint. Really? Yeah, really.

And they tried. They've tried. That's pretty cool. Yeah. Cool for you. And it's very annoying for them when old guys, so they think bloody hell, you know, maybe he's on to something. And they wanted the girls, and one of them was slightly,

he overweight and he wants to take his t-shirt and off and swim and stuff like that so he came on and of course my daughter wanted to be attractive or maybe acne or you know skin condition matters so gradually all three of them gave up bread none of them would eat bread ever i'd never seen them eat bread for years they've gradually and now have eight grandchildren who are all low carbon luckily they've gone away and found partners who also have chosen whole food approaches to health and then monitoring. And as it happens, of the grandchildren, three of them are quite ill with gluten.

So as gluten is changing, as bread is changing, three of them, they're just ill if they have bread. So that's been our family. There's a much higher concentration of Britain now. Bread isn't. And there's modern breads. Bread isn't what it was. No.

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

High proportion, I just say, can we just try going gluten? Yeah, try it and see what happens. You know, for some people. Just something about bread that, I don't know, you are younger than me, but when you were little, did bread go mouldy? I think it did. Yeah. So my mother, you would say to me, and the mould, do you remember it was like all different

colours of blue and green? And she would say, so we didn't have much money when we were little. So she would toast mouldy bread and tell me it was penicillin, which was a mum's clever way of getting you to eat it. And I remember that so clearly, she'd say, okay, it's gone a bit, there's only bits It's blue and green. It's just penicillin. I'll toast it for you and it'll be tasty.

You'll love it. You tried bread now. It never grows mold anymore, does it? We kept some, you can keep bread for weeks and weeks and it never go. Something's changed. Something has changed in the bread. It doesn't go moldy. You mentioned not having much money when growing up.

And one of the things that people will often say when it comes to eating more whole foods or eating a low-cal diet is the cost. How do you manage that? you practice? I've learned a lot from my patients because we're north of Liverpool, so I'm not, many of my patients are on benefit. So that is a great, it's a great question. And that's social security benefits.

Yeah, yeah, yeah, they're on benefit. So what they say, the patients tell me, the first thing is to be honest about what you're spending a baseline because they say, if you're being honest, you're buying packets of crisps, People just do. Fizzy drinks in cans at a pound a can. Yeah. And a pizza, a domino pizza at seven quid. So you should look at that budget. And if you include all of the money you spend on essentially junk,

you will be spending about the same when you go low carb. If you factor honestly in when you bought petrol, what did you buy? you know, most patients are spending a couple of quid. They buy the petrol, but then there's about two pounds, maybe a drink and a chocolate bar. So they say if you factor that in, it's about the same when you go low carb because yes, the ingredients do cost a bit more.

But they also say, if you're clever, so frozen raspberries are much cheaper. So frozen fish, for instance, is a fraction of the cost of fresh fish. frozen chicken thighs or go for mince. So make your own burgers. It takes moments to make your own burgers. Well, what's the price of a cabbage?

Or even a pint of double cream isn't that much? Or eggs. So there are many nutritious, nutritionally dense foods. Specifically, as well, I'd like to give a shout out to the Fresh Well app. So the Fresh Well app is a free app you can download. on your phone. This is the Freshwell practice and they've taken my work,

their younger doctors and of course they've made a free app and 200,000 people have downloaded that app and in it is low carb on a budget all done for you, all the recipes, all there all for free

and the Freshwell app is approved for use within the British Health Service. It's approved by the NHS. It's Kismet approved. So I think that, yeah, initially it's just working it out. It's planning.

It requires more planning. Because you have to think in advance. You can't just, I don't know, just buy sandwiches. So it does require some planning. That's what health does seem so difficult these days, doesn't it? But we used to live in a world where you didn't really have to think about health. Yeah. Your daily life, your environment didn't drive you to poor health.

No. And that's why I think health has, you know, has blown up these days. People want more health content, podcasts, books. They want to hear more from experts. And it's a kind of a reflection of the fact that we have become sick because of the state of the modern world. 50 years ago, you didn't need all this information of people because people weren't overweight. The environment was driving. You had to walk around to get stuff.

You know, you couldn't just sit at home and order stuff on your smartphone. There's a certain irony there, isn't there? There is. I mean, I remember the days before supermarkets. So people can't imagine. But there was a world with no supermarkets. I remember them coming in. Before supermarkets, my mother was forced to shop every day. We didn't have a freezer.

You know, we had a fridge, but she was shopping every day. You probably go to different shops, right? The butchers, the fishmonger, the grosses. It was a chore. It was a chore, but she was walking around. And I remember we had to help her carry it all in bags. because she didn't have a car either. So it was a very different world.

And you were naturally healthy because of it. Yeah, because we're walking around. And then she had to peel it and make it and all the rest of it. And I remember ultra-processed food coming in. I remember Arctic rolls were one of the first things. And we welcomed all these things because it was tasty, but what we didn't realize, it was a trap. And we've moved, we're moving ever faster away

from the world that we're adapted to live in. Young people are struggling to be happy. Whereas when I was little, kids, we were just kids. You didn't struggle to, you just had your life. You didn't need experts. And now it's becoming very difficult not to become overweight. It's becoming very hard not to suffer with anxiety or depression.

And it's a tragedy. And we've got to do something. I just want to finish off, David, talking to you about prevention. Yes. We started off talking about people who were already sick. Maybe they were talk to diabetic or they were pre-diabetic. They were just in that threshold just before. Yes.

But this topic of prevention is really interesting to me. My sense is that the NHS doesn't really have prevention in its DNA. I agree. And I'm not saying that to be critical of anything. The anxious has been wonderful that so many things over the years. But I don't think we really, I think it's very hard to do prevention well because I just think the whole model was developed around a different world and maybe more acute problems that people came in with.

So this idea of prevention is not really there. So my question to you is, if you could redesign the healthcare system to be more focus on prevention what are some of the things you would do what are some of the tests that you would like to offer people

that they don't currently get fabulous you're going to why not make me Prime Minister for a few weeks I think I'll do that because I think it's bigger than that I think it's beyond medicine now so with my new power because you did say I could be Prime Minister

is to bring in it then. The point you make is so good, the answer cannot be to drug everybody. The answer cannot be that we, what, we give the fat jabs to teenagers, shall we do them all? Do we even know the long-term consequences? We haven't a clue.

It's becoming ridiculous how many sick people there are, and prevention must be. I think the problem has been that we live in a political system and each government has to get results within a few years. Exactly.

So prevention doesn't sound quite as sexy. And yet it's the only way to survive. The health service is breaking. The health service, all my friends are breaking through the amount of chronic disease is getting worse and worse and worse. And so for me, my big picture is, just like cigarettes,

why don't we tax ultra-processed food? for the damage that it does. We know it affects all cause mortality. Yeah. We know that. But what should we do with the money? And I think should we not, this has been done in Brazil. There was a city in Brazil and what they did, they taxed, this was Coca-Cola, which was the problem, ultra-processed food.

And then they subsidized, locally produced food in farmers markets. Right. So that you, you know, you think, how is the food produced nearby? that deals with your air miles. It also helps local farmers and shopkeepers or, you know, the local economy benefits rather than flying avocados from Brazil, you know?

Subsidize locally produced foods. And then also you have to help people learn how to cook again. So we'd use the money. I find actually, most people are intelligent. Most mothers want to feed their families. But could we subsidize quality? food, quality whole foods produced locally, and that would mean that what you eat might depend on where you live.

Yeah. But actually, that's okay. And as part of that, and there was a really interesting experiment, I don't know whether you're aware of this in Gateshead in the northeast. They went through a period where there was a sort of moratorium on not allowing planning permission for any fast food outlets. Wow. And childhood obesity went down in those areas.

neighboring areas where they every single time you allow a fast food outlet to produce ultra-processed food and delivery it's an attack on the health of the local people so that in gateshead it worked so i would be doing those things thinking about planning permission thinking about one one other thing i do medically is why couldn't we give if a GP is if i'm going to give you any life long medication, why can't I have half an hour with you to do ethically the right thing and set before, why shouldn't we make the choice together? Yeah. I should be given half an hour paid, not for a 10-minute appointment, a half-hour appointment

so that we could explore the pros and cons of a potential lifelong medication. And then you could be part of the decision-making. and I believe that our practice has modelled this and you would save money against the standing, against the treasury. But the greatest thing is you're paying the money anyway, right? So if you don't give the time at the start, and before you know it, the patient's on the prescription and they're on the repeat prescription, they're still on it five years ago,

and we both know how that goes, right? Once people are on these things, it's... It never come off them. Very hard to come off. them. Very, very hard. Nobody has the energy to do it because it actually takes twice as long to take you off it than it did to put you on them. But the money you're going to spend is huge. But if you could frontend some of that money and go, not even, like even 2% of that money to have a 30 minute consultation at the start, you may not need it at all. And do you know,

I have said that exact thing to two ministers of health. I won't tell you they are, but I've said it twice. I've been a good idea who they might be. Two of them I've spoken to to say every time a GP starts a lifelong medication it's a standing order against the Treasury and it's just like your own personal bank account you're very careful with

standing orders. I'm really careful with them. Yeah. Because they just run invisibly and then where's all the money gone? And that's what we're dealing with now. Where's all the money gone? There's billions going. But the reason it's not happening is that you said it's the politicians unfortunately

generally speaking, it's about getting voted in again. Yeah. And so prevention takes too long. You can't show that as easily for the next round of votes, right? Yeah. What about on an individual level? So are there any blood tests that you don't currently have access to in the National Health Service that you think would be great at identifying this problem

years before they get tired of diabetes? Yeah. I wish, I wish I could do fasting insulins. Yeah. It's so obvious. But, you know, even, I cannot measure insulin at all ever. Yeah. So that I've wrong.

And I end up admitting people to hospital because I can't. So I can't die, you know, can't deal with somebody. Maybe they need insulin and there's an emergency because their own insular, they're not producing enough. I cannot get, never mind a fasting insulin. I can't get any insulin or anything. But a fasting insulin. would be transformative

because we might see this five years before you get type of diabetes, we may see your fasting insulin going up and we can go, wait a minute. Let me for the people watching, just explain that. And the reason, so if you're insulin resistant, your body is forced to increase the supply of insulin. So your hyper-insulinemic.

So one of the very first things you can measure is your fasting insulin. You've not eaten anything, but your insulin levels are high. and if I'm sure my insulin levels would have been high 10 years before. It's an early warning sign. And people in the States are astonished. They absolutely, you can't. No, and so I have to use surrogates for that.

So a surrogate, you know, if you look at a triglyceride level, that might give you an idea. Triglyceride and liver function might give me an idea. But yeah, give me the fasting insulin. Allow me to prescribe continuous glucose monitors. for people who are not even diabetic because they might learn. They might learn.

Information is power. That's my sense. David, it's such a joy talking to you. You've done some incredible work over the last 12 years. The fact that you published data on this, you publish articles on it, it's really given this whole movement so much more validity with many of our colleagues.

I want to express gratitude and appreciation to you for that. If people want to learn more about you, I know you've also done loads of low-car recipe books with chefs of London, which is amazing. Where would you point them to? You mentioned the Freshwell app as well, of course. Yeah, so there's the Freshwell app.

Just, it's a free app, download it. Please, please, follow me on X. Formerly Twitter. I'm low-carb GP. And we have a really dynamic group of clever people around the world. We're learning from each other. many, many clever people.

Yes, consider the, any of the Caldezi recipe books. So these are low-carb chefs and I've written books with them. It includes the physiology in there. Wow. It includes the psychology, so Jen does the psychology. I do the physiology and they do the food. And there are eight of those. What else?

I think that's mainly be curious. Be curious. be curious. Notice what works. Consider whether a continuous glucose monitor might be something that you could try to see how you're doing because you can buy those on Amazon. And right at the end of this conversation, David, if there's someone who's been listening to us who has throughout the conversation recognized that they haven't actually taken their health seriously, they've allowed the belly fat to accumulate year on year, they, perhaps, are noticing some of those signs and symptoms you mentioned right at the start,

the brain fog, the fatigue, the lack of stamina, the low mood, whatever it might be. But there's been something in this conversation that's inspired them. Yeah. What would you final words to them be? Two things. Very important. Number one, if you're already on drugs for diabetes, before you make a massive change to your diet,

consider how that might affect the medication. and you might be wise to check with your doctor before you cut the carbs dramatically. I mean, imagine if you're on insulin and you just cut the carbs, your dose would have to be adjusted and that might apply for other drugs as well. That's the first thing if you're on drugs already. The second thing is one thing I mentioned,

which was the teaspoon of sugar infographics that are now in 35 languages and they've been downloaded millions and millions of, times around the world. And they're freely accessible and with the diet sheet, all free of copyright, on the public health collaboration website. So this is a UK charity of which you and I were both founder members. Both of us started that. And it's doing great work. And there are the teaspoon of sugar infographics. There is the diet sheet and many, many other resources. So it's the public health collaboration website but also check with your doctor if you're on drugs that are being prescribed.

David, thank you so much for all the work you've done. Thank you so much for making the journey to the studio to come on the podcast. You're so welcome. And I look forward to the next time we get together. It's great fun. I'll do it again. Thank you very much. Thank you. I really hope you enjoyed that conversation. Do take a moment to think about one thing you can put into practice into your own life and one thing you could teach to somebody else. Remember, when you teach someone else, it not only helps them. It also helps you learn and retain the information. And of course, if you think this episode would be helpful for someone else in your life, please do consider sharing it with them. Also, if on the back of

hearing this episode, you want to dive deeper into your own metabolic health, do consider checking out Do-Health, a personalized health companion that I co-founded, powered by your individual biology and lifestyle, that I believe is the future of health. With Do-Health, you can regularly check what I consider to be 11 of the most important blood biomarkers, including fasting insulin, which of course, David mentioned at the end of our conversation, is one of the tests he wishes he had access to on the NHS. So if you want to be one of the first to join Do Health, you can see all details at Dr.chatterjee.com forward slash do.

Before you go, I just wanted to let you know about Friday 5. It is my free weekly email containing five simple ideas to improve your health and happiness. I share exclusive insights in it that I do not share anywhere else, including health advice, inspirational quotes, my comment on new research, and so much more. And in a world of endless emails, it really is delightful that many of you tell me

it's just one of the only weekly emails that you actively look forward to receiving. If that sounds like something you would like to receive each Friday, you can sign it for free at doctorchatterjee.com forward slash Friday 5. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts,

that option is now available for a small monthly fee. On Apple and on Android, all you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health. Making lifestyle change is always worth it, because when you feel better, you live more. home.