You’re Eating SUGAR Every Day — And You Don’t Even Know It | Dr. David Unwin

0:00 Do you want pleasure now or do you want something far better in the future?

0:03 So if you want pleasure now, eat the trifle, eat the cake.

0:06 But if you want a better future, well, you've got to work towards that.

0:10 Let's put a lot more energy into thinking about a healthy,

0:13 species-specific diet.

0:14 So if you had a human being in a zoo,

0:16 what would you feed them to keep them maximally well?

0:20 Isn't it what we should all eat?

0:21 What we're seeing at the moment is a gigantic

0:24 experiment and many of us are eating the wrong foods.

0:27 And I'm seeing the consequences in every clinic I do.

0:30 150 grams of boiled rice.

0:32 What is that equivalent to in terms of teaspoons of sugar?

0:35 And the answer is about 10.

0:37 The banana is about the same as 6 teaspoons of sugar on the glycemic load.

0:42 Bananas are sugar sticks, very little fiber.

0:44 You wouldn't believe the number of overweight

0:46 people that eat bananas for the potassium,

0:49 which is some sort of nonsense put out by the banana growers, I dare say.

0:53 I can sprint with my grandchildren, I can play and roll around...

0:57 That's life.

0:58 Eating cakes alone, that's not life at all.

1:00 Go for a little bit of pain now and a better future You'll be glad you did,

1:05 because I certainly am.

1:06 Doctor "Unwin," what would you say is the most

1:10 important thing about type 2 diabetes people aren't being told?

1:13 Oh, that's great.

1:16 The most important thing is that how it all turns out

1:23 for most of you and for myself depends upon my lifestyle mainly.

1:32 And so that again, for most of my patients with type 2 diabetes,

1:38 and I have type 2 diabetes,

1:41 every meal is both an opportunity or it could be a threat.

1:46 So you have a sort of choice, really, on a daily basis of what you eat.

1:52 Because for most of us, that's what affects blood sugar.

1:58 And it's blood sugar over time that cumulatively affects

2:03 what's going to happen in terms of your health.

2:07 So this can be a great message of hope.

2:11 And that's what gets me up in the morning and what sends me to my clinic.

2:17 I've just come out of clinic today and in every

2:21 clinic I am seeing the most amazing cases.

2:25 I've seen some this afternoon.

2:28 That people are choosing to try

2:32 and avoid lifelong medication and use lifestyle instead,

2:38 and then they feel empowered and often healthier and more cheerful.

2:46 It's a great journey.

2:49 I think the other thing I'd like to say is about

2:54 type 2 diabetes prevention because treating is one thing but I

3:01 believe that most people have type 2 diabetes because they didn't

3:07 know the risk they were running with how they were eating.

3:13 And that's exactly how I developed type 2 diabetes.

3:18 I had no idea that my diet was causing it.

3:22 And if you know that, then the question is could we prevent it?

3:28 And given that so many millions of people around the world suffer

3:34 with this and it affects all-cause mortality

3:38 and it isn't just about mortality, is it?

3:42 It's about health span.

3:44 So if we could prevent this, how wonderful would that be?

3:49 Maybe people don't have to have it in the first place.

3:54 Wouldn't that be exciting?

3:56 And you're probably going to explore that.

4:00 And this is some of the work we've

4:03 done in our practice where we're preventing diabetes.

4:07 All of it is very exciting work, really.

4:11 You mentioned early on the fact that you are type 2 diabetic.

4:16 You also mentioned the hope piece.

4:18 I want to make a connection there because somebody saying they're still

4:23 type 2 diabetic in a way that kind of kills the hope...

4:27 So I want to understand what you mean

4:30 by that and what the reversal potential is.

4:33 If we go back to when...

4:35 I'm 67 now, but when I was 55, my experience as a primary care physician was

4:43 that type 2 diabetes was a chronic deteriorating condition.

4:47 And that's exactly what I'd seen for 25 years.

4:51 So people would start and we'd put them on metformin and then I'd

4:56 use gliclazide and this drug and that drug

4:59 and then eventually finally, with insulin...

5:03 And meanwhile they'd get heavier and heavier and their health would deteriorate.

5:09 And that was really how I saw diabetes,

5:12 type 2 diabetes as a chronic deteriorating condition.

5:17 But contrast that with what I now believe is that well for around

5:23 50% of all the patients that I treat with type 2 diabetes,

5:29 they're achieving drug-free remission of diabetes.

5:34 So what that means is they're not using any medication

5:39 and they have a blood sugar that's not in the diabetic range.

5:46 So that's for me is hope because— relatively that's

5:50 a much better position to be in for me.

5:54 So that my drug-free type 2 diabetes remission has now lasted since about 2013.

6:00 That's 13 years I haven't taken tablets.

6:04 And if anything, my health is now significantly better

6:08 in so many ways than it was in 2013...

6:12 So that for me is a great message of hope...

6:15 that you could be older.

6:19 So I am older, but my health is so much

6:23 better and the health of a great many of my patients.

6:28 And it's also loads of hope in different ways, isn't it?

6:34 It's hope for clinicians because I became a doctor many years ago in 1986,

6:40 in a practice where I still am now,

6:43 just north of Liverpool on the west coast of the UK.

6:48 It's raining heavily, of course.

6:52 I became a doctor thinking I wanted to do

6:56 primary care because I wanted to be a larger fish

6:59 in a small pool with the idea that I could

7:03 help my community and I would know who my community was.

7:10 Fast forward 25 years, and I was a disappointed man,

7:15 because although I'd become very fond of my patients,

7:19 I didn't feel that I was making

7:22 the difference in the community that I had hoped,

7:25 and that my experience of medicine...

7:29 I wasn't quite sure why, but I was disappointed with myself,

7:34 really, and disappointed with my career, with a very vague...

7:40 I didn't really know why that was.

7:42 And I thought, I also didn't feel very energetic,

7:46 and a bit depressed, a bit anxious.

7:49 And so, you see now, here I am, so much older, having done.

7:56 I loved this afternoon.

7:58 I had such a happy, an experience of being a doctor, full of hope,

8:03 meeting amazing people who have changed their lives, and that's great fun.

8:09 So there's some more hope for you.

8:12 Hope for patients and hope for clinicians.

8:15 Because I'm the oldest practicing "GP" in a 100-mile radius of this room,

8:20 because all my friends, most of them retired 10 years ago or more,

8:27 because their experience of being a doctor was unhappy,

8:31 full of stress and anxiety.

8:34 And what a shame that is.

8:35 Because isn't being a doctor an amazing thing?

8:39 Doesn't it offer wonderful potential?

8:41 And yet most of my colleagues did not find the potential.

8:47 So hope, and more hope.

8:50 It's a powerful thing, is hope.

8:53 We can change the world.

8:55 Well, the reason I honed in on that is just the tense

8:58 you used where you referred to yourself as type 2 diabetic,

9:01 even how far you've come along the journey.

9:04 So that leads me to further dig in to try and understand,

9:09 metabolically, because of your past, do you see yourself as different than

9:15 somebody that's been metabolically healthy all along?

9:19 Yes, I do.

9:21 That brings up a couple of interesting points.

9:25 So the first thing is,

9:27 everybody loves the idea of reversing diabetes, and sometimes we do.

9:32 And probably Prof.

9:34 "Roy Taylor," a friend of mine from Newcastle University,

9:38 is a world expert on this, where

9:42 sometimes you actually improve insulin sensitivity

9:45 to a point where you can eat carbohydrates

9:49 again and not put up your blood sugar.

9:52 But I would say for most people, what you're doing is remission.

9:58 And I call it remission because I need that constant reminder that ice

10:03 cream and biscuits and bread and rice are finished from my point of view.

10:10 And that, in my case, I damaged my own metabolism.

10:16 I know how I did it, literally, mouthful by mouthful over many years.

10:23 So my metabolism is aged.

10:26 I think type 2 diabetes, insulin resistance,

10:31 <break time=“2.11s"/> is not to do with age particularly,

10:36 but I do think there's a concept of metabolic age,

10:40 and that I have some consequences

10:44 of the dietary choices through quite a long life, and I'm stuck with them.

10:49 But I'm not sorry for myself.

10:52 I'm in remission.

10:53 I'm using no drugs.

10:54 I'm physically very fit, incredibly active.

10:57 So why would I moan?

11:00 I am a little restricted in my diet.

11:03 But the key thing is I enjoy the food I eat.

11:06 I look forward to meals, and then I'm full.

11:10 So the deal for me, yes, I can't eat Christmas cake,

11:14 and a trifle is a thing of the past things.

11:18 But hey, somebody of 67, I can sprint,

11:21 I can run, I'm fit, and my brain works well.

11:25 I think that's another most important point.

11:30 So there are, just to be scrupulously kind of, clear,

11:36 some people reduce, <break time=“2.10s"/>

11:41 they improve their insulin sensitivity.

11:44 They also improve their pancreas, its ability to produce insulin.

11:49 And there are people who literally cure their diabetes,

11:53 and then can, in a moderate way, eat carbs again.

11:58 But I haven't met many of those, and I

12:02 think it <break time=“3.14s"/> gives false hope.

12:07 Because then, you just start doing what you did before.

12:12 And when you think of the number of us that are actually junk food addicts,

12:16 the thing an addict loves to hear is that cigarettes are fine,

12:21 wine is fine, and chips and burgers are all fine.

12:24 And so, a note of caution for me,

12:28 and that's how I run my practice with the idea that this is remission, hooray.

12:34 But be careful, you've eaten yourself into this thing once,

12:38 and you might eat your way into it again.

12:42 Which brings me to...

12:43 I'll shut up in a minute.

12:45 Just brings me to a point.

12:48 I've got 21 patients who've had drug-free remission more than once.

12:55 So what's happened is, they did a great job, well done.

13:00 And then they go on an all-inclusive holiday.

13:04 It's somebody's birthday, it's this, that, and the other,

13:08 there's always an excuse, and carb creep slithers its way in, and then,

13:15 we're out of remission, and then I have to start all over again.

13:19 But that's okay.

13:22 Some of my patients have been in remission three times over 13 years.

13:26 Where I think a lot of the listeners will have— experienced this.

13:30 The cookie jar is calling to you, and friends say, go on, just have one.

13:36 And then you do.

13:37 And then before you know where you are, you're back where you started.

13:42 So I like the idea of remission.

13:44 I think we need reminding that we are safer than we were before.

13:50 But that doesn't mean we can take it for granted.

13:54 When it comes to these patients

13:56 with carb creep and they've had multiple remissions,

14:00 what do you notice is different

14:03 psychologically or behavior-wise for those people?

14:06 Great point.

14:07 For many years, I called it carb creep,

14:11 but I think what I was doing was trivializing something far more sinister.

14:16 When you have intelligent people who know that what they are doing,

14:22 what they are eating is damaging their health,

14:26 you have to say, well, isn't this a bit like alcohol for alcoholics?

14:31 Isn't it a bit like cigarettes for those addicted to nicotine?

14:36 And of course, this is the life's work really of my very clever wife,

14:43 Doctor "Jennifer Unwin," who's a world expert on junk food addiction.

14:49 And gradually, over the years,

14:51 I've come to the conclusion that what we have here,

14:56 and it's very, very common, is intelligent people doing stupid stuff.

15:01 And they know that it's stupid stuff.

15:04 And that is not carb creep.

15:05 It's something far more sinister.

15:08 And if "Jen" was here, she'd be pointing out that 14% of the adult

15:15 population is probably an ultra-processed food addict now.

15:19 And in truth, I'm dealing with junk food addiction in every single clinic I do,

15:26 where I'm asking people, how are the cravings?

15:30 How are you doing?

15:33 If you don't help people with maintenance,

15:36 you've wasted all that effort that it was to get remission in the beginning.

15:42 So when it comes to these people that are more apt to fall back into carbs,

15:48 how different is the treatment you use with them?

15:52 So if the model is addiction, we can use this and think,

15:58 as a clinician, how would I help somebody with alcohol?

16:02 Or how would I help somebody addicted to cigarettes?

16:09 And the key thing, of course, is that moderation does not work...

16:13 It really does not work.

16:15 And that advising people to moderate bread or rice or burgers or ice cream,

16:22 any of these things, if you're an addict, well, you'll have a little bit.

16:28 And then you have all the rest and more and more and more.

16:33 And I was a bit like that.

16:34 And I know many patients who, if they were to have even a half slice of bread,

16:41 and bread's a very common addiction in my practice,

16:44 it's all over because you just cannot control it anymore.

16:49 And so using the model of how we look at addiction normally,

16:55 and then just moving that across.

17:01 You're thinking, first of all, abstinence.

17:04 Be clear.

17:06 Oh, and the first thing, of course, is honesty.

17:09 The first thing is honesty.

17:11 It isn't carb creep.

17:12 Have you been here before?

17:14 Many people say yes, loads of times I've lost weight.

17:17 A white-knuckle ride,

17:18 we went on holiday and two months later I put all the weight back on.

17:23 It's a really common story.

17:25 Be honest.

17:26 Could this be ultra-processed food addiction?

17:30 Could it?

17:31 Would it fit your life experience?

17:34 It's interesting, isn't it?

17:36 Because I never found a single food addict for 25 years, not one.

17:40 And do you know why?

17:41 Because I never asked.

17:43 One certain way to not find out is never ask.

17:47 And a lot of that time I was living with an ultra-processed food addict,

17:53 my wife, and it never occurred to us.

17:56 But now when I ask in clinic,

17:58 you're somebody that's gained weight and lost it loads of times.

18:03 Do you think you could be addicted to some foods?

18:07 And you would be astonished at the number of people who say, definitely.

18:12 And then I said, which foods they are,

18:15 because it's very important to be specific about your problem food.

18:20 And they will say, yes,

18:22 it's French fries or I don't know what you call crisps in Canada,

18:26 but you've probably got those little things in...

18:29 chips.

18:29 Oh, right, fair enough.

18:30 Chips.

18:32 The thing anyway, so be specific about what your problems are.

18:38 Be specific.

18:39 And then the next thing is, how has moderation worked for you so far?

18:44 How's it going in the last 20 years?

18:46 How's that going?

18:48 And they say, well, Christmas, oh my God,

18:50 and I went on a cruise and oh, dear, that was a disaster.

18:54 So then you come to abstinence, and then on top of that, you need support.

19:00 You need help.

19:03 Most people can't do it alone.

19:07 Most people would struggle.

19:09 You need support.

19:12 Also, what attitude do your family have?..

19:15 Because if they don't support you, you will fail.

19:19 Because they'll say, go on, your mother will just make you that cake,

19:24 or your sister will offer you this, that and the other.

19:27 So you probably need to share your problem.

19:33 If you believe you are addicted to junk food,

19:36 you probably need to share this with some of the people who love you.

19:40 And it may be helpful to ask, could you help me?

19:43 Because I'm going to try abstinence and I think I need help.

19:48 And there's a lot more to it than that because any

19:54 of these addictions are dealt with, battled with on a daily basis for years.

20:01 And "Jen" would tell you she's still,

20:04 she's an addict in remission and that fight goes on on a daily basis.

20:09 So that's a little trot through ultra-processed food addiction.

20:15 It's not carb creep for many people.

20:17 For some people, they can say, yep, you're right, I'm wrong,

20:21 I'll knock that on the head, I'll cut it back to one slice of bread or whatever.

20:27 And if it works for them...

20:29 fabulous.

20:30 If it doesn't work, they need to ask, why is this not working?

20:35 Am I possibly addicted after all?

20:38 And welcome to my world.

20:41 That's how the clinic goes...

20:43 Round we go.

20:45 You mentioned the fact that "Jen" has dealt with this addiction piece.

20:49 As her husband, her partner, someone that's been there through the journey...

20:54 what have you found to be helpful as a partner, supporting that person?

20:59 I love that question.

21:01 I think it's very important...

21:02 because I actually made it far worse.

21:05 Do you know when you love somebody,

21:10 it's really hard to watch them doing something that harms them.

21:15 So...

21:16 I would know that "Jen" was eating things she shouldn't, sometimes in secrecy.

21:23 I would see her suddenly start baking traybakes for the children

21:27 and I'd know that actually she's going to eat it herself.

21:32 I would also know that if she gained a lot of weight,

21:35 she became unhappy and stressed.

21:38 So...

21:39 as a sort of caveman husband,

21:41 it seemed obvious that I needed to stop her from doing the traybakes

21:45 and that I needed to knock this on the head and say, can I stop it?

21:50 What are you?

21:51 Or I'd throw stuff in the bin.

21:53 Or when she wasn't there, I'd find her secret stashes and throw them all away.

21:59 Or I'd deal with it head on.

22:02 But of course, that made her more secret.

22:05 It also made her defensive.

22:07 It caused us to have arguments and nobody won.

22:12 It was a very...

22:13 it really didn't help.

22:15 But I did not understand and neither did "Jen" actually, what was going on.

22:20 But...

22:20 the minute you think about...

22:23 somebody with an alcohol problem, the complexities and difficulties

22:28 of that and the problems of self-esteem considerable.

22:33 Because as an intelligent person, you keep doing stupid stuff.

22:38 So it needs a lot of sensitivity.

22:41 It needs gentle support, not aggressive support.

22:44 And sometimes you have to say nothing.

22:48 You have to just let it go if you can, because...

22:53 they're probably going to deal with it.

22:56 And better to let them...

22:58 pick the time and let them know that when they're ready,

23:04 you're there and you will support gently.

23:07 But I was far too heavy-handed.

23:09 But it was through love...

23:11 So you live and learn.

23:13 By the sounds of it,

23:14 this addictive nature of foods is affecting a significant amount of people.

23:19 Given that, when somebody comes to work

23:22 with you and they haven't tried quitting before,

23:25 is abstinence the first step for everybody?

23:29 For people with addiction?

23:31 Well, I'm trying to decipher.

23:32 If somebody comes to work with you and you don't know if they're addicted,

23:35 if they don't have that personality type,

23:37 do we have to assume until we find out otherwise?

23:40 I have certainly a high index of suspicion.

23:43 But if somebody feels that they're not an addict,

23:46 they may well be telling me the truth.

23:49 So you have to be like, fair dos, we've got plenty of time...

23:54 So we say,--— well, okay.

23:57 Cut it back, and let's see how we go.

24:00 And I have people who attain drug-free type 2

24:05 diabetes remission still on 150 grams of carbs a day.

24:10 So there are some people that can do it...

24:14 But equally, if you fail,

24:17 then we need to look a little harder at this, as to what really happened.

24:25 And honesty is the most important thing.

24:27 And I try and encourage people to realize I am not critical.

24:33 Just tell me the truth, and we'll work our way through it.

24:37 And also, I'm a great believer in reframing failure...

24:42 I don't like the idea of guilt and failure.

24:46 It's pointless emotion.

24:48 So...

24:48 nothing is as dead as what you did, "Jesse," yesterday.

24:54 Who cares?

24:54 But maybe you could learn from yesterday...

24:58 Maybe you could do Christmas differently or a holiday differently.

25:04 So I'm always fascinated by success.

25:08 What exactly did you do?

25:12 But I'm also very curious and interested in, by failure...

25:16 And the idea is being curious, not judgmental.

25:20 I'm just curious, with the idea.

25:24 So if Christmas was a disaster,

25:26 and that's what they come in, oh God, Christmas was a disaster.

25:30 And I put all the weight...

25:31 That's fair enough.

25:33 But specifically, what would you do differently next Christmas to avoid...

25:40 what could we learn?

25:42 And I help clients tease apart specifically

25:47 what they could do differently next Christmas, how they could plan for success.

25:54 And in that way, we try and reframe failure as a possible learning opportunity.

26:02 And who hasn't done stupid things?

26:05 Who hasn't made errors?

26:08 But some of the wiser ones learn from their errors

26:11 and it's a pretty good way to learn...

26:14 But if you keep doing the same thing and you get the same results.

26:20 Do you know, maybe it's time to do something different.

26:23 We're going to get to the protocol and what people can do if they're

26:27 in that boat of continuing to struggle and say

26:30 they've been trying to cut back on calories,

26:32 move the body more, following that classic advice that doesn't work,

26:36 at least not long-term...

26:38 But I want to talk about the physiology first,

26:41 because when it comes to type 2 diabetes,

26:43 the last stop for this train is type 2 diabetes.

26:46 But there's a whole lot of other problems happening along the journey.

26:52 First of all, how can people know if there's

26:55 changes with the physiology more early on, early signs?..

26:58 And then let's talk about what's happening under the hood.

27:02 Good idea.

27:03 I think you'd have...

27:06 One of the first things to say is that, I'm working

27:09 in the British National Health Service

27:12 with 10-minute appointments and many restrictions upon me.

27:15 For instance, I can't measure insulin at all under any circumstances.

27:20 I'm not allowed.

27:22 So we're working a little bit blind...

27:25 I dare say in Canada where you are, you can probably measure insulin.

27:29 But that would help, wouldn't it?..

27:32 So let's now just get to the model that I use with my patients.

27:36 A lot of this is thanks to my good friend,

27:39 Professor "Roy Taylor." We've cooperated together over

27:43 a very successful paper in "BMJ" Nutrition.

27:46 So you can read about this, our 2023 paper.

27:51 So what's going on?

27:52 So let's begin with the hormone insulin...

27:56 And this is how I discuss this with patients.

28:03 If a high blood sugar is damaging, and it is.

28:06 So we know, in fact, that if you have a high blood sugar within six hours,

28:12 you've damaged the non-stick lining of your arteries, the glycocalyx.

28:17 Within six hours, a spike of glucose is dangerous.

28:22 Nature, or God, or whoever,

28:25 has designed us really well to be protected from spikes of high blood sugar.

28:34 And that protection is complex, but the most important part of it is insulin.

28:41 Insulin is brilliant at getting rid of spikes of blood sugar.

28:48 Then the next question is that's interesting.

28:51 So it puts down blood sugar, where does the sugar go?

28:55 Because questions are more powerful.

28:58 Asking things is more powerful than telling people things.

29:02 So where does that sugar go?

29:04 Well-— I love, I think this is "Jason Fung." You must know...

29:09 wonderful, wonderful "Jason Fung." Yeah, I'm sure you do.

29:13 Well, he's done some lovely work on this and written some very good books,

29:18 and one of them is the idea.

29:20 Oh yeah.

29:20 Think of insulin as pushing sugar out of the bloodstream and inside cells,

29:27 where it can do a lot less damage.

29:30 A bit like a nuclear dump.

29:33 So...

29:33 the sugar goes in the cell, and what happens to it?

29:37 Well, a lot of it is turned into fat.

29:41 So this relates to all sorts of things.

29:45 And this can be how you develop a bigger belly,

29:50 that you start getting a fatter tummy.

29:56 On top of that, fat is building up inside your liver.

30:02 And in fact, we know now that a third

30:05 of everybody in the developed world has got fatty liver.

30:10 We know that, there's some really good papers on that.

30:13 A third.

30:15 Then you've got a problem,

30:17 because fatty liver interferes with the good work of insulin,

30:22 so that insulin doesn't work as well, and you become insulin resistant...

30:28 It's the first thing.

30:31 And if we think this through,

30:35 you still have that imperative to reduce blood sugar,

30:39 but your insulin isn't working as well.

30:41 So what does the body have to do?

30:44 Produce more insulin, and that is hyperinsulinemia.

30:48 So you then have two problems.

30:51 One is insulin resistance, and the other is high levels of insulin.

30:57 And there are some conditions which, in part, are caused by hyperinsulinemia,

31:04 and I happen to believe essential hypertension is one of them,

31:08 where insulin interferes with how you get rid of sodium at the kidneys.

31:14 I've written a paper on that with Professor

31:17 "Brady," a professor of cardiology at Glasgow University.

31:21 <break time=“3.69s"/> So you have-— insulin resistance and hyperinsulinemia.

31:31 For years, probably getting gradually worse.

31:36 But then there's another...

31:38 unfortunate thing working against you because fat is

31:42 building up in the pancreas, also the organ...

31:44 struggling to produce all that insulin.

31:48 And eventually what you have is a breakdown of homeostasis,

31:52 where you cannot produce enough insulin to regulate your blood sugar.

31:57 And at that point, blood sugar starts going up.

32:01 But actually, probably for 10 years before then,

32:05 you've had a problem that you didn't know about.

32:08 "Roy Taylor" calls it the long silent scream from the liver,

32:13 which he's trying to tell clinicians.

32:16 Think about...

32:17 abnormal liver function, think about fatty liver.

32:21 Because it's a call to do something different.

32:26 So then you come to what might you notice?

32:28 In which was the other part of your question.

32:32 What...

32:32 might somebody notice?

32:34 Well, of course, if your waistline's getting bigger,

32:37 if your belly's getting bigger.

32:41 It's quite likely your insulin isn't working as well.

32:45 Not necessarily, but it's quite likely.

32:49 And then also if you're insulin resistant, you have a problem with energy...

32:54 So you may feel this is what happened to me for certain, that...

33:00 I lacked energy and drive.

33:02 I had another problem as well, which was concentrating.

33:06 I had brain fog.

33:07 I couldn't think clearly.

33:10 I didn't realize that until I was sorted out because

33:13 then suddenly I haven't thought as well as this for years.

33:17 So these are all things that you could notice.

33:20 Tiredness, a big belly, <break time=“1.95s"/> and maybe brain fog.

33:27 What...

33:28 your physician might notice is I specifically talk

33:33 about a raised triglyceride because the fat that is

33:38 produced in the liver by all that excess

33:40 glucose sugar under the influence of insulin is triglyceride.

33:46 And again, I used to ignore high triglyceride levels because statins don't

33:51 help them very much and I didn't really know what it meant.

33:56 Well, actually a high triglyceride level arguably is a far more important...

34:01 cause of cardiovascular disease than a raised cholesterol of any type.

34:09 And so I'm interested in watching people's belly,

34:13 I'm watching the triglyceride "HDL" ratio, I'm watching blood pressure.

34:20 And of course, all of these are part of the metabolic syndrome.

34:27 Part of the metabolic syndrome.

34:30 Type 2 diabetes is a reasonably late player

34:33 and you've got a problem years before then.

34:38 It's interesting what we've discovered in our own work is

34:44 that-— aggressively the more damaged you are in terms of your metabolism,

34:50 the harder it is to solve.

34:52 <break time=“4.30s"/> Yes, if I take 100 people with pre-diabetes,

34:59 so these are people who still have quite

35:01 a lot of control of their blood sugar, but...

35:05 it's beginning to slip.

35:07 Well,-— if they go low carb,

35:10 93% of them will end up with absolutely normal blood sugar.

35:15 93% and none of them...

35:17 will develop type 2 diabetes, not one over a period of years.

35:25 If I leave you alone and wait until you've

35:27 developed type 2 diabetes and then I try low carb,

35:31 which is the diet we'll end up talking about.

35:35 If I try low carb in the first year after diagnosis.

35:41 73 out of the hundred will end up getting drug-free remission.

35:47 If I leave it, or if you leave it for five years, I'm getting about 51%.

35:53 So you see, the longer you leave this, the more

35:57 metabolically damaged you are and the harder it is to solve.

36:01 So really it makes a lot of sense to swim back upstream,

36:04 particularly I don't know if you were thinking about your children.

36:08 I don't know whether you've got any children,

36:10 but if you had children and if you loved them,

36:14 well, wouldn't it make more sense to start

36:17 a bit earlier rather than waiting, as I did?

36:20 Really shouldn't we be thinking about prevention?

36:23 What about our children?

36:25 What about...

36:26 what happens to them?

36:28 Because we know in my own practice, so as a young man back in 1986, I never...

36:36 ever saw anybody with type 2 diabetes under, let's say, 55.

36:41 And most of them were over 70...

36:44 We even had a different name for it in those days.

36:47 It was called maturity onset diabetes.

36:50 I never saw it...

36:52 And now regularly, I've seen people this afternoon in their 20s.

36:57 That's a new disease, it's very sinister.

37:00 And...

37:01 think about this, the damage that diabetes does

37:06 to your arteries is a function of time...

37:10 So the younger you are, the greater the potential for harm.

37:15 So maybe if somebody's over 80,

37:18 they could maybe enjoy a bit more carbohydrate and...

37:22 let it drift a bit, possibly.

37:24 Although I don't even, quite care for people over 80,

37:28 even maybe 90, if you're 90, you could perhaps leave it.

37:33 But a younger person, I'm trying really hard, really, really hard.

37:38 I...

37:38 hope that's answered your question.

37:41 That's great.

37:42 And I think it's important to caveat what

37:44 you said there about seeing more type 2 diabetes...

37:47 and seeing it younger, because somebody listening may be saying to themselves,

37:52 okay, you're a diabetes expert, more people are gonna come see you.

37:56 But you run an "NHS" practice.

37:58 Right, yes, thank you.

37:58 you're working with people in your proximity.

38:01 Where...

38:02 So it is actually a valid marker of the change.

38:04 Oh, yes.

38:05 So, again, let's just explain that.

38:08 So I'm a National Health Service "GP." We

38:10 are allocated our patients according to where they live,

38:15 and both I and the patients have no choice in this matter...

38:19 Only death, only my death or theirs allows us to escape each other.

38:24 So we've got 10,000 patients...

38:26 in a geographical area.

38:28 And— they're fixed, they're...

38:30 our patients.

38:32 And again, I happen to know that when I started in my practice,

38:36 I audited a month after I came into the practice and there were 56 people...

38:42 with type 2 diabetes...

38:43 We've now got about 600...

38:45 So that's a tenfold increase.

38:48 And that kind of epidemic is actually a pandemic...

38:52 And it's reflected all over the world.

38:56 Steadily...

38:56 there are more people with diabetes and they are younger...

39:00 and also they're getting fatter, they're heavier.

39:03 Many of the young people I...

39:06 deal with they very often weigh around 120 kilos, something like that.

39:12 They're very heavy people.

39:15 And so there you go.

39:17 One thing I want to highlight that you

39:19 brought up are these underlying changes that happen...

39:23 before type 2 diabetes.

39:25 Because if we just say type 2 diabetes,

39:28 people listening may go, okay, I'm not there right now.

39:31 I don't have to worry about this.

39:32 It's not me.

39:32 It's not me.

39:34 But I want to highlight the fact that there's vascular damage,

39:37 high blood pressure, adipose tissue,

39:40 accumulated potential connections to cancer, neurodegeneration, mental issues.

39:47 This could go on and on.

39:50 Yeah.

39:50 And that's why this is so important and beyond to me,

39:52 this diagnosis of type 2 diabetes.

39:52 Great point, Yes.

39:56 great point.

39:57 Because the major problems are happening 10, 15 years, potentially before that.

39:59 Yeah.

40:00 So.

40:02 Are you confident...

40:03 So it's a bit like death.

40:07 Let's talk about death for a minute.

40:08 So really, here we are.

40:11 We're worrying about heart attacks and strokes, cardiovascular disease.

40:15 And as you correctly said,

40:18 insulin resistance is linked to eight forms of cancer, particularly breast.

40:23 And we're seeing increases in colorectal cancer because of this.

40:28 So...

40:28 most people would rather not die, and most people would rather avoid cancer

40:35 and they'd rather avoid cardiovascular disease and strokes.

40:39 So really, it's most people, isn't it?

40:43 Isn't it?

40:44 A third of deaths are cancer and a third are cardiovascular disease.

40:47 So...

40:48 it's kind of two thirds of all the deaths.

40:52 What if you could live longer, or— particularly.

40:57 A moment on cancer.

40:59 We obsess about improving cancer treatment,

41:05 but we know that eight forms of cancer,

41:09 there's a strong association with cancer...

41:12 and central obesity.

41:15 Shouldn't we be obsessed equally with prevention of cancer?

41:20 Because if you had, like me, spent 40 years caring for people,

41:26 and when you tell them they've got cancer, it's almost like their life is over.

41:32 They're living from that moment on in fear, real fear, because,

41:37 well, it may have gone away, but will it come back?

41:40 What's that pain in my back?

41:42 Is it a secondary?

41:44 I'm coughing a bit, what's that?

41:46 So it's a sentence.

41:49 It's a cruel sentence...

41:50 And so, really, I'm quite interested in the idea of prevention.

41:57 And...

41:57 wouldn't that if we only spent...

42:00 Think about all the money spent on cancer research, which is good, it's good...

42:07 But have we really had value out of all that research?

42:12 Which is another point, of "Jason Fung's," isn't it?

42:16 And what if we put-— a lot more energy into thinking...

42:21 about a healthy species-specific diet.

42:24 So if you had a human being in a zoo

42:27 and you wanted to look after your pet human being,

42:31 what would you feed them to keep them maximally well?

42:36 And isn't that what our children should be

42:39 having and isn't it what we should all eat?

42:42 Because if you keep somebody in a zoo...

42:45 and you give them the wrong diet, well, there are problems, aren't there?

42:50 And I believe what we're seeing at the moment is a gigantic experiment,

42:55 a huge experiment with us all in there

42:58 and many of us are eating the wrong foods.

43:00 And I'm seeing the consequences in every clinic I do.

43:03 <break time=“3.43s"/> If you care for people, that's a bit sad really.

43:10 You've went a little bit into your health journey...

43:13 The fact you were a type 2 diabetic brain fog.

43:16 Let's get into your story in detail.

43:19 How you were practicing before you realized low carb and the power there.

43:24 And then we'll use that story to springboard into how you

43:28 walked out of that and how other people can do the same.

43:32 Well-— I was senior partner of this 10,000...

43:36 patient practice with...

43:37 We've got about probably got 10 doctors working there and three nurses.

43:43 It's a big thing to run, and the government advises us on guidelines,

43:51 and a good doctor will tend to...

43:53 follow the guidelines.

43:56 And that's what I did.

43:58 Until that was...

43:59 eat a little and often,— it's healthy whole grains, a basis,

44:07 starchy carbs are a third of your meal, all of those.

44:12 The first thing I noticed that...

44:15 didn't go well was the idea of weight loss.

44:20 So people would ask how they could lose weight and I'd say,

44:25 eat less and move more and more fiber and more water,

44:29 and all this kind of thing.

44:32 And the great majority of those people failed, failed, failed.

44:36 They might lose weight initially, but then they nearly all failed.

44:43 And the tragedy is...

44:44 I blamed those patients to a point where I got

44:48 really fed up with people with overweight as a problem, and in fact diabetes.

44:55 And as senior partner, I was the boss.

44:58 So I just snipped that out of my portfolio and gave it to...

45:02 a junior partner because I was so fed

45:05 up with these patients that never got any better...

45:08 and didn't lose weight.

45:10 And that is a shocking admission because what I know absolutely to be true

45:16 now is that the common denominator in all those failures was me and my advice.

45:23 And to blame the patients for what I now...

45:26 believe to be very, very poor advice is shocking.

45:32 And I'm guilty to this day for years of nonsense that I peddled.

45:37 But then again, in my defense, I was a tired doctor doing my best.

45:42 And the guidelines said very clearly that it...

45:46 should be low fat...

45:47 and so on and so forth, which your listeners know very well.

45:53 So that was the backdrop.

45:54 And blaming the patients, isn't that shocking?

45:58 Still think about that now.

46:00 And of course, many of them are still my patients now,

46:03 so we can kind of laugh about it.

46:06 Yeah, and then, of course, my own health deteriorated over that time and I

46:12 became a bit depressed and a bit anxious.

46:15 Really what most doctors do...

46:18 is they start dreaming of retirement, don't they?

46:21 And playing golf and doing other things.

46:24 And I planned for my escape.

46:27 I planned for my escape.

46:29 And...

46:30 by this time, I'm about 55.

46:34 This bit will be boring for people who've heard me on podcasts before.

46:41 So I really apologize.

46:42 But maybe some of you are new.

46:45 Maybe you are.

46:46 So, yes, two women changed my life.

46:49 One of them was a highly intelligent

46:52 and aggressive patient who wasn't taking her Metformin,

46:58 and would get paid according to people taking their Metformin,

47:02 which is the commonest drug for type 2 diabetes.

47:06 And...

47:06 so it was routine that when people weren't taking their Metformin,

47:11 they'd get a letter from me inviting them...

47:13 to come and chat to me about this.

47:15 And of course, basically,

47:16 I'm just going to tell you off and wave a shroud at you.

47:21 And this woman was and still is a remarkable woman.

47:25 So she knew,— she marches in and she says,

47:28 you think you're going to tell me off, don't you, about the Metformin?

47:32 Well, I've got a surprise for you,

47:34 Doctor "Unwin," because I've got a bone to pick with you.

47:38 When you do my blood test, you will discover that my blood sugar is now normal.

47:43 As you can see, I've lost three stone in weight.

47:47 And...

47:48 I've discovered that you were drugging me quite unnecessarily...

47:51 You gave me Metformin for years.

47:54 You never once told me that bread was sugar,

47:58 that rice was sugar and that potatoes were sugar.

48:01 And if I'd only known that, I could have been

48:05 saved the embarrassment of the diarrhea that your drugs caused me.

48:08 <break time=“3.13s"/> It was pretty obvious she'd come

48:13 in to complain and that that was utterly justified

48:18 and that I needed to listen and listen good

48:21 and listen fast because you need to be careful of...

48:25 powerful women that feel that.

48:27 And I've said this many times, but it's true.

48:30 She said, this is schoolboy...

48:32 biology, that starch is sugar.

48:35 So I have to wonder whether you're even medically qualified,

48:38 Doctor "Unwin." She really threw the gauntlet down with that.

48:42 And horribly, it was true.

48:44 And we did the blood test and she was right, of course.

48:47 She was in remission and...

48:49 she was one of 40,000 people online teaching each other how to cut the carbs.

48:56 And when I went online,

48:59 I was really upset because those people were being ridiculed by "GPs" like me...

49:04 for their hard work and success, and they were being told,

49:07 you'll die, your cholesterol goes sky high and you'll die.

49:12 And I thought, this is a terrible injustice, an awful injustice.

49:17 Then we have to speedily move in the second powerful woman,

49:22 who obviously is my wife, and...

49:25 she read a book by a really clever doctor,

49:30 Doctor "John Briffa," who wrote a bestseller on "Beat

49:35 the Diet Trap" in about 2011 or 2012.

49:39 And she read this book and she kept saying,

49:41 "David," you have to read this insulin resistance thing.

49:45 I didn't know what she was on about, but she made me read the book.

49:49 And then <break time=“2.01s"/> it was amazing.

49:53 And the rest is history, really, because we decided...

49:57 to.

49:58 I tried it, "Jen" tried it, we both improved...

50:01 and then we started working in the practice,

50:05 and there was initial real resistance

50:07 to this, and I faced resistance everywhere.

50:11 So this was in 2013, where I would be heckled in...

50:15 doctors' meetings, I'd be shouted down, I got hate mail...

50:19 for what I was doing.

50:20 It was very, very mysterious...

50:22 because I was thinking, well, this is so odd because everybody's loads better.

50:27 And...

50:28 it felt as if...

50:29 colleagues would prefer that I use drugs...

50:31 and not diet.

50:32 And I thought, that's weird, but it's all changed since then.

50:36 Anyway, there you are.

50:38 So it sort of changed and then my health improved.

50:42 And there is nothing like seeing it yourself to know that it's true.

50:48 And once you've seen it yourself,

50:50 nobody can argue me out of this because I know it to be true for myself.

50:56 And I've seen it with so many patients.

50:59 So we went from guidelines, wishy-washy guidelines in inverted commas

51:06 to seeing unbelievable changes in patients,

51:10 changes of a magnitude that I had never seen...

51:13 with drugs.

51:14 Really big changes.

51:15 The first ones actually wasn't diabetes.

51:18 The first things I saw was improvements in liver function.

51:23 So I'd got...

51:24 patients who'd got really poor liver function for years,

51:29 and I thought most of them drank.

51:32 They didn't.

51:33 It was non-alcoholic fatty liver.

51:36 And I wrote a paper on this and their fatty liver improved...

51:41 by about 35%...

51:42 or the gamma "GT" levels, which is a marker of liver function.

51:47 But what was crazy was...

51:49 those improvements in liver function happened in weeks.

51:54 So...

51:54 the blood results were coming in in the morning.

51:57 I could not believe what I was seeing.

52:01 Case after case of these improved liver function,

52:04 improved triglycerides again and then later, a few months later,

52:09 the improvements in hemoglobin "A1C," the average sugariness of the blood,

52:15 and— the first case of remission.

52:18 So there was the lady and then there was another one and another...

52:22 and another.

52:23 And now I've seen drug-free remission.

52:27 I think we're up to 157 or maybe 158.

52:30 I've seen somebody today that I think is probably number 158.

52:36 So, yeah, the blood results really amazing...

52:41 And bear in mind I'd sat there

52:43 for decades so I'm not easily amazed and astonished...

52:47 and galvanized interaction.

52:51 That is amazing.

52:52 And I want to talk about diet early days and then any pivots...

52:56 for you and the patients you made along the way.

52:59 Yeah, that's a good thought, isn't it?

53:01 Because I am learning.

53:03 So what have I changed?

53:05 Interestingly, the low-carb diet...

53:09 that we began with is mainly the same.

53:14 So if anybody wants to look at the diet sheet,

53:17 nothing I do is copyrighted, nothing.

53:20 So anybody can steal anything off me and the diet

53:24 sheet will either be in the papers I publish...

53:28 or a far easier way is just go to a British charity...

53:32 which I help set up, the Public Health Collaboration and look under.

53:38 In that on the website we store a lot of useful

53:41 information and the diet sheet is there for it, anybody to steal.

53:47 But yeah, let's talk about...

53:48 So there you could go and look at the diet sheet.

53:52 I think.

53:53 Yeah.

53:54 What's changed?

53:57 I think I've simplified it a bit...

53:59 Oh, I don't bother with calories much or portion control very much.

54:06 I just help people understand the diet.

54:08 Read the diet sheet...

54:09 and then if it doesn't work we have to ask why?

54:12 And then we get down into the nitty-gritty...

54:16 For many people I'm saying really base your meals on protein.

54:21 What have you got in the fridge?

54:23 What protein is acceptable to you?

54:25 What can you afford and what would you enjoy?

54:29 And then add a bit of green veg.

54:35 And some healthy fats.

54:37 <break time=“2.71s"/> But then again it needs refining.

54:42 It constantly needs refining because what you find is

54:45 that "Jen" and I don't have the same diet ourselves.

54:49 So it's very important to help the client refine and find out.

54:54 What their best...

54:55 diet is, because it's not the same from person to person.

54:58 So how do they get feedback?

55:00 How do they know whether something's good or bad for them?

55:05 And I think that's some of the refining that's taken place...

55:09 And a major part of course...

55:11 is continuous glucose monitoring.

55:13 This is speeding me up.

55:16 Oh my gosh.

55:17 So I'm going to tell you about a case that I

55:21 saw this afternoon now and this person has consented to share this.

55:26 So this is a 38-year-old man.

55:30 Do you deal in hemoglobin "A1C" in percentage or in millimoles per mole?

55:36 I'm the same as UK, in Canada.

55:39 Millimoles per mole.

55:40 Right.

55:41 That's millimoles per mole.

55:43 So this young man came to me three weeks ago with a hemoglobin

55:49 "A1C," the average sugariness of his diet sky high despite his medication.

55:55 So the result was 94, which is very, very high.

55:58 And in percentage terms,

56:00 for any American listeners it'll be something like 12 or 13%.

56:06 And he was symptomatic, of course, because...

56:09 that means you're weeing all the time.

56:13 So...

56:14 I broke the guidelines and I prescribed him a continuous glucose monitor

56:19 along with the diet sheet so that he could see, is it working?

56:25 What does your blood sugar look like 24/7?

56:29 And-— he came back a week later...

56:33 with an absolutely normal blood sugar on the trace.

56:38 Normal day after day.

56:40 Normal, normal, normal.

56:42 So I said to him, this is...

56:44 amazing, how do you feel?

56:45 And he goes, fabulous, I haven't felt this well in years.

56:49 And then I said...

56:51 I see you having some very low blood sugars, I think we need to stop your drugs.

56:57 So last week I stopped half his medication and he comes

57:01 in today and his blood sugar is normal day after day after day.

57:06 And I've stopped the other half of his medication in three weeks.

57:11 In three weeks.

57:12 This is a modern miracle because I know he's

57:14 safe because he's got a continuous glucose monitor on...

57:18 He's a clever person too, actually.

57:21 And of course I have to judge risk.

57:24 Don't try this at home, folks along the line, chat with your prescriber.

57:29 I am the prescriber for this person,

57:32 but it gives you the idea I couldn't have done that.

57:36 So within three weeks I've got somebody now,

57:39 and not everybody can do this, but he has.

57:43 I've got somebody with his blood sugar...

57:46 100% in range.

57:49 100% in range.

57:51 And that is amazing.

57:52 And it made him and I, we were just laughing.

57:55 This is medicine, as I love to do it.

57:59 Amazing case.

58:01 So that's a big difference.

58:03 I've got loads, actually.

58:05 This will go on for a bit.

58:07 Magnesium.

58:08 I've learned a lot about magnesium over time.

58:10 It supports insulin sensitivity.

58:13 Can be great for constipation as well.

58:17 In which case I'd use magnesium citrate.

58:19 So most of my patients,

58:21 modern diets are now deficient in magnesium because of modern farming,

58:26 doesn't look after the soil.

58:28 And so most of the food is magnesium deficient now.

58:33 So magnesium, that's a thing to add.

58:36 I know far more now that many of my patients,

58:39 when they go low carb, will need more salt because of the work.

58:43 The paper with Professor "Brady" that I was talking

58:46 about earlier on that you start weeing out salt.

58:51 Normally when your insulin levels recover.

58:55 So quite a lot— I'm better at avoiding what people

58:59 call as keto flu by ensuring that people have enough fluids.

59:04 And being open to the idea of more salt in the diet.

59:08 And magnesium...

59:09 I've learned that your blood pressure may be going to improve...

59:15 dramatically.

59:16 So I nearly fainted loads of times at the beginning

59:18 because I used to have high blood pressure.

59:21 I discovered when I stood up at my desk,

59:23 I was so dizzy, I had to hang onto the desk.

59:25 It was a completely new experience.

59:28 And it wasn't until I checked my blood

59:29 pressure I discovered I had low blood pressure.

59:32 I hadn't had low blood pressure for a decade.

59:35 And you see, the lowering of the insulin...

59:37 meant I was weeing out the salt.

59:41 And so ever since then I have needed more dietary salt.

59:45 And my blood pressure's been fine ever since.

59:49 And then you have to add.

59:53 Yeah, here's an important point.

59:57 At least 50%— of behavior change is not due to information.

1:00:04 Because if it was just...

1:00:06 like information, I could give you the diet sheet and walk away.

1:00:08 You wouldn't need me, would you?

1:00:11 If it was due to information,

1:00:13 nobody would smoke cigarettes ever again because you never

1:00:16 met anybody who didn't know that cigarette smoking causes...

1:00:20 cancer...

1:00:20 So behavior change is far more interesting than just supplying information.

1:00:26 A sensitivity and an interest in psychology

1:00:31 is really important in behavior change.

1:00:34 And I'm so lucky because I'm married to a very clever psychologist...

1:00:39 and we've worked together for many years now.

1:00:43 Things like hope, collaborative, working with patients, what are you hoping for?

1:00:50 What are your goals?

1:00:52 Not mine.

1:00:53 What are your goals?

1:00:55 Very important.

1:00:56 And then, why does continuous glucose monitors work so well?

1:01:02 Well, it's because you're getting feedback...

1:01:04 hard on the behavior.

1:01:07 So if you cheat, then you'll see that spike in 30 minutes time.

1:01:14 Whereas...

1:01:14 the...

1:01:14 hemoglobin "A1C" is an average over three months...

1:01:18 Can anybody remember what they ate three months ago?

1:01:22 I haven't the foggiest.

1:01:24 So you see hope, collaborative working and feedback.

1:01:31 But there's feedback in many forms.

1:01:32 So why don't you notice...

1:01:34 when you are your best self,

1:01:37 you're thinking better, you feel optimistic, you're sleeping well.

1:01:41 Why did that happen?

1:01:42 What did you do that day?

1:01:44 Could you do more of it?

1:01:46 How did exercise?

1:01:48 Probably, "Jesse," I would imagine in your own journey,

1:01:51 you've got into the habit of noticing what works for you.

1:01:56 For sure, I'm always testing things.

1:01:58 Yeah, it's fun.

1:02:00 And in that way Yeah, yeah.

1:02:02 you're individualizing,

1:02:04 you're testing hypotheses and then you're individualizing what you do.

1:02:09 And of course, over time, as circumstances change and...

1:02:12 I don't know, life events, stress comes with, people die,

1:02:16 babies are born, all these things.

1:02:20 Actually, your diet may need to change.

1:02:24 If patients are truly to be robust,

1:02:26 it's better if they can do this for themselves and that they don't need me.

1:02:31 Because I don't last forever.

1:02:33 It'd be better if you knew how to care for yourself.

1:02:36 And I expect that's your journey, isn't it, "Jesse?" Well,

1:02:39 the thing about our world is people taking

1:02:43 advice from the different leaders in the natural

1:02:45 health world are forced to test because no

1:02:48 two people are saying it the exact same way.

1:02:51 Absolutely.

1:02:51 Yeah.

1:02:52 So given that you can take all this different information from different experts

1:02:57 and you're forced to try different things

1:02:59 and see how they work with your biology.

1:03:02 And that would be my advice.

1:03:04 Don't just trust me and do it.

1:03:06 Measure something of what are the variables you're interested in?..

1:03:10 How will you measure them?

1:03:11 How will you know...

1:03:13 how this is going?

1:03:15 And then if you drift off for a bit,

1:03:17 you've got more of an idea what to do or what works...

1:03:20 for you.

1:03:21 And that's happened...

1:03:22 Back to your original question.

1:03:24 Well, yes, I've been doing this since 2013,

1:03:26 so of course I've noticed things and I've learned stuff.

1:03:29 And that's how...

1:03:30 in a way, the whole...

1:03:32 ultra-processed food addiction came on.

1:03:34 I called it carb creep for years.

1:03:37 And then I thought, actually I saw one guy had two toes amputated...

1:03:41 for this.

1:03:42 I'd sorted out his diabetes.

1:03:44 Then he ate food that he knew did him harm and then half his foot comes off.

1:03:50 That is not carb creep.

1:03:52 Something far more sinister, because...

1:03:55 he ate stuff and ended up with...

1:03:58 really...

1:03:58 terrible surgery and the wound healed very, very slowly.

1:04:02 And then you've got to think, what can you do about that?..

1:04:06 And then when I'm constantly wanting better results,

1:04:10 I've become very competitive,

1:04:12 really, and excited, and I like to throw down the gauntlet.

1:04:18 So people are...

1:04:19 sometimes critical of what I do, which is great...

1:04:22 So I would say, you go out there and beat me in your own practice.

1:04:26 Let's get some data...

1:04:28 and see how you do.

1:04:30 And if somebody gets better data than me,

1:04:33 well, I've probably got something to learn from them.

1:04:37 But, yeah, that's about all of it, really.

1:04:40 There'll be other things as well, but you could...

1:04:43 probably read one of the papers, because when I write a paper,

1:04:47 I try in the method to help other people who wanted

1:04:51 to do this know what's in the secret sauce, because I don't.

1:04:57 It isn't the "David Unwin" diet that makes me a fortune.

1:05:00 I'm an "NHS" "GP," paid for what I do.

1:05:04 So...

1:05:05 steal it and beat me.

1:05:08 Well, coming back to that "NHS" part,

1:05:11 we talked about it before and you just brought it up again.

1:05:15 That's going to mean a lot of different types

1:05:17 of patients are going to be coming to you.

1:05:19 Oh, yeah.

1:05:20 Patients that are used to conventional doctors...

1:05:23 who are going to write that prescription for things like Metformin, insulin.

1:05:28 So let's talk about...

1:05:30 a hypothetical patient, somebody metabolically deranged,

1:05:34 overweight, coming to see you.

1:05:37 How do you propose this different style of treatment to them?

1:05:41 And then again, let's walk through the early stages of what that looks like.

1:05:48 This happens in all sorts of different ways, but a common one...

1:05:52 would be somebody who comes in because their blood work is poor,

1:05:58 haemoglobin "A1C" is up...

1:05:59 So we're at a choice point.

1:06:01 So I'm saying to them, from the blood tests,

1:06:04 it's pretty certain you've got type 2 diabetes and high

1:06:08 blood sugar over time is damaging for your health.

1:06:11 So we need to sort this out.

1:06:13 We've actually got two approaches and you can help me decide which one.

1:06:17 The element of choice is really important.

1:06:21 Really important.

1:06:22 So you've got to help me...

1:06:24 We're going to work together to work out.

1:06:26 I could start Metformin right today.

1:06:28 I'm going to be honest with you, though,

1:06:30 there's a 30% chance of diarrhea with that one,

1:06:34 but it may not happen and we could try it and see or if

1:06:39 we could work out where the sugar was coming from in your diet...

1:06:42 and you ate less of it, maybe you'll never need medication.

1:06:46 And also you might lose weight and improve your blood pressure.

1:06:49 Which would you prefer?

1:06:52 So I'm giving you choice.

1:06:54 And the idea of choice...

1:06:55 is powerful and I've started you thinking,

1:06:59 because if I just tell you, then you become a passive...

1:07:03 recipient of my expertise...

1:07:05 If I involve you in the process and ask you questions, which would you prefer?

1:07:11 What do you think you're eating that might be putting up your blood sugar?

1:07:17 Questions like that.

1:07:19 How do you feel about lifelong medication?

1:07:22 Questions like that.

1:07:25 It starts you thinking...

1:07:27 And one of the great joys of this approach is patient activation,

1:07:33 by which you start off with patients,

1:07:36 very passive, they just take their tablets.

1:07:40 And what I've got now is partners thinking, working with me.

1:07:46 And it's a fabulous way to practice <break time=“1.81s"/> medicine.

1:07:52 And one of the things I'd say.

1:07:56 If you tell people what to do too early.

1:08:01 They say, I can't live without bread.

1:08:05 That tells me something, that tells me that I didn't motivate you enough.

1:08:11 If you're telling me I can't live without bread.

1:08:14 Because if you understood properly where you are

1:08:17 in the world and the risks there and the possible benefits,

1:08:21 you'll give up bread.

1:08:23 Unless you're a really serious bread addict,

1:08:25 in which case that needs addressing too.

1:08:28 But that comment, I couldn't give up bread, I can't live without bread.

1:08:32 Maybe you can't live with bread.

1:08:33 <break time=“3.82s"/> So that you can see

1:08:39 the psychological subtleties dealing with fellow human beings...

1:08:45 And it's to do with hope and choice and treating them as intelligent equals.

1:08:52 What I have, I suppose I have expertise in a very general way.

1:08:59 But that person has expertise in themselves.

1:09:04 And you shouldn't throw out their expertise...

1:09:08 lightly because you may have a very powerful ally,

1:09:13 as I find in that young man, a 38-year-old.

1:09:17 I've got a very.

1:09:19 I sort of got into his strengths...

1:09:21 and then he sorted himself out within weeks.

1:09:25 So this is the art of medicine.

1:09:27 There's the science of medicine, but there's the art of medicine too,

1:09:31 to do with hope, to do with psychology.

1:09:35 And it's endlessly fascinating.

1:09:38 Over the years, you give your patients this choice,

1:09:41 Metformin or this new diet and lifestyle.

1:09:44 Yes.

1:09:45 How many times have they picked the Metformin?

1:09:48 Never.

1:09:49 Not one, not a single patient has said,

1:09:52 give me the drugs when I do it in that way.

1:09:55 Not one...

1:09:56 Isn't that amazing?..

1:09:57 And of course, if you carry on doing that, you

1:10:01 start making substantial drug budget savings because people they don't like.

1:10:07 Another one is insulin for type 2 diabetes.

1:10:09 Who's going to choose...

1:10:11 insulin?

1:10:12 Because...

1:10:12 that's really hard on your life.

1:10:15 And so...

1:10:15 what's happening now is I'm receiving referrals...

1:10:19 from the whole of the practice.

1:10:21 So instead of sending them to an endocrinologist,

1:10:24 I get all of the hardest patients...

1:10:26 that the nurses and the doctors can't sort out because I've trained them all.

1:10:31 And these are people with much sicker people.

1:10:35 But it's really motivating.

1:10:36 So then I'm saying, well, how we're at a choice point.

1:10:41 We've got to do something because you're really ill.

1:10:45 Maybe it's insulin, or maybe not.

1:10:47 And if you could think about changing your diet,

1:10:50 maybe you don't have to have insulin, and maybe you could have much better

1:10:54 health now that they're really interested in that.

1:11:00 So the answer is, nobody's chosen Metformin.

1:11:02 I had one patient only who knew herself to be a chocolate addict.

1:11:08 And she said, I cannot give up chocolate, Doctor "Unwin"..

1:11:14 I can't do it.

1:11:17 I'll have to take the consequences.

1:11:19 So that was one incredible, honest person, actually,

1:11:22 who knew herself to be a chocolate addict...

1:11:24 and really was.

1:11:26 But that's the only one I remember.

1:11:29 And I'm seeing them kind of all the time.

1:11:34 You mentioned the fact that the diet, the protocol, is all available online.

1:11:38 But let's go over it in a general sense.

1:11:41 Somebody decides on the diet and lifestyle, it's their first visit with you.

1:11:46 Again, hypothetical patient, overweight, they have metabolic dysfunction.

1:11:52 How do you ease them into the diet and lifestyle?

1:11:55 Right.

1:11:56 And then does it change over time?

1:11:57 It does change, yeah.

1:12:01 So the first thing really...

1:12:02 is, again, the question, your blood sugar is very high.

1:12:06 Do you know what you are eating...

1:12:07 that puts your blood sugar up?

1:12:09 Because if they know already, then that saves a bunch of time.

1:12:14 And then if you do know,

1:12:17 could you-— eat far more protein, less of the starchy carbs?

1:12:22 And bear in mind, I've already explained about insulin.

1:12:28 That discussion has already happened about insulin,

1:12:31 insulin resistance, fatty liver...

1:12:33 and the danger of...

1:12:34 high blood sugar.

1:12:35 So that discussion happened already.

1:12:38 Do you know what's putting up your blood sugar?

1:12:41 And if you do, how sometimes, I'm saying, what do you think you could do?

1:12:47 And they— might say, I suppose I need to give up bread.

1:12:51 Yes.

1:12:52 What you're going to eat instead I don't really know.

1:12:54 Well, I'm saying, how about more eggs?

1:12:56 How about more protein?

1:12:58 Of course, the advice you give, again,

1:13:02 why general practice is such fun, is every person is so different.

1:13:06 So I'm having to factor in your education,

1:13:09 the job you do, your background, because the way I...

1:13:15 explain it...

1:13:16 would depend, are you 90 years old or are you a teenager or what are you?

1:13:20 And it varies greatly.

1:13:22 And that's why...

1:13:23 family practice is a skill,

1:13:25 because you wouldn't get the same chat with me hardly twice running.

1:13:30 Because I'm watching your eyes very closely while I'm talking and I can tell...

1:13:36 you're paying attention or you're drifting off.

1:13:40 One interesting concept is, so some people...

1:13:44 will say, well, the idea of I couldn't possibly live without bread,

1:13:51 maybe you're not scared enough.

1:13:53 Do you see?

1:13:54 Maybe I need to be a bit honest, because your hemoglobin "A1C" is sky high.

1:14:00 At that point you're losing a third of your life expectancy.

1:14:04 So some people are glib...

1:14:06 and say, it doesn't really, I don't care.

1:14:09 Ah, they do, actually.

1:14:11 They do.

1:14:13 So some people need scaring, and part of my skill is to know how to do that.

1:14:18 Other people need reassurance because they're too frightened already,

1:14:22 so they need more hope.

1:14:24 So a frightened person, and I see a lot of those who are worried and saying,

1:14:29 the great thing is you could very quickly get

1:14:32 this under control and you could feel so much better.

1:14:36 So do you see the subtlety?

1:14:38 I'm looking at you and I'm thinking, do you need a bit of scaring?

1:14:41 Are you a bit arrogant?

1:14:42 Are you a bit sort of, over my dead and bleeding body while I do what you want,

1:14:47 Doctor "Unwin?" Or are you...

1:14:48 actually a bit scared?

1:14:50 And what I do depends on what I see in your eyes.

1:14:54 And one of the skills of general practice is to read people very,

1:14:58 very quickly, because I've only got 10 minutes and what happens?

1:15:03 But that's why it's not boring, because it's not.

1:15:06 I am not a talking leaflet.

1:15:09 What happens, the psychology or another thing, is the family that you're in.

1:15:17 So I have to know what motivates you.

1:15:22 Have you got kids?

1:15:24 Because...

1:15:24 men with children really, really care about their children.

1:15:28 They don't want to be ill.

1:15:30 So what are the levers of change?

1:15:32 So you might not even care about yourself,

1:15:35 but being a dad, you want to be an active dad,

1:15:38 you do not want to be a liability, or maybe you have to earn a living...

1:15:42 Maybe you seriously need to earn a living...

1:15:45 The idea of going off sick is not acceptable because you've got to pay the rent.

1:15:50 So the...

1:15:51 I know...

1:15:52 I try and find out what matters to you and who you love.

1:15:57 So that very often I like...

1:16:00 Another question is, who does the shopping?

1:16:04 Who's cooking in your family?..

1:16:06 Can we meet?

1:16:08 Who is this person?

1:16:09 Do you want to bring them in?

1:16:12 And then I've got an ally, then there's a team and people who love each other...

1:16:18 will facilitate change...

1:16:19 And also I learn a lot by watching the husband or the wife...

1:16:23 I'm watching them too.

1:16:25 Sometimes they knew, but the person's a food addict, so...

1:16:30 they tried...

1:16:31 So it's...

1:16:32 endlessly fascinating...

1:16:34 And I'm giving you...

1:16:36 a confusing answer because people are confusing.

1:16:40 What motivates each of us is different.

1:16:44 Some people are very excited by maybe I could wear fashionable clothes.

1:16:49 <break time=“2.45s"/> It's quite common to avoid mirrors altogether

1:16:54 because you can't bear looking at yourself in the mirror.

1:16:58 Well, maybe we could improve that.

1:17:00 Maybe you could wear fashionable clothing.

1:17:03 For some people, they're frightened.

1:17:05 Commonly they're frightened because they're breathless.

1:17:08 That's really common.

1:17:11 They can't bend over, they can't climb stairs because they're so heavy...

1:17:15 and being breathless scares them.

1:17:18 So we offer the hope of, do you know what?

1:17:22 We might be able to help that a lot of breathing occurs at the diaphragm...

1:17:28 and a big belly splints the diaphragm so...

1:17:31 you can't shift it.

1:17:33 If we could move some of that fat, you'd breathe better.

1:17:37 Common related things, sleep apnea.

1:17:39 Terribly common.

1:17:40 Terribly common.

1:17:42 And a very long waiting list in the National Health Service.

1:17:45 And you stop breathing in the night and then

1:17:48 the wife's scared because she can hear you've stopped breathing.

1:17:52 It responds very well to low carb.

1:17:54 So...

1:17:55 I think I'm spending far more time

1:17:57 on your psychology and hope and motivation because the leaflet,

1:18:03 well, you could read that and learn.

1:18:05 And then I'm going to see how you do.

1:18:08 I need to see you again.

1:18:09 What we're going to measure.

1:18:11 If you do well, you don't need a lot more chat from me.

1:18:15 If you don't do well, I have to dig in deeper...

1:18:19 And at that point I might ask you to photograph everything you eat

1:18:23 for a few days on your phone and then I get to see...

1:18:26 what you're doing and then I'm over time learning and trying to come up

1:18:33 with better hypotheses that more closely fit

1:18:37 what is the individual in front of me.

1:18:39 It's gone a bit detailed.

1:18:42 That's how interesting it is.

1:18:43 And you can see that makes medicine seem really like a puzzle, doesn't it?

1:18:48 I'm a detective and a magician.

1:18:51 But it's worthwhile...

1:18:52 And none of this did I do for 25 years.

1:18:55 The first 25 years.

1:18:56 If only I'd started...

1:18:58 younger.

1:19:00 But hey, I'm doing it.

1:19:03 I love that approach.

1:19:04 It makes a lot of sense.

1:19:06 But underneath that, when you get in and you really leverage

1:19:11 that why and that motivation out of that person, is the diet...

1:19:18 very similar, when you find that unique way in?

1:19:22 That's good.

1:19:23 Let me think about.

1:19:25 Yes.

1:19:26 Because at the end of the day, we're gonna have to lower the carbs.

1:19:29 We need to find out how we're gonna motivate you, So.

1:19:33 Yeah.

1:19:33 we're gonna find out your why.

1:19:34 But...

1:19:34 in the end, Yeah, well.

1:19:35 Yeah, that's true.

1:19:36 you gotta bring these down.

1:19:37 It's very interesting.

1:19:37 So we run...

1:19:38 one of our ways to do this and make it affordable is to run group consultations.

1:19:45 So we do 30 at a time.

1:19:47 And my wife and I have done that from the very beginning.

1:19:51 So there was a meeting last night.

1:19:54 And what's really interesting, when you get these people all together.

1:19:58 They are actually eating in quite a similar way.

1:20:02 So they are...

1:20:03 leading with protein.

1:20:05 Mainly they're eating more protein.

1:20:07 And there is...

1:20:08 the protein and the green veg is going on.

1:20:12 And over time, what's very interesting too...

1:20:15 is they learn...

1:20:16 to go they tend to go lower carb.

1:20:19 And quite a few of them go keto over time because they find,

1:20:23 well, I'm just a bit.

1:20:24 I'm better when I do that.

1:20:27 And so although I say it's highly individual,

1:20:31 not many people can eat bread, not many people end up eating potatoes.

1:20:35 They give them up...

1:20:37 because they cause spikes and they're problematic.

1:20:41 Another thing that can be problematic...

1:20:43 are sort of miracle keto foods full of sweeteners, because then they get fat.

1:20:49 So many of them end up producing food themselves,

1:20:53 leading on protein, adding in green veg.

1:20:56 If you came last night, that's kind of if you saw the photos that I see,

1:21:02 because they photograph what they eat,

1:21:04 that I'm seeing a lot of very tasty meals leading with protein,

1:21:08 loads of green veg...

1:21:10 and a bit of fat.

1:21:11 But then...

1:21:12 there are exceptions.

1:21:15 But yeah, it's variable, but not as variable as you might think.

1:21:19 Good point.

1:21:21 And what about fruit?..

1:21:22 I find a lot of times when it comes to whole fruit,

1:21:27 a lot of the experts are saying, okay, you can include that in moderation...

1:21:32 and it has fiber.

1:21:33 But...

1:21:34 modern fruit, most, if not all, has been hybridized...

1:21:38 and is super high in sugar.

1:21:40 Things like bananas, oranges,

1:21:43 are these things you're having people take out right away?

1:21:47 Aha.

1:21:48 Now we need to come...

1:21:49 to my teaspoon of sugar equivalents,

1:21:52 because there is something there for the listeners to understand.

1:21:58 So right at the beginning, bear in mind these 10-minute appointments.

1:22:05 I've got a hell of a lot of information...

1:22:07 to get across in that time, and I had to find faster ways to do it.

1:22:13 And I became very interested in the glycemic load and the glycemic index.

1:22:19 And these give an idea...

1:22:22 of the sugariness of the carbohydrates that are in our food.

1:22:27 But the result comes out in grams for the glycemic load grams of glucose.

1:22:33 And my patients don't know what 25 grams of glucose looks like...

1:22:37 They don't cook with glucose, so they've no experience of it at all.

1:22:42 I had an actual idea, and could we possibly look at the maths

1:22:49 of the glycemic load in a way that patients do understood.

1:22:52 Could we redo the...

1:22:54 maths in terms of teaspoons of sugar?

1:22:57 Because my patients really do understand teaspoons of sugar.

1:23:01 And I found...

1:23:02 an international...

1:23:03 expert on the glycemic load,

1:23:05 Doctor "Geoffrey Livesey," and he said my idea of the way

1:23:10 of doing the calculations was correct in his opinion, and he helped me...

1:23:15 and he calculated out...

1:23:17 the glycemic load of different...

1:23:20 portions of 800 foods, and we published it.

1:23:24 But that means you can then...

1:23:26 do an infographic where you can say, well, so 150 grams of boiled rice what is

1:23:32 that equivalent to in terms of teaspoons of sugar?

1:23:36 And the answer is about 10.

1:23:38 So whether you have 10 teaspoons of sugar...

1:23:41 or you have a bowl of rice, it's about the same.

1:23:45 And then your particular point about fruit, well,

1:23:48 a banana is about the same as six teaspoons of sugar on the glycemic load.

1:23:53 Now, raspberries and berries are far less sugary...

1:23:58 So there's a spectrum of sugariness,

1:24:00 and it's to do with photosynthesis and sunlight and carbon dioxide.

1:24:06 So photosynthesis turns carbon dioxide into sugar.

1:24:12 And the more sun you've got, the sugarier.

1:24:14 So this is why oranges, all tropical fruits,

1:24:17 they're all too sugary for somebody like me.

1:24:21 Even an apple I could only eat a quarter

1:24:24 of an apple without it putting my blood sugar up significantly.

1:24:28 But I can eat a small handful of raspberries or strawberries,

1:24:32 particularly if it's in double cream.

1:24:34 And so these infographics, of course,

1:24:38 are on the Public Health Collaboration website.

1:24:41 There are seven of them...

1:24:43 They've now been translated into 35 languages and downloaded...

1:24:47 multiple of millions of times around the world...

1:24:50 So— all seven of them probably in any language a listener wants,

1:24:54 because volunteers have come to me and said,

1:24:58 they're so good, I'll translate into Russian or Mandarin or...

1:25:01 whatever.

1:25:03 And there are these infographics on fruit.

1:25:06 But in general, avoid fruit that has a lot of sunshine,

1:25:11 and you're left with berries, very much in moderation.

1:25:15 And then the question is are you going to eat

1:25:18 a kilo of raspberries or can you manage a small handful?

1:25:24 So that's my take on fruit and I particularly get cross about bananas,

1:25:30 which I get a lot of flak about...

1:25:33 But you wouldn't believe the number of overweight people...

1:25:36 that eat bananas for the potassium,

1:25:40 which is some sort of nonsense put out by the banana growers, I dare say.

1:25:45 But yeah, bananas are sugar sticks very little fiber.

1:25:50 And you make it worse with all the tropical fruits, far worse.

1:25:54 If you juice them, that's a real sugar bomb.

1:25:57 A glass of Florida orange juice...

1:25:59 if you have to.

1:26:00 I couldn't possibly have even a quarter of a glass

1:26:04 full of orange juice without it doubling my blood sugar.

1:26:08 I think it's important we're going here because for a lot of people who are

1:26:14 having ultra-processed foods going to fruit or starchy

1:26:16 veg would be heading in the right direction.

1:26:21 But I want to make sure people get success with this.

1:26:24 And if they're just swapping that out and having expectations...

1:26:28 like you talked about today, these fruits are better,

1:26:33 but they're not going to necessarily get you there.

1:26:36 Exactly, yeah...

1:26:38 So, no I think for me, the emphasis is on green veg,

1:26:43 above ground green veggies, healthy fats, whatever we mean by healthy fats.

1:26:50 And protein, lots of protein...

1:26:52 And I particularly say there's no evidence against eggs anymore.

1:26:58 That's all fallen completely to bits about 2016.

1:27:02 It's 10 years out of date...

1:27:04 that eggs are.

1:27:06 The idea of dietary cholesterol makes any difference to...

1:27:09 anything.

1:27:10 Dietary cholesterol is I don't believe, makes much difference.

1:27:15 So that's it.

1:27:16 Yeah.

1:27:17 Protein, green veg, and some healthy fats.

1:27:21 Fruit, be careful.

1:27:24 And also even nuts.

1:27:26 And because bear in mind, peanuts are not nuts.

1:27:30 A peanut is a legume, grows under the ground, not on a tree.

1:27:34 And for some people, salty peanuts are obesity right there

1:27:38 in the bag because they can't moderate them.

1:27:41 Cashew nuts are another problem because they're quite carby...

1:27:45 and some people really can't control those.

1:27:48 So I'd say with nuts,

1:27:50 don't have them salted because you probably eat too many...

1:27:54 and they should be tree nuts like almonds or walnuts or possibly pecans.

1:27:59 And of course, if you're not sure,

1:28:02 you should buy yourself a continuous glucose monitor and find out.

1:28:06 And then you'd soon know.

1:28:08 Does this food, we should be able to eat nutrient-dense food that you enjoy,

1:28:14 that you can afford,

1:28:16 that doesn't put up your blood sugar, because that's the whole...

1:28:20 That's what we're talking about, isn't it?

1:28:23 Eat nutrient-dense food, you need your vitamins, your minerals.

1:28:28 But...

1:28:29 eat food that doesn't put up your blood sugar.

1:28:31 And I can eat, for instance,

1:28:34 I could eat maybe a-— chicken butter curry with roasted sprouts...

1:28:39 I've done it, I've got the results...

1:28:41 It doesn't lift my blood sugar a tiny bit.

1:28:45 So I can have a great big plate, a very, very tasty curry with roasted sprouts.

1:28:51 I'm happy at the end of that.

1:28:53 And my blood sugar hasn't shifted a tiny bit.

1:28:57 That's nutrient density, really, without the consequences for my blood sugar.

1:29:03 Do you find early on in the journey somebody with a "CGM"..

1:29:07 having that curry would have a more exaggerated sugar spike than someone like

1:29:12 you who has done this for a long time and healed the body?

1:29:17 Not necessarily, no.

1:29:19 Because if you've been low-carb for a long time,

1:29:24 your body is no longer used to dealing

1:29:27 with carbohydrates and hardly ever produces much insulin.

1:29:31 So some people, like me, get a worse response than before.

1:29:37 But actually, if you carry on eating the carbs, it starts improving again.

1:29:41 <break time=“4.52s"/> What I don't know, because I'm not going to experiment.

1:29:49 I'm so happy with my diet and how I am.

1:29:52 I don't know to the extent that this is a physiological

1:29:56 adaptation and that if I carried on eating more carbs,

1:30:00 I'd be able to produce more insulin and it would improve.

1:30:06 I remember one time I was playing about.

1:30:08 So I've got a lot of followers on "Twitter," so...

1:30:11 please follow me on "Twitter," people "@lowcarbgp" on "Twitter." Very important.

1:30:18 So I remember I spent a week eating all the foods I'm not supposed to eat.

1:30:22 But what was interesting was by the end of the week,

1:30:26 my responses were much improved.

1:30:28 And I think that was just, I was cranking up the insulin supply.

1:30:32 And so...

1:30:33 my response to carbs is much better than it would have been years ago.

1:30:41 But-— some of it is worse just because I'm not so used to...

1:30:45 I'm keto.

1:30:46 To be honest, I've been in nutritional ketosis for years

1:30:50 now because it suits my mental state very well.

1:30:55 And gives me flexibility.

1:30:57 I'm not hungry...

1:30:58 I can fast if I need to fast because often you go places...

1:31:01 you wouldn't believe.

1:31:02 I'm often invited as a speaker to a diabetes event.

1:31:06 You'd starve to death in those events because

1:31:08 they offer me sandwiches which I cannot eat.

1:31:11 I often say to them,

1:31:12 there's nothing I can eat here that wouldn't put up my blood sugar.

1:31:15 These will be big national diabetes events.

1:31:18 Particularly if you've got "CGM" on, it's

1:31:20 hilarious because I can offer to eat stuff.

1:31:22 I'll say I'll eat it and then I'll share with you all...

1:31:25 what's just happened.

1:31:27 Even a milky coffee, a latte will double my blood sugar.

1:31:31 It'll put me up to 11 or 12

1:31:35 and has a consequence because I can't think straight...

1:31:38 So...

1:31:39 I did that recently and had to delay driving back because

1:31:43 I wasn't fit to drive because I'd had a milky coffee.

1:31:47 It's interesting to think how metabolism changes over time.

1:31:52 Somebody like you who has had lower insulin for a long period of time...

1:31:56 and then having carbs versus somebody coming to you as a new patient.

1:32:01 Body is full of glucose, insulin's running high,

1:32:05 and this is why I asked that question.

1:32:07 I'm just picturing them putting in more glucose

1:32:11 to a body that's already saturated with that and insulin...

1:32:14 and the difference on the "CGM." So just interesting to think

1:32:18 of different metabolisms along this journey and how that would change.

1:32:20 Yes.

1:32:20 Yes.

1:32:21 It does...

1:32:23 Well, as I've explained, I'm better than I was,

1:32:27 but my blood sugar will go up with quite small amounts of carbs.

1:32:33 And I believe it's because...

1:32:35 I don't have much insulin.

1:32:38 But I've noticed it will improve over time and that doesn't tempt me...

1:32:43 because I'm slightly addicted.

1:32:44 I appreciate this sense of control and I'm not

1:32:48 about to give that up 'cause it was hard-won and...

1:32:52 you go through periods of time feeling sorry for yourself.

1:32:55 I'm so sorry for me because I can't eat Christmas cake.

1:32:58 Well, I just needed to grow up and I eat loads of delicious food

1:33:03 and I'm well and healthy and I

1:33:06 love playing with my grandchildren, so that matters.

1:33:09 I enjoy playing with my grandchildren more than I do eating Christmas cake.

1:33:14 Somebody who is brand new to this, they're prioritizing protein,

1:33:19 some green veg, they want an objective number with the carbs.

1:33:23 What number do you like them to bring that down to?..

1:33:27 Yeah.

1:33:28 And then are we talking total or net?

1:33:31 Yeah.

1:33:31 Right, well I'm going to disagree with you now because what

1:33:36 this is about is where on the spectrum of carbohydrate eating are you.

1:33:43 So you see, I've got patients who've achieved drug-free type

1:33:48 2 diabetes remission on 200 grams of carbs a day.

1:33:53 So the idea of an absolute figure

1:33:56 is ridiculous because it depends where you started.

1:33:58 So that same person began at 400 grams of carbs per day,

1:34:03 so they dropped it down to 200

1:34:04 and that was enough for that person to achieve remission.

1:34:08 Do you see?

1:34:10 So I try and move people along the sugar spectrum to lower...

1:34:15 and then we see how is it for you.

1:34:19 Also, we had a dietitian do a "PhD" in the practice

1:34:22 looking at the diets of the patients that do well.

1:34:27 So the average...

1:34:29 person at Norwood Avenue who gets remission is

1:34:33 having about 70 grams of carb a day.

1:34:38 It's simpler here because we don't include fibre

1:34:41 in this, so we just say grams of carb, because it's...

1:34:45 the labeling here would have fibre as separate.

1:34:49 So that's just 70 grams of digestible carbohydrate

1:34:52 a day's average for my patients at Norwood Avenue.

1:34:57 So most of them, that would tell you, are on less than 100 grams a day.

1:35:02 Most of them, and some a lot less, because many of them go keto.

1:35:05 But there are exceptions, and if you start off very carby,

1:35:09 there are patients who are still eating bread, but not many.

1:35:13 Not many.

1:35:15 Partly because it's a really interesting piece of work

1:35:19 that looked at people with type 2 diabetes.

1:35:24 Food addiction is 600%,

1:35:27 actually 670% more likely in people with type 2 diabetes.

1:35:34 So a lot.

1:35:36 We once assessed— everybody in the group, in the waiting room,

1:35:40 because "Jen," you'll have to have "Jen"

1:35:42 on separately because this is her thing really.

1:35:46 But we actually, she's got a thing called the.

1:35:50 Well, it's a model really,

1:35:52 of a questionnaire to try and discover who is an ultra-processed food addict.

1:35:58 Every single person in the room, every single one,

1:36:02 without exception when they did that thing, was an ultra-processed food addict.

1:36:08 Everybody.

1:36:10 So that's the danger of, are you absolutely

1:36:14 in control over the small amount of bread?

1:36:17 And if you are, well, I'm...

1:36:19 good.

1:36:19 That's marvellous.

1:36:20 And if you're not, time will tell, and then I'll help you then.

1:36:24 I'd have to imagine for a lot of people just getting started,

1:36:29 having a specific number of carbs,

1:36:32 whether it be 50, 75, would make it a lot easier,

1:36:37 or even going keto or all the way to carnivore.

1:36:41 So somebody coming to you wanting that objective cutoff, what would you say?

1:36:49 It depends.

1:36:50 So, some people like figures and some people don't.

1:36:54 I think you're a person who clearly does.

1:36:57 Correct.

1:36:58 But there are other patients who find that very confusing,

1:37:01 and so for them, it's easier just not to eat bread, potatoes...

1:37:05 and to eat the protein.

1:37:07 That's why I try and make it simple.

1:37:10 For the people who want a figure, I'd say, well,

1:37:14 start about 100 grams of carbs and let's see how that feels for you.

1:37:19 But it's just a start-off point.

1:37:23 The carnivore thing, well, very interesting.

1:37:29 I've got patients who are carnivore and they do very, very well.

1:37:33 And then I've got others who go carnivore and then

1:37:36 get bored with it and can't stick it out.

1:37:39 For me, it's helping you find how you're going

1:37:42 to do this and how is it going to be sustainable.

1:37:47 And I need you to enjoy food.

1:37:49 And you're probably part of a family, so that all has to go on.

1:37:54 But yeah, I've got carnivore patients.

1:37:56 Another thing that I do explain to patients is,

1:38:00 then there's the whole thing of fasting, intermittent fasting,

1:38:05 or indeed probably you're better to eat your food

1:38:07 earlier on in the day and not later, because there's evidence of that.

1:38:13 If you're thinking about fasting, I would say, well, go low carb first,

1:38:17 so that you become a fat burner, because then it'll be so much easier for you.

1:38:22 Trying fasting when you're not low carb and the enzymes

1:38:26 are not already in your liver is a problem.

1:38:29 If, like me, you're a fat burner, fasting is much, much easier.

1:38:35 So the progression for me starts with let's try low carb.

1:38:41 Think about when you're eating the calories in the day,

1:38:44 can you have them earlier?

1:38:46 What fits in?

1:38:47 And I've got patients who like one meal a day, they do very well.

1:38:51 Two meals a day.

1:38:53 Don't eat more than three times a day, though.

1:38:56 That's another point, because that's a little stimulus to your insulin,

1:38:59 all those meals, so cut out the snacking first.

1:39:04 Try and eat no more than three times a day.

1:39:07 Try and avoid any kind of snacking in the evening, particularly.

1:39:12 Be careful, we talk a lot about don't have too much milk,

1:39:17 because that's got loads of sugar in.

1:39:20 And as I say, there are about 100 grams of carbs.

1:39:25 And then let's meet again and see how it's going, and bring your questions.

1:39:30 And also, of course, along with many of my patients, are very clever.

1:39:34 So why don't you look it up on these following websites,

1:39:38 and then you'll come back with more questions.

1:39:40 Or have you come across the "Freshwell" app?

1:39:43 It's free.

1:39:44 I've heard you talk about it, I believe.

1:39:46 Yeah, well, the "Freshwell" app is some younger doctors

1:39:49 who took my work and turned it into an app.

1:39:53 And it's free.

1:39:55 See, it's free because, like me, they want to help you, not to make money.

1:40:01 And also, it's "NHS" approved,

1:40:03 it's "QISMET" approved as a source of respectable information.

1:40:07 So this is the "Freshwell" app.

1:40:09 You can download it on your smartphone,

1:40:12 and it's full of recipes, and advice, and detail.

1:40:15 So we just send-— a code to every patient with diabetes.

1:40:22 Could you just look at the "Freshwell" app, see what you think about it?

1:40:26 To all of them.

1:40:29 Because information, if you're careful where you get it from, is easily there.

1:40:37 And if people followed me on "Twitter," they'd see there's

1:40:40 a sort of community that we're part of, a community,

1:40:45 on the whole, very caring people doing their best.

1:40:49 So where you're gonna get your information from is important.

1:40:53 "Freshwell" app, good idea.

1:40:55 I have heard you talk about it on another podcast.

1:40:58 Yes.

1:40:58 Yeah, yeah.

1:40:59 Coming back to fasting, somebody wanting to use that as a tool

1:41:04 to jumpstart what we're talking about today,

1:41:07 or if they've been following the diet and lifestyle for a while,

1:41:12 to have a breakthrough of a plateau.

1:41:14 How do you feel about multiple-day water-only fasts?

1:41:18 I've done it, so I experiment on my own body.

1:41:23 "Jen" and I have both done it, and it's interesting, the results were different.

1:41:31 "Jen" lost a lot of weight, but it actually,

1:41:37 it was bad for her in terms of food addiction and what happened afterwards.

1:41:43 Because she became obsessed with fasting and losing more and more weight,

1:41:48 and that actually, she overdid it in a way.

1:41:52 It took on a life of its own.

1:41:56 And she got to about eight days,

1:41:58 the longest fast she did, and the results looked wonderful.

1:42:03 But her reflection now is,

1:42:05 for her, it's not such a good thing in terms of— maintenance.

1:42:11 For me it's quite useful to maybe do a 24-hour one...

1:42:16 after a holiday, so it can be a reset.

1:42:21 Particularly if my appetite's getting...

1:42:23 So hunger is a really interesting signal clinically.

1:42:27 I use it a lot.

1:42:28 I say to people, are you hungry?

1:42:31 Because if you're hungry on this diet, it's not right for you in some way.

1:42:36 If you're hungry, that's odd.

1:42:38 It may mean not enough protein, it may mean too many carbs still...

1:42:42 But let's go into it.

1:42:44 So on holiday...

1:42:45 I kind of ramp up.

1:42:46 Even though it's low carb, I kind of eat more and sometimes I need...

1:42:51 I get into the habit of eating more.

1:42:53 My weight goes up a bit and then I just do a 24-hour fast

1:42:57 and that knocks that on the head

1:42:59 and it's surprising how the appetite shrinks away.

1:43:02 So for me that's a reasonably successful strategy

1:43:05 and I use it occasionally and it's there...

1:43:08 in the armoury.

1:43:11 As I'll be honest, as is going carnivore is another

1:43:15 way I've discovered now that actually instead of fasting altogether,

1:43:22 I can just go a few days on...

1:43:26 basically, beef or lamb.

1:43:29 A couple of days on that and my appetite drops behind again.

1:43:33 And then I reintroduce the green veg and all the rest of it,

1:43:37 and I've stopped the 24-hour fasts because it works just

1:43:43 as well for me to go carnivore for a couple of days...

1:43:47 And this is how I'd encourage everybody to experiment, see if it works.

1:43:51 And that has worked for me.

1:43:54 So I used to fast quite often.

1:43:57 But then I wonder, autophagy, that's interesting.

1:44:00 Maybe I'm going to get cancer now because

1:44:03 I'm not fasting and autophagy is not going on.

1:44:06 I don't know, it's all work in hand.

1:44:11 That's what I've discovered myself.

1:44:13 Also, I've discovered be careful of dairy,

1:44:17 because it can ramp up where I'm starting to glug,

1:44:21 glug, double cream down and butter on everything.

1:44:26 And that can be another source of drift.

1:44:29 Very important to be honest with yourself about what's really happening.

1:44:34 And if I'm putting butter on everything, well,

1:44:37 there are a lot of calories in butter.

1:44:40 I love full-fat yogurt and I can start eating

1:44:43 whole cartons of that, and where's that going to lead?

1:44:47 So...

1:44:48 there we are.

1:44:49 Earlier you mentioned salt, you mentioned magnesium.

1:44:54 Somebody embarking on this diet,

1:44:57 any other supplements or supplement-like things such as salt,

1:45:02 you'd suggest including?

1:45:04 Obviously, vitamin D.

1:45:07 We live in England and it rains for months and months and months.

1:45:13 So vitamin D.

1:45:14 And for my patients where we are, I'm saying you need to start

1:45:20 a supplement probably October through to March here,

1:45:24 probably Canada's about the same.

1:45:27 And because— I stopped measuring vitamin D because so

1:45:30 many of my patients were always deficient in it.

1:45:33 So vitamin D is...

1:45:35 one.

1:45:36 <break time=“3.43s"/> I'm still reviewing that.

1:45:41 I worry about supplements because clearly

1:45:43 people selling supplements are making money.

1:45:47 And I'm always thinking the reason I'm saying supplement...

1:45:51 with magnesium is I know you're not going to get

1:45:54 that in your diet no matter how you try.

1:45:58 But other things, if you're thinking of, for instance,

1:46:01 zinc or something, could you look into...

1:46:04 if you were thinking about that, could you look

1:46:07 into what foods might contain it and have more of that?

1:46:11 So, in my...

1:46:12 practice...

1:46:12 in the health service, the supplementing advice I give stops where I am certain.

1:46:19 And I'm certain vitamin D, I'm certain magnesium, and I'm certain for salt.

1:46:24 There's many other things that might be, but I'm just not that sure.

1:46:29 So I kind of making my mind up over time.

1:46:33 "Jen" is far more pro-supplement than I am,

1:46:36 and she'd give you a different answer because I noticed she takes quite a few.

1:46:41 But there's always this...

1:46:43 It's a bit like fish oils, isn't it?

1:46:45 Where the results from supplementation weren't quite the same as eating fish.

1:46:52 So— you've hit upon an area there of uncertainty for me,

1:46:57 and I'm still working on it.

1:46:59 And at the moment, those are the supplements I recommend.

1:47:05 Occasionally Brazil nuts for selenium, but not to overdo.

1:47:09 Organic Brazil nuts, I'd say, are...

1:47:11 a good idea.

1:47:13 And beyond that, I haven't really come across,

1:47:17 have I ever seen somebody with zinc deficiency that I've known about?

1:47:22 And the answer is, no.

1:47:24 I haven't.

1:47:25 Whereas vitamin D deficiency, yes.

1:47:27 Folic acid, oh, my goodness.

1:47:29 Loads of young people are deficient in folic acid.

1:47:31 That's...

1:47:32 really common.

1:47:33 Magnesium deficient, very, very common.

1:47:35 So— my expertise fades away on supplements

1:47:39 with a little bit of suspicion about the capitalism...

1:47:44 aspect of selling supplements and saying, you feel wonderful if you take this...

1:47:51 supplement.

1:47:52 And I've got to be really careful as an "NHS"

1:47:55 "GP" in that line and keep sort of super clean.

1:47:59 Last nutrition question.

1:48:02 When it comes to the green veg, you mentioned you'll periodically do carnivore.

1:48:07 Yes.

1:48:08 So you're not totally sold on that we need the veg all the time.

1:48:12 Are you including that for certain nutrition benefits or just

1:48:17 to be more social so you can include more foods?

1:48:19 How do you look at that piece?

1:48:21 I'm still looking at that.

1:48:25 I'm a great fan of...

1:48:27 "Paul Mason" in Australia.

1:48:29 Do you know?

1:48:30 What a fabulous guy.

1:48:32 And he says, this fiber thing is a bit overblown.

1:48:35 And it's certainly true to say it's very interesting

1:48:38 to try carnivore and find out what happens to your bowels.

1:48:42 And the answer is, actually, it's fine.

1:48:47 <break time=“3.25s"/> I don't know that you have to have fibre...

1:48:51 I do know that...

1:48:53 I enjoy green veg and I get a bit bored...

1:48:56 on carnivore and it doesn't seem to do me any harm.

1:49:01 And then you've got to think about, well, what about...

1:49:04 What about vitamin C?

1:49:05 Does that matter?

1:49:06 I think it depends how much carbohydrate you have.

1:49:10 And if you have less carbohydrate, you probably need less...

1:49:14 vitamin C.

1:49:15 So why do I bother with the green veg?

1:49:17 <break time=“5.16s"/> Oh, here's the point.

1:49:23 Here's the point.

1:49:24 So when you're on loads of junk food,

1:49:26 you no longer get any signals from your body as to what to do.

1:49:31 You get no useful signals.

1:49:34 But once you go...

1:49:36 low carb, you start getting signals of, wow, that state was really...

1:49:43 special, or whatever it is.

1:49:47 And I've noticed that I seem to get...

1:49:50 a craving for green veg and then really enjoy it.

1:49:55 So that can't be wrong.

1:49:57 It's not doing me any harm.

1:49:59 I really enjoy it...

1:50:01 and maybe there's a craving there.

1:50:04 I'll give you an example...

1:50:05 of magnesium, because the magnesium story is really interesting.

1:50:11 And— I'm going to shorten it for you because that's quite a long chat...

1:50:16 But...

1:50:17 I noticed for years and years I

1:50:19 really enjoyed a particular sparkling mineral water.

1:50:23 Turns out it has a really high level of magnesium.

1:50:27 And then I spoke to a professor of nutrition at Cambridge University about...

1:50:32 we were talking about magnesium, and he said,

1:50:34 of course, you do know that you can taste magnesium.

1:50:39 You can taste magnesium.

1:50:40 Humans can taste magnesium because it is so necessary to life that you

1:50:46 can taste which water has got magnesium in it and which hasn't.

1:50:50 And— I think that's true...

1:50:52 I think that's true.

1:50:54 So if I get a signal...

1:50:56 that I want, I could just fancy a crunchy salad.

1:51:00 Well, why don't I have one?

1:51:02 And...

1:51:03 I think let's be a bit flexible and also be

1:51:05 honest about what we know and what we don't know.

1:51:08 <break time=“3.29s"/> I don't really know whether is carnivore safe long-term,

1:51:16 or it's probably, but I've got to be careful with my patients...

1:51:21 and...

1:51:22 why don't I stick to what I do know, which is sugar is certain death.

1:51:29 And bread, avoid that...

1:51:30 Avoid junk food linked to all-cause mortality.

1:51:34 And then...

1:51:36 there's all the fascinating small-print stuff that you can

1:51:41 work out for yourself and see what suits you.

1:51:43 And yeah, I won't be too...

1:51:46 judgmental.

1:51:46 If it's working for you and you look well, it's probably all right.

1:51:52 What was the brand of water?

1:51:54 "Pellegrino." I'm a fan.

1:51:57 "Pellegrino." Yeah, "Pellegrino." And I used to think

1:52:01 it was a ridiculous indulgence that it seemed like...

1:52:05 how pathetic that I have to have "Pellegrino," and yet I did,

1:52:09 and I thought, well, it's no good.

1:52:11 I do enjoy it, I don't care why, but I do.

1:52:14 And then I discovered it's got one of the higher...

1:52:17 and then I managed to find some.

1:52:18 There's a German one.

1:52:19 I forget its name now.

1:52:20 There's a German sparkling water with even more in.

1:52:23 And I love that a lot.

1:52:25 Interestingly, your requirement for magnesium...

1:52:28 varies.

1:52:29 So...

1:52:30 I do a thing called "Keto Live" every year in the Alps,

1:52:35 and altitude stresses me considerably, and public speaking stresses me...

1:52:40 My need for magnesium is treble when I'm at high altitude...

1:52:45 and when I'm doing public speaking, it's treble,

1:52:49 and without it I'm cramping up badly.

1:52:52 Now I've discovered to vary my magnesium supplementation depending...

1:52:58 on how stressed I am and what I'm doing.

1:53:00 And altitude definitely is another factor.

1:53:03 See, nutrition is endlessly interesting.

1:53:07 I hear you.

1:53:07 I love it.

1:53:08 Yes.

1:53:09 We don't know.

1:53:10 There's loads we don't know.

1:53:11 And that's quite fun really.

1:53:13 How does movement fit into this?

1:53:15 Somebody coming to see you, they've lowered the carbs,

1:53:17 they want to do all they can do.

1:53:18 Oh, yeah.

1:53:20 Yeah.

1:53:21 How do you look at that?

1:53:22 Movement.

1:53:25 It's like this— with patients,

1:53:27 I'm trying to work out what the low-hanging fruit is.

1:53:31 How can I make your life,— how can we do this easily?

1:53:35 So if you weigh 100 kilos,

1:53:36 telling you to start going to the gym and moving around loads,

1:53:39 it's just like punishing you unless you want to do it.

1:53:43 But when after you've gone low-carb, you've lost a bit of weight,

1:53:48 have more energy, particularly if you're fat-burning,

1:53:52 and adding in exercise at this point can

1:53:54 really improve things still more because of course,

1:54:00 muscles are endocrine active, so they do stuff...

1:54:04 Also, it's a terrific sink for glucose.

1:54:07 So I have a thing called the dawn phenomenon, which...

1:54:10 people with type 2 diabetes have,

1:54:13 and I can soak that up wonderfully with 100 press-ups or a run.

1:54:20 So I like exercising, I love it.

1:54:23 And I tend to exercise in the morning...

1:54:25 because it deals with my dawn phenomenon...

1:54:28 And so, yeah, exercise improves insulin sensitivity.

1:54:33 So it's one of the levers I use with people who

1:54:36 don't seem to be doing as well and I don't know why.

1:54:41 I particularly like a bit of resistance

1:54:43 training for older people to build muscle mass.

1:54:47 So I explore that...

1:54:49 because sarcopenia...

1:54:50 is a real problem...

1:54:52 for people.

1:54:52 So increase the protein, but also, are you doing squats?

1:54:56 <break time=“1.90s"/> What sort of exercise might suit you?

1:55:01 And particularly, it's funny, when they go low-carb,

1:55:05 they have this spare energy,

1:55:06 so they're kind of more open to going walks or joining a gym.

1:55:11 And having the energy it gives you is very important...

1:55:14 because then you can follow through and do things.

1:55:17 Whereas...

1:55:18 making people exercise <break time=“2.23s"/> doesn't always go as well.

1:55:23 They just feel guilty because they don't.

1:55:26 So in my practice, on the whole, we try diet first,

1:55:29 but some of them do exercise and fabulous, well done.

1:55:33 But a lot of the gym people, there's more men for us do that.

1:55:41 So, yeah, exercise, I personally do.

1:55:43 I love running.

1:55:45 I don't enjoy press-ups and power squats as much,

1:55:48 but I make myself do it because I'm 67 and I've got to hang on to those muscles.

1:55:55 Somebody that's been with us now almost two hours, they're on the fence.

1:56:00 They feel a little bit of motivation,

1:56:02 but they need that nudge in the right direction to get going.

1:56:04 What would you say to them?

1:56:06 Yeah, I think it's how we began, really.

1:56:09 What if every meal you eat is a choice?

1:56:14 And what if your future health depends on how you eat?

1:56:21 And which future are you going to pick?

1:56:24 Because I know which future I would pick.

1:56:27 And yes, it's also, do you want pleasure now...

1:56:32 or do you want something far better in the future?

1:56:35 So if you want pleasure now, eat the trifle, eat the cake.

1:56:40 But if you want a better future, well, you've got to work towards that.

1:56:46 And...

1:56:46 I'm 67, I have eight grandchildren, all of whom I saw yesterday.

1:56:50 I can sprint with my grandchildren.

1:56:52 I can run with them.

1:56:54 I can play and roll around.

1:56:56 That's life.

1:56:58 Eating cakes alone, that's not life at all.

1:57:02 So I'd say to you, go for a little bit of pain now and a better future.

1:57:09 And...

1:57:10 you'll be glad you did, because I certainly am.

1:57:14 All right.

1:57:14 Perfect way to wrap up.

1:57:16 Thank you for that.

1:57:17 I think so.

1:57:18 Really enjoyed the conversation.

1:57:19 We're going to link up your "Twitter," the infographics,

1:57:22 your website, "Freshwell" everything in the show notes.

1:57:25 Thank you.

1:57:26 Lovely.

1:57:26 What was the last one?

1:57:27 Sorry.

1:57:27 The "Freshwell" app.

1:57:28 Put in a link for the "Freshwell" app.

1:57:30 Yes, we'll put that in there as well.

1:57:31 Before you do it, will you check

1:57:33 that it's available in Canada and the United States?

1:57:36 I think it is.

1:57:37 Do check.

1:57:38 Okay.

1:57:39 Okay.

1:57:39 If it is, it'll be included.

1:57:40 That was.

1:57:40 That was fun.

1:57:41 That time went very quickly for me, anyway.

1:57:45 Thank you, Doc.

1:57:46 Me too.

1:57:47 Bye-bye now...

1:57:48 Bye-bye.

1:57:49 Thank you for watching.

1:57:50 Stick around here for this other great interview.

1:57:52 You don't want to miss it.

1:57:53 I'll see you over there.

1:57:55 They're all on insulin, and within a month,

1:57:57 all of, all three of them were off of all their insulin.

1:58:01 And they'd been on the insulin for like 20 years...

1:58:04 Right.

1:58:04 So 20 years.

1:58:05 They got off in a month...

1:58:06 Calories are a distraction because the body