Diet Doctor Podcast #33 — Dr. David Unwin


Welcome to the Diet Doctor podcast
with Dr. Bret Scher. Today I am joined by Dr. David Unwin. Dr. Unwin is a general practitioner
in northern England. And what’s interesting is
when I usually do these introductions, I am going to tell you about their website
and their books and all their products… Dr. Unwin is completely different. He is a general practitioner
taking care of patients and that’s what he does
and that’s what he loves. And during this discussion
you’re going to see his journey, the journey he took from being
sort of the standard general practitioner to noticing and implementing
a low-carb lifestyle and the joy that brought back to him
in his practice because he was seeing
the improvement in this patients. It is a wonderful journey
and I hope you can pick up on his joy and how this process led him to see
medicine in a different light. And how not only has he been helping
the patient he sees, but now he has been taking on
leadership roles and advisory roles to try and help others implement this. And it’s a lesson we can all learn and
hopefully you will take away from this the type of physician
you should be looking for, but also how to interact
with your physician if he or she is not
of the caliber of Dr. Unwin. It’s a wonderful journey
and I hope you will enjoy this discussion. For the transcripts
please go to DietDoctor.com and you can also see all our past podcast
episodes there as well. Thank you very much and enjoy
this interview with Dr. David Unwin. Dr. David Unwin thank you so much
for joining me on the DietDoctor podcast. Hi, here I am. So as we can tell by your accent,
you are from England, correct? That’s right, the North of England. And you are a general practitioner
and you have been for how long? I started in partnership in 1986. And from 1986 to 2012 you practiced
in a particular manner. Yeah, well I was doing my best. I think I was pretty average really, but I was so disappointed
with the results I was achieving. And what do you mean by that? What were the results you were achieving
that were not up to what you wanted? When I look back now
it’s neat upon me really. I didn’t notice for the first few years and after a while you start to realize that
nobody looks really very much better… I’m talking mainly about people with obesity
and type 2 diabetes but other conditions as well. I think I just started noticing that people
didn’t really seem to look healthy for what I was doing. And what were you using
as the framework for how to treat them? Well we’re pretty closely regulated so I was using the usual guidelines
that all GPs in the UK use and the payment system is slightly based
on the guidelines as well. So it was a good idea
to do conventional medicine and they’re called QOF – quality and outcome
framework payments and we did very well with those
and so it looked on the surface of it that we were doing quite well. So the closer you adhere to the guidelines
the more you got paid basically? Yeah, although the QOF figures
on diabetes practice were quite disappointing. Which was a bit difficult to understand…
we can seem to be doing very well. So I had on one hand
a sort of sneaking suspicion or a feeling that the medicine wasn’t what I’d hoped. So when you’re young,
you become a doctor because you want to make a difference . It’s not really about money. You have a shining thing that you want
to make a difference and then the years pass by
and you sometimes wonder whether you are making much
of a difference. And patients didn’t look
really very much better and during my time
we’d had an eightfold increase in the number of people with diabetes so that didn’t look…
really a good reflection on me. Right. So there was an eightfold increase
in the people with diabetes. So we had 57 people when I started– In your practice? Yeah, out of 9000 patients. And now we’ve now got about 470. So I watched that happening. I just had a sneaking suspicion
I was letting people down somehow, that I wasn’t achieving
what I thought was health and what patients thought was health because some of the things I measured
seemed a bit better. But their experience of life
wasn’t improving. I’m guessing you weren’t the only person
to see that sort of a change, but for some reason it hit you more deeply and you had a deeper awareness
of what was happening. I think in part because I knew
I was coming to the end of my career and you tend to reflect… So when I was 55…
you’re tending to look back on your career and I was disappointed in myself really. And then how did you change? Well, several things happened. There was one particular case
I’ve talked about before where there was a patient who– so in 25 years I’d never seen a single person
put their diabetes into remission, I had not seen it once. I didn’t even really know it was possible. We were not that it’s possible. No, my model was
that the people with diabetes… It was a chronic deteriorating condition and
I could expect that they would deteriorate and I would add drugs and that’s what
would be normally going to happen. And then one particular patient
wasn’t taking her drugs and she actually went on the low-carb diet
and put her diabetes into remission. But she confronted me with, you know, “Dr. Unwin, surely you know that actually
sugar is not a good thing for diabetes.” “Yes, I do.” But then she said, “But you’ve never once
in all the years mentioned that really bread was sugar, did you.” And, you know, I never did. I don’t know what my excuse was. So this this lady had done
this wonderful thing and she’d also changed
her husband’s life as well. She’d sorted his diabetes out
and she’d done it with a low-carb diet and that really made me think
I didn’t know much about it. I didn’t know much about it. So I found out what she’d been on…
on the low-carb forum of diabetes.co.uk and to my amazement
there was 40,000 people on there, all doing this amazing thing. And I was blown away
but then I was very sad because the stories of the people online were full of doctors who are critical
of these people’s achievements. Right. And practice nurses who were saying,
“You’ll come to harm, you know. I won’t take any responsibility for you
if you give up your drugs. There is a definite fear factor there. Yes, there was. They were being blamed. I thought I was terrible, really terrible,
when they seemed to be doing their best. And at the same time– I was running
one day with my wife Jen and she was saying,
“How do you feel about retiring?” And I said,
“I don’t know, a bit disappointed.” And she said, “Shall we not do
one decent thing, one good thing in medicine together
before you finish?” And I had just seen this case
and begun to read around it. And so she said, “Who would be the group
of people who you’d really like to help?” And so I thought people with obesity
and type 2 diabetes. It would be a great challenge and if we
could help them that would be brilliant. And the next thing she said was,
“Why don’t we do this?” And I said, “Because we’re not paid.” And she’s a great woman,
she said, “So, we are not paid “and that’s why you won’t do this thing? Shall we not just think
our way around this?” So it was Jen’s idea. She said,
“First of all, why don’t we work for free?” So we came up with the idea
on a Monday night. The practice wasn’t being used very much and my wife would work for free
and I would work free. The partners wouldn’t mind. And another idea was, why don’t we do
the people in groups of 20? We were very cautious at the beginning. So it wasn’t just people with diabetes. I was really concerned
about the people with pre-diabetes. Because we’d just started screening
for them, so we knew who they were, but we weren’t doing anything for them
so it was ridiculous, because we knew who they were and we were just sort of waiting
until they would develop diabetes. Right, and that’s part of that eightfold
increase that you saw in diabetes where all those people had pre-diabetes
when you were taking care of them. Yeah, so why were we waiting? And within that group,
I think particularly the younger people, what a shame not to helm. So we sort of thought let’s begin
with the younger people with pre-diabetes and invite them in groups of 20
and do them as a group. And then Jen and I learned about low-carb
with these people. So we bought each one of them
a book on low-carb and then we did cookery lessons together
on a Monday night. I remember we did like–
how fast can Dr. Unwin make leek soup? So it’s about three and half minutes,
that sorts of things. So we did it in a group with the patients. And I was so surprised
because I had such fun. You had such fun
and probably were seeing a success you hadn’t seen in your practice and a new level of enjoyment
you hadn’t seen in your practice for a while. Well, the first thing I noticed was how I enjoyed the experience
of group work with my patients. Because we, doctors,
are used to one-to-one, but we are not really used to groups, so I was quite scared almost of not being
in charge of the one-to-one thing. But the group work was so great…
I wonder why was it so good? I think it’s so good because the group
dynamic becomes very interesting and patients try and help each other… And they were very kind to me
and then I started seeing them improve which happened quite rapidly. So you went from just doing it
on Monday nights to now basically basing
your practice on it. Yes. There was a difficulty because at the time what I was doing was seen as being
not dangerous but weird. And it’s important
to sort of set the stage, because you work for the NHS,
the National Health Services in England and it’s sort of a government run program
with one pair and one set of rules and would you say it’s fairly restrictive and what they say is within the scope
of what you can do? So interesting… I thought that, yes. So we developed this for a little while
and we started with pre-diabetes and then people with diabetes
started sneaking in, because they had heard and so they said,
“We want to do the same thing.” And then we started getting
some very good results with diabetes. And I thought what I was doing
was not really part of the guidelines, but you know I hadn’t really read
the guidelines, not all of them, because they go on pages and pages. So because I felt vulnerable, I thought
I’d read every word of the guidelines. And then inside the NICE guidelines
in the UK I found some pure gold. So the N-I-C-E, NICE guidelines. Yeah, and it says we should advise high fiber low glycemic index sources
of carbohydrate for people with diabetes. And when I found this, I was so excited because I knew then I got something
that could make what I was doing and it was effective but it could be safe and I was not going to be criticized
as much for this. That’s an interesting point that–
the low glycemic index because that’s a difficult thing for a lot
of people to understand and interpret and put into practice. But it’s a very calming catchphrase,
but maybe not the most practical. But it seems like you found
a more practical way to interpret this. That’s an interesting story. So I became obsessed
with the glycemic index and the glycemic load
which is calculated from it. And I was also obsessed
with the results we were getting. So I became a real low-carb bore. I went on and on to the partners. And one my partners, Scotty Scholz, she said, “David this is getting
really boring now, “because we don’t really understand. “You’re talking about the low GI, but we
don’t really know what you’re talking about. So why don’t you go away and come back
when you can really explain–” Yeah, she said, “When you can really
explain it to a plumber, to a student to other GPs.” So I am very grateful to Cottee because
she was absolutely right. I was a low-carb bore and GI
and all this. So I really started thinking about
how would you communicate the effects on your blood glucose of eating
foods with carbohydrate in. How can we help people understand the glycemic consequences
of their dietary choices? And I came up with an idea. The first thing really was
why was it so confusing? Why did people not understand it? Now I decided it was because people
are not really familiar with glucose, because a glycemic index and the glycemic
load always works out to grams of glucose. So this amount of food is equivalent
to so many grams of glucose as a glycemic load. And really I don’t think
doctors or patients are very familiar with glucose
as a substance. What do you mean by that?
Because glucose is sugar, right? Well, it isn’t really, is it. Because sugar is table sugar,
which is, you know,– so people know table sugar but
they don’t really use glucose in cooking. And they don’t really know
what does 10 g of glucose look like. They were not really familiar– particularly in the North of England
they are not using glucose for anything. They wouldn’t know what it looks like. So I was looking for something that patients
and doctors would understand and would be familiar to them. So I thought I wonder whether
it would be valid to redo the calculations in terms of something
we are familiar with which is a 4 g standard
teaspoon of table sugar. A 4 g teaspoon of table sugar! And put that into glucose equivalents. So now you can visualize it,
you can see the tablespoon– And you think that’s what it does. So I was really lucky,
I contacted the original people who developed and experimented and published the work on the glycemic
index and the glycemic load and they are actually in Sydney. And Prof… I think is Jenny Brand Miller. And I emailed her and to my amazement
she emailed back… I was so surprised. And I was asking for help…
“Is my idea valid and will you help me?” And she said, “I don’t know, but I know
somebody that will help you.” And that was Dr. Jeffrey Livesey who was one of the academics
who would work with her on the glycemic index and glycemic load
and Jeffrey has helped me. And so he redid the calculations
for 800 foods. 800 foods? Yes, in terms of teaspoons of sugar. So I can now tell you that 150 g
of boiled rice is about the same in terms
of what it will do to your blood glucose as 10 teaspoons of sugar. So whether you have 10 teaspoons of sugar
or 150 g, a small bowl of boiled rice, is about the same…
and patients find that very surprising. Very surprising, yeah. I’m sure you see people’s eyes
just pop open at this awareness
that they haven’t had before. It’s such a quick way for them
to understand how carbohydrates– And it helps them
because they’re so mystified, because so many patients say to me, “Dr. Unwin, I know that you shouldn’t have
sugar if you have diabetes, and I haven’t had sugar for months now
and yet my blood results are terrible.” And they don’t know how– and previously I didn’t know
how to explain this, but now I can say,
“Well, let’s look at what you’re eating.” And then if you are having a takeaway
the rice would– no wonder, or if you take boiled potatoes, 150 g,
that’s about 90 spoons of sugar. Or even a small slice
of healthy whole meal brown bread is the same as three teaspoons of sugar. So you can begin to see that some items
in your diet may not be a great choice if you have type 2 diabetes. And in fairness that glucose equivalent,
that sugar equivalent, is going to react differently
in different people depending on their metabolic health. But when you’re dealing with a population
that’s obese and pre-diabetic or diabetic, that’s where the concern is. So I can see how phrasing it that way
will really make people understand it better. I think that there are
two really important points. So one is helping them understand
that this is where the sugar is coming from. But the other vital thing is giving them
hope… It’s so important… I think hope is even more important. The idea that yes, you have diabetes but it
doesn’t have to be chronic deteriorating. And that original case that showed me
you could put into remission; if you could repeat that,
how wonderful for people… And when I now– because I think
we’ve done 60 patients who put their type 2 diabetes
into remission. So I’m able to say
with confidence to people, you know, you stand a good chance. In fact I can say that of my patients
who take up low-carb, about 45% of them will put their diabetes
into remission which is amazing. Remarkable, no drug can do that. No, and I’ve never seen
a single case of that in 25 years. -25?
-Yeah, not one. And now reliably week after week
I’m seeing people, I am getting them off drugs
for type 2 diabetes. And they’re coming in getting
these marvelous results and it’s such cheerful medicine
and it makes me– You know, I often ring them up. I love it now
when I get the blood results I keep them like a treat
for the end of the day. The hemoglobin A1c
is the liver function. I keep it like a treat,
because so many of them are good and I ring them up at home. You know, how often do patients get
a cheerful phone call from their GP to say, “I’m just ringing you to tell you…
it’s amazing you’ve done so well”? What do you use
as the cutoff for the diagnose? Is it an A1c–? I use a hemoglobin A1c. What level usually? So I think on the whole now
I agree with Roy Taylor. So I’m defining remission of type 2 diabetes
as being off drugs for at least two months. And hemoglobin A1c in millimoles per mole
of less than 48. You’d have to convert that into percent
for the listeners because I can’t remember what that is. Okay, I’ll have to work on that. Maybe it could come up on the screen,
that would helpful. So that’s the definition and Roy published that
in the British Medical Journal. And I have to remark which I’m sure
people on the video can see, but people in the audio
might not be able to– Your face sort of lit up as you were
describing it to me, the way you can call these patients
and give them the news. Your face just like lit up. Yeah, it’s such wonderful medicine. I’ve never thought
I’d live to enjoy it so much. And amazing, you know, I’m old,
I’m over 60 and I’m still there. I was supposed to be retired six years ago,
that was the plan, and I’m still there. It’s really addictive because all the time
you just look at the blood results and it’s not really
about the blood results, is it? Imagine the patients how they feel
when they come in and they’ve lost weight. It’s not even just diabetes,
is really not just diabetes. That was going to be my next question,
so you are you focusing on the diabetes, but what other, you could say
unintended effects or other downstream effects which actually
should be intended effects, but what else did you find? Interesting, so one of the things that
surprised me most in the beginning was dramatic improvements
in liver function… dramatic. The fatty liver going away. That was so interesting
because I saw patterns, I began to see that I could predict
the patients who are doing really well before they came into my room
because I’d get the blood results and I’d see the liver function improving and
I know this is one that is doing really well. The liver function would seem to improve
almost before anything else. Interesting. I’m now getting– it’s about 40% to 50%
improvement in liver function and gamma GT,
which is a thing I measure. The next really interesting thing,
and this happened to me as well… I used to have high blood pressure. But it started and when I stood up
I felt dizzy and my blood pressure was dropping. That happened in the first few weeks and
then it was happening with patients. And I was discovering that I could take– I could stop lots of drugs
that I had them on for hypertension. So every week I was stopping amlodipine,
perindopril, lots of drugs that they were on
to keep them safe because I worried that they would faint
if they stood up. So imagine how that is
for a doctor after 25 years… it wasn’t just about diabetes,
it started broadening out. So we had their blood pressure, the weight, they were losing significant weight
particular off the belly, they really liked that,
their belly was going down. Triglycerides were another thing. I had worried about triglycerides for years
and I never knew what to say to patients, because you did the blood test
and the triglycerides were sky-high, but I never really knew why. And of course there’s no real drug
for triglycerides, so what would you say? And I’m embarrassed to say
I used to fudge it. I’d say, “It’s a bit high. You probably need
to lose a little bit of weight. And we’ll redo again in six months and hope
another doctor did the test in six months. Why did triglyceride matter? But I found it dropping significantly. And another thing, I don’t know
whether you’ve noticed this. Have you noticed? The first change I see
in people is that their skin improves. That’s nearly one of the first things
within a couple weeks sometimes. Their skin improves and another thing is
their eyes look bigger. -Bigger?
-Yeah. I think they’re losing fat around the eyes. -How interesting!
-Yeah. I always have a little bet with myself. When I see them in the waiting room
from a distance, I have a little private bet…
“Oh, this one is going to be good.” Before I weigh them. And the ones who have the eyes look
brighter and bigger, they have nearly always lost weight. I wonder whether they’re losing either
periorbital fluid or periorbital fat. I don’t know, but it’s a thing I have noticed
again and again and I see first. And this goes back to sort of how
we started this conversation where you said people weren’t looking good,
they weren’t looking healthy. And I’ve heard you make that analogy,
I want to hear your analogy to animals about the same sort of thing. That’s a separate thing. So I had a lifelong interest
in natural history. I’m fascinated by wild animals,
I run a series of bird sanctuaries so I do a lot of watching
of animals in the wild. I’ve had all sorts of pets lots of weird,
weird animals I have had as a pet. Another one of the things
that had troubled me over the years was human beings
don’t look like healthy animals. If you go down the street,
how many would strike you as a really strikingly healthy animal? Not very many… Isn’t that odd? And yet wild animals on the whole
do look healthy and you could say, “Maybe it’s because
the wild animals are all just young and the people I’m seeing in the street
are mainly old”, but that’s not true because I started
to notice even 30-year-olds who should be in the prime of life
who were looking obese, with poor skin, they didn’t look healthy
and didn’t look happy either. And so I used to think
that this is really odd because human beings
are not looking healthy. And suddenly I had this thing
that they were looking healthy and not only did they look healthy,
they felt healthy. And another thing I noticed
at the beginning was people– So the average patient I’m dealing with
weighs 100 kilos and they are not exercising. About 220 pounds. Yeah, it’s understandable that you’re not
exercising if you weigh that much. -You don’t feel good.
-No. They felt sleepy, tired but when they’ve lost
a bit of weight, they start exercising. Again and again I find patients saying, “I am a bit bored in the evening
so I am starting to exercise.” So we were going from a population
who didn’t look healthy, didn’t act healthy and as I say I’ve been a bit mystified unlike
everything else in nature where people– sorry, where animals generally in nature
look pretty good. And now human beings were beginning
to look pretty good and I thought, “I’m onto something here.” But one of the things was I didn’t know any
other doctors who were like us. Completely alone at the beginning. How did that feel? I mean you really felt like you were hesitant saying like maybe I am doing
something wrong because nobody else is doing it? You wonder whether you’re bonkers. Am I trying to convince myself? But then I started with one,
and then it was 20 and then it was 25. It worried the partners in the practice,
what I was doing. They were cross with me because they said, “David shouldn’t you be concentrating
on sick people?” And that upset me because
if I don’t do something they are sick, so that troubled me. And then I knew that what I was doing was making some health professionals
uncomfortable and I remember one meeting– after I got my first paper published
I went to a big diabetes convention and the doctors stood up
and absolutely shouted at me and said that what I was doing
was dangerous and people would come to harm
and I should stop it. He was shouting at me. And other people when they heard my name
would just turn their back on me. Wow. It felt terrible. I was mystified because I thought,
“What am I to do?” Because if I go back to doing what I did
before, that was so depressing and I couldn’t understand the reaction
of the people that seemed so cross. The lack of knowledge
and lack of understanding, have you seen that change over time
or do you still see that level of resistance? It’s changed hugely, hugely
and it gives me joy because, you know,
I’m not alone anymore now, there’s loads and loads of doctors
doing this. In part of that I think
it has to do with your advocacy. So you started with treating the patients,
seeing the benefits to the patients, getting the joy back and now you’ve gone
on to be a sort of a leader and an advocate in the Royal College. So tell us a little bit for the American folks
what the Royal College and your role in it and what impact that’s having
on patient care? So the Royal Colleges in the UK… you can’t actually be either
a general practitioner or a consultant unless you’ve passed an exam set
by your Royal College. So there’s a Royal College
for general physicians, there’s a Royal College for psychiatrists,
dermatologists and a Royal College
for general practitioners. They’re responsible for quality really
and standards. They are unique I think almost in the world
in that they are independent. So if you can convince the Royal Colleges
what you do is reasonable and if there is published evidence for this
then they are going to listen to you. One of the things I’d say to other doctors
right at the beginning is keep data. So one of the things I did at the beginning knowing that what we did at Norwood
Avenue, that’s the practice, was a bit odd, was I felt I owed it to the patients,
really the patients, you can’t experiment on them, you really
got to do blood tests and keep the data. So I started with an Excel spreadsheet. It’s funny really,
I owe all of this to Prof Roy Taylor who is very famous in the world of diabetes. Should I tell you the story of Roy Taylor? -Sure.
-Okay. When my results first started coming in,
I couldn’t believe them. I thought there’s something– you know,
you can’t believe it and after all these years…
is it safe? What’s going on? So I contacted I think about 20 professors to say, “I’m getting these results
and I feel I need to tell the world. And I don’t know whether it’s right
or what’s going on.” And only one professor answered me
and it was Roy Taylor. He said, “What you’re doing is fascinating
and may well be clinically very significant. But we need to do the statistics.” I didn’t know how to do statistics. And he said,
“You need an Excel spreadsheet.” I didn’t know how to do
an Excel spreadsheet. And I had to get my accountant
to do an Excel spreadsheet for me because I didn’t know how to do it. But that started me with the data. So I’d say to anybody if you collect data– so now I know on average with the patients
I’m doing, I know what’s happening to them. When you start doing data is a bit laborious
and time-consuming on top of your day job but soon it becomes addictive. I love doing it now. So about twice a week I am loading my data
to see how they are doing and see how the averages are coming on. But that really helped convince
the Royal College. And then the other thing was
we started making drug savings. I think I should know we were doing this. It was actually… it was one–
so we are organized in the UK… GPs are organized into groups
of about 20. They are called CCGs. But then our CCG pharmacist
contacted me one day and said, “Do you realize you’re way
below average for our CCG? “Not only are you way below average, you are the cheapest practice
per 1000 head of population in our CCG.” And she said, “I think you’re spending about
£40,000 less every year on drugs for diabetes and is average for our area.” That’s remarkable. Well, it was amazing. I got her a bottle of champagne that one.
I was so excited. And it was true and we’ve kept that up
for three years now and that became very interesting
to the College, but also very interesting to other doctors
and also politicians. And now you don’t have to worry so much
about being outside standard of care because you’re showing you have evidence, you have data to show
how you are benefiting the patient and benefiting the bottom line
with medication prices. It’s not even that, is it, because I think I am doing low glycemic
index sources of carbohydrate for diabetes which is part of the NICE guidelines, but I think I just ignored that
and went straight to drugs. So I didn’t really believe
in lifestyle medicine. So now I am really focusing on that. And I tell you, I think it’s five years
or maybe six years now, every single patient
that I diagnosed diabetes with, I offered them a choice. So I say, “Right, we could do this two ways. “I believe that I can help you
with this with diet “and we need to start talking sugar
and starchy carbs, or if that isn’t your thing we can start drugs,
lifelong medication.” But, you know, not a single patient, not one
in all these years has asked for the drugs. -Interesting.
-Not one. So other doctors say to me,
“My patients wouldn’t be interested.” But, you know, my patients weren’t
interested for the first 25 years, because I didn’t give them that choice. And I think if we could give people
the choice and offer support– so I say, “Shall we for three months,
how about we have a go?” I’m up for this, I’m up for this thing. How about we have a go?
Shall we talk to your wife? Shall we– who does the cooking?
Who is doing the shopping in your family? And I think then they know I care. What would you advise to patients
who are seeing a doctor who doesn’t bring it up
and just prescribes the medication and doesn’t think it’s an option
or doesn’t think they would be interested, but in the back of their brain
they are wondering? How would you advise them
to address their physician? I think you always have to cooperate
with your doctor, because at the end of the day
he’s got your records and maybe you can’t get
another doctor anyway. Doctors are difficult, aren’t they?
There is not enough of us. You have to work with your doctor, but I think would it not be reasonable
to say to your doctor, “This is something I’ve read about.
Would you mind could I try this? Would you give me the trans to try this?” And I think if a patient
asks their doctor reasonably, then the doctor would at least have
to justify refusing that. Yeah, I think that’s good advice.
That’s similar to the advice I give. You’re not saying this is the way I am going,
this is what I want to do. You say, “Will you work
with me on a trial? And these are the things
we can measure. We can see how I feel on my weight
and my blood test and let’s just see what happens
in three months, in six months, then we will revisit it
and if I am feeling horribly we’ll come back
to the medication. Exactly and I think
you said a good thing there which is agree
what you’re going to measure what are the outcomes for success. So for me,
I find waist circumference very good. And the patient can do that
and then they’re getting feedback. Better than weight, better than
body mass index, waist circumference. I do both. I’ve actually had patients,
I don’t know about you, I’ve had patients whose diabetes has
improved significantly without weight loss. -Without weight loss, but–
-Have you had that? Yes, I have, but you can’t see body composition
changes without the weight loss. They change, absolutely,
some of them have put on muscle probably, but the belly has gone smaller, so it’s worth measuring both because
there are people who don’t believe that. There are clinicians who don’t believe you
could improve diabetes without weight loss. There are definitely yeah,
but you can. I was going to say something
about motivation, I think. This is some of the stuff I’ve learned
from my very clever wife Jen. And that is… the first thing
is giving patients hope. It’s a really interesting subject,
the subject of hope and how do we give people
hope of a better future and asking about their goals. The next thing is feedback is absolutely
central to behavior change, isn’t it? So I don’t know any of the listeners
who have seen my Twitter stuff but I do this graph of the week. So the computer systems generate graphs;
so weight, hemoglobin… So every week– this is the patient
that has done the best and those patients are so proud. So I always put it on Twitter. But what wonderful feedback that is! Let’s get into long-term
and short-term goals. So the short-term goals
are the stepping stones that get you to the long-term goals,
but they give you hope, they show you immediate feedback
that you’re having progress and it keeps you interested. That brings me to a point, you know… I didn’t used to recheck
hemoglobin A1c a lot often. So I wouldn’t check it for six months. But, you know, the fastest remission
of type 2 diabetes looking at the hemoglobin A1c
I’ve ever seen was 38 days. Wow! So this guy had hemoglobin A1c,
I think it was about 62. I brought it down to 38 mmol per mole. That’s really significant remission. And that was done in 38 days. Now previously I would’ve missed
that wonderful result because I wasn’t checking them
soon enough. So I would say if a patient
is losing weight and if they are really doing
the low-carb thing, it is worth redoing the hemoglobin A1c
certainly after two months. Because that feedback is like oxygen to that
patient and the doctor too, because you’re wondering
whether you’re doing a good things so I think it’s worth doing
a few more blood tests. So as part of the contract
for the patient with me… okay, you don’t want
to have drugs… great. Would you mind having
a few more blood tests? And generally on the whole they don’t. I think that’s a great perspective
of your approach in how you incorporate your wife’s approach,
Jen’s approach as well, because behavior change
and the psychology of behavior change is so important. We can talk about the biochemistry
of how things work, the science of how things work, but if we can’t get people
to buy into it and sustain it and it doesn’t really matter
what the science says. I think we’ve missed
a trick in medicine. So much of chronic disease depends
upon behavior change and who is an expert in behavior change? It’s the clinical psychologist,
but whoever asked the clinical–? And they know stuff
but we never ask them. And I realize now I’d spent 25 years
telling people what to do, like doing medicine to people. Whereas what I’m doing now
is more collaborating with patients. And that involves really taking on board behavior change
and people’s personal goals. Now what is their goal? You’ve got to talk to patients to find out
what are they hoping for. And again the Royal College
of Gen. practitioners is really committed now to collaborating
with patients because you can’t solve– One of the big things we’ve got
is multiple morbidity. People then got not one thing wrong
or two or three, they’ve got four or five things. You can’t possibly sort out
multiple morbidity without working with patients
and their goals. And as I say I think the British Royal College
of Gen. practitioners is way ahead in the world because they are the only people talking
about collaborating with patients, working with patients. -Important perspective.
-Yeah. And they’ve made me–
just to show off… can I show off? Please do, you need to. They’ve made me national champion for collaborative care in diabetes
and obesity in the UK because of my commitment
to working with patients. But it’s a selfish commitment
because it’s just better medicine. It’s just much more funds. So at the start people were yelling at you
and condemning you and now you’ve been made the champion
of collaborative care in diabetes. I mean that’s a remarkable journey. It’s a turn, I’m sure still irritating
a lot of people. it’s very difficult, you know,
I’m certain I am irritating people… But they’re working
on 10 minutes appointments… it’s hard and you can’t get locums. It’s a long day, it’s a really hard day. And then this doctor comes along
and starts saying, “What are you doing? You should be doing it this way. And why don’t you do this as well
and why don’t you run groups as well?” I really understand how difficult it is
if you’re very tired to start taking on because equally, how about heart disease,
how about so many other subjects on that? So any GPs out there that I’ve annoyed
I’m sorry, I apologize. Your story is fantastic and a great
learning experience for physicians. I mean I hope there are
a number of physicians listening who can see your progression and the joy
that you’ve gotten from helping people more than you were before and then for patients to understand
the type of doctor they should be looking for. I wish everybody could work with you
but clearly that’s not possible. But hopefully there are more like you
that they can work with and how to frame the conversation
a little bit differently with their doctor. I’ve got nothing to add on that. I think very often we are telling patients
what to do but we’re not framing it very well. So now I’m trying to frame
my information and advice in terms of physiology
that a patient can understand. And I think then the patient can decide
whether to take my advice or not, because they are in a better position. So I quite like to just add
a little bit about insulin. Sure. So I explain to patients
with type 2 diabetes that one of their problems is insulin. So what happens is if you eat
the 150 g of rice then you’re going to absorb about 10 teaspoon equivalents of glucose
into your bloodstream. What does the body do with that glucose?
Where does it go? Because you are programmed– we know
that the high blood glucose it’s dangerous. So your body has to get rid of the glucose. Insulin is the hormone that gets rid
of glucose to keep you safe. Insulin pushes glucose into cells
to get rid of it and it pushes glucose into your muscle cells
for energy, which is fair enough. But maybe you’re taking in more glucose
than you need for energy. What happens to the rest of it? And that glucose is being pushed
into your belly fat to make you fatter and it’s being pushed into your liver
to make into triglyceride and could give you fatty liver. And anybody with a big belly in middle-age
is beginning to understand that maybe the toast,
the rice, whatever, might have something to do
with the big belly. And so what I’m saying to them… They’ve got a little hook in their own lives
to think, “Maybe he is telling the truth.” And then if they take my advice
and the belly gets smaller they think, Dr. Unwin might have made
a good point. So I think this idea of really thinking about
communicating with people in 10 minutes, to give them information that is relevant
to the goals that they have. So if you want to get rid of your belly I can
talk about getting rid of belly fat, or people want all sorts of different things
but let’s talk about physiology. And particularly if you relate diet
to physiology, it becomes more powerful. I think so, yeah. Well, thank you so much
for sharing your experience with us and sharing your journey. I hope there’s a lot that people can take
from this to use in their own lives and try your path for health and I love to see that the joy in your eyes and the excitement
of healthy people come back. So thank you very much. I hope they like it too. This has been a pleasure.

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Reader Comments

  1. D B

    I just got home from a week in Aruba. I would say that 80-90% of adults (mostly middle-class Americans) over the age of 40 were overweight, many of them obese. Waiting at the airport gate leaving, out of 15 people sitting in my aisle, only 4, myself included, were of normal weight, 4 women were obese, the rest overweight. Very, very sad and costing a fortune. It drives me crazy listening to politicians talk about healthcare when the elephant (no pun intended) in the room is health. If we don’t change that, we’ll never, ever be able to pay for the cost of healthcare.

    The doctor is exactly correct, people do not understand that carbs and sugar are the same thing. There are no heart-healthy grains.

  2. Anet Roper

    I love and respect Dr Unwin and his wife. I watch their work closely, as I also live in the North of England. I’d love to get in contact with them, as I’m a Nurse Practitioner, working for the NHS, but I want to use my knowledge of LCHF to help my patients.

  3. TriniHoney

    What a pleasure this interview was! What a humble man… And therein lies the problem is that a lot of doctors are so proud… That they would never stoop to listen to what their patients say to them! God bless you!!!❤

  4. Pissedoff Chica

    When you get off drugs you also shed their side effects. Also, drug companies have become predatory with their marketing strategies, it would be satisfying to damage their profits.

  5. Elizabeth Blane

    I went to England last month and saw the AMAZING variety of carbs available there! My son and I remarked, as we saw the Jammie Dodgers on a shelf, "Wow, the Brits really are masters of carb creation and consumption!" Fortunately, there are doctors like Dr. Unwin to balance the scales.

  6. Donya Lane

    I think it's cool that Dr. Unwin's name is almost UNWIND. He found a way to unwind decades of health deterioration in his patients and in the way he (and others) practiced medicine. Bravo to a most compassionate and lovely man!

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