Dr. David Unwin, a UK general practitioner with over 35 years of experience, shares his revolutionary approach to treating chronic diseases through low-carb dietary interventions rather than lifelong medications. Working in the same practice since 1986, Dr. Unwin has achieved remarkable results by helping patients understand that common foods like cornflakes and rice convert to sugar in the body, leading to 20% of his type 2 diabetic patients achieving drug-free remission.
The conversation reveals how Dr. Unwin's practice saves £70,000 annually on diabetes medications alone, with potential national savings of £270 million if all UK practices adopted similar approaches. He discusses his teaspoon sugar equivalents system, which translates complex nutritional information into simple terms - showing patients that 150g of boiled rice equals 10 teaspoons of sugar, while cauliflower rice contains just 1/12th of that amount. This educational tool has been translated into 35 languages and downloaded millions of times worldwide.
Dr. Unwin addresses the growing epidemic of fatty liver disease, affecting 38% of the developed world, and explains how low-carb interventions can rapidly improve liver function before blood pressure or blood sugar improvements become apparent. He emphasizes the importance of real-world clinical data, having published 20+ papers documenting outcomes from his practice, and discusses his work with insurance companies who recognize the unsustainable financial burden of chronic disease management versus prevention through dietary intervention.
Key Takeaways
- Common starchy foods convert directly to sugar: 150g of boiled rice equals 10 teaspoons of sugar, 150g of mashed potato equals 9 teaspoons, and a banana equals 5.5 teaspoons in terms of glycemic load
- Low-carb intervention can achieve 20% drug-free type 2 diabetes remission rates, with practices potentially saving £70,000+ annually on diabetes medications alone
- Fatty liver disease affects 38% of the developed world population and responds rapidly to carbohydrate restriction, often showing improvement before blood sugar or blood pressure changes
- Continuous glucose monitors provide immediate feedback for patients struggling with dietary changes, helping identify hidden sugar sources like the 6 pints of milk daily that sabotaged one patient's progress
- Group consultations conducted in evening hours allow working patients and their food preparers to attend together, creating expert patient networks that assist newcomers
- Weight loss combined with rising blood sugar indicates either pancreatic cancer or misdiagnosed type 1 diabetes - a critical pattern requiring immediate insulin evaluation
- Real-world clinical audit data from family practices can achieve publication in peer-reviewed journals and influence policy when properly documented with baseline and follow-up measurements
- Insurance companies actively seek partnerships with practitioners demonstrating effective chronic disease reversal, as they face unsustainable costs from the international epidemic of metabolic syndrome
- Dr. David Unwin's Journey to Preventative Medicine and Type 2 Diabetes Remission
- BBC Documentary 'Truth About Carbs' - Teaching Patients About Hidden Sugars
- Patient Success Stories and Cost Savings from Low-Carb Diabetes Treatment
- Fatty Liver Disease Crisis - 38% of Population Affected
- Rising Diabetes Epidemic - 8-Fold Increase Since 1986
- Troubleshooting Difficult Cases and Using Continuous Glucose Monitors
- How Dr. Unwin Discovered Low-Carb Medicine Through a Patient
- Sleep Apnea and Weight Loss Success Stories
- Group Consultations and Social Media for Healthcare Change
- Teaspoon Sugar Equivalents Chart - Making Carbs Understandable
- Real-World Evidence vs Clinical Trials - The Power of Audit Data
- Publishing Research and Working with Insurance Companies
This is an auto-generated transcript from YouTube and may contain errors or inaccuracies.
they are the only ones with similar power to the drug companies so I'm actually working with a few insurance companies because they are paying and they know that life expectancy is dropping internationally they know that multiple morbidity is claiming people I see big farmer and big food claiming more and more lives but there is hope there is hope and one thing I would say is that our audit from our what we achieved at Norwood Avenue is is the most P popular paper that bmj nutrition has ever published and that means that bmj nutrition will take other papers from me because they know that people read [Music] them welcome to the plant-free MD podcast with Dr Anthony chaffy where we discuss diet and nutrition and how this affects health and chronic disease and show you how you can use this to optimize your health and happiness both mentally and physically hello everyone thank you for joining me for another episode of the plantree MD podcast I'm your host Dr Anthony chaffy and today I have a very special guest Dr David Unwin who has been looking forward to speaking to for quite some time Dr Unwin thank you so much for joining you're so welcome great so for people that haven't come across you in your work can you tell us a bit about yourself yes so I've um I'm a general practitioner just north of Liverpool in in the UK I've looked after the same population since 1986 so that's quite some continuity those patients um what else I'm obsessed really uh with the true causes of so many of the chronic diseases of modern life and that's been a great adventure because it's led me into a whole new world of preventative medicine but also actually curing chronic illnesses rather than using drugs so it's lifestyle medicine instead of lifelong medication I suppose uh the headline is that uh of all the people with type 2 diabetes in our 9,000 patient practice we've got 20% of everybody with diabetes into drug free type 2 diabetes remission very good we published a lot of papers we published about 20 papers some of them are quite well known we've done a BBC documentary that went out to four million people the truth about carbs um and I'm a Royal College of general practitioners clinical expert advisor on Diabetes so that's probably enough for you to start off with yeah well that that's very interesting about the the documentary about BBC I had I haven't seen that yet can you tell us a bit about that yeah so uh they the BBC contacted me with a challenge and uh they said okay so you're doing good work in your practice but could you replicate that work in the most deprived practice in merys side so they found me uh the hardest practice with the poorest patients and then they did over eight weeks I replicated what I do in my own practice with a lovely group of uh liver podlings and uh it was very very moving and it I hope it made great television I got so fond of those people and the usual things happened they lost weight the belly size went down blood pressure improved I think self-esteem is what I saw I saw those people come alive when they they'd never thought that they could take charge of their own health it had never occurred to them that there was an alternative to drugs and it uh was very successful it was with uh I don't know whether you've heard about the van Tolen twins these identical twin uh doctors who were very famous here in the UK um one and they've written a book now on food addiction so they've followed up that um and they're actually coming to the phc conference that we'll be talking about in a bit so that led on to many many other interesting uh things and it um a lot of fun a lot of fun yeah definitely what was the name of that BBC documentary so we can go and check that out the truth about carbs truth about carbs they did a series of different um ones on food and that was the truth about carbs right and so we were I mean headline thing was that people didn't realize that um a small bowl of cornflakes is the same as eight or nine teaspoons of sugar or small bowl of mashed potato so the truth being we were showing these people with diabetes and obesity the truth about how starchy carbohydrates digest down into sugar and clearly if you have diabetes you're trying to avoid a high blood sugar so for them it wasn't a difficult concept um the important thing was that teaching them how to shop and how to cook because in these very poor areas they didn't have fully functioning kitchens so it was all microwavable stuff right yeah well that that would definitely make it very difficult as well I think that's the I think that's the disconnect that some that there is in the in the system a bit because the patients are more than happy to make changes if they're giving this information they I mean some won't care some will say but some of you say look if you're your diabetes will improve you want to get your blood sugars down you can take all these medicines or a better ways you you just cut out these carbohydrates and all these sorts of things and they say oh really great I had a a conversation with a lady who's uh when I was on my on call for neurosurgery and her her child was having these weird issues and I ended up figuring out that she was having seizures very sort of odd presentation of seizures I was like okay look she's seizing we need to we need to to get her taken care of and I spoke to the mom and I said oh by the way you know if you just don't give her carbs and get her on a ketogenic diet there's about a hundred years of of data on this showing that this actually improves epilepsy and she said oh really no one told me that I was like yeah it's easy he like oh yeah we we'll do that right now you know it's like it was very quick was very easy and um it didn't it didn't didn't cost anything and I think that a lot of people really genuinely appreciate being told these these sorts of things as opposed to I you know I know the American diabetic Association um at least for a while uh was saying you know you don't have to limit carbs you know just make sure you you dose insulin appropriately keep them on the right medication to keep the blood sugar under control and you know that that makes sense when you realize you know that they're being funded by the people selling insulin and so but what you really need to do is just this is a carbohydrate problem you know not an insulin problem in fact there's too much insulin already yeah absolutely and so I find the same is if you offer people an alternative if you say today I could start lifelong medication but there is an alternative and do you know I've been doing this 12 years now not one patient in 12 years years has opted for the drugs if you give them the alternative not a single patient every one of them has said that's interesting and I said yeah and you could probably lose weight as well get get your belly down a bit get your blood pressure down and they say tell me more I'm often asked well you know or told really that well dran you can manage it but my patients would never give up bread they'd never give up corn flakes and it depends how you put it you know that the thing about Behavior change is motivation and so few people are comfortable with lifelong medication they're really interested in an alternative and it doesn't take very long and it can save loads of money in our own practice on the diabetic diabetes drug budget alone we save about 70,000 Sterling each year yeah wow because of this because if case after case after case you're offering an alternative and you don't start drugs then you after a few years you you find well we are now the cheapest in the in a 50 mile radius the cheapest practice in terms of drugs for diabetes because the whole team are offering this so it is an approach that can pay for itself because the drug cost no country that I I travel all over the world there isn't a country that is finding easy to fund the drugs for chronic disease and we're offering an alternative yeah and just imagine if all the the GP practices offered that I mean if you just you know 76,000 pounds every practice I mean that's we've done the sums in in one of the Publications somebody contacted me and said I've done the sums for you MH because in in England the drug budget is a we can find out what it is and I can tell you that if every GP prescribed as our practice does the saving per year would be 270 million Pounds Sterling wow so we know the kind of sums of money and that of course is just on Diabetes so when you add in essential hypertension and then you might go into Dermatology and you might go into joints being all of the things that you're aware of then actually uh it's possible that's a tip of the iceberg yeah I I think so I was looking at some data and statistics on exactly this and the amount of money that we spend as a as a a planet on these so-called non-communicable chronic diseases which are only getting worse they're more prevalent so from the Harvard uh School of of Public Health they crunch the numbers on just five ncds so diabetes cardiovascular disease uh respiratory and pulmonary disease Cancers and mental health issues and so just those five not even autoimmunity which is or hugely expensive with all the different you know biologics that people are on that those account or will account for over $1 13 trillion in medical spending and costs worldwide by 2030 and that's nearly doubled from 2010 so this is just going up and up and up so the idea that's that people say like well you know this is just a screening thing we're getting better at diagnosing of course it's not you know this is this is this is treatment costs you know these are these are getting more and more expensive to treat and so you yes you can get new treatments but um at the same time a lot of these things are off off patent and and you're just using the normal sort of drugs so it's just the the burden of disease is getting larger and larger and then that doesn't even take into account the human costs and the loss productivity and the sick days and the people going on disability and other sorts of things and that accounted for about $ 46 trillion trillion with a te between 2010 and 2030 and then just the cost of lost lives of of premature deaths was estimated to be in 2010 um I think $22 trillion and then by 2030 it's estimated to be over $40 trillion so again there's this doubling so this is just getting worse and so clearly what we're doing we're getting all these advancements in technology supposedly in medicine and yet things are just getting worse and so it doesn't matter what system you have it doesn't matter what budget you have nothing is going to withstand the pressure of this growing burden of disease I think that's how I came to this in the first place because in the in in my practice starting from 1986 to 2012 I'd noticed an Eightfold increase in the number of people with type two diabetes so that is a pan an epidemic is really bad and we had no extra money or staff to look after that eight-fold increase on top of which I noticed that the drugs I was using they didn't make that much difference it was so rare that I you didn't see people sparkling with health they they to me they were getting sicker and sicker and I was adding drug after drug and then drugs for the side effects of the drugs and it was really Miserable as a doctor who was miserable what must it be like for the patients and I would say every older doctor like me has seen that pattern a pattern of diabetes a pattern of central obesity coloral cancer breast cancer and mental health everything deteriorating and this for me is the urgency of this because it's getting worse and the people suffering with these diseases particularly metabolic syndrome and type two diabetes are getting much younger so that I never ever ever saw type two diabetes in somebody under 50 was I didn't see it in medical school and in fact we called it maturity onset diabetes in those days exactly because it was a thing that didn't matter very much because older people got it and oddly though we did teach them to cut the carbs at medical school that's what we taught and then very gradually that was forgotten that knowledge of carb counting was forgotten and it was all about forget the carbohydrates used drugs a bit like you were saying earlier the tragic of using insulin with type 2 diabetes when you're insulin resistant it's Bonkers you're insulin resistant and hyperinsulinemic and the answer is more insulin and that that's how Bonkers uh this has become and I don't know I I knew that medicine have lost Joy had lost um lost its way and so I can't tell you the difference it's made and that's what keeps an old guy like me still behind the desk because it's every every day I'm seeing cheerful well people which I didn't do for about 25 years hey everyone really happy to announce a new sponsor for the show and for everybody down in Australia Stockman staks who are delivering highquality grass-fed and finished pasture raised beef and other meats flash frozen and vacuum sealed to Door something I've been enjoying a lot of myself recently as well they also have have a great range of specialty items such as high fat keto mints and carnivore beef and organs mints with liver kidneys and beefart as well so use code chaffy today for free order of beef mints or another specialty gift along with your order at Stockman steak.com and I'll see you over there thanks guys yeah well that I I remember that transition from adult on diabetes and juvenile diabetes to type 1 and two um I was a kid in the 90s and that I remember I remember a news program coming on talking about this kid who had adult onset diabetes and fatty liver disease and they were saying how can this be he's he's a child how can a child get adult onset diabetes only adults get adult onset diabetes that's why it's named that and only alcoholics get fatty liver disease and these kids never touched a drop of alcohol and so instead of thinking about it for a second saying okay well what changed is there something in our environment that could be affecting this they just said you know was probably happening all the time and we just didn't notice it this is just a just a screening wow yeah and that was the beginning of the deceit yeah beginning of the deceit and the beginning of don't an international conspiracy and don't think too much about why your patients are ill you just need to keep up to date with the most modern treatments and I I swalled that for a very long time a very long time you mentioned fatty liver which is another Obsession of mine I mean we've come to a point now where 38% of the whole of the developed world has spatty liver wow why are there blackards in the streets why you know how come media is silent on this so interesting but 38% and in fact I audited our own patients I thought I wonder if that's true why don't we just audit and sure enough if you look at triglyceride if you look at liver function like gamma GT or alt we found a third of our patients have abnormal results a third I mean what do we wait what are we waiting for uh because the consequences of ignoring fatty liver they are serious um mind you I'm guilty because I don't know how you used to deal with fatty liver I just used to say to patients yeah it's really common we'll just do the blood test again in maybe a year perhaps you could exercise more and you know eat a bit less yeah I would just F them off really um you know we'll do it just kick it along the road and I'm so embarrassed I had patience I was doing that for years or the other thing was we one of my patients was I remember she three separate Specialists told her she probably drank alcohol and she really didn't she really didn't and since she's gone low carb her liver function has been normal now for over a decade I saw her Wednesday of last week looking fabulous and it I'd sent her to three separate Specialists to be told off and humiliated and then when she went low carb the liver fun the her liver was better and it the Improvement was one of the first things it happens really fast your liver cheers up before the blood pressure before your blood sugar it's a really fast transformation the Improvement in liver function yeah wow well that's really great um have you ever come across um sort of a sticky patient that that goes low car but still sort of has a bit of issue getting their their liver function numbers to improve yes well I mean I've come across a lot I I now fascinated by I don't call them sticky patients sticky I well my wife Jen you know she's a psychologist and and she's she's dead clever dead clever and she's she's taught me really to look at Patients not as a problem but as an interesting uh case and to be interested in curious about why things are not improving and there are various reasons the commonest one I'd say is people who are carb addicted and who struggle with low carb and I've The more I've started thinking about carb addiction and looking into it and discussing it with patients the more I'm convinced this is a problem and of course I didn't find a single patient with carb Addiction in the first 25 years of my life as a doctor and that is because I never asked them if you don't ask you will never find them and many doctors will say well I haven't got any patients with that well it's because you don't ask if I ask people are you struggling to give up bread and they say God it's so difficult in every Clinic I'm doing so some of the people who res results are not improving are struggling um with the diet some of them there's a mystery I'm always sort of hunting the sugar I had one patient who had fatty liver and type two diabetes and he was he was low carb but what I didn't know was that he drank six pints of milk a day and if every hundred Ms of milk has got four or five grams of sugar in it which it has that was this that was his problem and I never asked him what he drank and I I find and I've had people with sweet corn or beetro people who eat vast amounts of things you'd never guess and I've I must say I've become very interested in the use of continuous glucose monitors now for these intriguing cases and so I I prescribe against the guidelines we're not allowed to but I do anyway I wait for the day that I'm in jail I'm sure Anthony you'll come and visit me when I'm in G definitely and I just I prescribe against the guidelines because I believe it's morally the thing to do because P patients find out what's causing those spikes um and learn because the faster you get feedback from the behavior the faster you learn the hemoglobin A1c is a very very blunt tool the average of two to three months continuous glucose monitor you get that Spite you know know what you just consumed and I'm finding them so useful in clinical practice for people whose results are not as good as I would expect I would finally before you come in just say there are there's one to clinicians I would say if you have people whose blood sugars are not improving and they are losing weight that's odd that's really odd so if you have somebody who's losing weight but the blood sugar's going up it can either be a carcinoma head of pancreas or it could be a misdiagnosed type 1 diabetic and I found two in the last year because of course we've got hundreds of them I found two in the last year who needed insulin because they were actually type one and it's really important that no clinician misses that pattern of weight going down blood sugar going up and I've got some wonderful graphs that I put on Twitter to illustrate this because every nurse every doctor needs to look out for that pattern it's rare but um one of these people um ended up in hospital and was very ill so anyway I'll shut up now no that's perfect thank you very much for that so how did you come across the the low carb sort of diet and and use as a treatment modality for your patients how did I come across it yeah yeah uh um well uh I mentioned this before I had never come across it till 2012 when um a patient had stopped taking her metformin and so of course I wrote to her with the intention of telling her off and I was in for a surprise because she came and told me off and she said I haven't needed your metformin for months you never once told me that corn flakes bread rice were all sugar and since I've gone L carb my blood sugars are normal I've lost two or three stone in weight your metform and gave me diarrhea and now I don't need metform in ofnormal blood sugars and she said Dr I think I'm wondering whether you're even qualified I think you've something to learn I was I was dead scared and I'm sure Anthony your if a patient asks if you're qualified you should be frightened and I had the good sense to listen to shut up and listen and uh she was online with 40,000 other people this is back in 2012 learning about low carbon they were being rubbished by doctors like me and like you and I determined to learn learn fast and that's how it all started and and the results astonished me I'd never I'd not seen drugs achieve anything like this before to the extent that I was frightened of publishing my results because I thought i' been labed as a fraud and it wasn't until uh Professor Roy Taylor is a very well-known professor in the the world of type two diabetes I sent him my data and he said I will help you publish this it's very very important um and uh since then as I say we've published about 20 papers I think clinicians we're always in the shadow of academics and one of my personal things is that AUD your results showing the world what's possible is just as important as anything an academic does they suggest things they um can talk about possible um physiological mechanisms for things happening but in the real world we can show what is possible and I think that I have devoted my life in in the NHS to show what is possible in the British NHS St you know we're strapped for cash and I can tell you now it's possible for people who go low carb it's possible to get about 50% of them into drug-free remission and I've been doing that for years there's two more in the pipeline I've got aund so I hadn't met a single one in 25 years and I at one and this week um I know I'm meeting somebody on Thursday who will be my 138th successful drug drug free remission and I'm two more in the pipeline so I'm I'm showing what is possible and it's not just diabetes it's blood pressure it's liver function it's triglyceride it's lipid profiles and even mental health I keep wondering where this is going to end uh but it's very very exciting and I know you're excited in a in a similar way very much so I hope that it ends in people being a lot healthier and and the end to this rash of chronic diseases that are that are plaguing humankind and and only getting worse only getting worse so hopefully it does end that I often think about how you know we talked about the financial burden but the but the human cost is so tragic you know 90% of the deaths in America and Australia and I would imagine in in the UK and Europe are secondary to these non-communicable chronic diseases only 10% of the of the deaths come from something outside of that those 90% don't need to exist in my view and well and it isn't even deaths is it Anthony because for about 10 years before you actually die you you're starting to build up a whole Matrix of chronic misery diseases aches pains poor Mobility poor Mental Health and um I think you know it's just it's been talked about not just life span but what is your health span you know can you still work can you I can so I'm 65 and I can run I can I can outrun all my grandchildren not one of them can outrun me yet I they will obviously and it's my challenge they can um but anyway I I think that's personally great and that I so much of what I saw I put down to age including these things in myself too I had moderate hypertension and diabetes I was tired all the time I used to have a little sleep at lunchtime on my own couch and wake myself up with coffee and chocolate and it wasn't age and this is what you hear from patients they think they'd accepted poor health thinking well I'm you know I'm over 50 I'm slowing down now and what I would say as an older person is maybe that's not true and in fact what a message of Hope if it isn't true what if you're not finished um and that's certainly been true for me yeah absolutely well adding adding so much to people's life as well because of course it's not just it's not just about the deaths you're losing Decades of life and even though you're not you're not dead you're sick you're unwell and you know I mean even even just the things to the side I mean here in in Australia it's a 4 and a half year way to get into see us in the Neurosurgical department and so some of these people have quite a lot of pain they have radiculopathy and you pinch nerves and other sorts of things if it's not a life or limb-threatening emergency they have to wait and there's over 20,000 people right now waiting and so it's quite it's quite a large weight list but then you see these people and and then I you know I have people calling in saying hey look this patient is really unwell they can't work they're debilitated in pain it's just medications all the time and and and there's nothing you can do for them because your hands are tied but when I when I I do talk to people in my other capacity in my in my practice in in metabolic medicine lifestyle medicine youing affecting the things that we can actually affect um their pain resolves massively and these sort of chronic diseases that they're waiting to see a specialist for just go away and yeah I I've had that lots of times i' I'd cite sleep apnea as an example we have a very long waiting list for anything to do with sleep apnea and it's a matter of personal Pride that not a single patient that's come to me with sleep apnea has actually needed that Clinic appointment because I say to them okay this is really sad you know what's the Sleep apne Clinic going to do you're going to get a CPAP mask or you know it's not great really to be like that shall we have a shall we have a go while you're on the waiting list and it's not generally known but I think this was I saw this I think it was an Australian paper that sleep Happ there is fatty infiltration of the tongue like the liver and of course you can scan the tongue and the fat shines and uh they have a big tongue with fat in it and when you go low carb uh you start to eat your own fat you become a fat burner and uh the youngest guy I've done this for is 28 years old a married man of 28 and it's transformed his life he was so heavy when he first came to me we couldn't weigh him we didn't have the Machinery to actually weigh this guy what's interesting was his motivation uh I'm always fascinated by why what why would you do this and for him it was to be a better dad and you know goes camping now with with his children it's changed his life and he he's he's weighable now he's lost I don't know in Australia are you kilos or are you stones or what are you kilos and I'm pounds so hit me right okay so he he's lost I would say somewhere about a 100 kilos in weight we're estimating because we I used to I used to measure his waste with a piece of string because his waist was somewhere over 1.5 meters wow you know and just imagine what his life was like but anyway what did it for him was he was one of these uh cases I'm curious and excited with the potential uh and and he was referred so now the so there are nine doctors in the practice this and they they tend to send me the ones they find difficult and I change that into something of a personal Challenge and I'm curious and uh they give me such joy and that young guy I you know he keep he comes to see me I did this about three years ago and he comes to see me every six months just to shake my hand and say I'm still fine I'm still fine and that is why I'm a doctor that re hey guys just want to take a second to thank our sponsor carnivore bar I don't promote many products because honestly all you need to be healthy is to just eat meat for those times that you're out hiking road tripping or stuck at work and you want nutritious snack that is just meat fat and salt if you want it the carnivore bar is a great option so I like this product not because it's just pure meat but also because I want the carnivore Market to thrive as well and the more we support meat only products the more meat only products there will be available in the mainstream so if this sounds like something you'd like to get behind check it out using my discount code Anthony to get 10% off which also applies to subscriptions giving you 25% off total all right thanks guys well that's that's a great reason I think that that is what what people think of when they say I'm going to go into medicine I'm going to cure people I'm going to heal people I'm going to help people and unfortunately we're there are things that we can help and we can heal and we can cure but again 90% of what we're treating now are the chronic progressive chronic diseases that that don't have a cure supposedly and so the vast majority of your time is spent managing symptoms and managing these diseases as opposed to curing them which is sort of a very defeating sense I would imagine like that that's not yeah well most that was me I was mildly depressed every day was full of failure I was thinking of leaving medicine I decided to most of my friends retired aged 55 but a great majority of all my friends I'm now ancient in terms of general practice at 65 I'm a an anomaly and I was going to go too you're right and when you're young you're full of Hope and you want to make a difference don't you that's why most people is not about becoming rich as a doctor it actually is about making a change and I felt I'd failed completely um and now that's why I'm still there and I think so many of our colleagues are exhausted they're really exhausted because they're just shoveling day after day and then there's nothing to sustain them because they're not getting any joy and if you can find joy in medicine it's a wonderful thing absolutely well I've certainly found this to be very rewarding and very fulfilling when you can see this and you know I have I've patients come in sometimes and I you know I change their diet and I I tell them how it's going to affect them and I tell them you know if they do these things this this should be what they should expect to see and that happens you know especially when people can stick to it and we see their blood work and that all improving and their weight's improving their health is improving all these little problems are going away and I get patients coming in and they say you know they tell me all the different things that have improved how much better they feel and they say well you already know this you already you see this all time I was like it's always amazing to hear like it always smile on my face you're right so true I never Tire of these stories of joy and hope and I love looking at the blood work I used to hate you know every day here we go through the misery and now I actually keep it's a treat for me to go through the blood work because I'm so interested to see how people are doing particularly the hemoglobin A1 C's the triglyceride side levels and the liver function and I keep it as a treat to go through the blood work and then as an extra thing I ring patients up just two minutes just telling you it's amaz I never brang patients and now I'm often saying listen and they're dead scared why have you wrong oh because you've got the best results for 10 years I just had to tell you and that how many doctors are ringing up patients with the best results for years and I tell you I am doing that in every Clinic think I do um saying I've got people saying you know this is the best you've been for so long another thing I'd say is um one of the ways we did this we start we didn't have the money to see people individually and my partners actually forbad me from doing this work even though I was senior partner we had terrible arguments terrible they said you're not paid to do this kind of work you know this is prevention and so it was Jen's idea why don't we do it in our own time for free on a Monday night and do group consultations so we just wrote to people and we did the we just wrote to them particularly the pre-diabetics and invited them in in tches of 20 and we just I went low carb with my patients and learn with them and what a wonderful experience that was and we're still still doing these group consultations 12 years on there was one last Wednesday evening and we run them when working people can come you can bring whoever's cooking and shopping and what we have now is a whole lot of expert patients and they are helping with the work because they're they're helping with the ones who just come the newbies uh and I'd say again this is a we need to be we need to think about original ways to to get this out there because one to one it's it's going to take a long time one to one but group consultations will help as you probably know I use social media so I've got a large following on Twitter and every day I'm spending half an hour on Twitter trying to educate trying to get this message out and then again the media we had three pages in one of our major uh newspapers last week The Daily Express we had the front page of the daily Express that's how this is moving ahead in the UK the actual front page and two pages inside including a patient of mine with a before and after photo and those before and after photos they're powerful because they help you believe yeah amazing so that's a good question well how do you see this going and and what do you think we need to do to get this more mainstream because we're fighting against the Food and Drug companies that are pumping out billions of dollars to push out their studies and their disease management protocols because that's what makes the money and that's fair enough I I understand the idea but we obviously want to cure diseases so how do we get this out here and how do you see it going it's a great great question um I begin with inexorable courtesy inexorable courtesy because people have different views particularly over nutrition and you I have come to see that it doesn't help to argue with people um and so I think this is an area for being polite but try this is why I audit to show what's possible so I I hope I'm polite I hope I'm curious but I'm auditing I'm keeping records of what I do and then how do we how do we make it bigger how do we make it bigger well in the UK 16 of us set up a charity called the public health collaboration so I Jen and I were we discovered that we weren't alone that there were other clinicians who were horrified by what was happening in the field of Public Health and we were saddened by the quality of information that was out there and so we decided to set up a charity it's called the public health collaboration so I I don't know whether you have charities in or do you call them not for profit this is a a British charity and um so because there are many jobs to be done so we have all sorts of different levels but we've trained hundreds of ambassadors hundreds so no GP in the whole of the United Kingdom is more than 10 miles away from one of our trained ambassadors who would help that doctor run group consultations for free so we uh a public health collaboration nickola helps us run groups and has done for ages and brings food and runs the WhatsApp group so that's free help for tired healthc Care Professionals the public health collaboration is now we've got a sort of higher level of people with much more training this is the TLC uh um which is a service we offer for GPS who want a more qualified health coach and health coaching is about supplying information it's not they're not doctors but they are supplying relevant information and this now uh the TLC organization I think is is working with 40 separate practices or it might be 50 by now and it was given a a national award only two weeks ago oh wow that's great that we're running another thing which is all about food addiction and how do you help people who are struggling to give up the carbs we are trying very hard to work with media um so we're doing that and and really uh one of the reasons I'm on here today of course is to tell everybody about we run International conferences every year so we my wife always said if you want to become more influential you need to find your tribe you and I Anthony we're in the same tribe we're going to help each other I trust you right away and the more we find people that we recognize doing the same the more influential we are and these conferences have gone from being very small to very large a big budget and we fly some of the cleverest people in the world into London in this case this is May the 18th and 19th and 20th and there's three days of the people that we believe including you Anthony as the real movers and shakers around the world in lifestyle medicine these conferences are very important you can either come or you can uh just do it virtually and many many people do just look up Public Health collaboration uh 2014 conference and it's all there we've got some amazing speakers I don't know who are you looking forward to meeting Anthony well actually yourself I've long admired I'm not joking I was I was very disappointed that I wasn't able to get there last year and yeah that was a shame yeah and um so I've actually I've actually been looking forward to to this for quite some time and to me too you know I always knew that we were definitely the same on the same brain weight as far as this is concerned and as you say it's always nice to meet people that that are thinking along the same lines as you they've sort of you know they they they um have drank the Kool-Aid and they're just all right yep I'm all in yeah we know it works and we're yeah one of us counts for 20 ordinary GPS or whatever in terms of we don't clock off at five o'clock true we're doing it every day and we really care and it's just so exciting who am I looking forward to speaking oh Dave Feldman have you met him citizen stist yeah oh he's great clever and he's done a deep VI dive into his own physiology and actually the N equals one can be important he does it so well so well and you've got Gary torbes who's just written yet another bestseller ni he's he's very interesting he's a bit of a philosopher I find him fascinating to talk to all listen to and he'll be talking about my favorite subject diabetes um so he he's so interesting really really interesting then we've got Ellen CTO who you may not know she's a registered dietitian um who is fascinated in food addiction so she'll be talking about um food addiction so it's anyway three days uh all I can say is please come because we've spent a fortune flying people like you we're paying for you to come around so that's the the charity that we've set up the public health collaboration which is working at a political level so we need to talk to politicians and I was lucky enough to meet the uh Shadow Health secretary in Parliament two weeks ago um and obviously I bent his ear on this so we're working politically even you know planning permission like how many junk food Outlets do you allow near schools what about advertising of food to children that needs looking at there are many many there's something for all of us to do and that's why we thought let's get a charity together of people who want to make a change and many of them volunteer to become ambassadors or super ambassadors or they're wonderful on social media or whatever but that's been one of the ways uh another main way for us I don't know have you come across my teaspoons of sugar equivalents no I don't think I've come across that one oh well thank Kevin we got to that I wanted to find a way to help my patients understand how sugary carbohydrate food were and the glycemic load is really interesting but one of my partner said that I was a glycemic load bore and she said For Heaven's Sake will you find a better way to talk about a glycemic load and it worked out why don't you just get the glycemic load of a teaspoon of sugar and divide the glycemic load of a bowl full of corn flakes or a baked potato by the glycemic load of a teaspoon of sugar then you've got the teaspoon of sugar equivalent of that food so I can tell you that 150 g of boiled rice is the same as 10 tspoons of sugar in terms of the glycemic load I can tell you that 150 gram of mashed potato is nine teaspoons of sugar a banana is 5.5 teaspoons of sugar and I got together with Dr Jeffrey leavy an international expert on this and we published these teaspoon of sugar equivalents in 2016 they've now been translated into 35 languages they're everywhere they're massive I'm going to have to bring some for you to the you need them up they should be on your wall that wall is blank where are my teaspoon of sugar equivalents and I've done it for uh fruits so some fruits are much sugary than others raspberries are pretty good but bananas mangoes are really bad and I can tell you the teas spish sugar equivalents of 880 different foods all of which is then translated into all these I think it's 35 languages it's going up all the time these charts have been downloaded millions of times all around the world and generally it's the single most useful thing I've done with my life probably W the single most useful thing um because when you tell somebody uh the rice they are eating is the same as 10 teaspoons of sugar they they they realize maybe I could eat something else and when you tell them well cauliflower rice has got 12 12th of the sugar in it they then they'll do it and it's all about supplying not bullying people not shouting at them but supplying relevant information that is useful to people and then they can individualize their diet so I'm not telling nobody there there aren't two of us with the same diet even Jen and I don't have the same diet each of us finds out what's tasty how do we feel on that diet can we afford it and how does it sit with our beliefs and so this idea of information and the sugar equivalent of food if you have diabetes is very very useful and then of course you can experiment with a continuous glucose monitor and find out if I'm lying so you shall you shall have all my teaspoon of sugar equivalents I shall bring them I've got thousands yeah thousands and thousands so I'm glad so yes we're moving ahead in the media we're using social media we're using mainstream media I've written about 35 articles for our our most popular paper is the Daily Mail I've written 35 articles for them so we're not just publishing so we are publishing in bmj nutrition bmj but we're also we're also going to the the mo the broader media because this message we have to get through almost it's the Grassroots Revolution you see so many doctors are so tired that they're not doing it so I'm trying to get directly to intelligent people to say say have you thought about this have you thought about sugar why don't you try I'll tell you a story just before this podcast we had my daughter's carpets cleaned MH which we pay for as Mom and Dad do but the guy saw me a year ago and he said you know what a year ago I met you I gave up carbs I want you to know my belly has vanished and I've been off all the drugs for blood pressure for six months yeah my son done it and my daughter has on it and I was only with him for five minutes I gave him one of my charts and talked to him and a year later we've done the same for our plumber The Decorator the roofer the farmers that live nearby success spreads and Anthony you've come across this because people they look at you and they go well he looks fabulous how did he do that they're curious about success and if it works nobody can tell you to start eating bread nobody you won't do it I won't do it because I have done it and I know how I feel and it you don't need long with somebody just five minutes with a carpet cleaner while I paid him and I gave him the teaspoon of sugar equipment I said just take this as my gift and I just wonder whether you might find it interesting and he couldn't wait to see me this morning to show me his transformation isn't that wonderful that is yeah that's amazing and and that's it you know you said that you know the N of one is is very important I think honestly it's the most important I think the word that you're doing and Publishing your work you know yes in the hierarchy of of these sorts of things it's it's lowered down but it's the real world evidence it's the real world results yes and that's so just to the nals Wong I came to Australia actually and did a presentation on this on um and it was very popular and I've thought a lot about n equals one and I had have a friend who's a medical statistician and we worked out if you have enough data points before and after you can do a P value on a single person and we've been doing that so you can work out the P value is it likely that this person is fundamentally Changed by the diet what's the what's the likelihood because that's what a P value is it's How likely is it that this has occurred by chance so I'm now doing a series of n equals 1 with p values and if you're interested I've written an editorial on this um in bmj nutrition and it's about the value real world data and what clinicians what do we bring to the party and the rcts don't necessarily show you us the way out of this mess because they don't always roll out very well whereas if you start with something that's working in the real world and you can replicate it so I have there are doctors all over the world who have published similar to work to mine based on what I do in New Zealand in Australia in Malaysia in Canada in North America so if something can be replicated in the real world maybe that's an answer and this is why I've got hope for you from the insurance companies so Swiss re are the second largest reinsurance company in the world they've been working with me for six years because they're fascinated by what I can achieve and they the insurance companies are paying for the international pandemics of metabolic syndrome and all is misery and they are the only ones with similar power to the drug companies so I'm actually working with a few insurance companies because they are paying and they know they actuaries are telling them that life expectancy is dropping internationally they know that multiple morbidity is claiming people and so real world data is a great interest to them and of course data is the new oil it's power and what have clinicians got we have data in Primary Care our computer systems are sophisticated and I'd say everywhere people in Primary Care clinicians Frontline clinicians have far more power than we know the power is in our data people will pay for your data they'll take it but think about what you can do with your data why don't you audit just a simple audit of Baseline and latest followup in the UK you do not need ethics approval for audit audit is respectable work for a clinician you should know the average I know the average weight loss in my clinic is 9.4 kilos of 30 months I know what's happening I know the average Improvement in your blood pressure is 14 millimeters of mercury systolic and 7 millim of mercury diastolic with a quarter of the patients have deprescribing of their blood pressure medication oh know what happens to the lipids the triglyceride improves by a third on average all of these things I know about people that come to Norwood Avenue so I can say to you Anthony if you come to my clinic I can probably achieve this now why don't people running clinics why don't you do audit your Baseline and latest followup on consent I consent the patients but they love to consent and then you can publish it and that also uh there is the Journal of insulin resistance we have our own journal uh publishing audit I'm one of the editors so it just opens up a whole new world for the power of clinicians and our audit is is not a humble thing it's an important thing real world data matters just it matters equally to rcts and if you read my editorial in bmj nutrition it was the 3D of January BM J nutrition this year you will see what I mean where I'm looking at I'm looking a hard look at evidence evidence-based medicine it's a lot more than rcts a lot more and another um I think at times I've become very depressed with what's happening because I see big farma and big food claiming more and more lives but there are green shoots there is hope there is hope and one thing I would say is that our audit uh from our what we achieved at Norwood Avenue is the most P popular paper that bmj nutrition has ever published not the most popular last year or it's just the most popular paper they have ever published and that means that bmj nutrition will take other papers from me because they know that people read them so it's the popularity you see it it the papers wish to be popular you have to find out what are the levers of influence academic papers wish to be popular their impact factor matters so if if papers on audit and low carb sell if they're read as my paper was read many many times and it hit social media and media then the journals are looking for other they're looking for other papers when I began with the first paper nobody would publish me nobody I was turned down turned down turned down for months it's heartbreaking and you know if it hadn't been for Prof Roy Taylor and I never would have been published but now there is the world has changed there is interest and a lot of this is through social media because it affects the impact factor of peer-reviewed papers and you know when you and I I think you could become very influential Anthony because I'm old so the you know my years are obviously what I've got left is not much but if I can help younger clinicians become dangerous become impactful and uh use social Med media and media but also publish audit that would be great so that would be a great conversation for you and I um yeah when we meet in London that would be great and yeah i' I've thought about that as well trying to get uh data collected for our patient population yeah do it yeah yeah I think it'd be just do it an Excel spreadsheet find yourself that you could probably you could learn how to do the stats I have a statistician you soon get your P values and you it's a really respectable thing to say in my clinic this is what I achieve as I say I it also mean the reason I did it in the beginning IED hate mail actually made from dietitians I I really did horrible letters or they would when they people heard my name they would turn their back on me and refuse to speak I was heckled and shouted at in public meetings and I realized that what I did was irritating people and also let's be fair I'd been wrong about how I practiced medicine for the first 25 years maybe I was wrong again and the only way to find out whether I was wrong or not was collect careful data be methodical collect data it's easier now than it used to be and so I collected data to check that lipid profiles did improve to check what happens to Ral function I've written a paper on that by the way it improves yeah and then every paper I've written I will find a professor so I found an professor of nephology he came to see my clinic he knew some of my patients and we audited what happened to renal function the people at know Avenue and guess what it improves significantly on low C and then I found Professor Brady the professor of Cardiology and we looked at lipid profiles and blood pressure and guess what it improved significantly so cooperating with academics they some of them are very interested in meeting clinicians they're very interested in what what we think we've seen but they know clever stuff too and it's been a great joy to partner uh with some of these clever academics and I as you can tell I've become zealous in the idea that audit is is is not a low level of evidence it can be a high level of evidence and very if you audit a population which is similar to the population you practice medicine in then actually it may be very powerful bit like an RCT if they do an RCT that does not represent your population that was my problem with rcts because they eliminate people with obesity people with depression people on anti-hypertensives those are all eliminated from rcts so the population you left with isn't much like my patients at Norwood Avenue who are on average about 65 and they weigh 100 kilos and they've got diabetes and hypothyroidism and reflux esophagitis and depression and they're on the load of medications so the rcts you see it's to do with internal and external validity but you'll have to read my editorial to find out what that's about yeah it's probably time to stop I always talk too long no you're fine I know you I know you have to run you have your patience coming on thank you so much for coming on it's been an absolute pleasure uh please uh tell us where we can find you and more of your work and how people can uh support the public health collaboration bless you so on Twitter or X I am loab GP I'm there every day every day the public health collaboration is also on Twitter and many other social media things um yes support the public health collaboration and if anything I ever do is useful to anybody out there all I'd say is perhaps you would consider making the donation to our charity I assure you uh we're using every penny uh wisely and I'll never know whether you do donate or you don't but it's a thought isn't it and now with many thanks Anthony I've enjoyed speaking to your enthusiasm is absolutely evident your eyes light up with when you're interested and I think one or two of the things or I hope that one or two other the things I said interested you and I'm really looking forward to taking that conversation further perhaps into the Realms of evidence-based medicine that would be interesting as am I fantastic see you in London see you in London bye bye now so much take care hey guys thank you very much for taking the time out to listen to what I had to say if you like it then please like And subscribe to my YouTube channel and podcast and if you're on YouTube then please hit that little bell and subscribe and that'll let you know anytime I have a new video out which should be every week if not more and if you could share this with your friends that would help me get the word out and let me know that you like what I'm doing thanks again guys