Diet Doctor Podcast #33 — Dr. David Unwin

[, Music ] welcome to the dieting, doctor podcast with dr. Brett sure today, I'm joined by dr. David Unwin. Dr. unguent is a general practitioner in northern England and you know what's. Interesting is when I usually do these introductions.

I'm, going to tell you about their website and their books and all their products. Doctor Unwin is consummately 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 gonna 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 brought back to him in his in his practice because he was seeing the improvement in his patients.

It's, a wonderful journey and I hope you can pick up on on his joy and how this process led him to see medicine in a different light. And how not only is he been helping the patients he sees, but now he's, been taking on leadership, roles and advisory roles to try and help others implement this and it's.

It's, a lesson we can all learn, and hopefully you'll. Take away from this the type of physician you should be looking for, but also how to interact with your physician. If he's, not of he or she is not of the caliber of doctor Unwin, it's, a wonderful journey, and I hope you really enjoy this discussion for the transcripts.

Please go to dieting, dr. calm and you can also see all our past podcast episodes there as well. Thank you very much and enjoy this interview with dr. David [, Music ], dr. David Unwin. Thank you so much for joining me on the dieting.

Doctor podcast hi. Here I am alright, so as we can tell by your accent, you are from England correct right, the north of England, north of England, yes, and you're, a general practitioner, and you have been for how long I started in partnership in 1986, 1986 From 1986 to 2012, you practiced in a particular manner yeah yeah.

Well, I was doing my best yeah. I think I was very average really. I was so disappointed with the results I was achieving, and what do you mean by that? What were the results? You were achieving them.

We're, not up to what you wanted. When I look by now. It sneaked up on me really. I didn't notice for the first few years and after a while, you start to realize - and nosubstance looks really very much better.

I'm talking mainly about people with obesity and type 2 diabetes, but other conditions as well, and I think I was I just started - noticing that people didn't really seem to look wellnessy for what I was doing yeah and what Were you using as the framework for how to treat them? Well, we rec were pretty closely regulated, so I was using the usual guidelines that all gp's in the UK use and in fact, that the payment system is slightly based on the guidelines.

As well so it was a good idea to do conventional medicine and we they called quaff 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.

The closer you adhere did the guidelines, the more you got paid, yeah yeah, although the the the COFF figures on diabetes for our practice were quite disappointing, which was a bit difficult to understand.

We didn't seem to be doing very well, so I had on one hand I sort of sneaking suspicion or a feeling the medicine wasn't. What I'd, hoped mm-hmm. So when you're young, you you become a doctor, because you want to make a difference.

It's, not really about money. It's. All you have this 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, because you know patients, didn't, look really very much better in during my time.

We'd, had an Eightfold increase in the in the number of people with diabetes so that didn & # 39. T, look really a good reflection on me. He race, so there's, an Eightfold increase in the people with diabetes.

So he had 57. When I started people I was in total and your practice yeah it's of nine thousand patients yeah and we've now got about 470 so that that was so. There was that I watched that happening. I just had this sneaking suspicion.

I was letting people down somehow right that I wasn't achieving what I thought was wellness and what patients thought was wellness, 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 to see that sort of a change, but for some reason it hits 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 tending to look back on your career and I was disappointed steena. I was disappointed in myself really and then how did you change? Well, several things happen happened that there's. 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 for their diabetes into remission had not seen it once I didn't even really know it was possible. We're, not taught that it's passed. No. No, I my example was that the people with diabetes is 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 die and put her diabetes into remission, but she confronted me with you know, surely day doctor I mean.

Surely you know that actually sugars, not a good thing for diabetes name? Yes, I do, but then she said, but you never once in all the years mentioned that really bread sugar did you, and you know I never dated I don't know what my excuse was, and so the this this lady had done.

This wonderful thing - and she'd, also changed her husband's, life as well. She did she'd, sorted his diabetes out and she'd, done it with a low carb dieting, and that really made me think I didn't know much about it.

I didn't, know much about it, so I found out well, she'd, been on the low-carb form of diabetes, co, dot, 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 the stories of the people online were full of doctors who were critical of these people's, achievements right and practice, nurses, who were saying, oh, you'll come to harm you, you know, I won't, take any responsibility for you.

If you give up your drugs there's, a definite fear factor. Yes, the walls are they they were being blamed. I thought I was terrible. Really terrible when there would seem to be doing their best yeah and at the same time I went a run one day with my wife Jen and she she was saying you know he seemed.

How do you feel about retiring, and I said I don't know a bit disappointed and she said: shall we not do? Should we not do one decent thing? One good thing in medicine together before you finish, and I just seen this case and begun to read around it, and so she said well, 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, the would be a great challenge and if we could help, then that'd, be brilliant, then the next thing she said well, why don't? We do this and I said because we're, not paid, she's not paid, and so she and she's, a great woman.

She said so we're, not paid, and that and that's. Why you won't, do this thing, and so shall we not just think our way around this, so it was Jen's idea. She said why, first of all, why don't we work for free, so we came up with the idea of on a Monday night.

The practice wasn't being used very much and that my wife would work for free and I would work for free. So 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 that it wasn't just people with diabetes.

I was really concerned about the people with pre-diabetes because we 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 we knew who they were and we were just filter waiting till they trained diabetes and, as part of that, Eightfold increase the use where all those people had pre-diabetes when you were taking care of you yeah.

So why were we waiting, and within that group I think particularly the younger people, what a shame not to help them. So we 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 learnt about low carb with these people.

So we bought each one of them or each one of them a book on low carb, and then we did cookery lessons together on a Monday night. I remember I did we did like how fast can dr. Amin make leek soup it's about three and a half minutes.

Did that sort of things? So we did it in a group with the patients yeah. I was so surprised because I had such fun. It's. Such fun probably were seeing a success. You hadn't seen in your practice and a new level of enjoyment that 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're, not doctors. You know we used to want to Wong hey, but we're, not really used to groups.

I was quite scared, almost not being in charge of the one to one thing and then, 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, yeah surgery, so that the there was a difficulty because of the time what I was doing was seen as being I don't, know not dangerous, but weird it's like Him yeah and is important to sort of set the stage right because you work for the NHS, the natural wellness services yeah 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 on what what they say is within the scope of what you can do? Well, that's so interesting. I thought that, yes, yes and then so we trained this for a little while and we started with the pre-diabetes and then people diabetes started sneaking in because they'd heard it was, and so they started and they said well, 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 got to pages and pages so because I felt vulnerable. I thought I'll read the got every word of the guidelines and then inside the the nice guidelines.

In the UK I found some pure gold, so the NI CEO, nice nice guidelines of the UK - 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.

I knew it was effective, but it could be safe and I was just not going to be criticized as much for this. That's interesting. It's, an interesting point that the hanging on the low glycemic index, because that's, a difficult thing for a lot of people to understand or interpret and put into practice.

But it's, a very common catch phrase, but maybe not the most practical, but it seems like you, found a more practical way. Well, that's, an interesting story, so I became obsessed with the glycemic index, the glycemic load, which is calculated from it, and I tried.

I was also obsessed with the results we were getting, so I became a real low, carb or I went on and on to the partners and one of my partner, Scotty Schultz. She said you know David. This is getting really boring now, because we don & # 39.

T really understand you tell you talking to us about Lee the low GI, but we don & # 39. T really know what you're talking about, so why don & # 39? T you go away and come back when you can really explain the yeah.

She said when you can really explain it to a plumber to a student to other GPS, and so I'm very grateful to kotti because she was absolutely right. I was a low carb or, and the 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 dietingary choices, and I Came up with an idea: well, the first thing really was why 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 the 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 in it as a glycemic load and really, but I don't think doctors or patients are very familiar with glucose as a substance. What do you mean by that? Because beyond Lucas's, sugar range? Well, it isn & # 39.

T really is it? Yes, sugar is table sugar which right you know so that's table. So people know table sugar, but they don & # 39. T really use glucose in cooking and they don't really know: what does what does 10 grams of glucose look like? They were not really for me, particularly in the north of England.

They're, 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 wondered whether it would be valid to redo the calculations in terms of something we are familiar with, which is a four gram standard teaspoon of table sugar, a 4 gram teaspoon of table sugar and you put that into glucose equivalent.

So now I can visualize it, you can see the tablespoon and you can see you think that's, what it does so I was really lucky. I contacted the original people who trained and experimented and published the work on the glossy meat glycemic index and the glycemic load, and they are actually in Sydney and professor.

I think he's, Jenny brand Miller and I mailed her in. To my amazement. She mail back, I was so surprised and I was asking for help. I saying is my idea valid and will you help me and she said you know I I don't know, but I know somesubstance that will help you and that was dr.

. Jeffery leaves he who was one of the academics, who'd work with her on the glycemic index and glycemic load and Jeffrey has helped me, and so he redid the calculations for 800 foods in hundreds of 100 foods in terms of teaspoons of sugar.

Yeah, so I can now tell you that 150 grams 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 grams, 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 do pop open it's like awareness that they haven't had before yeah. It's such a quick way for them to understand how carbohydrates and and you know this, it helps them because they're, so mystified, because so many patients say to me well doctor I mean 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, yeah, you know, and they they don & # 39.

T know how to, and previously I didn't know how to explain this. But now I can say well let's. Look at what you're eating right and then, if you're having a takeaway, the rice would no wonder - or if you take, I don't know boiled potatoes 150 grams, that's about 9 teaspoons Of sugar, or even a small slice of wellnessy wholemeal brown, bread is the same as three teaspoons of sugar, so you can begin to see that some items in your dieting may not be a great choice.

You have type 2 diabetes and then right in an in fairness that that glucose equivalent that sugar equivalent is going to react differently in different people depending on their metabolic wellness. Yes, 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 how phrasing it that way will really make people understand it better.

I think there are two really important points, so one is them is helping them understand that they that this is where the sugars coming from, but the other vital thing is is giving them hope are so so important and 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 it into remission. If you could repeat that, how wonderful for people and when I now - because I think we've done 60 now so I've got 60 patients who put their type 2 diabetes into remission.

So I'm able to say with confidence to people, you know, stand a good chance yeah. In fact, I can say that of the of my patients who take up low-carb about 45 percent of them will put their diabetes into remission, which is amazing remark.

Well, no drug can do that. No, it can't. Then, particularly. I never saw a single case of that in 25 years time, Romania yeah not one - and now reliably week after week, I'm. Seeing people I'm, getting them off, drugs, photographer type 2 diabetes and they're coming in getting these marvelous results and it he's such cheerful meds, and it makes me like you know: I often bring him up.

I love it now. You know when you get the blood results, I keep them like a treat for the end of the day. You know they hemoglobin a1cs, that liver function and I keep it like a treat because so many of them are good.

I don't, bring him up at home yeah, you know. When did you is? How often do patients get a cheerful phone call from their GP to say I'm. Just need to tell you it's. Amazing! You've done so well. What do you use as the as the is the cutoff for the diagnosis is an a1c.

I use a hemoglobin a1c, okay, what level? Usually four, so I 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 mini moles per mole of less than 48.

Okay, you'd, have to convert that into a cent for the listeners, because I can remember that is okay. Well, after workout yeah, maybe could come up on the screen yeah. That would be helpful so that's.

What that's, the definition Android published at in the British Medical Journal, and I have to remark which I'm. Sure people on the video can see, but the people on the audio might not be able to you the your face.

Sort of lit up, as you were, describing it to me the way you you can call these patients and give them the news your face, like just lit out yeah, I mean it's, such wonderful medicine. I never thought I'd.

Live to enjoy it so much yeah amazing! You know I'm old. I'm over 60 and I'm still there I didn't expire 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 I don't know you just look at the blood results and it's, not really about the blood Results is it, you know, imagine the patients how they feel when they come in and they lost weight.

It's, not even just diabetes. It's, really not just diabetes. That was gonna. Be my next question, so you're, focusing on the diabetes, but what other you could say, unintended effects or other downstream effects, which actually should be interesting so in the in one of the things that surprised me most in the beginning was dramatic improvements In liver function, dramatic, a fatty, liver going away that was so interesting because I saw patterns.

I began to see that I could predict the patient's, so we're doing really well before they came into my room, because I got that I'd, get the blood results and I'd, see The liver function improving - and I know this is one that's.

Doing really well and that would the liver function would seemed to improve almost before anything else. Interesting. I'm now getting it's about 40 to 50 percent improvements in liver function and Gamma GT, which is a thing I measure that was the first thing.

The next really interesting thing - and this happened to me as well aced - have high blood pressure, but it started that when I stood up I felt dizzy. My blood pressure was dropping happens in the first few weeks and then it was happening with patients, and I was discovering that I could take it.

I could stop lots of the drugs that I had them on for hypertension, yeah. So every week I was stopping him lot of pain per enderpearl load to drugs that they were on to keep them safe, because I worried that they'd fainted.

This, too, though, right so imagine how that is for a doctor after 25 years that I patients it wasn't just about diabetes. It started broadening out. So do we had the blood pressure, the weight? They were losing significant weight, particularly off the belly.

Mm-Hmm they really like that the belly was going down. Triglycerides were another thing. I'd, worried about triglycerides for years, and I never knew what to say to patients, because you did the blood test and a triglyceride was sky-high, but I never really knew why yeah and of course, there's.

No real drug for triglyceride, so what you say - and I'm embarrassed to say, stir fudge it I'd, say it's a bit high. You know you'd, probably need to lose a bit of weight and we'll, redo it again in six months and hope.

Another doctor did the test in six months. It's. Really I didn't know what what did this? Why? 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 their skin improves that's nearly one of the first things within a couple of weeks. Sometimes the skin improves and the other thing is their eyes, look bigger, bigger yeah.

I think they're losing fat around the eyes. No interesting yeah. I always have a little bet with myself when I see them in the waiting room from a distance. I'm a little private better. This one's. Gon na be good this one's, gonna be good before I weigh them, and the ones who have the eyes look brighter and bigger.

They've, nearly always lost. Where now I wonder whether they're, losing either periorbital fluid or orbital fire, I don't know, but they it's, a thing I've noticed again and again I see first - and this goes back To sort of how we started this conversation, where you said people just weren't, looking good, they weren't looking wellnessy exactly and I've heard you make that analogy.

I want to hear your analogy to animals about the same sort of thing. Well, 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've had as pets, and I another one of the things that had troubled me over the years was human beings don't, look like wellnessy animals, you know.

If you go down the street, how many would strike you as are really strikingly wellnessy animal, not very many right, isn't that odd yeah and then yet wild animals on the whole do look wellness and you could say: well, 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'm. I started to notice even 30 year olds, who should be in the prime of life. We're. Looking abby's with poor skin, they didn't, look wellnessy and they didn't look happy either, and so I used to think well.

This is really odd, because human beings are not looking wellnessy and suddenly I had this thing that they were looking wellnessy and it not only did they look wellnessy, they felt wellnessy, and another thing I noticed at the beginning was people, so the average patient I'm dealing with weighs 100 kilos, they were 800 kilos and they're, 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 yeah, they felt sleepy tired, but when they & # 39, ve lost a bit of weight, they start exercising. Hmm again and again, I find patients say well. I'm a bit bored in the evening, so I'm starting to drill you know, so we were going from a population who didn't, look wellnessy, denied, wellnessy and, as I say, I'd, been A bit mystified, unlike everything else in nature, where people's, you know they were sort.

We're animals generally in nature. Look pretty good, and now human beings were beginning to look pretty good, and I thought I think I'm on to something here. But one of the things was, I didn't, know any other doctors who were SARS consummately alone at the beginning, yeah.

How'd? That feel I mean you really felt like you were. Were you hesitancy me? I'm. Doing something wrong because nosubstance else is doing it. Well, you wonder whether you're bonkers, really don't you in really mad.

You know am I am I trying to convince myself, but then you know I started with one and then there was 20 and then there was 25. It worried the partners in the practice, while I was doing they they were cross with me, because they said really David.

Why don't you shouldn't, you be concentrating on sick people when that upset me, because I thought well. If I don't do something they are sick, so really so that troubled me and then I knew what I was doing was making some wellness professionals uncomfortable, and I remember one meeting so I I got my first paper published and I went to A big diabetes convention and the doctor 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.

I didn't. He was shouting at me, yeah and other people when they heard my name would turn just turn their back on me. Wow, it felt terrible. I was. I was mystified because I don't. Well, what am I to do? Because if I go back to doing what I did before, that was so depressing yeah, and I was I couldn't understand the reaction of the people that seemed so cross.

Lack of knowledge and lack of understanding. Have you seen that change over over time, or do you still see that level of resistance it's changed him hugely yeah, hugely any. It gives me joy because I you know, I'm, not alone anymore.

Now there's, loads and loads of doctors. Doing this and part of that, I think, has to do with your advocacy. So you started with treating the patients seeing the benefits of the patient's. Getting the joy back and now you've gone on to be sort of a leader and an advocate in the Royal College so tell us a little bit about even for the American folks.

What a Royal College is and your role in it and what kind of impact that's having on patient care? Okay, so the Royal Colleges, the UK, you can't actually be either a general practitioner or a consultant.

Unless you & # 39, ve passed an exam set by your Royal College, so there's, a Royal College for general physicians as a Royal College for psychiatrists dermatologists and a Royal College for general practitioners.

They're responsible for quality really and standards. They're, 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're, going to listen to you and one of the things I'd, say to other doctors.

He right at the beginning is keep data mm-hmm. So one of the things I did at the beginning, knowing that what what we did at know, what Avenue that's, the practice was a bit odd was I felt I owed it to the patient to 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 I owe all of this to Professor Roy Taylor, who is very famous in the world of diabetes. Should I tell you the story of Roy Taylor, sure, okay, so Roy Taylor, when my results first started coming in, I couldn't believe them.

I thought there's, something you know I can't believe it. So I'm believed I don't, know weird. After all these years, is it safe? What's going on so I contacted, I think about 20 professors to say this.

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 and he said What you're doing is, is fascinating and may well be clinically very significant, but we need to do statistics.

I didn't know how to do to statistics, and he said well, you need an Excel spreadsheet. I didn't know how to do an Excel spreadsheet. I actually had to get the accountant to do my accountant to do an Excel spreadsheet for me, because I didn't know how to do it yeah and that that started me with the data.

So I'd, say to anysubstance. If you collect data so now, I know on average, with the patients I'm doing. I know what's happening to them and when you start doing dangerous a bit laborious, time-consuming on top of your day job I mean soon becomes addictive.

I don't know I love doing it now so about twice a week. I'm loading, my data to see how they're, doing and see how the averages are coming on, but that really helped convince the the Royal College and then the other thing was.

We started making drug savings, but I didn't actually know we were doing this. It was actually it was one. So we're organised in in in in the UK. Gps are organized into groups of about 20. They're called CCGs okay, 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 thousand head of population in our CCG interest, and she said I think you're spending about 40,000 pounds less every year on drugs for diabetes and his average for our area.

That was remarkable. Well, it was amazing was where I got her a bottle of champagne. That woman, I was so excited, and it was true and we've, kept that up for three years now yeah, and that became very interesting to the college there.

But also very interesting to other doctors and also politicians. So now you don't have to worry so much about being outside standard for care, because you're showing you have evidence. You have data to show how you & # 39.

Re benefiting the patient and benefiting the bottom line with medication, Lewis's, 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 wait strain to drugs yeah, so I didn't really believe in lifestyle medicine.

So what now I I'm, really focusing on that and I'll tell you. I think it's, five years or maybe six years now, every single patient that I diagnose diabetes. It with I offer them a choice, so I I say right well, we could do this two ways.

I believe that I can help you with this. With dieting - and we need to start talking sugar and starchy carbs, or if that isn't your thing, we could 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 And so well the doctors say to me: well, my patients, wouldn't be interested, but you know my patients weren't interested for the first twenty five 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 yeah I'm up for this yeah.

I'm up for this thing. How about we have a go? Shall we talk to you? I shall we, you know who does the cooking, who's, doing the shopping in your family and I think you then trainer. 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 he'd, be interested, but in the back of their brain they're wondering how would you advise them to address their physician right? I think you also 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 a difficult, and they know there's.

Not enough of us, you have to work with you, doctor boat. I think he's. Would it not be reasonable to say to your doctor? This is something I've read about. Would you mind, could I try this mm-hmm? Could I try this? Would you give me the trance 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 that's, similar to advice I give in that you're, not saying this is the way I'm 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 and my weight and my blood tests. Let's, just see what happens in three months and six months, then we'll revisit it enough.

I'm feeling horribly. We'll, come back to the medication question exactly and I think he said a good thing there, which is agree what you're gonna measure. What are the outcomes for success, and so for me I shall I find waist circumference very good.

Ain't weight, circumference and the patient can do that and then they're, getting feedback right better than weight better than substance mass index. Crete circumference both yeah. Both I mean because I've, actually had patients.

I don't, know about you. I've had patients whose diabetes has improved significantly without weight loss now, but you can see. Yes, I have and you, but you can't, see substance composition, changes absolutely some of them have they put on muscle, probably, but the belly's gone small hasn't it yeah.

So it's worth measuring both that's a really, and because there are people who don & # 39. T believe that you know there are clinicians who don't believe you could improve diabetes without weight loss right there.

Definitely, but you you, you can. I was gonna say something about motivation. I think this is some of the stuff I've learned from my very clever wife Jen, and that is so. The first thing is giving patients hope mmm 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: is feedback is absolutely central to behavior change.

Isn't it yes central, so I love that I don't know any of the any of the listeners who've seen my Twitter stuff, but I do this graph of the week, so our computer systems generate graphs Of waiting, hemoglobin and so every week this is the patient that's done the best and those patients, so brows always put it back up on Twitter, but what wonderful feedback that is yeah, so that's? We get into long-term.

In short-term goals, yes right, so the short-term goals are the stepping stones to get you to lung doctor bigos, but they give you hope. They show you immediate feedback that you're having progress and it keeps you interested it yeah.

That brings me to a point. You know I didn't used to recheck hemoglobin a1c. All that often so I wouldn't check it for six months mm-hmm, 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 two hemoglobin a1c.

I think it was about 62 and he brought he down to 38 millivolts per mole. That's, really significant remission yeah, and that was done in 38 days now previously. I would have missed that wonderful result, because I wasn't checking them soon enough right.

So I would say if if a patient is losing weight and if they they're, really doing the low carb thing. It is worth redoing the hemoglobin a1c, certainly after two months, because that feedback is is like oxygen to that patient and it under dr.

too, because you're wondering whether you doing yeah good thing. So I think he's worth doing a few more blood tests so that, as part of the contract for the patient with me, okay, you don't you don't have drugs great.

Would you mind having a few more blood tests mhm and do you know they on the whole they don't? I think that's, a great perspective of your approach and how you incorporate your wife's approach. Jen's approach as well, because behavior change in 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. You know.

I think we've missed a trick in in in medicine, so much of chronic disease depends upon behavior change and who's, an expert in behavior change. Oh, it's, a clinical psychologist, but whoever asked a clinic - and they know stuff, but we never asked him right and I realize now I'd spent 25 years, telling people what to do at doing medicine to people right, whereas what I'm.

Doing now is more collaborating with patients, and that involves really taking onboard behavior change and people's, personal goals. You know what what is what & #? 39 s? Their goal you've, got to talk to patients find out what are they hoping, yeah and, and I will again that the Royal College of General Practitioners is really committed now to collaborating with patients, because you can't solve one of The big things we've got as multiple morbidity, isn't.

It people have got 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 a patient and their goals and as I say they're all college, I think the British Royal College of jump Ratish.

They're way ahead in the world because they're. The only people talking about collaborating collaborating with patients working with patients one perspective and they've made me a just a show-off. Can I show these? Do I'm gonna see we do they've made me national champion for collaborative care in diabetes and a be seen in the UK because of my commitment to working with patients yeah, but it's.

A selfish commitment because it's, just better medicine, it's, just much more fun. So at the start, people are yelling at you and condemning you, and now you've, been made the champion of collaborative care and diabetes.

Yeah, that's, a remarkable it's, a journey it's, a turn I'm sure I'm, still irritating a lot of people. It's very difficult. You know. I'm certain. I am irritating people, but you know they're working at 10-minute appointments mmm, it's hard and I can't get locums.

It's, a really it's a long day. It's a really hard day and, and then this this doctor comes along and starts saying: oh what you doing you know 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'm. Very. 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 there right? So yeah any GPS out there that I'm annoyed that's, hurt that I've annoyed.

I'm. Sorry, I apologize well. 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 sort of 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. You know. I wish everysubstance could work with you, but but clearly that that's, not possible, but hopefully there are more like you that they can work with and how to sort of frame the conversation a little bit differently.

With your doctor, I've got another thing just to add on, I think very often we're, 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'd, be in a better position.

So I quite like to just add a little bit about insulin, sure in chile, so i explain to patients with type 2 diabetes that one of your problems is insulin. So what happens is if, if you eat the 150 grams of rice, then you know you're going to about 10 TSP equivalents of glucose into bloodstream? What does the substance do with that glucose? Where does it go because you are, you are programmed? We know that high blood glucose it's dangerous, so your substance has to get rid of the glucose.

Yeah insulin is the hormone that gets rid of glucose to keep you safe insulin pushinges glucose into cells to get rid of it, and he pushinges glucose into your muscle cells for energy, which is fair enough, but maybe you're taking in more glucose Than you need for energy or hums to the rest of it, and that glucose is being pushinged into your belly fat to make you fatter and it's being pushinged into your liver to make into triglyceride and could give you fatty, liver.

And anysubstance with a big belly in middle-age, but he's, beginning to understand that maybe a toast, the rice that whatever might have something to do with a big belly. And so what I'm saying to them. They've got a little hooking in their own life, so I think maybe he's, telling the truth and then, if they take my advice and the belly gets smaller, they think dr.

moon might have got 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 I can talk about getting rid of belly fat know.

People want all sorts of different things, but let's talk about physiology and particularly if you relate dieting to physiology it becomes more powerful. I think 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 too, to imply to their own lives and and sort of chart their path for wellness. And I love to see that the joy in your eyes and the excitement of helping people come back.

So thank you very much. I hope they like it all right. This is been a pleasure [, Music, ], [, Music, ], [, Music, ], [, Music, ]


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