Fatty Liver Expert: Your Liver Is Filling With Fat Right Now - Dr David Unwin

0:00 Your waste should be less than half your height. So half of that string should go around the fattest bit of your belly. And this is a really simple test for everybody at home. I mean it's not just done it your path. But fat on your belly is more worrying than fat on your legs or on your arms. And unfortunately, we've started to normalise things like the dad bot without realizing that isn't how you're supposed to be. And maybe a third of all the people in the world with type 2 diabetes don't even know they have it. But every year that you have poorly controlled type 2 diabetes, you're losing a hundred Days of life. And it's because people don't know the truth being fooled with the packeting and advertising. So let's talk about the food we have on this table, because this is how much sugar I would have thought was in all of these things here. Cereal, a potato, white rice, a banana, and a chocolate bar. So now I'm gonna give you the correct figure. The cornflakes is one, two, three, four, five, six, seven, eight. That chocolate bar is seven and a half. The banana, that's six. And then the potato is actually

1:01 Oh my gosh. And then 150 grams of boiled rice is I thought w rice was healthy. But each of us has a number of different health futures. And what I'm interested in is how do I get you to pick a lifestyle that will get you the future you want? Because my job is about behavior change. The floor is yours. All right, so off we go. Guys, I've got a favor to ask before this episode begins. The algorithm, if you follow a show, will deliver you the best episodes from that show very prominently in your feed. So when we have our best episodes on this show

1:36 The most shared episodes, the most rated episodes. I would love you to know. And the simple way for you to know that is to hit that follow button. But also it's the simple easy free thing that you can do to help us make this show better. And I would be hugely grateful if you could take a minute on the app you're listening to this one right now and hit that follow button. Thank you so, so so much. Doctor David Enwin.

2:02 You were named in twenty eighteen. among the top ten most influential doctors in the United Kingdom. Um you've got an incredible list of accomplishments and you're held in the highest regard, maybe of all the doctors I've ever had the chance to speak to, by many people that I've spoken to. We were talking before we started recording about what's on your mind. And what's been bothering you? And so the floor is yours.

2:24 What is front of mind for you, Doctor David? Well front of mind for me is the the idea that each of us has a number of different health futures. So you have So in your future. Uh, I don't know. There could be cancer. There could uh be multiple sclerosis or there there could be many futures. What I'm interested in is how do I get you

2:48 To pick a lifestyle that will get you the future you want. And I think that's Very difficult. In the world now. What is the best lifestyle'cause you're given so much conflicting

3:00 Advice. And the particular focus for me in terms of Picking health futures is around young people. Because They've got the longest time.

3:11 To make a difference. And It's getting harder and harder and harder to make good health choices in your lifestyle. It's really hard. I'd say it's a pandemic.

3:24 of poor metabolic health. Yesterday in clinic I saw two people under the age of twenty five who had Poorly controlled. Diabetes? And one of them was too heavy for me actually to weigh. And

3:38 This situation is completely new. So when I when I was a young doctor And just starting off in practice, that was in nineteen eighty six. Wow. A long time ago. Just north of Liverpool in the practice I'm still there now. Obesity was rare.

3:56 And we didn't have a single case. of type two diabetes in anybody under fifty five. Not a single case. It was quite unknown. And in fact. Type two diabetes had a different name. We've had to change the name because of the epidemic. Used to be called maturity onset diabetes. That meant old people. Right. Now we call it type two diabetes because we have to include so many young people.

4:21 It's really, really serious Uh because People are losing their life expectancy. And I'm witnessing this.

4:31 We're all sleepwalking into a metabolic disaster and the people praying the greatest price, in my opinion, are young people and it's a scandal. And I'm hoping mad, really. I think we've started to normalize.

4:46 The dad board. You know, the big tummy and ha ha without realising that maybe that isn't how you're supposed to be. So that that's what's on my mind. Young people. And their future.

5:00 And they don't even know. You say young people there. Yeah. biggest opportunity to change the trajectory of their future. But for The audience is listening that might be in their fifties now. Is this advice also applicable?

5:14 Absolutely. So we know from g government figures, UK government figures. But For every year. that you have poorly controlled type two diabetes, you're losing a hundred days of life. That's about a third of a year, isn't it?

5:29 So Whatever age you are, if you uh have poorly controlled diabetes. You're losing life expectancy and and Maybe a third of all the people in the world with type 2 diabetes don't even know they have it.

5:43 Because they haven't taken a test, so they don't know. What do you think kills people with type two diabetes? Um is it some Cardiovascular issue?

5:55 Yeah, well done. Well, you see you've not been to medical school. That most doctors that's what they say. Because we know uh that a high blood sugar over time Damages your arteries.

6:09 So it's a cumulative thing over time. But what you may not know Is that Actually A rising cause of mortality for people with diabetes is cancer. Oh really? Yeah. So eight forms of cancer. uh strongly associated

6:29 Uh with diabetes. I want to just define that term diabetes, because I think I went through a lot of my life assuming that diabetes was a disease that some people are born with, and because I didn't have it, I thought I don't need to worry about that. That's really important. Yeah. So f first of all there's type one diabetes and type two. Yeah. But before I can explain. About Diabetes I need to explain about insulin.

6:52 This is absolutely key to our whole discussion. So I've already said But a high blood sugar. damages your arteries. And in fact there's

7:04 Work to show that a very high blood sugar damages the non stick lining of your arteries within six hours. Really quick. It's called the glycocalyx, the non stick lining. And uh damage is occurring very quickly. So I'm gonna ask you a s really stupid question. When you say high blood sugar, I get high blood sugar when I eat lots of sugar. Okay. So first of all, we're actually talking about glucose.

7:29 Yeah. And sugar. can mean table sugar or it could mean many different things, but we're actually talking about blood. Glucose. Which comes from lots of foods. Which comes from many foods. Carbohydrate heavy foods. Yes. Yes, it does. It does.

7:45 That's right. But You have the hormone insulin to defend you. From poor dietary choices. So the question is what Does insulin do with the sugar you just ate? And here's the answer.

7:58 Yeah. Insulin, the hormone insulin produced by a pancreas gland. The sugar. And it pushes it out of the bloodstream inside cells.

8:12 Where it can be used for energy for you to run around? But what if you take in uh more carbohydrate than you need to run around. Well then That sugar is turned to fat.

8:26 Inside cells. because it's safer for you to turn that sugar into fat than it is is to have it damaging your arteries. So I am somebody with type two diabetes, so we can talk about me. Yeah. So I had a really heavy biscuit habit.

8:43 I was senior partner of the practice and it's stressful and I had Patients used to bring me biscuits all the time as a gift'cause they you know, they want the doctor to be happy. So in the drawer In the top of my desk was packet and packet of biscuits. So I'm

8:59 taking in more sugar and I didn't run around. And gradually my waist got bigger. And What was actually happening was

9:12 More sugar than I needed to run around. My insulin was working to get rid of that sugar. And it was giving me two things. One. A belly?

9:23 Mm-hmm. So I might you know, and I thought it's just middle aged spread, you know? And the other was I didn't know But my liver was filling with fat. And that's Um that

9:35 is very common now. So we have Well, it's a third of everybody in the developed world has fatty liver now. Here we got the wonderful props. Let's talk about these. Great. So fatty liver. This is the healthy liver here.

9:52 And you see the colour. Look at this one. It's yellow. The wrong colour. And it's because of fat.

10:01 So in that case, like has happened to me over years. My liver began. Two Fill with fat.

10:10 Because it was essentially overworked and glucose was being stored there. Yes. So I was taking in too much glucose. Insulin was doing its good job. Of taking it out of my bloodstream.

10:22 and forcing it inside cells in my belly, but unfortunately in my liver. Okay. laying down of fat in the liver. So if we look at Actually some proper liver. So this is the Put on your seat belts now,'cause this is somebody's uh somebody's actual liver.

10:41 So then that's the normal liver. But look at this is larger. That's a real human liver. Yes, these are human livers, and that's as it should be. But this look at this liver, it's larger. And it's larger. Because there's so much fat in it.

10:55 Now the twist in the story. Is fatty liver. interferes with the good work of insulin. So you develop a thing called insulin resistance, which means your insulin is no longer as powerful as it was. It's beginning to become difficult for you to deal with carbohydrate and sugar because your insulin isn't working as well.

11:17 And the only way to deal with that. Is the next twist in the story. You have to start producing more insulin. Do you see? Because it doesn't work as well. Yeah. So your pancreas has to Uh crank up the supply.

11:33 We need more. In Celine. So now you have two things. You have Insulin. Resistance, your insulin isn't working as well.

11:42 But at the same time You're trying to produce more insulin in the pancreas. This bit's called The Long Silent Scream from the Liver. This is work by Professor Roy Taylor, a friend of mine at Newcastle University, and he pointed out Uh. You've you've got fatty liver for about ten years. You don't even know.

12:03 You wouldn't know. That your liver's gone. Fatty and yellow like that. But unfortunately this is another twist. Fat is being laid down in the pancreas gland, the very gland that your life depends upon producing insulin, and your ability to produce enough insulin collapses.

12:23 And at that point you can't regulate blood sugar anymore. But upstream. of that, you have a problem. You've got that. But you don't even know. You you're talking about what's in my mind.

12:36 Why are we waiting? Until you actually have all the problems of type two diabetes. So Since twenty thirteen. I've got hundreds of patients and I'm monitoring

12:48 The baseline and latest follow up. So what happens to them? It's really important. And Now I have a a huge data set that I can interrogate

12:58 And answer questions. So number one question Let's think about pre diabetes. So this is in the long silent screen. Well I can tell you But the people with pre diabetes, in my practice, north of Liverpool

13:15 Ninety three percent of them. We'll get the A completely normal blood sugar. If they go low carb, ninety three percent. resolution and that will last for years.

13:26 Because I've checked. Okay. Yeah. How about we wait for the ten years? And Steven until Stephen you've got type two diabetes and then you go low carb.

13:36 At that point, if I can get you early. I've got a seventy three percent chance of you having a normal blood sugar. Let's wait another few years because you don't want to give up bread and you don't want to give up chips and pizza. Fair enough. I'll wait.

13:52 But you know, if we wait five years. You only stand a fifty percent chance. So do you see it goes ninety three? Over seventy percent. fifty percent. So the chances of me not needing drugs and be able to do a good job for you are diminishing. So

14:10 Really, it's a stitch in time. Mm-hmm. And so much of this you don't even know. You don't even know it's going on. One of the things that shocks me is um is how little we know about what's in our food.

14:22 Yes. You know,'cause I think we all know that like biscuits are a food that has a high glycemic index. Well done. Which is a term that I've learned from this podcast. Some carbohydrates are more sugary than others. And then so that's the glycemic index. What that is doing It's comparing different carbohydrates with pure glucose. Oh, so you see.

14:43 And then other sugar. Come further down. But there is there's something better than the glycemic index?

14:53 And that's called the glycemic load. The glycemic load takes portions of food And Predict. Yeah.

15:03 How will that portion of food actually affect your blood. Shooker. And am I right in thinking the glycemic load would factor in The amount of nutrients in the food that's like protein fibre. Yeah, because if you took watermelon well it's mainly water, isn't it? So you have to factor in

15:22 You can have quite a lot of watermelon. Uh to equal a chocolate bar. Mm-hmm. So the density, y you're all you're looking at the density of sugar in it as well. Okay. So that's why the glycemic load Is better.

15:36 Was there was there a moment in your career where You started to question what you had been told. Yeah. You know So you start as a young doctor.

15:48 I wanted to be part of a small community and stay there. And make a difference. And then comes the third bit really. So For the first twenty five years.

15:58 I was trying to do what's in the guidelines. I was trying to be a good doctor, but what I noticed I noticed Two things. Yeah. Number one, I notice what I've already Said to you.

16:11 the the health of the population I cared for. was deteriorating, it wasn't getting better. So if I'm the doctor in charge of the practice looking after these people And health is deteriorating. Am I not responsible? And

16:28 Where's where is all this difference I was hoping to make? He just wasn't panning out. At the same time I'd always in my heart felt that prescribing lots of drugs felt a bit Wrong.

16:42 It felt like a mini failure because How is somebody well? If they're taking six tablets a day. Was there one particular patient that you met? There were two.

16:53 Two things happened. Both to do with very powerful women. The first powerful woman was a lady I'd known for over ten years. She and her husband had cared for them both.

17:04 Yeah. They both had poorly controlled. Diabetes and they were both very heavy. At the time I could monitor How my

17:15 how compliant my patients were with their medication. And if I'm to be truthful, in part, that was how I was paid. So part of my payment was to do with our patients having In this case metfalmin, the most commonly used drug. For type two diabetes. Yep.

17:35 Yeah what you mean. Because there's a you're supposed to the the government approve of the fact that we give drugs that are needed for type two diabetes. So that you're given a sort of quota where it it's expec it's regarded as good practice that such a a certain percentage of your patients will be on metformin. What? Yeah. It's true.

17:56 So is it fair to say that you were somewhat incentivised to give people metformin? Yes, that would be true. But I think we should also be fair to say that the body of evidence at the time would say Uh that it's good practice to give met forming. to people with type two diabetes. And Conversely, poor practice not to use.

18:17 that forming, but we'll develop that. So the the backdrop is we're mu we're monitoring the patients who stop taking their metformin. Because that uh is Number one, poor practice, and number two actually costs me. So I wrote to the person.

18:33 Dear Mrs So and so I'm concerned that uh you're not you don't seem to be taking your metformin. Please make an appointment with me at your earliest convenience. Very British, very polite. Anyway, nothing prepared me for what was gonna happen that morning and it's changed my entire life. On that point. So

18:56 The lady w let's call her Mrs. Jones. That wasn't her name. She marches in. And

19:03 Uh she said to me. You think you're gonna tell me off, don't you, Doctor Unwin? Well. I've got news for you. I'm gonna tell you off.

19:11 I was scared, like what's going on? She's never been like this before. She was a A polite person. Anyway, she went on to explain. She said

19:22 When you do my blood tests. You will find that my blood glucose is completely normal. Despite the Not taking your metformin. And

19:33 She said. I'm wondering if you're actually qualified as a doctor. Because In the last ten years, did you ever once tell me that bread was sugar?

19:45 Or breakfast cereals with sugar. I had to learn online. Uh that bread is sugar. But rice is sugar. The breakfast cereals are sugar.

19:57 And when I cut those foods I don't need your metformin now. She w she made it worse. She said. This is school boy. Biology.

20:07 You should have learned that when you were sixteen. I was dead scared because you know complaints as a GP it's really bad. They go on for years and years. But mainly I was scared because every word she said was true. And one thing I had learned about when you're an older doctor is you've got to listen to people properly.

20:28 If they're complaining. Don't deny it. Don't Defend yourself. Take it. So I said okay.

20:38 I've got I want to learn what you've You know, if this is true, will you meet me again, let's do the blood test. So we did the blood test, it was true. It was the first case of drug free type.

20:52 I've never seen a single case in twenty five years where people came off medication. I was fascinated. Because she'd done it. Like a miracle. But there was another detail I just share with you.

21:06 She was one of forty thousand people. Online. Learning from each other. How to do it. Um I

21:15 Looked. They were being rubbished. by the healthcare professionals. So people like me were Telling them you'll die.

21:23 What you're doing is dangerous. And I was ashamed. Really ashamed.

21:31 And it's complete coincidence. But In the same month. Uh we have to introduce my wife. Chen.

21:41 Is there a photo? Come on, let's see Jen. This is Jen. Oh Probably the cleverest woman in the world. She's so clever, I love that woman. So Jen.

21:51 Yeah. Uh so her back she is a Um a clinical health psychologist and she specializes she's fascinated by the role of hope. in disease and the difference it can make. And she spent her life researching the difference that hope makes to clinical outcomes.

22:10 So It just so happened that she was in a supermarket and she saw some a discounted diet book. That one that's the bulk. Escape the diet trial by Doctor John Briffer. Yeah, Doctor John Briffer. What a lovely guy.

22:26 So Jen bought that book. Just around the time I'm telling her about this patient. So she said you have to read this book about the low a low carbohydrate approach. to um

22:38 insulin resistance to type two diabetes. And in the book. Everything That my patient had

22:49 And but It was done in a medical way. F and I understood. She said, David, why Why are you

22:59 sort of failing. Why don't you Do one thing. before you retire, why can't you do a cheerful something you really believe in? Why don't you have a go at this low carb?

23:11 Yourself. Yeah. She said. Why don't you and me Go on this diet.

23:18 See if some patients would volunteer and do it with us. Yeah. And I mentioned it to the partners. And they said no. These are other doctors. I'm supposedly the boss.

23:32 Uh but At the time low carb was not respectable. And they didn't like it. And they said, We don't want you to do this.

23:41 And Partly'cause they said, well how Mm You know Is that a good use of the the resources of the practice?

23:50 Because if you're doing this, David, maybe you're not treating chest infections or other things and there's pressure on the health service. So this felt a bit they felt it was a bit self indulgent. So go back to my wife and said the partners say no. And she said. Yeah. We're both gonna work for free.

24:09 And we'll do it. Why don't we do this? In our own time. In On in an evening. when the pr is no resources.

24:19 So that's exactly what we did. We found eighteen volunteers Who were interested. And then Jen and I So that was twenty of us.

24:30 We started meeting every Monday night. Talking about low carb learning. How'd you cook stuff? How'd you do it? We did it together. And one of the nurses We're so excited. Heather is her name.

24:45 You know? Thumbs up to Heather. Heather said I'll work for free. I'll help you. I'd love to do this. I want to I want to believe in what I do.

24:56 Yeah. And then the magic begins. The results I couldn't believe it. I could not you know, I'd never seen anything like it. And the first thing The first thing I saw was

25:08 Was the liver function improving? You see, because I'm doing blood tests, cause I know I'm doing Something weird. I'm doing something that I would be criticized for. So if you're gonna do a weird thing, you need to measure stuff.

25:23 You can't, you know, it's these are patients, so you can't just experiment and not be, am I doing harm? what's happen what's happening to the cholesterol and the lipid profiles. So I was monitoring stuff really closely. The liver function though, Stephen. I got people who I thought they were drinking.

25:44 Alcohol? And I thought the liver problem was due to alcohol? And they'd had abnormal liver function for ten years. And suddenly within weeks the liver function was improving often by a third or fifty percent.

26:00 I was so excited. Can you imagine? I'm sitting there and the laboratory results are coming in. And that like Wow. And then another And another.

26:13 So that was the first thing, then the weight. So we're all meeting every Monday night. And we got the scales and everybody gets weig every Monday night. And the weight started falling off people. It really did.

26:25 And then the All sorts of other weird stuff started happening. Some of which I couldn't make sense of for years. The first one was People said, Are you hungry'cause I'm not?

26:38 They started saying things like Do you have to eat breakfast? Mm, si, si. Where and I also I wasn't hungry.

26:46 I wasn't hungry. They were telling me the truth'cause I was experiencing this with them. Yeah. Why are we not hungry? That's so odd.

26:56 And I was starting I Not bothering with breakfast, so I'd Can Eat it. You don't have to have it.

27:02 I'm a I'm a belly. Went away. The next thing was I noticed when I stood up From my desk? I felt dizzy.

27:13 Weird. Now I hadn't told anybody, but I had Mm. moderate high blood pressure for years.

27:20 But I didn't like to be a patient. So I never went to a doctor. I just put my head in the sun, so I had high blood pressure for years. When you talk about blood pressure, it was low normal. Why?

27:34 I didn't know. But on the patients as well, I'm doing that as well. I'm measuring all the blood pressure. And It's improving.

27:42 So it's getting weirder and weirder, liver function. Improving. Weight going down. Blood pressure improving.

27:51 In those days we were The blood test that we we did was the thing called a hemoglobin A one C. The A one C in America. This is the average sugariness of your blood for the preceding three months. So the results take a while. But then when

28:09 The uh Hemoglobin A one C came in, there it was. we were getting really spectacular improvements in in average blood sugar. Yeah. And that's so

28:20 That's kind of how it began. So that's twenty thirteen. So that's thirteen years ago. And uh The rest is history, but that I was completely blown away. And I was full of curiosity about all these other things and how was it?

28:37 Why were these things improving? So in those thirteen years, how has your fitness, your health changed? My mental powers were much greater. I could concentrate better. I wasn't fretti. So I noticed that. I the next thing I noticed was I needed

28:55 A lot less sleep. So yeah, in the beginning. I used to have to have a little sleep on my doctor's couch every lunchtime. So

29:06 I'm a senior partner, so you press Do not Disturb and you put the curtains round and have little Nap. on my own couch for twenty minutes. It was the only way I could get through the day. Yeah. I didn't need that nap anymore.

29:19 I was less sleepy. I needed an hour's less sleep a day. I could Think better. I was m I could cope with the same problems.

29:31 And this is so weird. But mentally I was Stronger. It was like being a younger man. Um the way

29:40 I don't know, y y I think you have a sense of mental horsepower. Going back to the top of this conversation, you talked about how everybody listening right now has a variety of different health futures. Yeah. And which which health future they end up in is gonna be determined by the everyday decisions they make. Yes, yes. So I wanna really zoom in on some of those everyday decisions. We talked about you and your biscuits, and at the time you said you were you were probably quite sedentary as a doctor. Yeah. Sitting in a chair, patients coming in. Yeah. You weren't doing exercise. No, um I didn't.

30:12 fundamentally believe it would make that much difference. T. And this is such a great point, you've you've a really great point. So Let's think about weight loss. So I would give advice on weight loss.

30:26 to my patients and I would say eat less and move more. And I'd even sometimes say that Belson thing, you know, the no fat people came out of Belson. I've never heard that before. But it's a horrible thing to say to a patient, isn't it? Well, that that's in World War Two, where they all starved poor things. So the the point is you're saying to somebody with an obesity problem. It's their fault. You're blaming them.

30:52 That's exactly the point, and that's what I did. And it's worse than that because I give them that advice, and it just about never works. I did a horrible thing. I used to say to them right. Yeah.

31:06 So Why don't you just have two tablespoons of all bran a day? Oh breakfast cereal. Yeah. Uh with skim milk. And I would advise a few v multivitamins.

31:18 and uh a couple of pints of skimmed milk a day. That was my advice. And then when it didn't work, who do you think I blamed them? Yeah.

31:28 Yeah. And this was all part of my epiphany. I never joined the dots. That the failure was not theirs, it was mine.

31:39 And that's horrible, isn't it? Imagine twenty five years of I was blaming patients for their failure to lose weight. And it was my failure. Because I didn't give them w advice that worked. And if you keep giving the same advice to people and it doesn't work, shouldn't I have questioned

31:59 But it's not happening in society overall. How are we doing? How are we doing? With health. How's it going? It's a disaster, isn't it?

32:08 So we need to do something different. But for me, for twenty five years, I I did not believe that lifestyle was was key and now I do.

32:19 And that's why I didn't I didn't think that the biscuits made that much difference. Obviously I knew basic nutrition, so I made sure there's protein and uh there's iron and stuff. I fundamentally

32:35 Believed that Drugs is what I should be using. Medication. And that lifestyle was a sort of Add on.

32:45 It's not terrible. what I believe the average person thinks as well. Yeah. Yeah. Um we were talking before we started recording about some of my friends. They are there's there's two friends I mentioned. One of them is a very, very successful businessman Um everybody knows who this person is. And They asked me this weekend is pizza healthy. And I just couldn't believe it.

33:08 Gob smacking it. It's like oh what pizza wow. 'Cause they were choose trying to choose between They usually have a big twelve inch pizza for lunch. And and he was asking me, What's healthier, Stephen? Uh Nando's chicken or this Yeah.

33:23 And I literally looked at him like I was looking at a ghost. I was like, are you winding me up? And he was genuinely serious. He's almost sixty years old now. And he doesn't know if a Chicken breast. Is healthier. than a twelve inch pizza. And the other example that I mentioned to you before we start recording is a very famous Premier League football superstar legend who you would assume had gone through those sort of fifteen, twenty years of of being a an academy player and then a a pro athlete.

33:49 What has sugar in and what doesn't. Big spaghetti carbonara, is that healthy? Is that health food? Because he said to me during his football years, they were told always to carbload. And again, this It it gave me a huge amount of empathy because it made me realise how even though there's podcasts like this where we talk so much about health and even though there's the internet now, the app th this information is not getting through to the average person s for some reason. And they too, I believe Think exactly what you just said. But health is, you know, it's this sort of accessory.

34:19 Well, My fate is determined anyway. And if I do this health stuff, which is a bit of an inconvenience, because these Percy pigs taste great. Yeah um or these these c these candies taste great, then I might be able to look a little bit better, a little bit more aesthetically pleasing. But my fate is determined.

34:38 The simple point. Yeah. Yeah, nutrition we're not teaching it. So there's only three macronutrients. There's only Protein.

34:46 Fats and carbohydrate. And yet your friends there haven't even got The three micronutrients. And they are successful. Intelligent people. So Somewhere.

34:58 We're going badly wrong, aren't we? There was a another example that's really front of mine to me, which was you know, I'm in Dragon's Down at the moment and someone came in and pitched a Fruit snack business. And it's basically dried out fruit pieces. Now, I'm loving this already. Yeah.

35:16 I looked at the back. Yes. And it said In the range of sixty to seventy percent sugar. Because what they've done is they've taken exotic fruits like mangoes, dried them out, and now you have this little chip, which is this m just m piece of mango. Sixty, seventy percent sugar. So I'm looking at the back of this thing thinking This is Candy. This is basically candy. Thank you. But I'm looking around and every'cause it'cause it uses the word fruit. Yes.

35:42 People have this sort of halo assumption that if the word fruit is on it, fruit juice. Fruit. It'll sell. Yeah. And who and also it's sort of who cares about the consequence but will make a pile of money selling dried up fruit. And they miss What you read on the back. Yeah. Is that okay? How's that? You know, what if somebody had type two diet what for kids this we'll just give them?

36:05 Yeah. You've touched on another another thing about What's going wrong? When we look at my practice and this Epidemic.

36:18 And really, as I've said already, it's not an epidemic, it's a pandemic. It's everywhere. I go all over the world and obesity, type two diabetes Uh poor metabolic health is in It's everywhere. It's everywhere.

36:33 Yeah. And I think one of the things I think I've got to do it. Touching on what you just said. Yeah. is so you you wake up and you have your cereals for breakfast.

36:42 Which we have some cereals there. And then uh you'll have why don't why don't you have a big glass of Fresh orange juice as well. Great idea.

36:54 And then Uh y y y okay, that's your breakfast. But then on the way in you have a little snack be and people do. Crisps or something like that. And then even at school they might get a muffin.

37:08 Mid morning? Fair enough. They might then have an apple. Yeah. At lunchtime you're gonna have some sandwiches. And then you've eaten your sandwich so you'll

37:19 I don't know, you might have might have a cake or something, or some ice cream. Then you'll go home and then it's time for you You know, maybe your chips or your pizza. What you've actually done. It has sugar. We do sugar, with your sugar, sugar, sugar, sugar, sugar all day long.

37:34 Yeah. There's hardly any protein. Going back then to those macro Where was the protein? To grow you. You know, and that that's the thing that that's changed over time that we are The snacking

37:48 So I've I come across a lot of Young people. And their mother is saying I can't get him to eat any proper food. He just eats snacks all day long. And it he won't. I can't. They can't get protein in them and some of them are actually thin kids.

38:05 The not all fat. Let's talk about what you just said there. And we can walk through the day using the food we have on this table. Now I just want to caution that we do have some people that are probably out walking their dog listening and can't see. So we're gonna have to do a bit of a voiceover as to what's going on. But yeah, you said wake up in the morning, you have your cereal. Yeah. Now cereal growing up I thought was a health food. Me too. Yeah. Me too. How much sugar is in the average standard bowl of let's say frosted cereal? Well we can do this

38:33 Different way, Stephen. This is actually like a test for you laid out here. Oh gosh, is that for you. Yeah, th this is a test for you and I'll describe it. So what you've got, you've got um A bowl of we'll call them f The cornflakes. Mm-hmm. Then you've got to be a little bit more. I

38:51 Potato, a baked potato. It isn't baked yet, but you could bake it if you want. You've got a hundred and fifty grams and this is boiled rice. So it's not dry, it's boiled rice. You've got a very ripe banana. And at the end there You've got a delicious looking chocolate bar. Yeah.

39:09 So You've got there. Uh some cubes of sugar. And this is the test bit, you see. As to how I'm gonna give you we'll score you in the end. So what I'd like you to do is consider These Relatively.

39:24 And each of those cubes of sugar represents a four gram teaspoon of sugar. Yeah. So if you could now just go along these and put beside each food what you believe to be the equivalent in terms of teaspoons of sugar, and then I'll give you a score and see how you do. Okay. And uh those are the answers, so I'm going to turn it down so you don't cheat. Okay, so I'm gonna score them as I Would have thought Two years ago. Thank you. Yes. Because because two years I've interviewed a lot of experts, so I'm I'm generally quite shocked by all these things. But I'm gonna score them as I would have thought when I was thirty one years old, two years ago. So Yes, that's great. Serial Honestly

40:02 Yeah. Um there's no sugar on it. It's not a sugared cereal, it's just the dry flakes I honestly didn't think there was sugar in that. Yeah. So If you had pushed me, I would've m Well give it one, eh? I'll give it one. Thank you. But I didn't think there was sugar in that.

40:18 Again, a potato. I didn't think there was any sugar in a potato. So even giving it one feels like I'm lying because I didn't think there was sugar in a potato. And I'll be honest, rice. I didn't think there was any sugar in rice. Okay. A banana? It tastes sweet. Yes. So my brain would have said One.

40:35 Yeah. But this uh this chocolate bar that's in front of me I would have said. I'm gonna say two. Okay. I'm gonna say three.

40:46 Right. I actually think it was two, but that's how much sugar I would have thought was in all of these things here. Cereal, a potato, white rice, a banana, and a chocolate bar. Right. To be fair I still kinda do, but I know better. So now I'm gonna give you the correct. Fake up. Yeah. Now

41:03 Uh this is worked out from the glycemic load that we already Disgust. So I explained about the glycemic load. Yeah. And then

41:13 So in clinical practice I had a problem. And my problem was in ten minutes trying to explain to you how you could eat differently and why you should eat differently. And so I needed a way to do it. of quickly communicating with children, with old people, with a teacher.

41:32 the consequences of dietary choices. So I came up way the new idea which was why don't we represent the glycemic load And instead of using grams of glucose which nobody understands. And what's glucose anyway. Instead of doing that, we redid the calculations.

41:55 redoing it for tea four gram teaspoons of sugar. And that's my teaspoon of sugar equivalent. system and I'm using that now to give you the correct answer. Okay. Right. The cornflakes is one

42:10 Two Full Five. Six, seven, and eight. One, two, three, four, five, six, seven, eight.

42:22 Eight. N with no frosting. No frosting, no milk, nothing. The potato obviously depends on its size. That's quite a big one. So that one is one, two, three, four, and there's more.

42:39 Fine. Thanks. Is nine. There they go. Is that nice?

42:49 Yeah. Right. I'm gonna leave the rise to last. That chocolate bar. is actually you could do it for me.

43:01 Yeah. Is Seven. and a half. So yeah.

43:06 You can Give it seven. Seven. Seven. Now, the banana depends on the size and how ripe it is. A ripe banana has more sugar in it, you probably know when you eat it. But that

43:21 Let's say that banana is quite a ripe one. It looks quite ripe. Let's say that's six,'cause it's a big banana. Oh my gosh. Okay. Yeah. Then

43:34 The final one. Obviously it's gonna be the killer, isn't it? I thought rice was healthy. Hm. Well depends on the depends, so

43:47 One. This is A hundred and fifty grams of boiled rice. Three. Four

43:54 Five. Six. Seven. Eight. Nine.

44:01 And ten. So that's the winner. And I would say that's the single fact around the world. So my my teaspoon of sugar. There we are.

44:12 That's one of my teaspoon of sugar charts. So what you've got there is the food. A glycemic index. The s the serving size. And then the teaspoons of sugar. There. So this is available. The Public Health Collaboration is a charity I helped set up with Dr. Rangan Chatterjee.

44:33 Ten years ago. It's our tenth anniversary tomorrow. Yeah. These infographics. There are actually far more than this. This is there's seven more. They're available in thirty five languages. Volunteers have translated this To go all over the world.

44:50 It's not copyrighted. I want people to steal it. Take it, use it. So the The white rice fact. I would say

45:00 has astonished people all over the world and led to me becoming far better known. What about Orange juice. A lot of um parents, including my parents, give me gave me orange juice. And I used to think orange juice was a health food. So I would literally I'd go to the fridge, I'd get open the sunny delight or whatever it was. Sunny delight. And I would drink that. Yeah. And I'd think I'm gonna be strong and big and my body's gonna love me. Well let's So that

45:25 There's a lot of sugar in orange juice. So a lot of sugar in orange juice. And you've taken away Olive. Once you take it from the fruit. as it was meant to be and you juice it, the sugar hit is fast. Mm. So what that does.

45:41 Is If you think if we go back to insulin again. Um So you you you drink the orange juice, your blood sugar goes up rapidly.

45:53 So your body responds rapidly with insulin. Then you what happens? Your blood sugar falls. But then you're kind of hungry again. And that's what happened to me with the biscuits, wasn't it? I ate biscuits. My blood sugar is up.

46:09 That insulin comes in. Heavy and slow, but too much. Then I thought I was having a panic attack'cause I had low blood sugar. And what's the answer to that? More biscuits. And round you go. Right. And that's how Without thinking you'd start the day, said Starting the day with a sugary breakfast.

46:28 without enough protein in it is driving hunger. And then you wonder why. You're ravenously hungry. Yeah. Ten o'clock.

46:36 There was a few others that shocked me. One of them was um I was in Peru and obviously Peru's quite famous for chocolate'cause of the cacao and all that stuff. And so we went to a chocolate making class. And um he told us to make Dark chocolate, normal chocolate. And then white chocolate. Yeah. And when I made the white chocolate, this guy got me this big

46:55 Glass cylinder. And he goes. Here's some white sugar. He goes, Pour it in. So I you know, I get it and I pour some in and I and he goes, No, no, no, no, my friend. Pour it in. Yeah. And I pour it and pour it and pour it and pour it and pour it and pour it and pour it. And I'm not kidding you. I feel Like and I have to check the facts here, so community note me on the screen, drive to your team. I feel like I pulled into this huge glass cylinder. Yeah.

47:19 Eighty percent. Of white sugar. Yes, and then it's true. Yeah, and then put some syrup in it. This is this is white sugar. It was like some syrupy stuff, some oil stuff. And I was like, So white sugar um So white chocolate is like eighty percent white sugar.

47:36 Yeah. I've never eaten white chocolate since. Yeah. Ever. You that's so important. So Very often people think they're a chocaholic. That's really common that people say to me I'm I'm addicted to chocolate. Yeah.

47:50 If you look at if you actually look at how much sugary there is in milk chocolate. Uh You know, there's many teaspoons of sugar in milk chocolate. If you eat. Ninety percent.

48:03 Dark chocolate. There's only about two teaspoons of sugar in a bar. And what you find with the Chocaholics is I say Mm. If you're addicted to chocolate, why don't you get a bigger hit and have the dark chocolate and they say, Oh, I couldn't eat that, it's too bitter. What they're actually addicted to is the sugar. So I've done the the raise.

48:23 For the the folks at home. There is one of these sugar infographics on chocolate e on that subject of chocolate because I want people to understand The consequences of what they do. So

48:37 Just to We've just looked up the stats. I think this is this is this is what I saw. I've just looked up the facts to make sure everything is true. When I made that bar of white chocolate in Peru, this

48:53 was the total ingredients and this is how much sugar I they asked me to put into it. I've looked at it and thought, okay, so white chocolate is basically like seventy odd percent just pure white sugar. And nobody knows. Yes, it's Exactly. And the other one I've got to be in my bonnet about is smoothies. Yes, because I had one too. I thought smoothies were healthy. Yeah.

49:14 No. You know, I'm on X or Twitter quite a lot and that's the kind of thing fills me with rage and I have to take a photo with like my Look the sugar.

49:26 Yeah, it fills me with rage. I've got another thing. This is fun. I've got another I've got a question. Right. Stephen. Why don't we we could take all the blood out of me? Right.

49:37 There'd be five liters. We could bleed me out right now. There would be five liters of blood in me. Let's get it in a bucket, all right? Five liters of blood. Yeah. How much sugar?

49:49 Would be In that five liters of blood. I've no idea. Because it relates to The consequences of eating some of these things.

50:02 So I would just like you to estimate so if let's say my blood sugar is normal. Yeah. Um If you have a normal blood sugar, I would like you to guess How much sugar is there in my entire blood system?

50:19 Thank you. No. The answer. Is this Let me show you.

50:25 That is all there is. You too. I am not. And do you see immediately. That's all. And I'll do it on Twitter for you, X. I can show you the calculations. So you see if I have a banana And I have diabetes. Yeah.

50:42 There's too much sugar for me. See, because glucose is number one vital But number two toxic if you have too much of it. The level of it in my blood is controlled minutely. Wow. It's controlled. To this extent.

50:58 And I think that single fact you didn't know that, did you? I did not at all. And it m it immediately shows you how it's so easy to have more sugar than you actually need. Given not. And if your insulin stops working. For me. I've done an awful lot of this, so I monitor my blood sugar with a continuous

51:16 A curse. Monitor? And I get my blood sugar up on my phone. At any time what my blood sugar is and we'll do it in a minute and see. Yeah.

51:26 But you see, if I If I eat A banana. It doubles my blood sugar because I can't regulate my blood sugar. Because of the diabetes. Yeah. So a whole banana is far too much for me.

51:39 And we'll double. My blood sugar because you see if if I'm only supposed to have this much And I have that much. Gosh, yeah, it's what it's too much for me. And I feel ill. Giving uh you know, I go out into the world and I speak to the people that listen to the show and they're like taxi cab drivers, it's a lot of taxes. Do you know I wonder I I've I've got this bias towards thinking that everybody that listens is a tax c I've got this bias towards thinking that everybody that listens is a taxi cab driver because I really only spend my time In the office. Or in a taxi. So I get lots of feedback from these cab drivers. And the average person out there listening now

52:14 they don't know how to check if the food they are eating is good or not. Because the labels on these foods I I've got so obsessed by the marketing. Yes. And um you know, I was looking at this bag of s sweets the other day and it said Made with real fruit juice. And they put it front and center. Yeah. I'm I was almost tricked. So I can't imagine someone who like me who doesn't spend I can't imagine someone who doesn't spend their time interviewing health experts.

52:39 how easily the general public is being tricked. So what is your advice in terms of spotting this stuff. Like what do I look at?'Cause right now I spend a lot of time looking at the sugar part. Yeah, that's great. There's different ways we can do this and obviously this is how I spend every clinic. That's I'm in clinic yesterday. This is what I'm doing. I'm trying to help people understand. It's sometimes easier to talk about what Maybe what you would eat rather than what you wouldn't eat.

53:06 So I For somebody With insulin resistance. or type two diabetes, I would tend to say, Well why don't you base your meal On protein.

53:16 So what have you got in the fridge? Could it be chicken, could it be eggs? What would it be? So that's your protein. Have loads of it.

53:26 Yeah. Then I'm thinking right. Green Veg. Will y what green veggie. Would you tolerate what green veg could you buy? Might be frozen beans.

53:35 It might be salad or whatever. And then I'm saying how would you make that green veg Tasty. Poor barbecue sauce on the top. Uh.

53:44 No, full fat mayo. Full fat mayo. Or butter, or olive oil, or whatever. So that I say barbecue because when I looked at the back of mine I had the shock horror of realising that there's it's a common one. Thirty Sugar cubes. In a bottle, a standard bottle of barbecue sauce. It's just pouring sugar on top. It is. It is. You have to be so vigilant and I I think to do it successfully

54:09 I'm quite interested in the idea of could you eat real food? That's not in a packet. It's It's it's Russian roulette. food out of packets, and yet I understand my patients north of Liverpool.

54:22 you know, where are they gonna buy the stuff. So I try and help them with You could do it that way. If you're not if you're gonna eat stuff out of packets, you have to wise up. and you have to look at the carbohydrate content And bear in mind every four grams.

54:40 He's Broadly equivalent to sugar. So if if if if there's a if there's If something's got a hundred grams of carbs in it. I've already said carbohydrate varies in how sugary it is, but it gives you an idea, it's very sugary. So you see the the area made with the cornflakes is there's no sugar there, but it's all carbohydrate. And it

55:02 It's a very sugary carbohydrate. We need to just explain that for for people, which is when I looked at those corn flakes The question I asked you is they're not frosted, so there's no sugar on them. But what the body is doing is it's converting the carbs into glucose. Right. I've got a good way. So we have to think of starchy carbs.

55:22 Uh. Actually glucose molecules holding hands. Okay. And then digestion comes along. And breaks down they're they're not holding hands anymore and they become free sugar again. Exactly. Exactly. I don't know whether when you went to school was this thing where you chew bread for ages and then you could see if it became sweet or it turned into sugar. It's a schoolboy experiment that's done a lot.

55:51 that uh the amylase the enzyme in spit. Uh turns. Starch into sugar. But that's the point. Starch.

56:01 Is soon to be sugar. Glucose holding hands. Yeah. And when it holds hands it's not sweet. But then when you digest it, it's no longer holding hands. And that is is broadly what And you're not alone because didn't I make that error? Isn't that what the lady in twenty twelve That's what she was so furious that I was make so here we are, senior partner of a large practice.

56:27 had forgotten. Uh that starch with sugar. And we come full circle because And so many other people. They they

56:37 Patients say to me, Doctor Marin. I know. uh not have sugary things. I've given up. sugar in th my tea and coffee. And I don't understand why my blood sugar is so high.

56:50 People say that very often and then of course we use the teaspoon of sugar equivalents or a continuous glucose monitor to really show them what's going on. Something that a lot of people have is bread. Yes. Um White bread. So I I did some research and it said a single slice of white bread contains about zero point five sugar cubes, but a full loaf.

57:10 Can pack up to twelve cubes of sugar in it. That's true. But it doesn't It doesn't include the fact that the wheat that makes the bread will turn into sugar as well. Okay. So on my teaspoon of sugar equivalent.

57:26 Even a small sli slice of brown bread. is about three teaspoons of sugar. Is there a healthy bread? That's a really great great question. And of course it depends.

57:40 How well your insulin's working. So if you're young and you take a lot of exercise and your insulin's really Good. then Maybe brown bread is

57:51 is okay. If you're like me though, with insulin resistance there it It would have to be Uh low carb bread. So I wouldn't normally eat bread under any circumstances, but I might have low carb Bread.

58:05 I uh did some research said sprouted grain bread, never heard of that before, or one hundred percent whole grain rye are the healthiest options because they contain zero added sugar and high fibre. So I'd say. Again, it depends. How much exercise do you take? How do you know?

58:25 Have you had your fasting insulin measure? Do you know if you're insulin resistant or not? Um If you're healthy, take lots of exercise sounds good. Fair enough. If you s if you're beginning to develop a tummy, or maybe not so good. And if you don't know I'm a great one for experimenting.

58:46 And that's where I come back again. To consider Uh Buying a continuous glucose monitor, the thing you wear on y I've got one on me now, and it tells my phone how is my blood sugar. So I can experiment then. I could try your bread and within an hour I would know. This

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1:01:00 And let me know what you think. All you have to do is search coach.stand.store now to get started. Am I wise to be looking at the back of packets? I look at the back of everything I eat. Yes. Um and I'm building against a mental model of the different levels of carbohydrates and sugar content and fibre and all these other things and proteins, et cetera. But I always seem to zoom in on the sugar. Yeah.

1:01:24 Ah right. There is an error there. Okay. So y that's brilliant and you the fact you're interested And trying to do it. It's great because you learn so much more. Because of course The sugar is one thing, but you must also look at the carbohydrate. Okay, carbohydrate content now.

1:01:43 Um this is done differently in the United States from here. confusingly. Here we talk about carbohydrate. Separately from fiber. So that in the UK when it says carbohydrate Uh

1:02:00 Turns into sugar. In the States you've got Uh the carbohydrate including fiber, so it makes it more complicated for you. Because you need to know which

1:02:12 How much of that carbohydrate are you going to absorb? Well let's go back to the three micronutrients. So You should be interested in Protein. How much you want you want you want to be

1:02:25 A muscly kind of guy. So you want your protein. Uh the carbohydrate, well why do you need that, I'm wondering. Yeah. And then fats well you might need those for fat soluble vitamins. So those are the uh the three things

1:02:39 So that you become more sophisticated. And if things have a lot of preservatives, if they have an awful lot of ingredients, I'm immediately suspicious. I think one of the things that people that I've come to learn through interviewing people like yourself is that it's not just the direct consequence of having a big uh glucose spike or It's also the fact that when I eat things like Mars Bars or the white rice here. I then get more hungry later. Exactly. Which means I eat m even more sugar that same day. And the next day. And the next day. And of course

1:03:12 That's what my patients right back in twenty thirteen. It was the absence of hunger they found fascinating. And I did'cause I'd been hungry all my life. Because all my life I'd been uh Carb heavy. And I didn't realise that The more carbs you eat, the hungrier you become.

1:03:30 I don't know, have you ever tried fasting? I bet you have. Oh my gosh, yeah. Right. I fast most days to be honest. I'm I haven't eaten today and it w what time are we? We're well I don't know, uh one one PM and During the Dragons Den filming I I don't eat often until the evening, so isn't that interesting. So I used to I used to have a model which was

1:03:51 Um That if I didn't eat, I was hungry, right? So if I didn't eat for even twice as long, I'd be twice as hungry. And it would rise exponentially until I went mad. And what's surprising that you must have found is as you fast you don't become more hungry, do you? Yeah. It's crazy. Well, isn't that interesting? the actually aga the more I eat, the hungrier I become.

1:04:14 And that's when I'm on keto. Pardon? When I'm on Keto. Yeah. I I can't believe I can't it's like a Hunger just vanishes. And the thing that the remarkable thing I love what are those cinnamon roll things? I love those cinnamon rolls usually. I love them. And when I started doing the ketogenic diet, which is very, very, very low carb, I remember walking up to this cinnamon roll concession stand in Cape Town and looking at them. And they were doing nothing to my brain.

1:04:39 There was no temptation, no craving. I've had that. Honestly, I've had that with Christmas cake. It was my kryptonite. It was the kind of thing I was sneaking down when they'd all gone to bed and having more. And then one day you can look at it and it and you think it's not actually food. Your brain, how that isn't food. Yeah, exactly. And I'm the same with buns as well.

1:05:04 And all sorts of things that a lifetime Of And they're no longer food. And it feels like a superpower'cause I can r I'm such a man. In fact, I I throw this down as a challenge to men.

1:05:15 Are you man enough? To resist. You know, what whatever it is. Let's do a challenge. Come back in a week and tell me you've not had any biscuits. Mm.

1:05:27 It works. It works. What do you think of the ketogenic diet? Wow. That's a f That's the big question, isn't it? And don't you think we need to begin with what you want?

1:05:40 So I think we need to begin with your goals and hope. Why would He said Are you wanting to lose weight? Are you wanting to sort out type two to buy diabetes? Or I'm f I mean George Aread, Doctor George Arid is a close friend.

1:05:57 Mm. And nutritional psychiatry is really growing in the Ian Campbell in Edinburgh University is doing some amazing work with bipolar disorder and other things. So Why are you doing it? That's so that's my first thing because There's this I see it as there is a spectrum of carbohydrate that you're on.

1:06:16 So I try and find out where are you now? And I you know, approximately where are you now? And then I'd say well could you Could you Give up bread or reduce it.

1:06:28 And then I'd say Let's let's measure whatever parameter we want. Which might be blood work or weight or whatever, then we say, How are you doing? Are you happy now? Is this is it?

1:06:40 Or do you want to do it? Would you like to go a bit lower? And what I've discovered with my patients over thirteen years is they tend to go lower over time because when the experiment When they go Kita, what they like is the brain thing. Oh gosh, yeah. And that's what I'm that's Right. So I would say to you now,'cause I'm interested, why would you go kita, what you're after?

1:07:02 Um so I'm gonna put the brain thing at the top of the list, which is just the clarity of thought. Obviously in my job I have to sit here with very smart people like you. Yes and I have to talk sometimes for three, four hours, whatever it might be. But also I'm on television a lot now and I'm speaking um you know cameras n nine cameras rolling, BBC one, and I've got to think of something smart to say to this entrepreneur stood in front of me on that's pitching to me. And then also I'm in meetings, you know, I'll leave this conversation now and I'll go straight downstairs and I'll have two hours of straight meetings about very, very complicated things about buying companies. I'll be meeting founders, interviewing people, and what I've noticed profoundly because so much of my job centers And what I mean by that is some days I'm on it. Yeah. And some days I'm almost embarrassed by my inability to string a sentence together. Today I'm I'm j I'm almost testing myself now by trying to speak really, really fast and thinking with my brain connected with my mouth. That's like that's actually like what I do. I try and see if I if it flows out. Today I'm okay.

1:07:57 Yeah. Um but there are days where I'm stumbling over myself and I go, What's what's causing this? What's the causal factor and how do I prevent this? Keto. I always sound like Buster Rhymes. It always just always uh it's always working. And then I'd say The aesthetic stuff,'cause I wanna look good as well, especially for you know my fiance, so I wanna be in shape. I wanna be uh and then I'd say the third is being strong.

1:08:22 And then the fourth is I wanna live. Long Exactly. I want to have a long health span. Not just a long life span, but I want to be able to do things as I age. So you see your that's exactly why I began this meeting with the you've got a clear idea about your preferred future.

1:08:40 Mm-hmm. And it's it's it's it it's fairly specific too. And the more specific you are, the more likely you are to be successful. And then you're noticing. Then afterwards comes the feedback. Do you think most people even have thought about this? No. I was just thinking about my listeners and I was thinking, they're listening right now, I wonder if they have written down their top four. Yeah.

1:08:59 So I do you know what I'd love to do now is tell you something about my wife's work because it relates to changing behavior fast. I'm not. She won't mind. So th we're back to Jen now. Clever woman. She spent two years Um thinking about

1:09:16 C B T. And what was what this is a type of therapy and what were the necessary parts of it and what was junk. And she reduced CBT down to something I'll teach you right now. All right. So well off we go. Off we go. So

1:09:32 The first thing is to think about Your health goals. So to think about What in a year's time? If what you do is great.

1:09:43 How does that look? Specifically. So I'll give you an example. You might think you'd like to lose weight. But that isn't specific enough.

1:09:54 Yeah. What difference would that make to you? So y y we'll do it now. So if you you said you wanted to be in shape. Yeah what I don't know, what do you mean by that? Do you want to lose weight? What do you tell me more. Um, I want to be

1:10:10 Able to Mm. What I'm really I think. Scared of gonna be completely honest. Yeah. Is I'm scared of

1:10:35 Having the same health profile as my dad. Hm. Right. Yeah. I think o a lot of us look at our parents and go

1:10:48 Is that my future? Yes. Yeah. Make it even more specific, I remember walking down some stairs. I've said this once before, but I I remember walking down some stairs in Bali long steep set of stairs down to go white w water rafting with my fiance. And I remember as I walked down those stairs recalling that my dad loses can't walk up a single flight of stairs without

1:11:11 Problems. And I remember thinking, oh my dad wouldn't have been able to come whitewater rafting because we've got to walk back up these stairs. Yeah. And so my dad would have lost out on one of the great joys of life, which is doing enjoyable things with friends and people you love because his health is now in that regard is gone. Um so I I've always thought of that. And then generally like I I remember when I was younger my dad used to play like football with us and all these things and he's unable to do that now. Um And so

1:11:38 I'm sure. And because I've done this podcast so many times with health experts, I've realized that the decisions I make at thirty, which is where I am now. exist on this really interesting, quite predictable. Cove. Of

1:11:52 Inevitable decline. However Not like Inevitable. Uh

1:12:00 loss of lifestyle. What I mean by that is I just have this picture in my head of all these graphs I've seen where like your peak is around maybe twenty thirty. And then you go in down, which we all accept. But how far you go down is determined by decisions you make right now. The decisions I make now will end me at seventy eight years old in either the inability to walk or Oh. The ability to run.

1:12:23 Yeah. And it's all about what I do now. Yeah. So that's Let's just refine that.

1:12:29 I've got your goal. Yeah. No. So let's park your goal. Yeah. Now the next thing we've got is in the past

1:12:38 What have you done that's worked? towards those goals. So you probably tell me some stuff you've done that's worked. Um Yeah, yeah, anything. Anything quickly that you did that worked at him that was is is the is a first, you know, helped That you did and you remember that worked. So tell me anything. So I said to myself one year that I was gonna go to the gym every single day. Terrible idea. Because I got five months in and then I missed a day, then it was over. I said to myself another year, I think it was for twenty seventeen, that I'm gonna get a six pack for summer.

1:13:11 Terrible idea. Because when summer came or I got the six packs. So those two incidents um helped me change my idea and the idea that I came up with was I said Not a Achievable thing is a goal, but consistency is the goal. My consistency became a

1:13:32 For the last four years, this idea that the goal my fitness goal is consistency means that every day I wake up I get a shot at it. And if I fuck up today, then I've got another shot tomorrow. Right. Leave it there. That's good. So we we did the goal, and then we did the next thing. What what I just The next thing is is resources. Mm. What do you bring to the consultation that you've done in the past Intelligence, resources, friends that will help.

1:14:00 You come already with expertise in yourself. So it's not I'm not the expert to tell you what to do. You've already got some stuff. Yeah. Then we go to the next thing. So if we had your goal at the beginning which was the fitness and the so and so Today.

1:14:18 What might be a small step towards your goal, a realistic small step towards the goals we've already established? So I can think of two. Mm. Creating a social pact. Which again was one of the things that helped. We made a WhatsApp group.

1:14:38 This is quite funny. We made a WhatsApp group, we put ten friends in it, and we made a simple rule. Whoever's the least consistent every month is evicted, and we invite a new friend in. Wow. They've done that for four years. I've not been evicted in four years, which means that I'm doing enough, I'm consistent enough over those four years to not be evicted. Every day when we work out, it puts our workouts into the group chest. And um every every week and every month, um, there's a winner.

1:15:02 And there's this league table, and you get these little emoji medals. And there's actually I w won one year, so I've got this physical massive gold belt on my bookshelf at home and it says fitness blockchain world champion. Brilliant. So I've done that for four years. Um so social pack really helped me, the the sort of accountability to others. Yeah. And The other The other honestly was just

1:15:24 Mm. As I said a second ago, when I set the the goal of going to the gym every single day, I set myself up for failure. Now I set myself the goal of consistency, which means that I can do have bad days where I do twenty minutes or fifteen minutes yesterday,'cause I was finished Dragon's Done late, drove down to London, got home at one A. M. I did Eighteen minutes. Yeah.

1:15:44 And reducing the size of success really helped me Two Keep my feeling of momentum. Brilliant. We're nearly at the end of your degree in psychology. Okay. And I'm gonna pull it together. The final thing is Um when things

1:16:02 If you what would you notice for you when things are going well, what would you notice? So you've done some of these things. What is it you actually notice? As in a benefit to me, but what what do you notice? So if you do if tomorrow is a really good day, what might you notice at the end of it?'Cause you've much experience in this now, what would you notice? I mean the first thing that comes to mind is just hard fail. Yes.

1:16:29 I just feel Do you mean emotionally or energetically? Great. I feel good about myself. Yeah. Um energetically I feel more energetic. Um

1:16:40 And there is this um There is this element of identity in there where I have a an opinion of myself and who I think I am, and I think I'm a healthy person and I think I'm someone that's in control. And when I'm when I'm not going When I'm not performing the consistent behaviors that I want to do I think I start to question identity in a way that's that causes a lot of discomfort and say, Well you're not in control of your own life. Like how that's crazy. So it I think it it links into self esteem. Yeah. It really. So what we've just did, we have the goals

1:17:11 Gee. Yeah. Then we had your resources. Oh. Yeah. Then we had increments.

1:17:18 What things had you done? Little things on the way, and then finally I invited you to notice and reflect. And that spells grin. And that's Jen's published Grin Model. I just did it for you right there. And I could do it faster than that. I do it in nearly every surgery I do because what I'm trying to do is find out about you.

1:17:38 Mm-hmm. And you didn't find out much about me in that process, did you? No. But I found out a lot of really useful stuff to you and it's motivational. And much better to do that than me tell you what to do. And I'm not a talking leaflet. But motivation, this is what Jen has taught me, is key in everything we do. And the Grin model Isn't bad.

1:18:01 Clever woman. So what do we do with the grin model and so this is really helping me figure out how to change my behavior? Yes. How d how does one apply it or are you saying that everyone listening now should should answer those four questions themselves? I do. Because otherwise It's possible. to spend a lot of time blaming yourself. Mm-hmm. You know, and particularly around if we're discussing weight problems and so on, you can spend a lot of time saying

1:18:28 I'm to blame. Or I wish. Or I shouldn't have. But you know, y after Christmas everybody feels like this.

1:18:37 But what is much better rather than focusing You're wasting energy if you start thinking about guilt and negative stuff. And what Jen's trying to do is Getting you to engage. But

1:18:52 In in thinking about a better future. And what the whole of that five minutes was engaging you First of all the goal of a better future, then some resources towards your better future, then the first steps towards the better future, and then noticing what's good. Because I think in medicine what we've done

1:19:17 How do you get a doctor's attention? You get the doctor's attention by saying Oh it's so bad. It's so so bad. My pain is so so bad. And I realized I had Trained my patients.

1:19:32 you know, they got my attention. And if you do that, the result is a very miserable two hour surgery. But if you can t even people having a r a terrible time Have got hope if you can find it.

1:19:48 They have goals if you can discuss them. And you could have somebody with a drug addiction or what you know I see People, dying people, also every clinic I'm seeing. Sad stuff.

1:20:00 But If you can Also investigate. hopes and good stuff. As a doctor I'm so much more energetic, so much more hopeful. I'm having a great time. And I wasn't when I was fifty five.

1:20:15 And that's the process. But there's so many people listening now that that maybe they, you know,'cause they listen to this show and they've got the sort of basics, they go, Do you know what I understand this stuff and I'm making good progress, but I live with or love someone. Yes. Who I I'm s I'm scared they're going down a slippery slope. Yes. And I don't know what to do.

1:20:34 Do I intervene? Do I hide their sweets? Do I blame what do I do? That's so hard. I think You can. What you in that p position to some degree? Yes.

1:20:46 Uh yeah. So uh my first wife I had a very severe addiction problem. So I lived with that for twelve years and she's unfortunately died now. Um So I lived with very, very serious addiction for twelve years. And what you're doing then is you're living with uncertainty.

1:21:06 serious uncertainty. Uh you never you cannot say what you'll come home to. You have no idea. No idea. It brings chaos into your life. It's very, very hard. Addiction.

1:21:20 Yes. A f are you able to say what kind of addiction Was it a food addiction or a drug addiction or Mm nearly everybody concerned has died now, so i I don't know whether I can say or not, but it was very serious. multiple addictions, I will say that and she ha she died some years ago. Yeah.

1:21:38 And it doesn't matter. It it it it actually wasn't food addiction. Mm-hmm. But it brings it I have so much sympathy.

1:21:46 With Dealing how sh how hard it is to deal with uncertainty. And not be able to you love somebody and you can't do anything. Very hard. There are things you can do, I think.

1:22:00 Um If you can engage people in in that Talking about goals. That can help. Uh what we will do now is we'll change that conversation to

1:22:13 to the current Mrs. Unwin, which is what we laughingly say. This is Jen. So we we've been together for thirty years now. And Jen's story is that she actually is an ultra processed food A date, genuinely. Yeah. And what that means is

1:22:30 I didn't under Neither of us understood what that was, even though she's a consultant psychologist. She didn't realise that That she was an ultra processed food addict. What she saw it as was a weight problem.

1:22:45 And All her life she She's She's been Boomerang dieting, so she'd be a big woman and then a little woman and a big woman and I used to watch it all. What's going on?

1:22:56 And then she would There be tray bakes. Like she's trying to lose weight. And making tray bakes, saying it's for the children, and then scoffing a lot herself. So then I

1:23:09 Because I loved her. And I think blokes, we try and solve problems, don't we? We're like caveman wanted to rescue her. So I'm s I'm Either throwing the food away. Or I'm

1:23:22 Tackling her? And then she we're having such arguments'cause she's defensive and cross. I d I couldn't understand with an intelligent woman what's going on. But then Uh this is only a few years ago she understood for the first time

1:23:38 This is addiction. When you have intelligent people Highly, highly intelligent people doing stuff that harms their health repeatedly. Is this not? Like cigarettes.

1:23:54 Like alcohol. That's is ultra processed food addiction and there's a patient I'd like to tell you about that is. Explains it.

1:24:03 Even more clear, and this patient has consented for me to tell you. Because he wants to help the world. Yeah. So this is a guy who's a very successful guy. He runs um he's a wealthy person with a successful business. He's not stupid. He has type two diabetes. He's fifty five. He has type two diabetes. He's very much overweight.

1:24:24 Unfortunately, he needs really serious surgery. because both his knees have been so destroy by his weight that he can hardly walk because he's in real agony. But His type two diabetes is so

1:24:40 Bad. His blood sugar control is so bad the anesthesis won't Touch him. So he's trapped. Can't get the op.

1:24:49 Because his blood sugar is high. He can't run his business easily'cause he can't hardly walk. So Obviously what we do is we say you need to go low carb.

1:25:01 And it works for a bait. And he loses some weight, but then he gains the weight again. And this goes on for four years, while I see him r so regularly, every month. What's going on? What's going on? Oh excuses the grandchildren Um I've got a holiday Christmas, it goes on. Anyway, then his wife came to see me and she said, Doctorman, I need to level with you, you need to understand what's going on.

1:25:25 I find that my husband is getting up at four in the morning and eating Bread out of the fridge. So What I do now, what I started doing was at the end of every day, I put all the bread in the bin if it hasn't been eaten that day.

1:25:42 But then I discovered my husband was going in the bin to eat the bread. Then what she does, she's a uh A very formidable woman, she started putting detergent, liquid detergent on any bread that goes in the bin. But he still eats it. He's getting up at four in the morning rummaging through the bin to eat the bread with the detergent on.

1:26:04 For then? She tries something else, and she says this is the only thing that will stop my husband from eating bread if it's there. I spray bleach on the bread and and leave the can of bleach By the bin, so he knows don't even look. Okay. What I've described to you

1:26:23 is addiction. This is an intelligent person and Imagine his self esteem how it was. To live like that, concealing what he was doing.

1:26:33 And not telling his doctor,'cause I'm trying so hard for him for years and he he's so sweet to me now and he often uh shakes my hand and gives me a hug. He said, You tried. You really tried. Anyway. My stories have a happy ending always.

1:26:49 What I did for him in the end. He needed everything. So low carb. Then I got him using a continuous glucose monitor.

1:26:57 Mm-hmm so that he would get feedback immediately and see that spike. And also I could see the spikes as well. 'Cause he had to come and show me his tracings. And on top of that. I did something unusual. I gave him a low dose of the new GLP one drugs.

1:27:15 One of those. The three together. He managed to not He couldn't moderate, but he could abstain.

1:27:27 And then he could do it. The Azempic. helped reduce the noise. The cravings in his head, the feedback from the CGM helped him. Know how he was doing.

1:27:39 And the support he got from me and the low carb. pulled together in all three and he's had his operation now. It's so it's a happy story. He's got maintenance.

1:27:50 All his life he's gonna have to sort that out. Um and it's a wonderful example because I think we trivialise this. We call it carb creep. Like it doesn't matter. But there are many people listening to us right now whom they know They know that

1:28:07 They're addicted to various foods they know because when you ask them They often burst into tears. Often I somebody will say, I've never told anybody in my entire life. About and bread is a common one. And if you're not addicted to bread, you can't imagine it.

1:28:23 But if you are addicted to bread, they say this sounds so stupid. I'm so embarrassed to tell you I can't Control. How I eat bread. Mm-hmm. So it's not great for your self esteem, is it?

1:28:35 But people might be addicted to many things and Uh my wife's published many papers on this and written a book and this, that, and the other. Um and she would say about fourteen percent of the population. has some aspects of ultra processed food addiction.

1:28:53 Um and It kind of explained so much. Why are intelligent people Eat foods they know. I've got another example.

1:29:07 patients with type two diabetes, we got drug free remission. Hooray. I've done that now a hundred and fifty seven times. So every one of them I'm cheering when it happens. So this guy we did it. Drug free remission. Then he vanished for a while. And um

1:29:26 Mm-hmm. Came back. With two dead toes. And he had to have them amputated. And what's the right thing. They started rotting.

1:29:34 Because diabetes takes the blood supply particularly from your toes, so we had to have surgery to have part of his foot removed. And So you call it carb creep. And he ended up with half his foot taken off.

1:29:49 That's not carb creep. Something far more sinister. But I never give up. And unfortunately the wounds took a long time to heal because he's sugary. So we do it all over again.

1:30:00 I got him back into remission. Because this time he and his wife are really determined. But it's a struggle and he needs Help and support. to achieve that. He's not a foolish man. He's an intelligent man, and yet

1:30:17 Various foods call to him. Eat me, eat me and it's very difficult for him. And that's the I mean that's a very extreme example. But many people

1:30:30 with overweight and some who are not overweight are struggling with very, very significant carb. Cravings and they really Really. Uh struggle to control them. For those people, I assume there's a lot of people. And actually some people have seasons.

1:30:47 Where they're in control, they're out of control, they're in control. You know. I've been there. Um What is step one today? So they're listening to you, they go, Fucking all, I don't want to lose my toes and all of these problems. What is step one now?

1:31:02 Now are we talking about for somebody with type two diabetes or somebody who can't control what they're eating? Someone that can't control what they're eating. Right. So Step one. We just did it. I think step one

1:31:15 Is Acknowledging that is your problem. Because if you don't if you're not honest about your problem, how are you ever gonna sort it out? Honesty. Honesty and that's very hard for people. All of us have made excuses, you know, me and my biscuits. I believed that the it was easier for me to think that that was stress and a reasonable reaction.

1:31:39 to the stress of running a practice than it was to say, I've got Uh You know, biscuits for me it took me a year. To give them up. A yeah.

1:31:49 How pathetic is that? I was so driven that it took me a whole year. How did you give'em up? Um I did it by weaning myself off a bit like methadone. So I went from um I like chocolate ginger biscuits and then I went to digestive plain and then I went to oat biscuits and then Eventually I went to Armand's. Why don't you just do it all at once? I should have done. And uh J Jen Jen's a great believer in cold turkey, like what is the thing.

1:32:17 Sophie. I wasn't man enough for that and it took me a whole year. So the first The first thing is Be honest. Truth.

1:32:25 Be honest with yourself, even if you can't Tell other people. Is there an addictive potential there? Could that be? Does that fit? Number two. specifically which foods is your problem.

1:32:43 And be honest. Um because if you If you're not honest then it you number three is have a plan.

1:32:52 For abstinence. Because if you if if there is an uh if you have got an addictive potential Um It won't be one biscuit. And we all who you know, how many of us have said

1:33:07 I'm gonna give up. Ice cream or biscuits. Or pizza or whatever it is. And then you have a change. You did. What or you have a drink, or whatever you think tomorrow. Work stresses you out. Yeah, tomorrow. Tomorrow, tomorrow, tomorrow.

1:33:20 So it's very important to be specific about the food and then to have a plan. for how you are going to do it. And another thing is sometimes It's helpful.

1:33:34 You know the people around you that love you. Maybe share with them. But it's it's That it's important. And that I need I might need some help.

1:33:46 Please be tolerant with me, like cigarettes. Please be tolerant if I'm short tempered. I'm gonna try and do this thing because it's important. The difficulty it depends whether the person that loves you Yeah, it doesn't help. What you're asking for is

1:34:09 Gentle support. And tolerance. I can think of a time of my life where I was with somebody and I was They were so into the health. Yeah. That it made me start to hide.

1:34:21 When I was eating bad, I wouldn't have a Exactly Thank you for that. That's that's what happens. And you see that People become Deceitful. Yeah. So the m if you police somebody you love The result is deceit.

1:34:37 She would uh she She knew that I was monitoring, so she starts hiding the wrappers, or then I'd find them in the car. And that and and but then we have a situation that we can no longer talk about it. Because So the If if somebody if you're forcing somebody to become deceitful, you have to back off a little bit.

1:34:58 Yeah. Because that deceit. then affects self esteem and that can make them worse. And you didn't want to make them worse. And then they're lonely because they they can't share the bad days. Yeah, it it's really good. I wonder, please could we show Jen's book at this point? Of course. So can I just explain the book? So this This is Jen's book.

1:35:19 Yeah. And the most important thing is Jen doesn't make a penny out of this book. So it's fork in the road with the idea that in your journey Which one are you gonna pick? Did you see?

1:35:31 So it's fork in the road. She doesn't make any money from this. Every penny goes to a charity that she's set up. Helping people with food addiction. It's available on Amazon. And self published on Amazon.

1:35:46 It's not a lot, is it? It's about fifteen pounds. Oh no, it's less. I think it might be ten. Ten quid. Okay, I'll tell you what I'll do. Yeah. I'll buy a thousand of them.

1:35:57 Fabulous. And I'll put a link below in the comment section. And so I All you've got to do. Is If you've really enjoyed this conversation and you'd like to get Jen's book Um

1:36:10 Fork in the road. A fork in the road. Maybe we could even get some of them signed. Not all of them, because that'll print your hand, but we could probably get a couple of them signed. Click below and um we'll send a thousand of them out. And that's just a thank you from from me to both you and Jen, but also to the community who tune in for these conversations. And it's so great that people can get such simple information that's so accessible and so um rigorous in its scientific credentials. um in a way like this that they can that could change some people's lives. Great. Isn't that a wonderful thing, you know? A simple book like this, which isn't long either.

1:36:44 No, it's not a big read. Could change some people's lives. That's such a wonderful thing. Equal day.

1:36:52 Uh just making myself a delicious coffee. From the freezer? From the freezer, have you not heard about Comtier? No. Oh my gosh.

1:37:00 This is gonna change your life. I invested in this company called Cometeer last year, and then I'm one of the sponsors of this podcast because they've taken a pretty revolutionary approach to making coffee. Every coffee is precision brewed at ten times the strength. And then they flash freeze it. With liquid nitrogen to lock in the flavour and freshness and then it's delivered to you on dry ice in these recyclable aluminium capsules still frozen. Like a lice cube. All you have to do is pop The

1:37:29 Capsule out. Add some hot water. And then you stir it and you are good to go. You can also make delicious iced coffee drinks as well. Just pour it in. Stir it up. And for anyone that hasn't tried it, you can get thirty dollars off your first order of Cometeer coffee if you go to cometeer.com slash Steven. I've done almost 700 interviews with some of the most interesting people in the world, and one of the things you learn, which is unexpected, is that vulnerability is the doorway to connection. And after sitting here for two, three hours with a guest, I feel a deep sense of connection to them. And as they leave, what I get them to do.

1:38:10 Is to write a question in the diary of a CEO. We've taken all of the questions from the diary of a CEO. We have But the question Here on this card with the name of the person that wrote it. So you can sit at home as I do with my fiancee. And my colleagues at work and other people in my life, whenever we get a minute We play the Diverseo conversation cards, and it is incredible.

1:38:34 What happens. These are great if you're in a romantic relationship and you want to connect your partner more. These are also great if you're in a team and you want to bond your team together. And I have to say they're also great for families that want to learn more about each other and that need a good excuse to spend some time in a digital world in the analog environment connecting human to human. It is remarkable. What the right question at the right time can do. Go to the diary Dot. Um And you can get these conversation cards.

1:39:01 Right now. You said something earlier on about the link between Uh sort of your diet dietary choices and cancer. I've actually got a friend of mine who used to work for me who is going through a a cancer process at the moment. She's very, very young. She's actually younger than I am. And she was diagnosed with breast cancer. She's a really good friend of mine, um, and she was my actually my manager for a couple of years. She's called Katie. she's very public about this, so she's posting her journey online so I can I can say her name. And um I've been following her and she's she's you know, she's removing a lot of the the foods we've talked about today from her diet. So she's very friend of mind for me at the moment. And I was looking at some of the stats around the link between our dietary choices and cancer outcomes and I'm gonna read them. Now my team might cut some of them out, but I think they're worth hearing.

1:39:46 Because hearing them I think is quite um Enlightening. A massive French study found that drinking just a hundred mil of sugary drinks per day, which could be, you know, a third of a can of soda, is associated with a Almost twenty percent increase risk.

1:40:04 Cancer. Women who consume two or more dietary drinks daily have over double the risk of early onset Calorical cancer. compared to those who drink less than one a week. High consumption of sugary sweetened beverages is linked to a seventy eight percent high risk of estrogen dependent

1:40:23 Endometrial cancer in women. Drinking twenty ounces of sugar. A sugary soda daily is linkeding your telomeres, which are the protective caps on your DNA, equating to four point six years of extra biological aging, which is a major risk fact for cancer. High sugar intake causes.

1:40:40 Chronic hyper Sliminia. Chronic hyper insulinemia. Can I So that is when I'm saying when the insulin levels are high. Which I explained at the beginning.

1:40:53 Which can inhibit Apetosis. The natural process where damage or cancerous cells self destruct. Wow. Two more. Fructose is processed in the liver.

1:41:04 And converted into lipids, which are fats, which is what we were talking about earlier. Which recent studies show certain humans directly consume to build their cell membranes. And lastly, Diets high in added sugars chronically elevate C reactive proteins called CRPs, an inflammation marker that is heavily correlated with tumor progression and A metastasis. Yeah.

1:41:28 So what I'd like to This is that is so interesting. And it Important point. We talk so much round the world.

1:41:38 Yeah. Treating cancer. Yeah. Well.

1:41:42 What about prevention? Because for your friend. That's her life sentence and she's living with uncertainty and fear. And when I tell patients They have cancer. You know, you feel it right here because you just took away

1:41:57 So much. And it's interesting, do we try hard enough? If we know that Are we trying hard enough to prevent cancer? Because that's what we should be doing.

1:42:11 It. I think after smoking. Hm. Diet is the next commonest cause of cancer. And

1:42:20 No, how serious does it have to get? Yeah. When when you you just gave all those references then. And uh I know that Uh junk food is linked.

1:42:31 To all cause mortality is linked to so many things. Uh what what are we prepared to sacrifice? For enjoying You know, treats and snacks. It's kind of when you look at it like that.

1:42:44 It's really bonkers. Really bonkers. This sounds a bit crazy, but sometimes I imagine receiving a diagnosis. Yeah. And I do a bit of I guess a they might call that premortem. um a pre mortem, not a postmortem, where I imagine on that day The decisions I wish I would have made.

1:43:01 And I'm not saying all cancer is linked to what we eat because that's not the case, but I'm I'm imagining like the worst diagnosis I can ever be given and the doctor telling me that my lifestyle choices contributed to that over the last five, ten, fifteen years. And in that moment Is there any Sugary drink that is worth it. There's just not you would just wish With every bone in your body when you come home and tell your fiance, your partner, your kids, that you've got this horrific diagnosis, you just wish

1:43:30 That you had made a different decision. I also think that's a very good strategy for dealing with problems. You know, your life must be so complicated I can't begin to imagine how many problems you're solving and the complications and the people you deal with. And yet all of them are as nothing. against the cancer diagnosis, aren't they? So that you would look at the problems you have right now and you'd laugh. Yesterday I was worried about the traffic or whatever. And

1:44:01 I think it's a leveller. Mortality. He's a leveller. All my life I've been obsessed with деf And it worries me. I can't

1:44:10 Sought out in my head. What does death mean? Or you know. It really scared me when I was a child the idea of death. But what it's given me is a drive To not waste time. And and to think about what's the best use.

1:44:26 of today. And and you seem to have that kind of energy as well. The interesting thing about this idea of wasting time as well is through everything you've talked about today, we we can both Waste less time, but also Have more time.

1:44:40 And when I learnt about the difference between like lifespan and health span, that also added to this equation. Yeah, people still live to eighty years old, but They're healthy for like thirty, forty years. And That's a very imp the idea of Health span is very important because we know in the UK it's going down.

1:44:58 Oh is it? Yes. Um uh It's it they're looking at that. Now lifespan is hanging out there as sort of stuttering along but health span. is going down in the UK and it's worth thinking why that is.

1:45:13 Well I would hazard a guess it's uh relates to all the things you've talked about. In England You're totally right. It says in England the situation is particularly alarming. Health span is actively declining even as overall lifespan slowly creeps up. Recent 2024 to 2026 data from the Office of National Statistics, the ONS, and the Health Foundation paints a stark picture of the UK's widening six years gap. Over the last decade, healthy life expectancy in the UK has fallen by roughly two years. As of the latest data, men in the UK can expect to spend about sixty years in good health and women about sixty years.

1:45:51 of good health as well. Because overall life expectancy Engle in England is rising. Um people are now spending roughly Up to twenty three years at the end of their lives with poor health and in sickness. This means the average person spends nearly a quarter of their life managing chronic illness and or disability. And that's exactly the point, isn't it? That's exactly the point.

1:46:16 And it relates to another thing I'd like to tell you about as well. This is um Government figures. Every taxpayer. in England pays an extra seven thousand pounds tax per year For the consequences of ultra processed food.

1:46:32 Mm. Everybody's paying. Tax, extra tax, seven thousand pounds a year. And this is because it's not just the cost of the drugs. The bigger c bigger cost is this is the people not paying tax themselves and not able to work because they're ill. And that is that's two thirds of the cost.

1:46:54 is the lack of revenue because so much of our population isn't well enough to work and that's very and a lot of it's young people too. It's very serious. I know I think about thirty, forty percent of our listeners are in the United States. So I've got some bad news for everybody in the United States as well. The US currently holds a rather grim record. It has the largest health span to lifespan gap. On earth. Despite the United States having lower overall life expectancy than almost all of its peer nations and premature death rate that is nearly twice the average of comparable countries.

1:47:28 It's healthy. span stat sit as the worst in the world. So if you're in the United States, as things stand, you will be sicker for longer. Um We're trying to k catch up though, aren't we?

1:47:40 We're doing you know, we're doing our best to case. We're doing our best to catch up. Um I have this piece of string here. Yes. Um which is a I guess a mechanism you use to figure out if people's Waste? And I guess fat levels are too high on the on the belly? I think it's bigger than that.

1:47:57 I'm interested in low cost ways. for people to find out, well how y how are you doing? How are you doing? And so one recognized way looking at metabolic health is Your waste Should be less

1:48:12 than half your height. So if we have a piece of string which we have there, I believe you're six foot one. Yes. And you've you've marked halfway, so half of that string should go around the fattest bit of your belly. People come up to me all the time, you know and they go, Oh my God, you're so much taller than I thought. Yeah. Because they've only ever seen me sat down. My entire career is people watching me. So that's like cut it in half. Okay and then let's see Will it go around your belly, yes or no? Okay, so I've cut the the string in half. Yes. Which part of my belly'cause the fattest part. Yeah, so be honest about the fat part. Okay.

1:48:45 Can I look? Yeah. You did it. Yeah. Is that Let me see. I mean it's it's not It is it's yeah, you've you've just done it, you've passed it. Yeah. Okay, thank you. It's so interesting. So funny in the butt.

1:49:05 is a very interesting thing for you. And as I say it's insulin resistance tends to put weight on your belly. But you may have a very muscular abdomen. Let's pretend it's that, you know? Yeah, you're just about there. You're just about there. But it's a really simple test for everybody at home. Piece of string. As long as you are tall, cut it in half. Will it or will it not go around your middle? Okay, so everybody at home go buy some string. Yeah. I mean there's lots of other things you can do. But that that's as as

1:49:34 A simple way because you wait alone. As I said, it it's where the fat is distributed. It It's fat on your belly is more worrying than fat on your legs or on your arms, really, so So one of the things people always ask me about is supplementation.

1:49:50 Um Good, bad, and different what's your what's your point of view? Right. So my point of view is If you can My my gut reaction is to try and use diet.

1:50:04 To give you what you need. If you can. Which diet? A lower a real food. Lowish carbohydrate diet. is my preferred thing with plenty of protein.

1:50:16 In there. And healthy fats. I'm very interested in farming. and regenerative agriculture and all that kind of thing. And what I know

1:50:27 Yeah. is that the nutrient profile of crops grown today is not nearly as good as it was a hundred years ago. So we have some problems and it it's to do with the soil. If you keep just adding nitrogen and harvesting crops. Yeah.

1:50:43 Those crops do not contain as much zinc or magnesium particularly. Yeah. And so The tragedy is that although my aim would be to have you healthy with a real food Don't.

1:50:56 There are some things you cannot get in the diet now that your grandparents could, and one of them is magnesium. It's very, very difficult. Two Get enough magnesium. Mm-hmm.

1:51:10 in your diet without supplementation. And As you get older, you absorb the magnesium. Less and less. Also a lot of medication interferes with magnesium absorption, particularly drugs for um acidity. So magnesium supplementation. for most people.

1:51:29 Okay. Yeah. I sleep a lot better. I think we also need to talk about magnesium, which magnesium,'cause it varies a hell of a lot. And um this bit's embarrassing. Depends on your bowels.

1:51:48 Okay. Right. Have you got fast or slow bowels? You don't need to tell Tell me. If you If you if you tend to be a bit constipated. Magnesium citrate.

1:51:59 Is it Very good. It helps. It's more laxative. And it You ab you absorb some of it anyway.

1:52:07 If your bowels are Not a problem. And particularly if you're wanting better sleep. Or mood. Magnesium glycinate or threonate is actually crosses the

1:52:19 Blood. brain barrier, but won't help with constipation. So that's a very quick thing on magnesium. Have you Have we got time for me to tell you about the first cow I ever bought? Go ahead. And it's relevant to magnesium. Go ahead. Right.

1:52:34 So My wife and I My wife Jen. We have this idea.

1:52:40 That if you love somebody. Then gifts are You should try and think what would that person like. Don't buy somebody a present you would like. Yeah. And it was Jen trying to get me to grow up. Yeah. Right.

1:52:53 Yeah. And this is how she did it. So She said to me one day. Right.

1:53:01 Get a coat and a pair of Wellingtons, I'm gonna take you out. And She drove me into Lancashire. And there was a field of cows and she said, I have bought you Any one of those cows'cause I'd always wanted a cow.

1:53:14 And we had a field. And she'd How What a woman is this. She knew I wanted she went.

1:53:22 This field. I've I I bought a cow, you just pick which one you like and he'll transport it home. How does this relate to magnesium, you're wondering? Well.

1:53:36 It does. Because. The farmer said, You can have whichever cow you like, but I've lost fifteen cows. Uh to a thing called the staggers. this year and you cannot have the cow unless you

1:53:48 Promise me you'll buy magnesium supplements. Because the grass is now so short of magnesium that Uh cows die fitting if you don't give them a magnesium supplementation. But it's better than that. At the same time, I had a patient that I couldn't work out why he was fitting.

1:54:08 I was really fond of this guy and I kept being called out and admitting him to intensive care. Fitting. And we couldn't work out it wasn't a brain tumour. Why was he fitting? And I expect you've joined the dots it was magnesium deficiency. Because of medication he was on. And that's the first time

1:54:26 I ever seriously thought about magnesium the most interesting Subject very important. and the modern diet is most people are magnesium deficient. And Uh problem is you can't measure it.

1:54:41 So your blood magnesium, the serum magnesium. um doesn't reflect what's going on because magnesium is mainly inside your cells. So in the you have to get The intracellular magnesium level.

1:54:56 But do you know what? It's just easier to try a magnesium supplement and see how you feel. So do you take magnesium? I do because the guests, the experts on my podcast have told me that magnesium is one of my five uh uh for me I've said to myself I'll take five supplements a day. Um five. Yeah, I'll take five. So vitamin D because I'm inside all the time. Vitamin D, so yes, definitely. And I'm black, so that you know Well that combined, but everybody and particularly in the W most people just don't get enough sunshine. It'd be better if you could do it with sun. But yeah, vitamin D is very, very important. I take magnesium. Yeah. Which magnesium do you take? That's a great question. I think it's citrate. Citrate. Right. But I actually think it varies depending on what my team get me. Yes, yeah. Um but that's good to know'cause I'll think about my bowels. Creatine.

1:55:45 Yeah. Um there's this fiber supplement that I take because I did a couple of blood tests and um they said that fibre would help this particular fibre supplement would help reduce my LDL. Yeah. Cholesterol? Yeah. And Multivitamin.

1:56:03 Cover everything. That sounds okay, really. Yeah. I mean one of the worries the one of the clinical things I find Is honestly if you ask people how many supplements they're taking, there's a carrier bag comes in and there's a blue one and a yellow one and a and it's possible to over supplement

1:56:23 Quite easily. Mm-hmm. particularly maybe vitamin D, you can know various uh vitamins. You handed this as well. Oh that's vitamin D. Fine. Fine. So I think that that's I would agree with you. Uh basically. Mine's mine's also going um off my blood test results. So I've done two blood test results. Actually, I've done two blood test results in the last month.

1:56:44 One with Function Health, who are a sp a partner of ours, a sponsor of ours. And another one with um With Niko. Health? Which is a actually a company that I've just invested a couple of million quid into, which is this health testing Company. Have you heard about Nika?

1:56:59 No. Make a healthy walk in. Two hundred and ninety nine dollars whatever. you lay down, you get all of your your sort of blood tests done, you get all of these incredible tests done on your body. Um they show like how you know how

1:57:11 How good your circulation is from your like neck to your toes. You stand in front of this scanner, it takes like two thousand, three thousand photos of your body, tracks all of your musels, tracks your heartbeat, does all of these incredible things. And then instead of Waiting two weeks for the results. You walk into a room and your entire body is on this screen. Yes. And you can look at you know, all these different parts of your body. They do the blood tests.

1:57:33 At the very start. And then literally like It felt like twenty minutes later, I'm in a room, I've got my blood test results back. I can see my entire body. They're going through my LDL, my this, my that. the other. They're showing my heartbeat. They're showing every single mold on my body. And it costs two hundred ninety nine pounds and you get results then.

1:57:50 And I my my alternative, and this is me really plugging, the alternative that I used to do every year was this honestly, I'll be honest, it was this seven thousand pound health screening. Well, I take it would take me six, seven hours and I'd get the results back in two weeks. So what Niko have tried to do it's actually a company started by the founder of Spotify. Danny Lack. And yes, so I did my blood test the other day, and both my function health test and my my Niko Health test said the same thing.

1:58:17 And then I took those results and I I processed them using some AI tools and said, like what am I deficient in? And one of the things I was deficient in was Omega three. That was the other one. Uh omega three vitamin D. I had high LDL. And so they said this fiber thing would be really good for you. And Yeah, those are the main things. Otherwise I was great, but

1:58:37 Yeah, high LDL. That makes me think of something. When you're screening I think the important point is that You don't just scare people. Yeah. So I've had a lot of experience. Yeah.

1:58:52 of scared patients. So GPs we we're we worry about screening'cause what happens is People do that. And then people get scared and use up loads of appointments in the health service trying to sort out What's good is if you do screening that relates to actionable points and then you help the people understand what they can do. Yeah. And Avoid leaving them as

1:59:17 Just worried. Exactly. You know, if if I can I might be able to tell you accurately you're gonna die aged whatever of whatever, but if you can't do anything about it you don't want to know. Yeah. What you do want to know is what can I What can I take action on? What can I you know, it's about optimising, isn't it? The things that I h hate about the health checking process before Nico was like I hated how expensive it was and that's quite it's quite a privileged thing to be able to get a health a full body health scan. So but now you can do it for two ninety nine, but then it was I walked into a room straight away with a doctor.

1:59:49 Yeah. And the doctor sat me down. beautien of my body and was like, do this, this, this, this is fine, this is fine. And she was so nice about it. But Yeah, I say that'cause I'm so passionate about it,'cause I realise there's a certain privilege that people that are able to access private healthcare have. That I think is really, really unfair. Well obviously I

2:00:08 I think that's unfair'cause I only work in the health service. Yeah. The state self I don't do any private patients or because I think it It would be wrong.

2:00:22 And because don't you think health inequality is getting really bad. Yes, exactly. And it kinda troubles me. And else if you If you start in the UK and you go northwards, it just gets worse and worse. And and the States is the same where

2:00:38 It's not like the same nation. Oh my gosh. You go to California, there's one kind of a thing and then you go elsewhere and it it's not the same. But hopefully this is changing. Um this is I I I think social media helps because It didn't cost much, does it, to go on social media and find out things. Exactly. And people like you.

2:01:00 who have um increasing increasingly loud voice across lots of podcasts and who are reaching millions and millions and millions and millions and millions of people. Um and what's difficult though is not to become confused. You know, because you have the newspaper saying eggs are good, eggs are bad. And then you have this expert who's saying this and another expert saying the other.

2:01:22 I think what I've tried to do He's base what I say on real world data. And that's different. So I'm I'm Very careful to

2:01:34 take baseline data from my patients and then update it all the time. So what I'm The publications I've done are based on On the real world. the health service in the north of the UK, I can't Cherry pick my patients.

2:01:50 I'm allocated my patients by the state. So it I I can't just pick wealthy people or people that will live longer. Allocated people and that's that. So Part of what I do is proof of concept.

2:02:05 Because if you can achieve this in the north of England, near Liverpool. And if other people can replicate it in Australia, New Zealand, North America. Maybe it's true. Perhaps.

2:02:18 Okay. Doctor David Unwin. We have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they're leaving it for. And the question left for you is I'm sure the guests will figure out who left this one. Um if humanity organized to make contact with a more intelligent species. Yes. Who should represent humanity and why?

2:02:40 Funny. That's a brilliant question. Who should The first person the this is a person I'm going to nominate.

2:02:55 What about David Attenborough? You know, he's a hundred years old and he's spent so long Um Thinking about the planet. And wouldn't he be a wonderful ambassador and because I am passionate about biodiversity, I'm passionate.

2:03:12 About Sustainable. agriculture and sustainable food. I pick David Atoms. I think that's a wonderful choice. I think the aliens would really like him. They would. That's my answer.

2:03:27 Thank you so much for what you do. Um you're really remarkable in a way that's quite rare. And listen, I would know because when I'm not sure. No, you really are remarkable. You're really remarkable in a way that's very rare. And I don't say this to all of my guests, but you are for v for a variety of reasons. Okay, I'm gonna give you all of the feedback. Thank you. The first w the first, the most notable is you're a very kind human and Y the way that you speak is very nice to listen to. Again rare. The other thing that I noticed is you're very, very, very natural and good at telling stories. And listen, why does this matter? Because the human brain, from what I've discovered from doing this podcast, is really orientated towards stories. Now you could sit here and say Banona bad. Or you could say magnesium good, but I'll never forget the cow story.

2:04:09 Yeah. You know, I'll never forget the calorie. I could have re I could have forgotten that magnesium good, magnesium bad, but y the way that you tell these stories is so captivating that It enables me to learn in a way that is engaging and that is rare. Very, very rare. And the other is just um your your depth of experience, your humility, your willingness to admit when you were wrong, which means that I trust you so much with what you're telling me because you're you're saying I'm a I'm an imperfect human too. I've made mistakes both in myself, with my patients And this is what I've learned from it. And um the other thing is just your ability to simplify.

2:04:42 It's remarkable. Listen, I sit here all day with super geniuses from this university and Harvard and Stanford and whatever else, and I'm struggling to understand what the hell they're talking about because they don't take a second to build the bridge between The science. And the average person. And you do that so naturally. So I I have no Coming from you, that means a great deal. No, but it really does. Thank you.

2:05:04 It's just what forty years in general practice does to you because if you wish to be effective and if you notice as in the Grin model Mm-hmm. I'm I'm watching your face. I'm watching an audience. And I'm reading how I'm doing or you're getting bored or I need to move on or whatever. And that's what I do with patients. I watch

2:05:24 Very carefully. But coming from you'cause you really do know,'cause you've had all sorts so that means such a lot. It's a really rare skill and actually'cause it's so rare, I would just implore you To do more. And I know you're only doing so much, but it's like it's so rare.

2:05:40 That You can have such a massive impact. Yeah. How we So I'm trying to get bigger on Twitter so this will help me um

2:05:52 Immensely. Um how can the audience? How can the audience? With your mission.

2:06:00 Well At Low Carb GP on Twitter, please follow me on X. Low carb GP. Yeah. The other thing that would help very much is to support the British charity that I set up, the Public Health Collaboration. Um it's our ten year anniversary. We set up these were clinicians who got together, sixteen clinicians said how we do in rubbish. Can we do better? Can we give clearer public health advice?

2:06:28 So it's called the public health collaboration. So please Please support our charity. Go online, find out about it, come to our Conferences. I'd also say notice Each of us.

2:06:42 is on A journey. Be clear about your goals. Notice what works for you because that's what you're doing. And each of us see yourself as an experiment.

2:06:55 Don't be frightened of experimenting, but if you're going to experiment, notice Measure something. Measure something, and then you'll see how you're doing. Um, and I I one thing I think that gives me hope is continuous glucose monitors because

2:07:13 You're getting you know individualizing right there. How is my blood sugar. I can check mine in a minute and see how I'm doing. I think continuous glucose monitors. Which by the way, are only twenty, thirty dollars on on Amazon or a webcam. Yeah, I I would think you know what?

2:07:30 If you loved your dad Or you had somebody in his Christmas. And you could buy useless Ornament or something, and they don't need it anyway. But would they be interested to find out about their blood sugar?

2:07:43 Yeah. You'd ask them first, but if they've They've got A mobile phone. They could try a continuous glucose monitor and find out. Have you have you tried one? I have, I have. And what did you learn?

2:07:57 I mean so much. Ah, well did you? I learned that all these things I thought were ha were Had no sugar in them, have loads of sugar in them. Exactly. I had no idea about ketchup. And the point is once you've seen it on your phone. You can't then see it. No. And I see them as the The cavalry coming over the hill.

2:08:17 Because We can't be fooled much longer. I'm just gonna look at seeing what my blood sugar is right now. So can I just show you So what that is, that's somebody with type two diabetes, but look, my blood sugar's absolutely level. Well.

2:08:34 And that's good. Uh because You want it, but look how how level it is. And that is because I don't eat stuff that puts up my blood sugar. If I was to have some of those, you'd get a um you'd get a spine. But that's feedback. Also means if I get very stressed, it puts up my blood sugar. And you've been so kind, I haven't been stressed. So other podcasters are not as gentle and kind as you and I get a horrible spite. So I was gonna open here's some feedback for you, Steven. So you and I have been together for a few hours and my blood sugar

2:09:12 I felt safe. So you've done your job too and there's some feedback for you. No spiking. I'll tell you a final story. The final story. Um

2:09:24 So type two diabetes is is brand new as a problem for pediatricians. What is a pediatrician? So a pediatrician is a doctor who specialises in the diseases of children. People under sixteen years old. And the The international problem is

2:09:41 that children everywhere are now suffering from type two diabetes. Okay. But The pediatricians have had no training. Because it's a new disease.

2:09:55 So Um A large group of pediatricians. Sent for me, And said please do a keynote.

2:10:03 Yeah. And teach us w what to do because they, although they're specialists, they haven't experienced in type two diabetes. This is a new disease of children. What we're doing. What we're doing.

2:10:16 Leave it at that. We didn't show the foie gras, but I'll eat some of that later. Doctor David Unwin. Thank you.

2:10:26 Wait. Fabulous. I enjoy that.

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