Fatty Liver Expert: The Toxic Ingredient Silently Filling Your Liver With Fat - Dr David Unwin

0:00Your waist should [music] be less than

0:02half your height. So, half of that

0:04string should go around the fattest bit

0:06of your [music] belly. And this is a

0:07really simple test for everybody at

0:09home. I mean, it's not loose.

0:11>> you [laughter] just done it. You passed.

0:13But fat on your belly is more worrying

0:15than fat on your legs or on your arms.

0:17And unfortunately, we've started to

0:18normalize things like the dad bod

0:20without realizing that isn't how you're

0:22supposed to be. And maybe a third of all

0:24the people in the world with type 2

0:25diabetes don't even know they have it.

0:27But every year that you have poorly

0:29controlled type 2 diabetes, you're

0:30losing 100 days of life. And it's

0:33because people don't know. The truth

0:34being fooled with the packaging and

0:36advertising.

0:37>> So, let's talk about the food we have on

0:39this table. Because this is how much

0:40sugar I would have thought was in all of

0:42these things here: cereal, potato, white

0:44rice, a banana, and a chocolate bar.

0:46>> So, now I'm going to give you the

0:48correct figure. The cornflakes is 1 2 3

0:524 5 [music] 6 7 8. That chocolate bar is

0:567 and a half. The banana, that's 6. And

0:59then the potato is actually Oh my gosh.

1:02And then 150 g [music] of boiled rice is

1:06Oh.

1:07I thought rice was healthy.

1:09But each of us has a number of different

1:12health futures. And what I'm interested

1:14in is how do I get you to pick a

1:15lifestyle that will get you the future

1:17you want. Because my job is about

1:19behavior change.

1:21>> The floor is yours. All right. So, off

1:23we go.

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1:59Do we have a deal?

2:00If you do it, I'll tell you what I'll

2:01do. I'll make sure

2:03every single week, every single month,

2:04we fight harder and harder and harder

2:05and harder to bring you the guests and

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2:15with the show.

2:17>> [music]

2:20>> Dr. David Unwin.

2:22You were named in 2018 among the top 10

2:25most influential doctors in the United

2:28Kingdom. Um, you've got an incredible

2:30list of accomplishments, and you're held

2:33in the highest regard, maybe of all the

2:34doctors I've ever had the chance to

2:35speak to, by many people that I've

2:36spoken to.

2:38We were talking before we started

2:39recording about what's on your mind.

2:41And what's been bothering you.

2:43And so, the floor is yours. What is

2:45front of mind for you, Dr. David? What's

2:46front of mind for me is the the idea

2:49that each of us has a number of

2:52different health futures. So, you have

2:55So, in your future, uh, I don't know,

2:57there could be cancer. There could,

3:00uh, be multiple sclerosis, or there

3:02there could be many futures. What I'm

3:04interested in is how do I get you to

3:08pick a lifestyle that will get you

3:10the future you want. And I think that's

3:13very difficult in the world now to know

3:16what is the best lifestyle cuz you're

3:18given so much conflicting advice.

3:21And the particular focus for me in terms

3:23of

3:24picking health futures is around young

3:26people because they've got the longest

3:29time

3:31to make a difference.

3:33And it's getting harder and harder and

3:36harder to make good

3:38health choices in your lifestyle. It's

3:40really hard.

3:41I'd say it's a pandemic

3:44of poor metabolic health. Yesterday in

3:47clinic, I saw two people under the age

3:49of 25 who had poorly controlled

3:53diabetes, and one of them was too heavy

3:55for me actually to weigh.

3:57And this situation is completely new.

4:01So, when I when I was a young doctor

4:04uh and just starting off in practice,

4:06that was in 1986.

4:09Wow. And that's a long time ago. Just

4:11north of Liverpool in the practice, I'm

4:13still there now. Obesity was rare, and

4:17we didn't have a single case of type 2

4:20diabetes in anybody under 55. Not a

4:24single case, it was quite unknown.

4:26And in fact, type 2 diabetes had a

4:28different name. We've had to change the

4:30name because of the epidemic. Used to be

4:32called maturity-onset diabetes. That

4:34meant old people. Right? Now we call it

4:37type 2 diabetes because we have to

4:39include so many young people. It's

4:42really, really serious

4:45uh because people are losing their life

4:48expectancy.

4:49I don't I'm witnessing this. We're all

4:52sleepwalking into a metabolic disaster,

4:54and the people paying the greatest

4:56price, in my opinion, are young people,

4:59and it's a scandal, and

5:01I'm [snorts] hopping mad, really. I

5:03think we've started to normalize

5:06the dad bod.

5:08You know, the big tummy and haha without

5:11realizing that maybe that isn't how

5:13you're supposed to be.

5:15So, that that's what's on my mind. Young

5:17people

5:18and their future. And they don't even

5:21know.

5:22You say young people there Yeah.

5:24>> because they've got the biggest

5:25opportunity to change the trajectory of

5:27their health future.

5:29>> Yes. But for the audience that's

5:30listening that might be in their 50s

5:32now, is this advice also applicable?

5:34Absolutely. So, we know from get

5:36government figures, UK government

5:38figures,

5:40that for every year that you have poorly

5:43controlled type 2 diabetes, you're

5:45losing 100 days of life. That's about a

5:48third of a year, isn't it?

5:50So,

5:51whatever age you are, if you uh have

5:54poorly controlled diabetes, you're

5:57losing life expectancy, and and maybe a

5:59third of all the people in the world

6:00with type 2 diabetes don't even know

6:02they have it.

6:03Because they haven't taken a test, so

6:05they don't know.

6:07What do you think kills people with type

6:092 diabetes?

6:11>> [snorts]

6:11>> Um is it some

6:13cardiovascular issue?

6:15Yeah, well done. Well done. You don't

6:17receive You've not been to medical

6:18school. You're doing all right.

6:19That most doctors, that's what they'd

6:21say, because we know

6:24uh that a high blood sugar over time

6:27damages your arteries.

6:29So, it's a cumulative thing over time.

6:32But what you may not know

6:34is that actually

6:37a rising cause of mortality for people

6:40with diabetes is cancer. Oh, really?

6:43>> Yeah. So, eight forms of cancer

6:46uh are strongly associated uh with

6:49diabetes. I want to just define that

6:51term diabetes, because I think I went

6:53through a lot of my life assuming that

6:54diabetes was a disease that some people

6:56are born with, and because I didn't have

6:58it, I thought I don't need to worry

6:59about that.

7:00>> really important. Yeah. So, first of

7:02all, there's type 1 diabetes and type 2.

7:05But before I can explain

7:08about diabetes, I need to explain about

7:11insulin. This is absolutely key to our

7:14whole discussion.

7:16>> [sighs]

7:16>> So, I've already said that a high blood

7:19sugar

7:21damages your arteries. And in fact,

7:23there's work to show that a very high

7:25blood sugar

7:26damages the nonstick lining of your

7:29arteries within 6 hours. Oh, wow. Really

7:31quick. It's called the glycocalyx, the

7:33nonstick lining.

7:35And uh damage is occurring very quickly.

7:37So, I'm going to ask you a really stupid

7:39question. Yeah. When you say high blood

7:41sugar, I get high blood sugar when I eat

7:43lots of sugar.

7:45Okay. So, first of all, we're actually

7:47talking about glucose. Yeah. And sugar

7:51can mean table sugar or it could mean

7:53many different things, but we're

7:54actually talking about blood glucose.

7:57>> Which comes from lots of foods.

7:58>> Which comes from many foods.

8:00Carbohydrate heavy foods.

8:02Yes. Yes, it does. It does. So, that

8:04that's right.

8:05>> Okay. But

8:07you have the hormone insulin to defend

8:09you from poor dietary choices. So, the

8:12question is what does insulin do with

8:15the sugar you just ate? And here's the

8:18answer.

8:19Insulin, the hormone insulin produced by

8:21your pancreas gland,

8:24it pushes

8:26the sugar

8:28and it pushes it out of the bloodstream

8:30inside cells where it can be used for

8:33energy for you to run around.

8:36But what if you take in uh more

8:39carbohydrate than you need to run

8:41around? Well, then that sugar is turned

8:45to fat inside cells

8:48because it's safer for you to turn that

8:50sugar into fat than it is is to have it

8:53damaging your arteries.

8:55So, I am somebody with type 2 diabetes,

8:58so we can talk about me.

9:00So, I had a really heavy biscuit habit.

9:04Uh I was senior partner of the practice

9:06and it's stressful and I had patients

9:09used to bring me biscuits all the time

9:11as a gift cuz they you know, they want

9:12the doctor to be happy. So, in the

9:14drawer in the top of my desk was packets

9:17and packets of biscuits. So, I'm taking

9:20in more sugar and I didn't run around.

9:23And gradually my waist got bigger.

9:26And

9:28what was actually happening was

9:30as I took in

9:32more sugar than I needed to run around,

9:35my insulin was working to get rid of

9:37that sugar.

9:38And it was giving me two things. One,

9:42a belly. Mhm.

9:44>> [clears throat]

9:44>> So my, you know, and I thought it's just

9:45middle-age spread, you know? And the

9:48other was I didn't know,

9:50but my liver was filling with fat.

9:53And that's

9:54that is very common now. So we have

9:59well, it's a third of everybody in the

10:01developed world has fatty liver now.

10:03Here we got the wonderful props. Let's

10:05talk about these. Great.

10:07So fatty liver,

10:09this is the healthy liver here.

10:12And you see the color.

10:14Look at this one.

10:15It's yellow.

10:17It's the wrong color.

10:19And it's because of fat.

10:21So in that case, like has happened to me

10:24over years,

10:26my liver began to fill with fat. Because

10:30it was essentially overworked and the

10:32glucose was being stored there. Yes. So

10:35I was taking in too much glucose.

10:38Insulin was doing its good job of taking

10:41it out of my bloodstream and forcing it

10:43inside cells in my belly, but

10:45unfortunately in my liver. Okay. And so

10:48there's a progressive laying down of fat

10:51in the liver. So if we look at actually

10:53some proper liver, so this is the put on

10:56your seat belts now cuz this is

10:58>> somebody's somebody's actual liver.

11:01So then that's the normal liver. But

11:03look at this is larger. That's a real

11:06human liver.

11:06>> Yes, these are human livers and that's

11:08as it should be. But this look at this

11:10liver, it's larger. And it's larger

11:13because of so much fat in it. Now the

11:15twist in the story is fatty liver

11:19interferes with the good work of

11:21insulin.

11:23So you develop a thing called insulin

11:25resistance, which means your insulin is

11:27no longer as powerful as it was. It's

11:30beginning to become difficult for you to

11:32deal with carbohydrate and sugar because

11:34your insulin isn't working as well.

11:37And the only way to deal with that

11:40is the next twist in the story.

11:42You have to start producing more

11:44insulin.

11:46Mhm. Do you see? Because it doesn't work

11:47as well.

11:48>> Yeah. So, your pancreas has to

11:51crank up the supply. We need more

11:53insulin. So, now you have two things.

11:56You have

11:57insulin resistance. Your insulin isn't

12:00working as well.

12:02But at the same time, you're trying to

12:05produce more insulin in the pancreas.

12:08This bit's called the long silent scream

12:10from the liver. This is work by

12:12Professor Roy Taylor, a friend of mine

12:15at Newcastle University. And he pointed

12:17out that

12:19you've you've got fatty liver for about

12:2110 years. You don't even know. You

12:23wouldn't know that your liver's gone

12:26fatty and yellow like that.

12:28But unfortunately, this is another

12:30twist. Fat is being laid down in the

12:33pancreas gland, the very gland that your

12:36life depends upon producing insulin. And

12:39your ability to produce enough insulin

12:42collapses.

12:43And at that point, you can't regulate

12:46blood sugar anymore.

12:47But upstream of that, you have a

12:50problem. You've got that.

12:52But you don't even know. You're talking

12:54about what's in my mind. Why are we

12:57waiting

12:58until you actually have all the problems

13:00of type 2 diabetes? So, since 2013,

13:05I've got hundreds of patients, and I'm

13:07monitoring

13:08the baseline and latest follow-up. So, I

13:11what happens to them? It's really

13:13important.

13:14And now I have a a huge data set that I

13:17can interrogate and answer questions.

13:20So, number one question,

13:23let's think about prediabetes. So, this

13:25is in the long silent screen.

13:28Well, I can tell you

13:30that the people with pre-diabetes in my

13:32practice north of Liverpool,

13:3593% of them will get

13:38a completely normal blood sugar if they

13:41go low carb. 93%

13:43resolution and that will last for years

13:46because I've checked.

13:48Okay.

13:49How about we wait for the 10 years and

13:51Steven until Steven you've got type 2

13:53diabetes and then you go low carb.

13:57At that point, if I can get you early,

13:59I've got a 73% chance of you having a

14:02normal blood sugar.

14:04Let's wait another few years because you

14:06don't want to give up bread and you

14:07don't want to give up chips and pizza.

14:09Fair enough, I'll wait.

14:12But, [snorts] you know, if we wait 5

14:14years, you only stand a 50% chance.

14:17So, do you see? It goes 93 over 70% 50%.

14:22So, the chances of me not needing drugs

14:25and be able to do a good job for you are

14:27diminishing. So,

14:29really it's a stitch in time. Mhm.

14:32And so much of this you don't even know.

14:34You don't even know it's going on.

14:36One of the things that shocks me is

14:39is how little we know about what's in

14:40our food. Yes. You know, cuz I think we

14:43all know that like biscuits are a food

14:46that has a high glycemic index. Well

14:48done. Which is a term that I've learned

14:49from this podcast which means Some

14:51carbohydrates are more sugary than

14:53others.

14:54And then So, that's the glycemic index.

14:56What that is doing

14:58is comparing different carbohydrates

15:00with pure glucose. All right. So, you

15:03see pure glucose is 100 and then other

15:05sugars come further down.

15:09But, there is there's something better

15:11than the glycemic index and that's

15:13called the glycemic load.

15:16The glycemic load takes portions of food

15:20and predicts

15:23how will that portion of food

15:27actually affect your blood sugar? And am

15:30I right in thinking the glycemic load

15:31would factor in the amount of nutrients

15:33in the food? Exactly. So like protein,

15:35fiber. Yeah, because if you took

15:37watermelon, well, it's mainly water,

15:39isn't it? Mhm. So you have to factor in

15:42you can have quite a lot of watermelon

15:45uh to equal a chocolate bar. Mhm.

15:48So the density you what you're looking

15:50at the density of sugar in it as well.

15:52>> Okay. So that's why the glycemic load

15:55is better.

15:57Was there was there a moment in your

15:58career where

16:00you started to question what you had

16:02been told?

16:03Yeah.

16:04You know,

16:05so you start as a young doctor. I wanted

16:08to be part of a small community and stay

16:10there and make a difference. And then

16:13comes the sad bit, really. So I

16:16for the first 25 years, I was trying to

16:19do what's in the guidelines. I was

16:21trying to be a good doctor.

16:23But what I noticed I noticed

16:26two things.

16:28Number one, I noticed what I've already

16:30said to you, that the health of the

16:32population I cared for

16:35was deteriorating. It wasn't getting

16:37better. So if I'm the doctor in charge

16:39of the practice looking after these

16:41people,

16:42and health is deteriorating,

16:45am I not responsible?

16:47And where's where is all this difference

16:50I was hoping to make?

16:52It just wasn't panning out. At the same

16:54time, I I'd always in my heart

16:57felt that prescribing lots of drugs felt

17:00a bit

17:01wrong.

17:02It felt like a mini failure because how

17:05is somebody well

17:07if they're taking six tablets a day? Was

17:09there one particular patient that you

17:11met? There were two.

17:13Two things happened, both to do with

17:15very powerful women.

17:18The first powerful woman was a lady I'd

17:20known for over 10 years.

17:22She and her husband I'd cared for them

17:24both.

17:25They both had poorly controlled diabetes

17:28and they were both very heavy.

17:30At the time I could monitor how my

17:35how compliant my patients were with

17:37their medication.

17:39And if I'm to be truthful, in part that

17:42was how I was paid.

17:44So, the part of my payment was to do

17:46with all the patients having in this

17:49case metformin, the most commonly used

17:51drug

17:52for type 2 diabetes.

17:53>> Part of your payment? Yep. Yeah, how

17:55would you mean?

17:55>> Well, because there's a you're supposed

17:57to that the government approve of the

18:00fact that we give drugs that are needed

18:03for type 2 diabetes. So, that you're

18:05given a sort of quota where it's expe-

18:08it's regarded as good practice that such

18:10a a certain percentage of your patients

18:12will be on metformin. What? Yeah.

18:15It's true. So, is it fair to say that

18:17you were somewhat incentivized to give

18:19people metformin? Yes, that would be

18:21true. But, I think we should also be

18:23fair to say that the body of evidence at

18:25the time would say

18:27uh that it's good practice to give

18:29metformin to people with type 2 diabetes

18:32and

18:34conversely poor practice not to use

18:37metformin, but we'll develop that.

18:39So, the the backdrop is we're we're

18:42monitoring the patients who stopped

18:44taking their metformin because that uh

18:46is number one poor practice and number

18:49two actually cost me.

18:51So, I wrote to the person.

18:53Dear Mrs. So-and-so, I'm concerned that

18:56uh you're not you don't seem to be

18:57taking your metformin. Please make an

19:00appointment with me at your earliest

19:02convenience. Very British, very polite.

19:05Anyway, nothing prepared me for what was

19:08going to happen that morning and it's

19:09changed my entire life

19:12on that point. So,

19:16the lady with let's call her Mrs. Jones.

19:19That wasn't her name. She marches in and

19:23uh she said to me, "You think you're

19:25going to tell me off, don't you, Dr.

19:26Unwin?

19:27Well, I've got news for you. I'm going

19:30to tell you off."

19:31I was scared. Like, what's going on?

19:34She's never been like this before. She's

19:35a

19:36a polite person.

19:38Anyway, she went on to explain and she

19:40said,

19:42"When you do my blood tests, you will

19:44find that my blood glucose is completely

19:46normal

19:47despite not taking your metformin."

19:52And she said,

19:55"I'm wondering if you're actually

19:56qualified as a doctor

19:59because

20:00>> [snorts]

20:00>> in the last 10 years, did you ever once

20:03tell me that bread was sugar or

20:05breakfast cereals were sugar? I had to

20:07learn online

20:10uh that bread is sugar,

20:12that rice is sugar,

20:15that breakfast cereals are sugar.

20:17And when I cut those foods, I don't need

20:19your metformin now."

20:21And she She made it worse. She said,

20:24"This is schoolboy biology. You should

20:27have learned that when you were 16."

20:31I was dead scared because, you know,

20:34complaints as a GP is really bad. They

20:36go on for years and years.

20:38But mainly I was scared because every

20:40word she said was true.

20:43And one thing I had learned about when

20:45you're an older doctor is you've got to

20:46listen to people properly. If they're

20:48complaining,

20:50don't deny it. Don't defend yourself.

20:54Take it.

20:55So, I said, "Okay.

20:58I've got I want to learn what you've you

21:00know, if this is true, will you meet me

21:02again? Let's do the blood test." So, we

21:04did the blood test. It was true.

21:06It was the first case of drug-free type

21:092 diabetes I'd ever seen.

21:12I'd never seen a single case in 25 years

21:15where people came off medication.

21:18I was fascinated

21:20because she'd done it, like a miracle.

21:23But there was another detail I'd just

21:24share with you.

21:26She was one of 40,000 people online

21:30learning from each other how to do it.

21:34And when I looked

21:36they were being rubbished by the health

21:38care professionals. So people like me

21:41were telling them you'll die.

21:43What you're doing is dangerous. And

21:47I was ashamed, really ashamed.

21:50>> [snorts]

21:51>> And it's complete coincidence, but

21:54in the same month

21:57uh we have to introduce my wife, Jen.

22:00Is there a photo? Come on, let's see

22:02Jen.

22:02>> This is Jen. Oh.

22:05She's probably the cleverest woman in

22:06the world. She's so clever, I love that

22:09woman. So Jen

22:11uh so her back she is a um a clinical

22:16health psychologist and she specializes

22:19she's fascinated by the role of hope

22:22in disease and the difference it can

22:24make. And she spent her life researching

22:27the difference that hope makes to

22:28clinical outcomes. So

22:31it just so happened that she was in a

22:33supermarket and she saw some a

22:36discounted diet book. That one. That's

22:38the book. Escape the diet trap by Dr.

22:41John Briffa.

22:42>> Dr. John Briffa. What a lovely guy.

22:45So Jen bought that book just around the

22:48time I'm telling her about this patient.

22:51So she said you have to read this book

22:53about the low a low carbohydrate

22:55approach

22:56to um

22:58insulin resistance to type 2 diabetes.

23:02And in the book

23:05everything that my patient had told me

23:07was there.

23:09And but it was done in a medical way

23:12from and I understood.

23:14She said, "David, why

23:16why are you

23:19sort of failing? Why don't you

23:22do one thing

23:24before you retired? Why can't you do a

23:26cheerful, something you really believe

23:28in?

23:29Why don't you have a go with this low

23:30carb? Yourself? Yeah. She said, "Why

23:33don't you and me

23:36go on this diet

23:38for see if some patients would volunteer

23:40and do it with us?"

23:43And I mentioned it to the partners.

23:46And they said no. These are other

23:48doctors? Yeah, so I'm senior partner.

23:50I'm supposedly the boss.

23:53Uh but

23:54at the time low carb was not

23:56respectable.

23:57And they didn't like it. And they said,

23:59"We don't want you to do this."

24:01And partly cuz they said, "Well, how

24:05it you know, is that a good use of the

24:07the resources of the practice?"

24:10Because if you're doing this, David,

24:11maybe you're not treating chest

24:13infections or other things. And there's

24:14pressure on the health service. So this

24:16felt a bit they felt it was a bit

24:18self-indulgent. So go back to my wife

24:21and said, "The partners say no."

24:23And she said, "I I I'll tell you what

24:25we're going to do.

24:27We're both going to work for free. And

24:29we'll do it. Why don't we do this

24:32in our own time in on in an evening

24:36when the practice has no resources."

24:39So that's exactly what we did. We found

24:4218 volunteers

24:44who were interested amongst the

24:46patients. And then Jen and I So that was

24:4920 of us. We started meeting every

24:51Monday night

24:53talking about low carb, learning

24:56how do you cook stuff? How do you do it?

24:59We did it together. And one of the

25:00nurses

25:02was so excited, Heather is her name,

25:04let's give her a, you know,

25:06thumbs up to Heather.

25:08Heather said, "I'll work for free. I'll

25:10help you. I'd love to do this. I want to

25:13I want to believe in what I do."

25:16And then the magic begins. The results,

25:19I couldn't believe it. I could not, you

25:22know, I'd never seen anything like it.

25:23And the first thing

25:25the first thing I saw

25:28was the liver function improving.

25:31You see, cuz I'm doing blood tests, cuz

25:32I know I'm doing something weird. I'm

25:35doing something that I would be

25:37criticized for.

25:40So, if you're going to do a weird thing,

25:41you need to measure stuff.

25:43You [clears throat] can't, you know,

25:44it's these are

25:45patients, so you can't just experiment

25:47and not be am I doing harm?

25:50What's happening What's happening to the

25:51cholesterol and the lipid profiles? So,

25:54I was monitoring stuff really closely.

25:57The liver function though, Steven.

26:00I got people who I thought they were

26:02drinking alcohol,

26:05and I thought their liver problem was

26:06due to alcohol.

26:08>> [snorts]

26:09>> And they'd had abnormal liver function

26:11for 10 years, and suddenly within weeks

26:15the liver function was improving, often

26:17by a third or 50%.

26:20I was so excited. Can you imagine? I'm

26:22sitting there, and the laboratory

26:24results are coming in,

26:26and they're like, "Wow."

26:29And then another

26:30and another.

26:33So, that was the first thing, then the

26:34weight. We all meet every Monday night,

26:37and we got the scales, and everybody

26:38gets weighed every Monday night, and the

26:41weight started falling off people. It

26:43really did.

26:45And then the all sorts of other weird

26:47stuff started happening,

26:49some of which I couldn't make sense of

26:51for years.

26:53The first one was

26:55people said, "Are you hungry cuz I'm

26:57not?" And they started saying things

26:59like,

27:00"Do you have to eat breakfast?"

27:03Where and I also I wasn't hungry.

27:06I wasn't hungry. They were telling me

27:08the truth cuz I was experiencing this

27:10with them.

27:12"Why are we not hungry?"

27:15That's so odd. And I was starting I not

27:17bothering with breakfast, so I didn't

27:20didn't eat it. You don't have to have

27:22it. And my and my belly

27:24went away. Next thing was I noticed when

27:27I stood up from my desk,

27:30I felt dizzy.

27:32Weird.

27:34Now, I hadn't told anybody but I had

27:37moderate high blood pressure for years.

27:40But I didn't like to be a patient. So I

27:43never went to a doctor.

27:45I just put my head in the sand. So I had

27:47high blood pressure for years.

27:49When they took my blood pressure, it was

27:50low normal.

27:52Why?

27:53I didn't know.

27:55But on the patients as well, I'm doing

27:57that as well. I'm measuring all the

27:58blood pressure.

27:59And it's improving.

28:02So it's getting weirder and weirder.

28:03Liver function improving.

28:06Weight going down.

28:09Blood pressure improving.

28:11In those days, we were

28:14the blood test that we we did was a

28:16thing called a hemoglobin A1C.

28:18The A1C in America.

28:21This is the average sugariness of your

28:23blood for the preceding 3 months. So the

28:25results take a while.

28:27But then when the

28:30hemoglobin A1C came in, there it was.

28:33We were getting really spectacular

28:35improvements in in average blood sugar.

28:39And that's so that's kind of how it

28:41began. So that's 2013. So that's 13

28:44years ago.

28:46And uh

28:48the rest is history, but that I was

28:50completely blown away and I was full of

28:53curiosity about all these other things

28:56and how was it? Why were these things

28:58improving? So, in this 13 years, how has

29:01your fitness, your health changed? My

29:03mental powers were much greater. I could

29:06concentrate better. I wasn't fretty.

29:09So, I noticed that.

29:11I The next thing I noticed was

29:14I needed a lot less sleep.

29:17So, yeah, in the beginning

29:20I used to have to have a little sleep on

29:22my doctor's couch every lunchtime.

29:25So, I was senior partner, so you press

29:27do not disturb and you put the curtains

29:30round and have a little nap on my own

29:32couch for 20 minutes. It was the only

29:34way I could get through the day.

29:36I didn't need that nap anymore.

29:39I was less sleepy.

29:40I needed an hour's less sleep a day.

29:43I could

29:45think better. I was I could cope with

29:48the same problems.

29:50And this is so weird.

29:53Mentally, I was stronger. It was like

29:56being a younger man.

29:58Um the way

30:00I don't know. You I think you have a

30:02sense of mental horsepower.

30:05Going back to the top of this

30:05conversation, we talked about how

30:07everybody listening right now has a

30:08variety of different health futures.

30:11>> And which which health future they end

30:13up in is going to be determined by the

30:15everyday decisions they make.

30:17>> Yes. Yes. So, I want to really zoom in

30:18on some of those everyday decisions. We

30:20talked about you and your biscuits. And

30:22at the time you said you were you were

30:23probably quite sedentary as a doctor.

30:25Yeah. Sitting in a chair, patients

30:27coming in.

30:27>> yeah. [clears throat] You weren't doing

30:28exercise.

30:30No. Um I didn't fundamentally believe it

30:34would make that much difference.

30:36Hm. And this is such a great point.

30:39You've You've really great point. So,

30:41let's think about weight loss.

30:43So, I would give advice on weight loss

30:46to my patients and I would say eat less

30:49and move more. And I'd even sometimes

30:51say that Belsen thing, you know, the no

30:53fat people came out of Belsen. I've

30:56never heard that before. But it's a

30:57horrible thing to say to a patient,

30:59isn't it?

30:59>> What's Belsen? Well, that that's in

31:01World War II where they all starved to

31:03death.

31:03>> Oh, okay. So, the the point is you're

31:05saying to somebody with an obesity

31:07problem It's their fault.

31:09>> Yes, you're blaming them. That's exactly

31:12the point and that's what I did.

31:15And it's worse than that because

31:18I give them that advice and it just

31:19about never works.

31:22I did a horrible thing. I used to say to

31:24them, "Right.

31:25So, why don't you just have 2 Tbsp of

31:29All-Bran a day?

31:30Oh, breakfast cereal?

31:31>> Yeah.

31:32Uh with skim milk and I would advise a

31:35few multivitamins

31:38and uh a couple of pints of skimmed milk

31:41a day."

31:42That was my advice. And then when it

31:45didn't work, who do you think I blamed?

31:47Them. Yeah.

31:49And [snorts] this was all part of my

31:50epiphany.

31:52I never joined the dots

31:54that the failure was not theirs, it was

31:57mine.

31:59And that's horrible, isn't it? Imagine

32:0125 years of I was blaming patients for

32:04their failure to lose weight.

32:06And it was my failure

32:09because I didn't give them advice that

32:12worked. And if you keep giving the same

32:14advice to people and it doesn't work,

32:16shouldn't I have questioned

32:19But isn't that happening in society

32:21overall? How are we doing? How are we

32:23doing

32:25with health? How's it going?

32:26It's a disaster, isn't it?

32:28So, we need to do something different.

32:31But for me, for 25 years, I did not

32:35believe that lifestyle was key and now I

32:38do.

32:39And that's why I didn't I didn't

32:43think that the biscuits made that much

32:44difference.

32:46Obviously, I knew basic nutrition. So, I

32:48made sure there's protein and there's

32:50iron and stuff.

32:52I fundamentally

32:54believed that

32:56drugs is what I should be using,

32:58medication, and that lifestyle was a

33:01sort of

33:03add-on.

33:04Is that terrible? I I think this is so

33:06important because it really gets to

33:08what I believe the average person thinks

33:11as well.

33:11>> Yeah. Yeah.

33:12>> Um we were talking before we started

33:14recording about some of my friends. They

33:16are There's There's two friends I

33:17mentioned. One of them is a very very

33:18successful businessman.

33:20Um everybody knows who this person is

33:23and they asked me this weekend, "Is

33:24pizza healthy?"

33:26And I just couldn't believe I It shook

33:28>> It's gobsmacking. It's like, "Oh, what?

33:30Pizza? What?" Cuz they were choose

33:31trying to choose between They usually

33:33have a big 12-in pizza Yeah. for lunch.

33:36And And he was asking me, "What's

33:38healthier, Stephen? Nando's chicken or

33:40this 12-in pizza he was going to get?"

33:43And I literally looked at him like I was

33:44looking at a ghost. I was like, "Are you

33:45winding me up?" And he was genuinely

33:47serious. He's what 4 or 60 years old now

33:50and he doesn't know if a chicken breast

33:54is healthier than a 12-in pizza. And the

33:56other example that I mentioned to you

33:58before we started recording is a very

33:59famous Premier League football superstar

34:02legend who you would assume had gone

34:04through those sort of 15-20 years of

34:06being an academy player and then a a pro

34:08athlete knows

34:11what has sugar in and what doesn't. And

34:12he was asking me, "Is Is a big spaghetti

34:14carbonara, is that healthy? Is that

34:16health food?" Because he said to me

34:17during his football years, they were

34:19told always to carb load. And again,

34:21this

34:23It It gave me a huge amount of empathy

34:24because it made me realize how even

34:26though there's podcasts like this where

34:27we talk so much about health and even

34:28though there's the internet now, the

34:30have this information is not getting

34:31through to the average person for some

34:33reason and they too I believe think

34:36exactly what you just said that health

34:37is you know it's this sort of accessory

34:39where

34:41my fate is determined anyway.

34:43And if I do this health stuff which is a

34:45bit of an inconvenience because these

34:46Percy Pigs taste great.

34:48>> Yeah. Um all these these these candies

34:50taste great then I might be able to look

34:53a little bit better a little bit more

34:54aesthetically pleasing but my fate is

34:56determined. The simple point.

35:00Yeah nutrition we're not teaching it. So

35:01there's only three macronutrients.

35:03There's only protein, fats, and

35:06carbohydrate. And yet your friends there

35:09haven't even got the three

35:11macronutrients

35:13and they are successful intelligent

35:15people. So somewhere we're going badly

35:19wrong aren't we?

35:19>> Someone came in and pitched a fruit

35:22snack business

35:24and it's basically dried out fruit

35:26pieces.

35:27Now I looked at the back I'm loving this

35:29already.

35:31I looked at the back and it said in the

35:33range of 60 to 70% sugar because what

35:37they've done is they've taken exotic

35:39fruits like mangoes, dried them out, and

35:42now you have this little chip which is

35:43this piece of mango. 60-70% [snorts]

35:46sugar. So I'm looking at the back of

35:47this thing thinking

35:48this is candy. This is basically candy.

35:51>> Thank you. But I'm looking at around and

35:53every because it because it uses the

35:54word fruit

35:55>> Yes. people have this sort of halo

35:57assumption that if the word fruit is on

35:59it fruit juice fruit will sell. Yeah.

36:02And who and also it's a sort of a cares

36:04about the consequence but will make a

36:05pile of money Yeah. selling dried up

36:07fruit and they miss

36:10what you read on the back. Yeah. And

36:12it's 60-70% [clears throat]

36:13sugar. I was like this is not healthy.

36:15>> How's that? You know what if somebody

36:16had type two that what for kids this

36:18we'll just give them

36:20Yeah. And I

36:23you've touched on another thing about

36:26what's going wrong. So

36:29when we look at my practice and this

36:31epidemic

36:33and really, as I've said already, it's

36:34not an epidemic, it's a pandemic. It's

36:37everywhere. I go all over the world and

36:39obesity, type 2 diabetes,

36:42uh poor metabolic health is in it's

36:45everywhere. It's everywhere.

36:48And I think one of the things

36:50touching on what you just said

36:52is so you you wake up and you have your

36:55cereals for breakfast. Which you've got

36:57some here.

36:58>> Which we have some cereals there.

37:00And then uh you'll have Why don't Why

37:03don't you have a big glass of fresh

37:05orange juice as well?

37:07Great idea.

37:09And then uh

37:11you Okay, that's your breakfast. But

37:12then on the way in, you have a little

37:14snack and people do. They buy a bar or

37:17some crisps or something like that.

37:20And then even at school, they might get

37:21a muffin

37:23mid-morning.

37:24It's fine enough. They might then have

37:25an apple.

37:27At lunchtime, you're going to have some

37:28sandwiches

37:30and then you've eaten your sandwich, so

37:32you'll I don't know, you might have

37:35might have a cake or something or some

37:36ice cream. Then you'll go home and then

37:39it's time for you, you know, maybe your

37:41chips or your pizza.

37:43What you've actually done is have sugar

37:45with your sugar with your sugar. Sugar,

37:47sugar, sugar, sugar all day long.

37:50There's hardly any protein. Going back

37:51then to those macro Where was the

37:53protein to grow you?

37:56You know, and that That's the thing that

37:58[snorts] that's changed over time that

38:00we are

38:02the snacking. So, I've I come across a

38:04lot of young people

38:08and their mother is saying, "I can't get

38:09him to eat any proper food. He just eats

38:12snacks all day long and it it won't I

38:15can't They can't get protein in them."

38:17And some of them are actually thin kids.

38:19They're not all fat. Let's talk about

38:21what you just said there and we can walk

38:23through the day using Yes. the food we

38:25have on this table. Now, I just want to

38:26caution that we do have some people that

38:28are probably out walking their dog

38:29listening and can't see. So, we're going

38:30to have to do a bit of a voice over as

38:32to what's going on. But, you said wake

38:34up in the morning, you have your cereal.

38:35Yeah. Now, cereal growing up I thought

38:38was a health food. Me, too. Yeah. Me,

38:41too. How much sugar is in the average

38:43standard bowl of, let's say, frosted

38:45cereal?

38:46Well, we can do this different ways,

38:48Steven.

38:48>> Mhm.

38:49>> [clears throat]

38:49>> This is actually like a test for you

38:51laid out here.

38:52>> is that for Okay. Yeah, that This is a

38:54test for you and I'll describe it. So,

38:56what you've got, you've got um

39:00a bowl of we'll call them They're corn

39:02flakes. Mhm.

39:04Then you've got a potato a baked potato.

39:07It isn't baked yet, but you could bake

39:09it if you want.

39:10You've got 150 g and this is boiled

39:13rice. So, it's not dry, it's boiled

39:15rice.

39:16You've got a very ripe banana.

39:19And at the end there, you've got a

39:21delicious looking chocolate bar. Yeah.

39:24So, you've got there

39:27uh some cubes of sugar and this is the

39:29test bit, you see, as to how I'm going

39:32to give you We'll score you in the end.

39:34Okay. So, what I'd like you to do is

39:35consider these relatively

39:39and each of those cubes of sugar

39:41represents a 4 g teaspoon of sugar.

39:44Yeah. So, if you could now just go along

39:46these and put beside each food what you

39:49believe to be the equivalent in terms of

39:52teaspoons of sugar and then I'll give

39:54you a score and see how you do. Okay.

39:56>> And And those are the answers, so I'm

39:57going to turn it down so you don't

39:59cheat. Okay, so I'm going to score them

40:01as I would have thought 2 years ago.

40:05Thank you. Yes. Because 2 years I've

40:07interviewed a lot of experts, so I'm I'm

40:08generally quite shocked by all these

40:10things, but I'm going to score them as I

40:11would have thought when I was 31 years

40:13old 2 years ago. Yes, that's great.

40:15>> Cereal, Yes.

40:17Yeah. um I And there's no sugar on it.

40:19It's not a sugared cereal. It's just the

40:21dry flakes. I honestly didn't think

40:23there was sugar in that. Yeah. So,

40:26if you would have pushed me, I would

40:28have

40:29Well, give it one, eh? I'll give it one.

40:31>> Thank you.

40:31>> didn't think there was sugar in that.

40:32>> One. Again, a potato, I didn't think

40:35there was any sugar in a potato. So,

40:38even giving it one feels like I'm lying

40:39because I didn't think there was sugar

40:40in a potato. And I'll be honest, rice, I

40:43didn't think there was any sugar in

40:44rice.

40:45Okay. A banana. Ah. It tastes sweet.

40:47>> Yes.

40:48>> brain would have said one. Yeah. But

40:50this

40:51this chocolate bar that's in front of

40:52me,

40:54I would have said

40:55I'm going to say two.

40:57Okay. Two or

41:00I'm going to say three. Right. I'm going

41:01to say three. I actually think it was

41:02two, but Right. That's how much sugar I

41:04would have thought was in all of these

41:06things here. Cereal, a potato, white

41:07rice, a banana, and a chocolate bar.

41:10Right. Well, To be fair, I still kind of

41:11do, but I know better.

41:12>> [clears throat]

41:12>> So, now I'm going to give you the

41:14correct

41:15figure.

41:16Now, uh this is worked out from the

41:19glycemic load that we already discussed.

41:23So, I explained about the glycemic load.

41:26And then,

41:28so, in clinical practice, I had a

41:29problem.

41:30My problem was in 10 minutes trying to

41:33explain to you how you could eat

41:35differently and why you should eat

41:37differently.

41:38And so, I needed a way of quickly

41:41communicating with children, with old

41:44people, with a teacher,

41:46the consequences of dietary choices.

41:49Mhm. So, I came up with a new idea,

41:52which was why don't we represent the

41:55glycemic load,

41:58and instead of using

42:00grams of glucose, which nobody

42:02understands, and what's glucose anyway,

42:05instead of doing that, we redid the

42:07calculations,

42:09redoing it for tea four-gram teaspoons

42:12of sugar. And that's my teaspoon of

42:15sugar equivalent system and I'm using

42:18that now to give you the correct answer.

42:20Okay. Right. So, the the cornflakes is

42:23one, two,

42:27four, [snorts]

42:28five,

42:30six, seven, and eight.

42:32One, two, three, four, five, six, seven,

42:37eight.

42:38And with no frosting? No frosting. I

42:41know. No milk, nothing.

42:44The potato, obviously it depends on its

42:46size. That's quite a big one.

42:49So, that one is one, two, three, four,

42:52and there's more.

42:54Five, six.

42:58Is nine.

43:00There they go. Nine.

43:02>> Equivalent of nine sugar cubes. Is that

43:03nine? Yeah. Right.

43:09And we're going to leave the rice till

43:10last.

43:11That chocolate bar

43:14is actually You could do it for me.

43:16Yeah. Is seven

43:19and a half. So, you

43:21you can give it seven. Seven.

43:25Seven.

43:27Now, the banana depends on the size and

43:30how ripe it is.

43:32A ripe banana has more sugar in it as

43:34you probably know when you eat it. But

43:35that Let's say that banana is quite a

43:38ripe one. It looks quite ripe. Let's say

43:39that's six cuz it's a big banana. Oh my

43:42gosh.

43:47Okay.

43:48Then, the final one

43:50obviously is going to be the killer,

43:52isn't it?

43:54I thought rice was healthy.

43:57Well, I I thought rice was

43:58>> really healthy.

44:00>> Depends. So,

44:01one. This is 150 grams of boiled rice.

44:06three,

44:07four,

44:08five,

44:10six,

44:12seven,

44:14eight,

44:15nine, and

44:1710. So, that's the winner.

44:19And I would say that's the single fact

44:22around the world. So, my my teaspoon of

44:24sugar,

44:26there we are.

44:27That's one of my teaspoon of sugar

44:28charts. So, what you've got there is the

44:31food,

44:33the glycemic index,

44:36the the serving size, and then the

44:38teaspoons of sugar there. So, this is

44:41available. The Public Health

44:42Collaboration is a charity I helped set

44:45up with Dr. Rangan Chatterjee

44:4710 years ago. It's our 10th anniversary

44:49tomorrow.

44:51These infographics,

44:54there are actually [snorts] far more

44:55than this. This is the seven more.

44:57They're available in 35 languages.

45:00Volunteers have translated this to go

45:02all over the world.

45:04It's not copyrighted. I want people to

45:06steal it, take it, use it. So, the

45:10>> [snorts]

45:10>> the white rice fact,

45:13I would say

45:15has astonished people all over the world

45:17and led to me becoming far better known.

45:20What what about orange juice? A lot of

45:23parents, including my parents, give me

45:25gave me orange juice. And I used to

45:26think orange juice was a health food.

45:28So, I would literally I'd go to the

45:30fridge, I'd get open the SunnyD or

45:31whatever it was. SunnyD. And I would

45:33drink that and I'm going to be strong

45:36and big and my body's going to love me.

45:38Well, let's

45:39So, that there's a lot of sugar in

45:41orange juice. It's a lot of sugar in

45:43orange juice. And you've taken away all

45:46the Once you take it from the fruit

45:49as it was meant to be and you juice it,

45:52the sugar hit is fast. Mhm. So, what

45:55that does

45:56is

45:58if you think if we go back to insulin

45:59again,

46:01>> [snorts]

46:01>> um

46:03So, you you you drink the orange juice,

46:05your blood sugar goes up rapidly.

46:08So, your body responds rapidly with

46:10insulin.

46:11Then, you What happens? Your blood sugar

46:13falls.

46:15But then you kind of hungry again.

46:17And that's what happened to me with the

46:18biscuits, wasn't it? I ate biscuits.

46:22My blood sugar is up. Then insulin comes

46:25in heavy and slow, but too much. Then I

46:28thought I was having a panic attack cuz

46:30I had low blood sugar. And what's the

46:32answer to that? More biscuits. And round

46:34you go. Round. And that's how without

46:36thinking, you'd start the day starting

46:39the day with a sugary breakfast

46:42without enough protein in it is driving

46:45hunger. And then you wonder why you're

46:48ravenously hungry at 10:00.

46:51There was a few others that shocked me.

46:52One of them was I was in Peru. And

46:55obviously Peru's quite famous for

46:56chocolate cuz of the cacao and all that

46:57stuff. And so we went to a chocolate

46:59making class.

47:00And he told us to make dark chocolate,

47:03normal chocolate, and then white

47:05chocolate. Yeah. And when I made the

47:07white chocolate, this guy got me this

47:08big glass cylinder.

47:11And he goes, "Here's some white sugar."

47:13He goes, "Pour it in." So, I you know, I

47:14get it and I pour some in and I And he

47:16goes, "No, no, no, no, my friend. Pour

47:18it in."

47:19>> Yeah. And I pour it and pour it and pour

47:21it and pour it and pour it and pour it

47:22and pour it. And I'm not kidding you. I

47:24feel like And I have to check the facts

47:26here. So, community note me on the

47:28screen, divers your team. I feel like I

47:30poured into this huge glass cylinder

47:33Yeah.

47:33it 80% of white sugar. Yes, you would.

47:37And then It's true. Yeah. And then he

47:39And then he said, "Put put some syrup

47:40in." I was like, "What?" I said, "This

47:42is This is white sugar." It was like

47:43some syrupy stuff, some oil stuff. And I

47:45was like, "So, white sugar um So, white

47:47chocolate is like 80% white sugar?"

47:50Yeah.

47:51I've never eaten white chocolate since.

47:54Ever.

47:55You That's so important. So, very often

47:57people think they're a chocoholic.

48:00That's really common [clears throat]

48:01that people say to me, "I'm I'm addicted

48:03to chocolate."

48:05If you look at If you actually look at

48:06how much sugar there is in milk

48:08chocolate,

48:09uh

48:10you know, there's many teaspoons of

48:12sugar in milk chocolate.

48:15If you eat

48:1690% dark chocolate, there's only about

48:19two teaspoons of sugar in a bar.

48:22And what you find with the chocoholics

48:23is I say,

48:25"Oh, if you're addicted to chocolate,

48:27why don't you get a bigger hit and have

48:29the dark chocolate?" And they say, "Oh,

48:30I couldn't eat that. It's too bitter."

48:32What they're actually addicted to is the

48:34sugar.

48:35What they're So, I've done that There is

48:37for the the folks at home, there is one

48:40of these sugar infographics on

48:43chocolate on that subject of chocolate

48:45because I want people to understand

48:48the consequences of what they do.

48:50So, just to illustrate this cuz I've

48:53just

48:54I've just looked up the stats, right?

48:56>> Yeah. So, I think this is this is this

48:58is what I saw, right? I've just looked

48:59up the facts to make sure one thing is

49:01true.

49:03When I made that bar of white chocolate

49:05in Peru,

49:05>> Yeah. this

49:07was the total ingredients, and this is

49:09how much sugar I they asked me to put

49:11into it. Blinding.

49:12>> I I looked at it and thought, "Okay, so

49:14white chocolate is basically like 70-odd

49:16percent just pure white sugar."

49:19>> Yeah. And nobody knows. Yes, exactly.

49:22>> Exactly.

49:22>> The other one I've got a bee in my

49:23bonnet about is smoothies. Yes, I

49:25>> I had one, too. I thought smoothies were

49:27healthy. Yeah. No.

49:29They're the

49:30You know, I'm on X or Twitter quite a

49:32lot, and that's the kind of thing fills

49:34me with rage, and I have to take a photo

49:37with like my Look at the sugar. Uh

49:40there was Yeah, it fills me with rage.

49:42I've got another thing. This is fun.

49:44I've got another I've got a question.

49:45Right, [clears throat] Stephen.

49:47>> [sighs and gasps]

49:48>> Why don't we We could take all the blood

49:50out of me, right? There'd be 5 L. We

49:53could bleed me out right now, there

49:55would be 5 L of blood in me.

49:58Let's get it in a bucket, all right? 5 L

50:01of blood.

50:02How much sugar would be in that 5 L of

50:06blood?

50:08I've no idea. I don't Well, it's an

50:09interesting question, isn't it? Because

50:11it relates to

50:13the consequences of eating some of these

50:15things.

50:16So, [snorts] I would just like you to

50:18estimate So, let's say my blood sugar is

50:21normal. Yeah. Um

50:24if you have a normal blood sugar, I

50:26would like you to guess how much sugar

50:28is there in my entire blood system.

50:31>> At one one cup like this.

50:34Thank you.

50:35No.

50:36The answer is this. Let me show you.

50:40That is all there is.

50:42You're joking.

50:43>> I am not. And you see immediately One

50:45sugar cube.

50:46>> That's all. And I'll do it on Twitter

50:48for you, X. I can show you the

50:50calculations.

50:52So, you see, if I have a banana

50:55and I have diabetes, that there's too

50:57much sugar for me.

50:59See, because glucose is number one

51:01vital, but number two toxic if you have

51:04too much of it.

51:06The level of it in my blood is

51:07controlled minutely. Wow. It's

51:10controlled to this extent.

51:13And I think that single fact You didn't

51:15know that, did you?

51:15>> No, I did not at all. And it it

51:16immediately shows you how it's so easy

51:19to have more sugar than you actually

51:20need.

51:22Given that And if your insulin stops

51:24working.

51:24>> So,

51:25for me,

51:27I've done an awful lot of this. So, I

51:28monitor my blood sugar with a continuous

51:31glucose monitor.

51:33And I get my blood sugar up on my phone.

51:35So, I can check at any time what my

51:37blood sugar is, and we'll do it in a

51:39minute and see.

51:40But you see, if I if I eat a banana,

51:44it doubles my blood sugar because I

51:46can't regulate my blood sugar. Because

51:48of the diabetes. Yeah. So, So, a whole

51:50banana

51:52is far too much for me

51:54and will double

51:56my blood sugar. Because you see if I'm

51:58only supposed to have this much and I

52:00have that much

52:02it's too much for me and I feel ill.

52:04Giving you know, I go out into the world

52:06and I speak to the people that listen to

52:08the show and they're like taxi cab

52:09drivers. There's a lot of taxi Do you

52:11know I wonder I I've got this bias

52:12towards thinking everybody that listens

52:14is a taxi cab

52:15I've got this bias towards thinking

52:16everybody that listens is a taxi cab

52:18driver because I really only spend my

52:20time in the office or in a taxi. So, I

52:22get lots of feedback from these cab

52:24drivers. And the average person out

52:26there listening now

52:28they don't know how to check if the food

52:31they are eating is good or not because

52:33the labels on these foods I I've got so

52:35obsessed by the marketing. Yes. And you

52:38know, I I I was looking at this bag of

52:40sweets the other day and it said made

52:42with real fruit juice and they put

52:44[snorts] it front and center. And I I I

52:46was almost tricked.

52:48So, I can't imagine someone who like me

52:49who doesn't spend I can't imagine

52:51someone who doesn't spend their time

52:52interviewing health experts

52:54how easily the general public is being

52:56tricked. So, what is your advice in

52:57terms of

52:59spotting this stuff? Like what do I look

53:01at? Cuz right now I spend a lot of time

53:02looking at the sugar part.

53:03>> Yeah, that's great.

53:05There's different ways we can do this

53:06and obviously this is how I spend every

53:08clinic. That's I'm in clinic yesterday.

53:10This is what I'm doing. I'm trying to

53:11help people understand.

53:14It's sometimes easier to talk about what

53:17maybe what you would eat rather than

53:19what you wouldn't eat.

53:21So, I for somebody

53:23with insulin resistance or type 2

53:25diabetes, I would tend to say well, why

53:28don't you base your meal on protein? So,

53:31what have you got in the fridge?

53:33Could it be chicken? Could it be eggs?

53:36What would it be?

53:38>> [snorts]

53:38>> So, that's your protein. Have loads of

53:40it. Yeah. Then I'm thinking, right,

53:43green veg.

53:45Will you What green veg is would you

53:46tolerate? What green veg could you buy?

53:48It might be frozen beans, or it might be

53:51salad, or whatever.

53:53And then I'm saying, how would you make

53:54that green veg

53:56tasty? Put barbecue sauce on the top.

53:58Ah, no, full-fat mayo. Full-fat mayo, or

54:02butter, or olive oil, or whatever. So,

54:05that I say barbecue sauce because when I

54:07looked at the back of mine, I had the

54:08shock horror of realizing It's a It's a

54:10It's a common one. 30 sugar cubes in a

54:14bottle a standard bottle of barbecue

54:16sauce.

54:16>> Table.

54:17It's just pouring sugar on top.

54:18>> is. It is. You have to be so vigilant,

54:20and I I think to do it successfully,

54:23I'm quite interested in the idea of

54:25could you eat real food that's not in a

54:27packet?

54:29It's It's It's Russian roulette, food

54:31out of packets. And yet, I understand my

54:35patients north of Liverpool,

54:37you know, where are they going to buy

54:38the stuff? So, I try and help them with

54:41You could do it that way.

54:43If you're not If you're going to eat

54:44stuff out of packets, you have to wise

54:46up, and you have to look at the

54:49carbohydrate content,

54:51and bear in mind every 4 g

54:55is

54:56broadly equivalent to sugar. So, if if

54:58if there's a If there's If something's

55:01got 100 g of carbs in it,

55:04I've already said carbohydrate varies in

55:06how sugary it is, but it gives you an

55:09idea it's very sugary. So, you see the

55:11the area you made with the cornflakes

55:13Mhm. is there's no sugar there, but it's

55:15all carbohydrate. Mhm. And it It's a

55:17very sugary carbohydrate. I think So, we

55:20need to just explain that for for

55:21people, which is

55:22>> Yes. When I looked at those cornflakes,

55:24the question I asked you, is they're not

55:25frosted, so there's no sugar on them.

55:27But, what the body is doing is it's

55:29converting the carbs into glucose.

55:32Right, I've got a good way.

55:34So, we have to think of starchy carbs

55:37as

55:38actually glucose molecules holding

55:40hands. Okay. And then digestion comes

55:43along and breaks down

55:47they're they're not holding hands

55:48anymore and they become free sugar

55:50again. Cuz we think if it's not sweet,

55:52it's not glucose.

55:53>> Exactly. Exactly. I don't know whether

55:55when you went to school, was there this

55:56thing where you chewed bread for ages

55:59and then you could see if it became

56:00sweet or it turned into sugar. I didn't

56:03know.

56:03>> schoolboy experiment that's done a lot

56:05to prove that uh the amylase, the enzyme

56:09in spit

56:11uh turns starch into sugar. But that's

56:14the point. Starch is soon to be sugar.

56:17It's glucose holding hands. Yeah.

56:19>> And when it holds hands, it's not sweet,

56:21but then when you digest it

56:22>> Exactly. it's no longer holding hands.

56:24>> Perfect. And that was is broadly what

56:27and you're not alone because didn't I

56:28make that error?

56:30Isn't that what the lady in 2012

56:34that's what she was so furious that I

56:36was made So here here we are, senior

56:38partner of a large practice

56:41had forgotten

56:43uh that starch was sugar and we've come

56:46full circle because and so many other

56:48people

56:50they they

56:51patients say to me, "Dr. Unwin,

56:54I know

56:55uh not to have sugary things. I've given

56:57up sugar in my tea and coffee and I

57:01don't understand why my blood sugar is

57:03so high."

57:05People say that very often and then of

57:06course we use the teaspoon of sugar

57:07equivalents or a continuous glucose

57:09monitor to really show them what's going

57:12on.

57:13Something that a lot of people have is

57:15bread. Yes. Um white bread. So I I did

57:18some research and it said a single slice

57:19of white bread contains about 0.5 sugar

57:22cubes, but a full loaf can pack up to 12

57:25cubes of sugar in it.

57:27That's true.

57:29But it doesn't

57:31it doesn't include the fact that the

57:34wheat that makes the bread will turn

57:36into sugar as well. Okay. So, on my

57:38teaspoon of sugar equivalent

57:41even a small slice of brown bread is

57:44about three teaspoons of sugar. Is there

57:47a healthy bread?

57:49Now, that's a really great great

57:51question.

57:52And of course, it depends

57:54how well your insulin's working.

57:57So, if you're young and you take a lot

57:59of exercise and your insulin's really

58:01good

58:03then

58:04maybe brown bread is is okay. If you're

58:07like me though with insulin resistance,

58:09there it it would have to be a low-carb

58:12bread.

58:13So, I wouldn't normally eat bread under

58:15any circumstances, but I might have

58:17low-carb bread. I did some research that

58:21sprouted grain bread, never heard of

58:23that before, or 100% whole grain rye are

58:26the healthiest options because they

58:27contain zero added sugar and high fiber.

58:29So Right. I mean, what I'd say to people

58:34again, it depends

58:36how much exercise do you take? How do

58:38you know?

58:39Have you had your fasting insulin

58:41measured? Do you know if you're insulin

58:43resistant or not? Mhm.

58:45Um

58:47if you're healthy, take lots of

58:49exercise, sounds good. Fair enough. If

58:51you if you're beginning to develop a

58:53tummy, well, maybe not so good. And if

58:55you don't know

58:58I'm a great one for experimenting.

59:00And that's where I come back again

59:03to consider

59:04uh buying a continuous glucose monitor.

59:08The thing you wear on I've got one on me

59:09now, and it tells my phone how is my

59:11blood sugar, so I can experiment. Then I

59:13could try your bread, and within an hour

59:16I would know.

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1:01:21Am I wise to be looking at the back of

1:01:23packets? I look at the back of

1:01:25everything I eat. Yes. And I'm building

1:01:27I guess a mental model of the different

1:01:29levels of carbohydrate and sugar content

1:01:31and fiber and all these other things and

1:01:32proteins etc. But I always seem to zoom

1:01:35in on the sugar.

1:01:36Yes. The added sugar.

1:01:38Ah, right. There is an error there.

1:01:40Okay. So you that's brilliant and you

1:01:42the fact you're interested and trying

1:01:45is great because you'll learn so much

1:01:47more. Because of course

1:01:51the sugar is one thing but you must also

1:01:53look at the carbohydrate.

1:01:55The carbohydrate content. Now

1:01:58um this is done differently in the

1:02:00United States from here.

1:02:03Confusingly, here we talk about

1:02:06carbohydrate

1:02:07separately from fiber.

1:02:10So that in the

1:02:13UK when it says sugar.

1:02:16In the States you've got uh the

1:02:19carbohydrate including fiber. So it

1:02:22makes it more complicated for you.

1:02:24Because you need to know which

1:02:27how much of that carbohydrate are you

1:02:28going to absorb? Well, let's go back to

1:02:31the three macronutrients. So

1:02:34you should be interested in

1:02:36protein. How much you want you want you

1:02:38want to be a muscly kind of guy so you

1:02:41need want your protein.

1:02:43Uh the carbohydrate Well, why do you

1:02:45need that? I'm wondering.

1:02:47And then fats. Well, you might need

1:02:49those for fat soluble vitamins. So those

1:02:51are the

1:02:52uh the three things so that you become

1:02:55more sophisticated. And if things have a

1:02:57lot of preservatives, if they have an

1:02:59awful lot of ingredients, I'm

1:03:01immediately suspicious. I think one of

1:03:03the things that people that I've come to

1:03:05learn through interviewing people like

1:03:06yourself is that it's not just a direct

1:03:08consequence of

1:03:09having a big glucose spike or

1:03:13you know, having high blood sugar. It's

1:03:15also the fact that when I eat things

1:03:17like Mars bars or the white rice here,

1:03:20I then get more hungry later. Exactly.

1:03:22>> I eat even more sugar that same day, and

1:03:24the next day, and the next day.

1:03:25>> course, that's what my patients, right

1:03:29back in 2013, it was the absence of

1:03:31hunger they found fascinating. And I did

1:03:33cuz I'd been hungry all my life. Because

1:03:36all my life I'd been uh

1:03:39carb heavy. And I didn't realize that

1:03:42the more carbs you eat the hungrier you

1:03:43become. I don't know, have you ever

1:03:45tried fasting? I bet you have.

1:03:47>> gosh, yeah. Right.

1:03:48>> I fast most days to be honest. I'm I

1:03:50haven't eaten today. And it What What

1:03:51time are we in? We're What I don't know.

1:03:52Uh

1:03:531:00 1:00 p.m. And during the Dragon's

1:03:55Den filming, I I don't eat often until

1:03:58the evening. So Great. So, isn't that

1:04:01interesting?

1:04:02So, I used to I used to have a model

1:04:04which was

1:04:05um that if I didn't eat, I was hungry,

1:04:08right?

1:04:09>> Mhm. So, if I didn't eat for even

1:04:12twice as long, I'd be twice as hungry,

1:04:14and it would rise exponentially until I

1:04:16went mad.

1:04:17>> Yeah.

1:04:18And what's surprising that you must have

1:04:20found is as you fast, you don't become

1:04:22more hungry, do you?

1:04:23>> Yeah, it's crazy.

1:04:24>> Well, isn't that interesting?

1:04:25>> Mhm. That actually get the more I eat,

1:04:27the hungrier I become. It's the same

1:04:29when I'm on keto. Pardon? When I'm on

1:04:31keto.

1:04:32>> Yeah. I I can't believe I can't It's

1:04:34like

1:04:35hunger just vanishes. And you know the

1:04:36thing that the remarkable thing I love

1:04:38What are those cinnamon roll things? I

1:04:39love those cinnamon rolls usually. I

1:04:41love them. And when I started doing the

1:04:43ketogenic diet, which is very, very very

1:04:45low carb, I remember walking up to this

1:04:47cinnamon roll concession stand in Cape

1:04:49Town, and looking at them, and they were

1:04:51doing nothing to my brain. There was no

1:04:54temptation, no craving.

1:04:55>> had that.

1:04:56>> I said, "Where's the craving?"

1:04:58>> Yeah. I honestly I've had that with

1:05:00Christmas cake. It was my kryptonite. It

1:05:02was the kind of thing

1:05:04I was sneaking down when they'd all gone

1:05:07to bed and having more.

1:05:09And then one day you can look at it and

1:05:10it and you think it's not actually food.

1:05:13Mhm. Your brain know

1:05:14that isn't food. Yeah, exactly.

1:05:16>> And and I'm the same with buns as well.

1:05:18And all sorts of things that a lifetime

1:05:21of and they're no longer food. And it

1:05:23feels like a superpower cuz I can I'm

1:05:26such a man. In fact, I I throw this down

1:05:28as a challenge to men.

1:05:30Are you man enough to resist, you know,

1:05:33what whatever it is? Mhm. Let's do a

1:05:36challenge. Come back in a week and tell

1:05:38me you've not had any biscuits.

1:05:40Mhm. It it it it works. It works. What

1:05:43do you think of the ketogenic diet?

1:05:47Wow, that's a Oh, that's a big question,

1:05:49isn't it?

1:05:52And don't you think we need to begin

1:05:53with what you want?

1:05:55So, I think we need to begin with your

1:05:57goals and hope. So, why would Is it Are

1:06:01you wanting

1:06:02to lose weight? Are you wanting to sort

1:06:05out type 2 diabetes or I'm I mean,

1:06:09Georgia Ede to Georgia Ede is a close

1:06:11friend. Mhm. And nutritional psychiatry

1:06:13is really growing in the is Ian Campbell

1:06:16in Edinburgh University is doing some

1:06:18amazing work with bipolar disorder and

1:06:20other things.

1:06:21So,

1:06:22why you doing it? That's So, that's my

1:06:24first thing because

1:06:26this is I see it as there is a spectrum

1:06:29of carbohydrate that you're on.

1:06:31So, I try and find out where are you

1:06:32now?

1:06:34And I, you know, approximately where are

1:06:35you now?

1:06:37And then I'd say, "Well, could you Could

1:06:39you

1:06:40give up bread or reduce it?"

1:06:43And then I'd say,

1:06:44"Let's Let's measure whatever parameter

1:06:46we want, which might be blood work or

1:06:48weight or whatever. Then we say, 'How

1:06:50are you doing?

1:06:52Are you happy now? Is this Is it?

1:06:55Or do you want Would you like to go a

1:06:56bit lower?' And what I've discovered

1:06:58with my patients over 13 years is they

1:07:01tend to go lower over time because when

1:07:03they experiment

1:07:05when they go keto, what they like the

1:07:07brain thing. Oh, gosh, yeah. And that's

1:07:10what I'm That's Right. So, I would say

1:07:12to you now, cuz I'm interested, why

1:07:14would you go keto? What are you after?

1:07:17Um so, I'm going to put the brain thing

1:07:18at the top of the list, which is just

1:07:19the clarity of thought. Obviously, in my

1:07:21job, I have to sit here with very smart

1:07:22people like you, and I have to talk

1:07:24sometimes for 3 4 hours, whatever it

1:07:25might be. But also, I'm on television a

1:07:27lot now, and I'm speaking, and you know,

1:07:29cameras nine cameras rolling, BBC One,

1:07:32and I've got to think of something smart

1:07:33to say to this entrepreneur sitting in

1:07:34front of me on That's pitching to me.

1:07:36And then also, I'm in meetings, you

1:07:38know, I'll leave this conversation now,

1:07:39and I'll go straight downstairs, and

1:07:41I'll have 2 hours of straight meetings

1:07:42about very very complicated things about

1:07:44buying companies. I'll be meeting

1:07:45founders, interviewing people. And what

1:07:47I've noticed profoundly, because so much

1:07:49of my job centers on speaking and

1:07:50articulation, is there is this wild wild

1:07:53wild variance that I hate.

1:07:55And what I mean by that is some days I'm

1:07:57on it, Yeah. and some days I'm almost

1:08:00embarrassed by my inability to string a

1:08:01sentence together. Yeah. Today, I'm I'm

1:08:03almost testing myself now by trying to

1:08:05speak really really fast and think my

1:08:06brain's connected to my mouth. That's

1:08:07That's actually like what I do. I try

1:08:08and see if I if it flows out. Today, I'm

1:08:10okay. Yeah. Um but there are days where

1:08:13I'm stumbling over myself. Yeah. And I

1:08:17go, "What's What's causing this? What's

1:08:18the causal factor, and how do I prevent

1:08:20this?" That's one. Keto, when I mean

1:08:22keto,

1:08:23I always sound like Busta Rhymes. It

1:08:24always just

1:08:26Yeah. It always It's always It's always

1:08:27working.

1:08:28And then I'd say

1:08:30the aesthetic stuff, cuz I want to look

1:08:31good as well, especially for, you know,

1:08:32my fiance. So, I want to be in shape. I

1:08:34want to be Uh and then I'd say the third

1:08:36is being strong. And then the fourth is

1:08:39I want to live long. Exactly. I want to

1:08:41have a long health span, not just a long

1:08:43life span, but I want to be able to do

1:08:45things as I age. So, you see, you're

1:08:47That's exactly what I began this meeting

1:08:50with.

1:08:51You've got a clear idea about your

1:08:53preferred future. Mhm. And it's it's

1:08:55it's it's fairly specific, too. And the

1:08:57more specific you are, the more likely

1:09:00you are to be successful. And then

1:09:02you're noticing. Then afterwards comes

1:09:04the feedback. Do you think most people

1:09:05even have thought about this?

1:09:07No. I was just thinking about my

1:09:08listeners, and I was thinking, they're

1:09:10listening right now. I wonder if they

1:09:11have written down their top four. Yeah.

1:09:14So, I Do you know what I'd love to do

1:09:16now is tell you something about my

1:09:17wife's work because it relates to

1:09:20changing behavior fast.

1:09:22And that She won't mind. So, that we're

1:09:25back to Jen now, clever woman. She spent

1:09:272 years

1:09:29um thinking about CBT.

1:09:32And what was what This is a type of

1:09:34therapy, and what were the necessary

1:09:37parts of it, and what was junk.

1:09:39And she reduced CBT down to something

1:09:41I'll teach you right now.

1:09:43All right? So, we'll Off we go. Off we

1:09:45go.

1:09:46So, the first thing is to think about

1:09:50your health goals.

1:09:52So, to think about what in a year's

1:09:55time, if what you do is great, how does

1:09:58that look specifically?

1:10:01So, I'll give you an example. You might

1:10:04think you'd like to lose weight.

1:10:06But that isn't specific enough. I want

1:10:08to know

1:10:10what difference would that make to you?

1:10:12So, you we'll do it now. So, if you you

1:10:14said you wanted to be in shape, what I

1:10:17don't know what do you mean by that? Do

1:10:18you want to lose weight? What do you

1:10:19Tell me more.

1:10:21>> [snorts]

1:10:21>> Um I want to be

1:10:25able to

1:10:29Hmm.

1:10:30>> [clears throat]

1:10:35>> What I'm really, I think, scared of,

1:10:39I'm going to be completely honest, Yeah.

1:10:40is I'm scared of

1:10:49having the same health profile as my

1:10:51dad.

1:10:52Ah, right. Yes.

1:10:53>> Because I've seen We have the same, you

1:10:55know, we have a lot of the same

1:10:57genetic profile. Yes.

1:10:59>> So,

1:11:00I think a lot of us look at our parents

1:11:02and go, "Is that my future?"

1:11:04>> Yes.

1:11:05Yeah. And to make it even more specific,

1:11:08I remember walking down some stairs.

1:11:10I've said this once before, but I

1:11:11remember walking down some stairs in

1:11:13Bali, long steep set of stairs, down to

1:11:16go white water rafting with my fiance.

1:11:19Yeah. And I remember as I walked down

1:11:20the stairs recalling that my dad loses

1:11:23can't walk up a single flight of stairs

1:11:25without problems. And I remember

1:11:27thinking, "Oh, my dad wouldn't have been

1:11:29able to come white water rafting because

1:11:30we've got to walk back up these stairs."

1:11:32And so, my dad would have lost out on

1:11:33one of the great joys of life, which is

1:11:34doing enjoyable things with friends and

1:11:36people you love because his health is

1:11:38now in that regard is gone.

1:11:41Um so, I I've always thought of that.

1:11:43And then generally, like I I remember

1:11:45when I was younger, my dad used to play

1:11:46like football with us and and all these

1:11:48things and he's unable to do that now.

1:11:51Um

1:11:52and [clears throat] so, I'm And all

1:11:54because I've done this podcast so many

1:11:55times with health experts, I realized

1:11:57that the decisions I make at 30, which

1:12:00is where I am now,

1:12:01exist on this really interesting, quite

1:12:03predictable curve of inevitable decline.

1:12:08However, not like inevitable

1:12:14uh loss of lifestyle. What I mean by

1:12:16that is I just have this picture in my

1:12:17head of all these graphs I've seen where

1:12:19like your peak is around maybe 2030, and

1:12:22then you going down, which we all

1:12:23accept.

1:12:25But how far you go down is determined by

1:12:27decisions you make right now.

1:12:28>> Absolutely. The decisions I make now

1:12:30will end me at 70, 80 years old in

1:12:32either the inability to walk

1:12:35or the ability to run. Yeah. And it's

1:12:38all about what I do now. It is. So, that

1:12:41Let's just refine that so we we we we we

1:12:44I've got your goal Yeah.

1:12:45>> now.

1:12:46So, let let's park your goal.

1:12:49Now, Now next thing we've got is in the

1:12:52past

1:12:53what have you done that's worked

1:12:56towards those goals? So you probably

1:12:57tell me some stuff you've done that's

1:12:58worked.

1:13:00Um

1:13:03little things like going to the gym.

1:13:04>> Yeah, yeah, anything. Anything quickly

1:13:06that you did that worked that that was

1:13:09is is a is a first, you know, helped

1:13:12that you did and you remember that

1:13:13worked. So tell me anything. I said to

1:13:15myself one year that I was going to go

1:13:16to the gym every single day. Terrible

1:13:17idea. Because I got 5 months in and then

1:13:19I missed today then it was over. I said

1:13:21to myself another year, I think it was

1:13:222017, that I'm going to get a six-pack

1:13:24for summer. Terrible idea. Because when

1:13:27summer came or I got the six-pack

1:13:28>> My question was what did work in the

1:13:30past, not what didn't work. So what has

1:13:32worked for you in the past?

1:13:34>> So those two incidents um helped me

1:13:36change my idea and the idea that I came

1:13:39up with was I set not a

1:13:41achievable thing as a goal, but

1:13:43consistency is the goal. Correct.

1:13:45>> became for the last 4 years this idea

1:13:48that the goal my fitness goal is

1:13:50consistency means that every day I wake

1:13:52up I get a shot at it and if I up

1:13:54today then I've got another shot

1:13:55tomorrow.

1:13:56>> Right. Right. Leave it there. That's

1:13:57good. So we we did the goal and then we

1:14:00did the next thing. What What I just The

1:14:02next thing is is resources. Mhm. So it's

1:14:05it's

1:14:06what do you bring to the consultation

1:14:09that you've done in the past?

1:14:11Intelligence, resources, friends that

1:14:13will help.

1:14:14>> Yeah. You come already with expertise in

1:14:17yourself. So it's not I'm not the expert

1:14:19to tell you what to do. You've already

1:14:21got some stuff. And then we go to the

1:14:23next thing.

1:14:24So if we had your goal at the beginning

1:14:27which was the fitness and the so on so

1:14:31today

1:14:32what might be a small step towards your

1:14:35goal, a realistic small step towards the

1:14:38goals we've already established?

1:14:45So I can think of two. Good. of them is

1:14:48uh

1:14:48creating a social pact, which again was

1:14:51one of the things that helped. So, we

1:14:52made a WhatsApp group. This is quite

1:14:53funny. We made a WhatsApp group. We put

1:14:5510 friends in it. We made a simple rule.

1:14:57Whoever's the least consistent every

1:14:58month is evicted, and we invite a new

1:15:00friend in. Wow.

1:15:01>> We've done that for 4 years. I've not

1:15:03been evicted in 4 years, which means

1:15:04that I'm doing enough I'm consistent

1:15:06enough over those 4 years to not be

1:15:08evicted. Every day when we work out, it

1:15:10puts our workouts into the group chat.

1:15:12>> Yeah. And um every every week and every

1:15:15month um there's a winner, and there's

1:15:17this league table, and you get these

1:15:19little emoji medals, and there's

1:15:21actually I what one one year so I've got

1:15:22this physical massive gold belt on my

1:15:24bookshelf at home that says fitness

1:15:25blockchain world champion.

1:15:26>> Brilliant. So, I've done that for 4

1:15:28years. Um so, social pact really helped

1:15:30me. The the sort of accountability to

1:15:32others.

1:15:32>> Yes. Yeah.

1:15:33And

1:15:34the other

1:15:36the other honestly was just

1:15:39>> [clears throat]

1:15:40>> as I said a second ago, when I set the

1:15:42the goal of going to the gym every

1:15:43single day, I set myself up for failure.

1:15:45Now,

1:15:46I set myself the goal of consistency,

1:15:48which means that I can do have bad days

1:15:50where I do 20 minutes or 15 minutes.

1:15:52Yesterday, cuz I was finished Dragon's

1:15:54Den late, drove down to London, got home

1:15:55at 1:00 a.m., I did 18 minutes.

1:15:58>> of success really helped me to

1:16:04keep my feeling of momentum. Brilliant.

1:16:07We're nearly at the end of your degree

1:16:09in psychology.

1:16:10>> Okay.

1:16:10>> And then [clears throat] I'm going to

1:16:11pull it together.

1:16:12The final thing is

1:16:14um when things

1:16:17if you What would you notice

1:16:19for you when things are going well? What

1:16:22would you notice?

1:16:25So, you've done some of these things.

1:16:27What is it you actually notice? I mean,

1:16:29the benefit to me

1:16:30>> Yes. Yeah. Yeah. What you What do you

1:16:32notice? So, if you do If tomorrow is a

1:16:34really good day, what might you notice

1:16:36at the end of it cuz you've much

1:16:38experience in this now? What would you

1:16:39notice?

1:16:41I mean, the first thing that comes to

1:16:42mind is just how I feel. Yes. I just

1:16:44feel

1:16:45Do you mean emotionally or

1:16:46energetically?

1:16:47>> [clears throat]

1:16:48>> Great.

1:16:48>> All of it. Emotionally, I feel good

1:16:49about myself.

1:16:50>> Yeah. Um energetically, I feel more

1:16:52energetic.

1:16:54Um and there is this um

1:16:58there is this element of identity in

1:17:00there where I have a an opinion of

1:17:02myself and who I think I am, and I think

1:17:04I'm a healthy person, and I think I'm

1:17:05someone that's in control. And when I'm

1:17:07when I'm not going when I'm not

1:17:09performing the consistent behaviors that

1:17:11I want to,

1:17:12I think I start to question that

1:17:14identity in a way that's that causes a

1:17:15lot of discomfort and say, "Well, you're

1:17:16not in control of your own life. Like,

1:17:18how does that's that's crazy."

1:17:19>> So, I think it it links into

1:17:20self-esteem. Yeah. It really. So, what

1:17:23we've just did, we had the goals.

1:17:25G Yeah. Then we had your resources. R

1:17:30Yeah. Then we had increments. What

1:17:33things had you done, little things on

1:17:36the way. And then finally, I invited you

1:17:38to notice and reflect. And that spells

1:17:40grin. And that's Jen's published grin

1:17:43model. I just did it for you right

1:17:45there. And I could do it faster than

1:17:47that. I do it in nearly every surgery I

1:17:49do because what I'm trying to do is find

1:17:52out about you. Mhm. And you didn't find

1:17:54out much about me in that process, did

1:17:56you? No. But I found out a lot of really

1:17:59useful stuff to you, and it's

1:18:00motivational. And much better to do that

1:18:03than me tell you what to do. And I'm not

1:18:06a talking leaflet.

1:18:08But motivation, this is what Jen has

1:18:10taught me, is key in everything we do.

1:18:13And the grin model isn't bad.

1:18:16Clever woman. So, what do we do with the

1:18:18grin model? And so, this is really

1:18:20helping me figure out how to change my

1:18:22behavior? Yes. How do How does one apply

1:18:24it? Or Are you saying that everyone

1:18:26listening now should should answer those

1:18:28four questions themselves?

1:18:29>> do because otherwise, it's possible to

1:18:33spend a lot of time blaming yourself.

1:18:35Mhm. You know, and particularly around

1:18:37if we're discussing weight problems and

1:18:39so on, you can spend a lot of time

1:18:41saying, "I'm to blame." or "I wish." or

1:18:46"I shouldn't have." That you know,

1:18:48after Christmas everybody feels like

1:18:50this.

1:18:51But what is much better rather than

1:18:54focusing

1:18:55you're wasting energy if you start

1:18:58thinking about guilt and negative stuff.

1:19:01And what Jen's trying to do is getting

1:19:04you to engage

1:19:06by in in thinking about a better future.

1:19:09And what the whole of that 5 minutes was

1:19:12engaging you

1:19:14in in

1:19:16first of all the goal of a better

1:19:17future, then some resources towards your

1:19:21better future, then the first steps

1:19:23towards the better future, and then

1:19:25noticing what's good.

1:19:27>> Mhm.

1:19:28Because I think in medicine what we've

1:19:30done,

1:19:32how do you get a doctor's attention? You

1:19:33get a doctor's attention by saying,

1:19:36"Oh, it's so bad. It's so so bad. My

1:19:39pain is so so bad."

1:19:42And I realized I had trained my patients

1:19:46to think that moaning was how,

1:19:49you know, they got my attention. And if

1:19:51you do that, the result is a very

1:19:53miserable 2-hour surgery.

1:19:56But if you can talk even people having a

1:19:59a terrible time have got hope if you can

1:20:02find it. They have goals if you can

1:20:05discuss them.

1:20:06And you could have somebody with a drug

1:20:08addiction or what you know, I see people

1:20:09dying people all sort every clinic I'm

1:20:11seeing

1:20:13sad stuff.

1:20:14But if you can

1:20:17also investigate

1:20:19hopes and good stuff, as a doctor I'm so

1:20:22much more energetic, so much more

1:20:24hopeful. I'm having a great time.

1:20:27And I wasn't when I was 55. And that's

1:20:30the process. I bet there's so many

1:20:31people listening now that that maybe

1:20:33they, you know, cuz they listen to this

1:20:34show and they've got the sort of basics,

1:20:36they go, "Do you know what?

1:20:37I understand this stuff and I'm making

1:20:39good progress, but I live with or love

1:20:41someone Yes. who I I'm I'm scared

1:20:45they're going down a slippery slope.

1:20:46Yes. And I don't know what to do. Do I

1:20:49intervene? Do I hide their sweets? Do I

1:20:51blame What do I do?

1:20:52>> That's so hard, isn't it? That's so

1:20:54hard. I think you can Weren't you in

1:20:57that position to some degree?

1:20:59Yes. Uh yeah. So, uh my first wife

1:21:04had a very severe addiction problem. So,

1:21:07I lived with her for 12 years and she's

1:21:09unfortunately died now. Um

1:21:12so, I lived with

1:21:14very, very serious addiction for 12

1:21:17years. And what you're doing then is

1:21:19you're living with uncertainty.

1:21:21Serious uncertainty.

1:21:23Uh you never You cannot say what you'll

1:21:26come home to. You have no idea. No idea.

1:21:30It brings chaos into your life. It's

1:21:31very, very hard.

1:21:33Addiction?

1:21:35Yes. Are you able to say what kind of it

1:21:37Was it a food addiction or a drug

1:21:38addiction or It was a It was

1:21:41Nearly everybody concerned has died now,

1:21:43so I don't know whether I can say or

1:21:45not, but it was very serious multiple

1:21:48addictions. I will say that. And she had

1:21:50She died some years ago.

1:21:53And it doesn't It It It actually wasn't

1:21:56food addiction. Mhm.

1:21:57>> [clears throat]

1:21:58>> But it brings I have so much sympathy

1:22:01with

1:22:02dealing how how hard it is to deal with

1:22:05uncertainty

1:22:06and not be able to You love somebody and

1:22:08you can't do anything. It's very hard.

1:22:11There are things you can do, I think.

1:22:14Um

1:22:16if you can engage people in in that

1:22:19talking about goals, that can help.

1:22:23Uh what we will do now is we'll change

1:22:25that conversation to to the current Mrs.

1:22:29Unwin, which is what we laughingly say.

1:22:30This is Jen. So, we we've been together

1:22:33for 30 years now.

1:22:36And Jen's story is that she actually is

1:22:39an ultra-processed food addict,

1:22:41genuinely.

1:22:42And what that means is

1:22:45I didn't under- Neither of us understood

1:22:47what that was, even though she's a

1:22:49consultant psychologist, she didn't

1:22:51realize

1:22:53that she was an ultra-processed food

1:22:54addict.

1:22:56What she saw it as was a weight problem.

1:22:59And

1:23:00all her life, she's she's been boomerang

1:23:04dieting. So, she'd be a big woman and

1:23:06then a little woman and a big woman. And

1:23:08I used to watch it all. What's going on?

1:23:11And then she would there'd be tray

1:23:13bakes. Like she's trying to lose weight

1:23:16and making tray bakes, saying it's for

1:23:18the children and then scoffing a lot

1:23:20herself.

1:23:22So, then I'd

1:23:24because I loved her and I think blokes

1:23:26we try and solve problems, don't we?

1:23:28We're like caveman. Yeah, wanted to

1:23:30rescue her. So,

1:23:32I'm I'm

1:23:33either throwing the food away

1:23:36or I'm tackling her. And then she's

1:23:39we're having such arguments cuz she's

1:23:40defensive and cross.

1:23:43I I couldn't understand with an

1:23:44intelligent woman what's going on.

1:23:47But then

1:23:48uh this is only a few years ago, she

1:23:50understood for the first time

1:23:53this is addiction. When you have

1:23:55intelligent people

1:23:58highly highly intelligent people doing

1:24:01stuff that harms their health

1:24:02repeatedly,

1:24:04is this not

1:24:06like cigarettes? Is it not

1:24:09like alcohol? That is ultra-processed

1:24:12food addiction. And there's a patient

1:24:14I'd like to tell you about that is

1:24:17explains it even more clearly. And this

1:24:19patient has consented for me to tell you

1:24:22because he wants to help the world.

1:24:24So, this is a guy is a very successful

1:24:27guy. He runs He's a wealthy person with

1:24:29a successful business. He's not stupid.

1:24:33He has type 2 diabetes. He's 55. He has

1:24:35type 2 diabetes. He's very much

1:24:37overweight.

1:24:39Unfortunately, he needs really serious

1:24:42surgery

1:24:44because both his knees have been so

1:24:46destroyed by his weight that he can

1:24:48hardly walk because he's in real agony.

1:24:51But, his type 2 diabetes is so

1:24:55bad.

1:24:56His blood sugar control is so bad, the

1:24:58anesthetist won't touch him.

1:25:00So, he's trapped. He can't get the op

1:25:03because his blood sugar is high.

1:25:06He can't run his business easily cuz he

1:25:08can't hardly walk.

1:25:10So,

1:25:11obviously, what we do is we say you need

1:25:13to go low-carb.

1:25:16And it works for a bit, and he loses

1:25:18some weight, but then he gains the

1:25:19weight again.

1:25:21And this goes on for 4 years while I see

1:25:24him so regularly every month. What's

1:25:26going on? What's going on? Oh, excuses,

1:25:29the grandchildren.

1:25:31Um I've got a holiday, Christmas. It

1:25:33goes on. Anyway, then his wife came to

1:25:34see me, and she said, "Dr. Unwin,

1:25:36I need to level with you. You need to

1:25:38understand what's going on.

1:25:40I find that my husband is getting up at

1:25:424:00 in the morning and eating

1:25:44bread out of the fridge."

1:25:47So,

1:25:49what I do now what I started doing was

1:25:51at the end of every day, I put all the

1:25:54bread in the bin if it hasn't been eaten

1:25:55that day. But then I discovered my

1:25:57husband was going in the bin to eat the

1:25:59bread.

1:26:01Then what she does, she's a

1:26:03a very formidable woman, she started

1:26:06putting detergent, liquid detergent, on

1:26:08any bread that goes in the bin.

1:26:10But he still eats it.

1:26:13He's getting up at 4:00 in the morning

1:26:14rummaging through the bin to eat the

1:26:16bread with the detergent on.

1:26:19So then,

1:26:20she tried something else and she says

1:26:22this is the only thing that will stop my

1:26:23husband from eating bread if he's there.

1:26:26I spray bleach on the bread and leave

1:26:29the can of bleach by the bin so he knows

1:26:32don't even look.

1:26:34Okay?

1:26:35What I've described to you

1:26:37is addiction.

1:26:39This is an intelligent person and

1:26:41imagine his self-esteem how it was to

1:26:44live like that, concealing what he was

1:26:46doing.

1:26:48And not telling his doctor cuz I'm

1:26:50trying so hard for him for years and

1:26:52he's so sweet to me now and he often

1:26:55shakes my hand and gives me a hug. He

1:26:57said, "You tried. You really tried."

1:27:00Anyway, my stories have a happy ending

1:27:02always.

1:27:04What I did for him in the end, he needed

1:27:06everything. So low carb.

1:27:08Then I got him using a continuous

1:27:11glucose monitor. Mhm. So that he would

1:27:13get feedback immediately and see that

1:27:15spike. And also I could see the spikes

1:27:18as well cuz he had to come and show me

1:27:20his tracings.

1:27:22And on top of that,

1:27:24I did something unusual. I gave him a

1:27:26low dose of the new GLP-1 drugs.

1:27:29Ozempic? One of those. Yeah. Um

1:27:32and

1:27:33the three together,

1:27:37he managed to not He couldn't moderate

1:27:39but he could abstain.

1:27:41And then he could do it. The Ozempic

1:27:44helped reduce the noise, the cravings in

1:27:48his head. The feedback from the CGM

1:27:51helped him know how he was doing.

1:27:54And [snorts] the support he got from me

1:27:56and the low carb pulled together and all

1:27:58three and he's had his operation now.

1:28:01And so it's a happy story but he's got

1:28:03maintenance. All his life he's going to

1:28:06have to sort that out.

1:28:08Um and it's a wonderful example because

1:28:11I think we trivialize this. We call it

1:28:13carb creep, like it doesn't matter. But

1:28:16there are many people listening to us

1:28:18right now, and they know

1:28:21they know they're addicted to various

1:28:23foods. They know because when you ask

1:28:25them, they often burst into tears.

1:28:27Often I somebody will say I've never

1:28:29told anybody in my entire life

1:28:32about and bread is a common one.

1:28:34And if you're not addicted to bread, you

1:28:36can't imagine it.

1:28:38But if you are addicted to bread, they

1:28:39say this sounds so stupid. I'm so

1:28:41embarrassed to tell you I can't control

1:28:44how I eat bread. Mhm. And

1:28:47so it's not great for your self-esteem,

1:28:49is it? Mhm.

1:28:50>> But people might be addicted to many

1:28:52things and

1:28:53my wife's published many papers on this

1:28:56and written a book and this that and the

1:28:58other.

1:28:59And she would say about 14% of the

1:29:01population

1:29:04has some aspects of ultra-processed food

1:29:06addiction.

1:29:08And

1:29:10>> [snorts]

1:29:11>> it kind of explains so much

1:29:13why are intelligent people eating foods

1:29:17they know

1:29:18do them harm. I've got another example.

1:29:21One of my patients with type 2 diabetes,

1:29:24we got drug-free remission.

1:29:26Hooray! I've done that now 157 times. So

1:29:30every one of them I'm cheering when it

1:29:32happens. So this guy, we did it.

1:29:34Drug-free remission.

1:29:36Then he vanished for a while

1:29:38and

1:29:40um

1:29:40and came back with two dead toes.

1:29:44And he had to have them amputated. Now

1:29:46what

1:29:47>> Yeah.

1:29:47They started rotting

1:29:49because diabetes takes the blood supply,

1:29:52particularly from your toes. So we had

1:29:55to have surgery to have part of his foot

1:29:56removed.

1:29:58And so you call it carb creep, and he

1:30:01ended up with half his foot taken off.

1:30:03That's not carb creep. Something far

1:30:05more sinister.

1:30:07But I never give up. And unfortunately,

1:30:10the wounds took a long time to heal

1:30:11because he was sugary, so we do it all

1:30:13over again.

1:30:15I got him back into remission.

1:30:17Because this time he and his wife are

1:30:19really determined, but it's a struggle

1:30:21and he needs help and support

1:30:26to achieve that. He's not a foolish man.

1:30:29He's an intelligent man and yet various

1:30:32foods call to him.

1:30:34Eat me, eat me and it's very difficult

1:30:36for him to not and that

1:30:40I mean, that's a very extreme example.

1:30:42But many people

1:30:45with overweight and some who are not

1:30:47overweight are struggling

1:30:49with very, very significant carb

1:30:52cravings and they really, really

1:30:55struggle to control them.

1:30:58There should be a button just down below

1:31:00here and if it says subscribe, you're

1:31:01already subscribed. If it says subscribe

1:31:03bar, that means you're not yet. If

1:31:06you're not not subscribed, please could

1:31:07you do us a favor and hit that button.

1:31:08It helps to show more than you know and

1:31:10according to the algorithm, you're

1:31:11someone that watches our show, but you

1:31:13haven't yet hit that button. Thank you

1:31:14so much.

1:31:15For those people and I assume there's a

1:31:17lot of people and actually some people

1:31:19have seasons where they're in control,

1:31:21they're out of control, they're in

1:31:22control.

1:31:23You know, I've been there.

1:31:25Um

1:31:25What is step one today?

1:31:29So they're listening to you, they're

1:31:29going hell, I don't want to lose

1:31:30my toes and all of these problems. What

1:31:33is step one now?

1:31:35Now, are we talking about for somebody

1:31:37with type two diabetes or somebody who

1:31:38can't control what they're eating?

1:31:40>> Someone that can't control what they're

1:31:41eating.

1:31:42>> Great. Right. So,

1:31:44step one,

1:31:45we just did it. I think step one is

1:31:49acknowledging that is your problem.

1:31:51Because if you don't if you're not

1:31:53honest about your problem, how are you

1:31:54ever going to sort it out? Honesty. So

1:31:57the first thing is honesty and that's

1:31:59very hard for people.

1:32:02All of us have made excuses. You know,

1:32:04me and my biscuits. I believed that that

1:32:07it was easier for me to think that that

1:32:09was stress and a reasonable reaction to

1:32:12the stress of running a practice than it

1:32:14was to say, "I've got a

1:32:17You know, biscuits for me, it took me a

1:32:18year to give them up. A year.

1:32:22How pathetic is that? I was so driven

1:32:25that it took me a whole year. How did

1:32:26you give them up?

1:32:27Um I did it by weaning myself off a bit

1:32:30like methadone. So, I went from um I

1:32:33like chocolate ginger biscuits and then

1:32:35I went to digestive plain and then I

1:32:38went to oat biscuits and then eventually

1:32:41I went to almonds.

1:32:42>> Why didn't you just do it all at once? I

1:32:44should have done.

1:32:45And uh Jen Jen's a great believer in

1:32:47cold turkey. Like, what is the thing?

1:32:49Stop it.

1:32:51I wasn't man enough for that and it took

1:32:53me a whole year. So, the first The first

1:32:55thing is be honest.

1:32:58Truth Be honest with yourself even if

1:33:00you can't tell other people. Be honest

1:33:02with yourself.

1:33:05Uh

1:33:05Is there an addictive potential? Like,

1:33:07could that be Does that fit?

1:33:10Number two,

1:33:12specifically, which foods is your

1:33:14problem?

1:33:16And be honest.

1:33:18Um because if you If you're not honest,

1:33:21then it you Number three

1:33:23is have a plan for abstinence.