Dr Rangan ChatterjeeHow to Improve Your Blood Sugar, Energy & Metabolic Health | Dr David Unwin
CHAPTERS
- 0:00 – 4:24
Early warning signs of insulin resistance: fatigue, belly size, brain fog, mood shifts
The host asks how metabolic health declines long before a type 2 diabetes diagnosis. Dr. David Unwin describes the early symptoms he noticed in himself and links them to developing insulin resistance.
- •Dr. David Unwin describes post-meal tiredness and evening sleepiness as early clues.
- •He highlights increasing belly size and shares a simple string test (waist more than half height).
- •He describes brain fog, low mood, and “frettiness” (circular worrying) as part of the picture.
- •He mentions fatty liver and high triglycerides as blood-test markers that can appear early.
- 4:24 – 6:40
From ‘middle-aged and tired’ to fit at 67: reversing multiple markers without medication
The host reflects on how varied symptoms may share a single root cause and notes that Dr. Unwin speaks in the past tense about them. Dr. Unwin explains the changes he experienced after changing his lifestyle, including improved fitness and blood pressure without medication.
- •The host emphasizes that seemingly separate symptoms can share a common root cause.
- •Dr. David Unwin says he is “changed,” now running regularly and sprinting with his grandchildren.
- •He reports no longer being on medication and gives an example of blood pressure improving substantially.
- •The discussion frames the overall message as empowering and reversible for many people.
- 6:40 – 12:58
A dissatisfied GP meets a patient in drug-free remission—and everything changes
Dr. Unwin explains he felt disillusioned in practice, seeing population health worsen despite increasing prescriptions. A patient who stopped metformin and achieved drug-free remission confronts him, forcing him to reconsider how carbohydrate advice is communicated.
- •Dr. David Unwin describes frustration with a ‘prescribe-more-as-things-worsen’ pattern.
- •He notes a large rise in type 2 diabetes cases within the same practice population over time.
- •A patient achieves drug-free remission and challenges him for not explaining starch-to-sugar basics.
- •The patient’s experience introduces him to an online community where people were teaching themselves diabetes control.
- 12:58 – 17:45
Support, behavior change, and a late-career reinvention
Dr. Unwin credits his wife Jen’s expertise in behavior change and hope as a key influence. The host and guest contrast Dr. Unwin’s former burnout and skepticism with his current enthusiasm, research activity, and public advocacy.
- •Dr. David Unwin describes his wife Jen as a clinical health psychologist specializing in behavior change and hope.
- •He recalls being too tired and considering early retirement before his approach shifted.
- •The host contrasts Dr. Unwin’s current public work (publishing, travel, conferences) with his past state.
- •They underline the idea that it’s never too late to change and regain vitality.
- 17:45 – 24:21
Normalizing chronic ill health—and why diet change can improve many conditions
The conversation expands from diabetes to a broader societal view: poor health has become accepted as normal. Both speakers discuss how diet improvements often lead to unexpected benefits across many symptoms and conditions.
- •Dr. David Unwin says seeing widespread preventable ill health drives his urgency and sadness.
- •He describes a shift from a world where chronic disease felt rare to one where it feels normalized.
- •The host shares that a short period of whole-food eating can improve multiple issues at once.
- •Dr. Unwin lists improvements he has seen beyond blood sugar, including skin issues, IBS, depression, joint pain, sleep apnea, and more.
- •They discuss sequencing: diet improvements can make exercise easier and safer to add later.
- 24:21 – 32:26
What Dr. Unwin says to a newly diagnosed patient: choice, tracking, and food swaps
The host asks for a practical walkthrough of a first consultation after diagnosis. Dr. Unwin describes offering a clear choice between lifestyle change and lifelong medication, then focusing on identifying which foods drive blood sugar spikes.
- •Dr. David Unwin describes using HbA1c to explain ‘average sugariness’ and insulin resistance.
- •He emphasizes presenting alternatives: lifestyle change vs lifelong medication, to support collaboration.
- •He notes that stress, sleep deprivation, and illness can affect blood sugar, but says food is the main driver in most cases he sees.
- •He describes using a continuous glucose monitor for one patient to learn personal triggers (e.g., bread, cereals).
- •He outlines a nutrient-dense pattern: more protein, green vegetables, and selected fats (e.g., butter, full-fat dairy).
- 32:26 – 36:49
Teaspoons-of-sugar equivalents: making carbs visible and contextualizing “healthy” foods
Dr. Unwin explains his “teaspoons of sugar equivalent” framework to communicate glycemic impact in an intuitive way. The host probes how context matters—what a metabolically healthy person may tolerate versus a population where metabolic health is increasingly rare.
- •Dr. David Unwin explains using glycemic load to estimate teaspoons-of-sugar equivalents for common foods.
- •He gives examples such as rice, potatoes, chips, and bananas having high sugar-equivalent impact.
- •The host emphasizes this is about blood sugar impact and context, not a universal label of ‘healthy’ vs ‘unhealthy.’
- •They discuss that truly metabolically healthy people may tolerate more carbs, but suggest they are now uncommon.
- •Dr. Unwin mentions having a very young patient with type 2 diabetes and expresses concern about the trend.
- 36:49 – 46:14
Informed consent in chronic disease care: why medication decisions need real discussion
The conversation shifts to medical ethics and how chronic medications are started without the kind of consent expected for procedures. They discuss examples including metformin side effects and broader concerns about patients not being told likely risks.
- •The host frames Dr. Unwin’s approach as ‘proper informed consent’ because it presents clear options.
- •Dr. David Unwin questions why lifelong drugs can be started without detailed consent unlike minor procedures.
- •They discuss metformin’s gastrointestinal side effects, using one patient’s experience as an example.
- •The host raises concerns about patients not being told key risks of SSRIs, using an example from a prescribing reference.
- •They talk about balancing how common a side effect is with how serious it may be.
- 46:14 – 51:18
Low-carb in practice: what to eat, transition symptoms, and the ‘dual-fuel’ concept
Returning to implementation, the host asks what people eat when they cut staple carbs. Dr. Unwin explains a practical food structure, common early adjustment symptoms, and his model of humans as a dual-fuel engine that can burn sugar or fat.
- •Dr. David Unwin says people often worry ‘what’s left’ and responds with meals built around protein plus green vegetables.
- •He describes low-carb cooking substitutions used in his family (e.g., almond flour) and notes carb reduction can be individualized.
- •He says many patients report less hunger; some experience a short ‘keto flu’ adjustment period.
- •He explains the dual-fuel idea and links high insulin levels with reduced ability to burn stored fat.
- •He distinguishes ketosis (a fuel state) from ketoacidosis (a dangerous condition, often associated with type 1 diabetes).
- 51:18 – 58:43
Evolution, ‘perpetual autumn,’ and real-world outcomes data from his NHS practice
They explore whether ketogenic-style eating aligns with ancestral patterns and how modern food availability changes behavior. Dr. Unwin then shares audited outcomes from his practice, describing remission rates, HbA1c improvements, and medication cost reductions.
- •Dr. David Unwin recounts a conversation with a researcher studying ancestral diets and discusses seasonal carb intake.
- •He uses the metaphor of modern life as ‘perpetual autumn’—constant access to sugary, starchy foods.
- •He reports practice data: a large proportion of patients with diabetes go low-carb in his NHS practice.
- •He describes outcomes at three years including drug-free remission for many and significant HbA1c improvements for most others.
- •He reports reduced diabetes drug spending compared with local practices and frames it as scalable savings.
- 58:43 – 1:01:51
Earlier is better: pre-diabetes reversal rates and why delay reduces remission odds
Dr. Unwin explains that outcomes appear better when intervention happens earlier in the metabolic decline. He contrasts results for pre-diabetes, newly diagnosed diabetes, and longer-standing diabetes, arguing for acting before progression.
- •Dr. David Unwin describes audit findings showing many people with pre-diabetes return to normal blood sugar on low-carb.
- •He reports higher remission likelihood when low-carb is offered soon after diagnosis than after years of diabetes.
- •They discuss the idea of ‘metabolic age’ being more important than chronological age for these outcomes.
- •The host highlights that what is taught as a progressive, irreversible disease is contradicted by these results.
- •The discussion emphasizes prevention and early action rather than waiting for deterioration.
- 1:01:51 – 1:06:57
Pushback, safety concerns, and the blood-sugar damage model (kidneys, eyes, nerves)
The host asks about criticism of low-carb approaches, and Dr. Unwin describes professional backlash and the concerns raised. He then explains what his data showed for cardiovascular and kidney markers and discusses how blood sugar spikes can damage tissues.
- •Dr. David Unwin recounts early professional hostility and key concerns: kidney function and lipid profiles.
- •He says practice data showed cardiovascular risk markers improving and reports kidney function improved in analysis with a nephrology professor.
- •He argues that improved metabolism should logically improve other body systems too.
- •He describes blood sugar spikes as damaging blood vessels and links this to eyes and kidneys.
- •He shares an ophthalmologist’s observation that retinas improved in people who had changed diet, and mentions neuropathy improvement.
- 1:06:57 – 1:15:43
His personal before-and-after: 300g carbs, constant snacking, and now two meals a day
Dr. Unwin details the diet pattern he followed before his diagnosis and how it continually spiked his blood sugar. He contrasts that with his current intake, meal timing, and examples of meals, including how he runs while fasting.
- •Dr. David Unwin describes starting the day with orange juice and piling sugar onto ‘healthy’ breakfast foods.
- •He recounts frequent biscuits, sandwiches, crisps, chocolate, and pasta, describing it as ‘sugar with my sugar.’
- •He estimates he used to eat roughly 300 grams of carbs daily and was largely sedentary at work.
- •He says he now eats around 40 grams of carbs per day, typically eating once or twice daily.
- •He gives meal examples (omelet; pork with coleslaw; lamb chops with broccoli, butter, almonds; raspberries and cream) and says he often runs fasted.
- 1:15:43 – 1:18:21
Multiple paths to remission—and the physiology of liver fat, insulin resistance, and collapse
They emphasize low-carb is not the only route to remission and discuss alternative approaches including very low-calorie programs and bariatric surgery. Dr. Unwin then explains the physiology of how excess sugar becomes liver fat, drives insulin resistance, and eventually leads to type 2 diabetes.
- •Dr. David Unwin says there are multiple approaches to remission, including very low-calorie diets and bariatric surgery.
- •They discuss trade-offs of bariatric surgery, including irreversibility and risks, and the importance of learning upstream causes.
- •The host introduces the concept (attributed to Roy Taylor’s work) of liver fat and pancreatic fat as central to type 2 diabetes.
- •Dr. Unwin explains how excess sugar is converted to fat in the liver, leading to insulin resistance and higher insulin output.
- •He describes a ‘double whammy’ where pancreatic fat impairs insulin supply, after which the system ‘collapses’ into type 2 diabetes.
- 1:18:21 – 1:58:26
Food addiction, ‘no cheat days,’ and sustaining change long term
The host and Dr. Unwin address food addiction as a controversial but clinically visible reality. Dr. Unwin shares striking patient stories, explains why maintenance fails without addressing addictive patterns, and describes why he and his wife avoid “cheat days.”
- •Dr. David Unwin argues addiction criteria can apply to ultra-processed foods: continued use despite harm and inability to stop.
- •He shares a patient story where bread cravings were so strong the person ate bread from the bin and even after deterrents were applied.
- •He links food addiction with long-term maintenance challenges and describes group consultations where many screened positive for addiction.
- •He contrasts his wife’s stronger addictive pattern with his own, and describes craving rebound after sweets.
- •He describes a personal example of eating a dessert leading to a prolonged anxiety/depression-like rebound, reinforcing his decision to avoid cheat days.
- 1:58:26 – 2:15:46
Cost, modern food environment, and prevention-focused policy and testing
They tackle affordability concerns and strategies for low-carb eating on a budget, including planning and using cheaper whole-food options. The conversation ends with a broader prevention agenda—policy tools, longer consultations for informed consent, and early-detection tests such as fasting insulin.
- •Dr. David Unwin says budget comparisons should include spending on snacks, sugary drinks, and convenience foods; he suggests low-carb can be comparable with honest accounting.
- •He suggests lower-cost choices like frozen foods, mince, eggs, cabbage, and home cooking; he mentions a free app with budget-focused recipes.
- •Both describe how modern environments make health harder and how ultra-processed food became normalized over time.
- •Dr. Unwin proposes prevention measures such as taxing ultra-processed foods and subsidizing locally produced whole foods, and restricting fast-food outlet expansion.
- •He argues for longer initial consultations before starting lifelong medications and says he wants access to fasting insulin testing and broader use of continuous glucose monitors as early-warning tools.
