Dr Rangan ChatterjeeYou May Never Eat Sugar Again! – How To Reverse Diabetes & Prevent Early Death | Dr. David Unwin
EVERY SPOKEN WORD
120 min read · 23,742 words- 0:00 – 5:24
Early warning signs of insulin resistance (before prediabetes and diabetes)
- RCDr. Rangan Chatterjee
David, welcome to the podcast.
- DUDr. David Unwin
Rangan, thank you.
- RCDr. Rangan Chatterjee
I have been so looking forward to this for a number of years. In fact, I can't believe we're only doing it now-
- DUDr. David Unwin
[laughs]
- RCDr. Rangan Chatterjee
... because I think we share quite a similar philosophy-
- DUDr. David Unwin
We do. We do
- RCDr. Rangan Chatterjee
... about health and maybe life in general.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
To start, I wanted to talk about the continuum of health. You're someone who has helped over 150 people in your practice put their type 2 diabetes into remission, which is amazing, and we're gonna-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... talk about how you've done that. But at the same time, I don't think there's an awareness out there that type 2 diabetes is the end process. Things have been going wrong with your-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... metabolic health for a number of years.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
So what would you say are some of the signs that we can look for in ourselves that might indicate our metabolic health is a little bit off, and maybe we're on the road to getting type 2 diabetes?
- DUDr. David Unwin
That's a fabulous question. You're right, it starts years before, uh, you actually have type 2 diabetes. And the things I would say, or the things I noticed in myself actually, because I have type 2 diabetes, so I know a bit about this. The first thing is I used to find myself tired, particularly after meals. So I remember after lunch, even in the practice, I'd have to have a little nap on my own doctor's couch. Isn't that terrible? And I was only 55. I... And I thought that was aging. So the first thing is tiredness, particularly after meals, and also the... I was always ready to lie down in the evening. I was always thinking I'd put my feet up instead of doing anything. That's one thing. Um, another one is, is your belly size, and I, I think loads of us have noticed that. That you, you... We, we, we call that just middle-age spread, but I think that is... That's a euphemism really, because if your belly is more than half your height, you may have a problem. So all you have to do actually is get a piece of string as long as you are tall, cut it in half, and will it reach round the biggest bit of your belly? And in my case, it wouldn't have done. So belly size is another early, uh, thing that people might notice. What else might they notice?
- RCDr. Rangan Chatterjee
Cognition.
- DUDr. David Unwin
That certainly happened to me. Yeah. They call it brain fog, don't they?
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
Again, I thought this was normal ageing, so I was 55, which s- I'm now 67, so it's kind of crazy. I just noticed that the younger partners in the practice seemed to have s- intellectually more horsepower, and that was another thing for me, sort of fogginess. Um, but then another odd thing, I remember a thing at Christmas. I got sleepier and sleepier through Christmas and, and slightly depressed. And again, all of that turned out to be reversible, and all of it turned out to be those early signs that I was becoming insulin resistant.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
And my insulin wasn't working properly. I mean, and then you have the, the various biochemical tests that doctors might do. So, uh, any sign of fatty liver, but maybe we'll come onto that. A third of everybody in the world now has fatty liver.
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
So I had that as well.
- RCDr. Rangan Chatterjee
Wow.
- DUDr. David Unwin
Um, and then in blood tests, uh, a high triglyceride, uh, is a thing that people may have and not know why, why they've got that. So that's on the lipid, fasting lipid panel-
- RCDr. Rangan Chatterjee
Yeah
- DUDr. David Unwin
... if you do a triglyceride, and it might be high. One final thing with me, I became fretty. So I would sort of chew on stuff for days and sort of circular thinking. It was funny 'cause when I improved my diet, all of those things went away, and my confidence increased. So that's my personal experience, actually.
- RCDr. Rangan Chatterjee
Yeah. It's really interesting. You're talking about what on the surface seems to be quite a variety of different symptoms.
- DUDr. David Unwin
Yeah.
- 5:24 – 7:33
David Unwin’s personal turnaround: from unwell GP to medication-free vitality
- DUDr. David Unwin
I'm changed, really changed. So yeah, I'm 67 now, and I run regularly, which would've been impossible when I was a younger man. It didn't occur to me it was a, a thing I c- I could do. So I can, I can out-sprint my grandchildren.
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
And I'm 67. I've got eight amazing grandchildren. They think it's hilarious seeing an old guy run. They say that I win because they, they laugh so much-
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
... 'cause they think it's so funny to see an old guy s- actually sprinting.
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
But I can, uh, and all of these things have changed, and I'm not on any medication. Oh, I didn't tell you. I had high, significantly high blood pressure.And do you know, I didn't want to be a patient. Isn't that stupid of me? So I put my head in the sand. I knew it was high. It wasn't that bad. It was like one sixty over ninety-four, ninety-five. I never went to a doctor, but, uh, now my blood pressure's ab-about one twenty over seventy.
- RCDr. Rangan Chatterjee
Wow!
- DUDr. David Unwin
So that's another-- yet another thing, high blood pressure that I sorted out, and all of these things, no medication. And I'm so lucky. So very, very lucky.
- RCDr. Rangan Chatterjee
There's so much I want to cover with you today, David. So let's perhaps start off with your personal story.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
Yes, you've helped, I think hundred and fifty-three patients now put their type 2 diabetes into remission. I wanna hear how exactly you've done that because I think that's gonna be very helpful for everyone listening-
- DUDr. David Unwin
Yeah, I hope so
- RCDr. Rangan Chatterjee
...as to what they might be able to do in their own lives.
- DUDr. David Unwin
Yes. Yeah.
- RCDr. Rangan Chatterjee
But why don't we start off with you? Because you were the patient.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
You were skeptical of any kind of approach that could perhaps work, and I believe that there were two, what you call two very intelligent women-
- DUDr. David Unwin
[laughs]
- RCDr. Rangan Chatterjee
...who helped you see things differently.
- DUDr. David Unwin
Yeah. They were two formidable women, I would say. Formidable. Uh, so yeah, what a shock. The-- Little bit more background before we come to that.
- RCDr. Rangan Chatterjee
Sure.
- 7:33 – 12:58
The clinical ‘wake-up call’: a patient who achieved drug-free remission
- DUDr. David Unwin
So I was unhappy in practice. So I, I was the senior partner of a large practice, ten thousand patients, and I'd-- I wasn't... I was dissatisfied somehow in my mid-fifties with what I'd achieved. You know, we all become-- You-- When you-- Do you remember when you're young, you know, why'd you become a doctor? And it's all like you're all excited by the difference you're gonna make, aren't you?
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
And you can't wait to, you know, get into practice. And I, in my mid-fifties, I was disappointed because it didn't really feel that great because actually the health of the population that I cared for had got worse, not better.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
S-- I, I mean, an example, we're talking about type 2 diabetes. So when I first joined the practice, which was in nineteen eighty-six, so I've been there since nineteen eighty-six, we had just fifty-seven people with type 2 diabetes. Fast-forward, we've now got six hundred.
- RCDr. Rangan Chatterjee
Wow!
- DUDr. David Unwin
So that's a tenfold increase, and it's the same population. But along-- So that-- There's an epidemic for you, an epidemic of type 2 diabetes.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
But I'd also seen an epidemic of obesity. Really just astonishing. So back-- we're going back now to twenty twelve, and I, I'm aware of all these epidemics of poor-- lots of chronic h-ill health. And so h-how, how was I doing? The answer was poorly.
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
So... And I had a sort of feeling. It felt depressing, all the prescribing. Don't know how you felt about that. But I was... You know, you, you add one drug, and then people deteriorate, and you add another drug, and it feels sort of wrong somewhere. Also, they didn't look well. So nobody came in like they were amazingly well, and that's how we come to the first very formidable woman because, um, part of the payment in general practice was to be sure that your patients are taking metformin for their type 2 diabetes. Metformin, I mean, it, it's the baseline treatment for type 2 diabetes. And I had a lady, we knew she wasn't cashing in her prescriptions for months. She was somebody I'd known for years. And so I, I wrote to her to say, "Please, can we, can we have a chat? Because I'm a bit worried about your, your type 2 diabetes." Nothing prepared me, uh, for that woman marching in, um, because she'd, she'd actually got her diabetes into drug free remission, so she wasn't taking any medication. She was a woman who'd had diabetes for a decade. And when we did the blood test, her blood sugars were normal. So I didn't know that could even be done after years of medication.
- RCDr. Rangan Chatterjee
And this was in twenty twelve?
- DUDr. David Unwin
This was-
- RCDr. Rangan Chatterjee
Wow!
- DUDr. David Unwin
...twenty twelve, towards the end of twenty twelve, and she marched in. But the point was she was angry with me, and she felt I had let her down. And she said-- she explained, really. She said, "I never told you, but the metformin you'd been giving me, uh, gave me diarrhea. But that was a bit embarrassing to mention, so I didn't. I carried on trying to take it. Um, and if only you had told me that it wasn't just sugar I should be avoiding, but the starchy carbohydrates that break down into sugar, I could have had better health years ago, 'cause I had to find out about bread and rice and potatoes-
- RCDr. Rangan Chatterjee
Mm
- DUDr. David Unwin
...as sugar all by myself. And you're my doctor, but you never mentioned that once, and I, I wonder why you didn't. Surely, Doctor, I mean, this is schoolboy physiology. You know, bread, you should know, uh, from O-level biology that bread is starch, and starch is sugar molecules holding hands. So, you know, I'm even wondering whether you're medically qualified. How could you not have mentioned this in ten years?"
- RCDr. Rangan Chatterjee
How, how did you feel when she was starting to attack you like this?
- DUDr. David Unwin
[laughs] Well, you know, as you get older as a doctor, you fear complaints.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
You really do, because they can run on for years. So I was scared, mainly because she was right. It was a completely justified complaint, and I felt I had let her down. So we, we had to say, "Okay, I agree. I've got stuff to learn."Uh, you know, maybe I have. Perhaps I can do better. Will you help me to do better? And that was-- that helped deflect her anger, but I'm grateful to her because she pointed me... It turned out she was one of forty thousand people-
- RCDr. Rangan Chatterjee
Hmm
- DUDr. David Unwin
... on a website, all teaching themselves how to improve diabetic control, but being ridiculed by healthcare professionals. They were being ridiculed. So that was the beginning of my mind cracked wide open, 'cause here was proof, right in front of me, that there was a different way. And it's funny, uh, when you look back in life, it's really odd how things can come and change you.
- RCDr. Rangan Chatterjee
Yeah.
- 12:58 – 24:21
Hope, behaviour change, and the shift from ‘doctor as prescriber’ to ‘doctor as learner’
- DUDr. David Unwin
Lot of pivotal moments. And there was another one. The other formidable woman is my wife, Jen. She's a, a clinical health psychologist, and her, her expertise is, um, behavior change and the use of hope in chronic disease.
- RCDr. Rangan Chatterjee
Wow.
- DUDr. David Unwin
So that's really relevant.
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
And, uh, she read a book, which was Beat the Diet Trap by Dr. Briffa. Perhaps you remember Dr. Briffa.
- RCDr. Rangan Chatterjee
John Briffa, I do.
- DUDr. David Unwin
John Briffa. And he was talking about, uh, diet, insulin resistance in this book, and she kept reading it out to me, "David, you have to listen to this. You've got to." And I was a bit resistant to that as well, 'cause I was too tired. You know, why is she going on at me like this? But she-
- RCDr. Rangan Chatterjee
It's a vicious-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... it's a vicious cycle, isn't it?
- DUDr. David Unwin
It is.
- RCDr. Rangan Chatterjee
You're, you're feeling frustrated at work.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
You know deep in your heart that you're not helping as many patients as you thought you were gonna help-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... when you were at medical school. There's this sort of evidence coming in front of you that there is a better way to do it, but you're, you're probably too knackered to act on it.
- DUDr. David Unwin
I was.
- RCDr. Rangan Chatterjee
Plus, you've been doing it that way for 30 years.
- DUDr. David Unwin
Yes. Well, my expertise lay in using medication, um, and I was really tired. I was really tired, and I was actually thinking of retiring anyway. I was thinking of going probably when I was 55, and many GPs do go when they're 55 now. So I'm, I'm now, I think I'm the oldest practicing GP maybe in a 100-mile radius. They've all gone because they get fed up and tired. I was really tired. I wasn't actually well.
- RCDr. Rangan Chatterjee
Yeah. It's kind of interesting hearing that and putting it in the context of what you do today. You're very, very active on social media.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
You are constantly on X-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... sharing helpful information, showing you what you're able to do with your patients, publishing data. You're being-- you know, you're traveling to different places.
- DUDr. David Unwin
I do.
- RCDr. Rangan Chatterjee
You're starting charities to help people improve their lives.
- DUDr. David Unwin
Yeah, yeah.
- RCDr. Rangan Chatterjee
You're talking at international conferences. So, you know, h- what does that feel like? If you reflect back and we compare the David Unwin of today with the David Unwin of just 13 years ago-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... right? Con- can- contrast that for me.
- 24:21 – 28:45
What to say to a newly diagnosed type 2 diabetes patient (and why consent matters)
- RCDr. Rangan Chatterjee
But let's start off with people who do have type 2 diabetes.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
Which is, you know, do you know the latest stats in the UK? I mean, how common is this now?
- DUDr. David Unwin
It's somewhere-- I'd say somewhere between five to ten percent of the population, something like that. But we don't know because I'm finding people all the time who don't even know they have diabetes.
- RCDr. Rangan Chatterjee
Yeah. So they're not showing up on the research.
- DUDr. David Unwin
No.
- RCDr. Rangan Chatterjee
Right.
- DUDr. David Unwin
But it's going up, that's for sure. It, it's going up. So yeah, let's start with what-- Do you want to start with, say, a person that's just been diagnosed or-
- RCDr. Rangan Chatterjee
Yeah, let's-- In fact, maybe the best way for the audience is to just imagine, you know, what would you say to a patient, right?
- DUDr. David Unwin
Perfect.
- RCDr. Rangan Chatterjee
Who-- A patient who's just been diagnosed-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... with type two diabetes. What do you say to them?
- DUDr. David Unwin
Yeah, I can think of a good example. So yeah, I had a, a guy who, who has given his permission, called Dan. He was thirty-nine years old. And, uh, we did a, the hemoglobin A1C, which is the average sugariness of his blood. And if you have the result which is above forty-eight, then that means you've got type two diabetes. So he came into me, and his result was ninety-six, which is sky high. That's really, really high. So what I'm saying to Dan is, "Okay, we've done this blood test, which is the average sugariness of your blood, and it's really, really high. It looks as if your insulin is not working properly. So your insulin is there to get rid of blood sugar, and you're not doing that properly." Um, so the, the point for Dan, uh, right that day is, we've got al-- you and I have alternatives today. I'd, I'd love to suggest a lifestyle change that could have you with much better health and change all sorts. Or it's lifelong medication. Which would you prefer? And the important thing, I think, is to give the patient the choice so that it becomes a collaborative approach.
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
And, um, so Dan, uh, was interested in, in avoiding lifelong medication because he thought, "Well, I'm only thirty-nine, so I'd quite like not to be on, on drugs." And then we're talking about, okay, so if your problem is a high blood sugar, what are you eating that puts your blood sugar up? It's as simple as that. What are you eating? Because a high blood sugar for most people is what they've eaten in the few hours before. So we have to acknowledge that stress can put up blood sugar-
- RCDr. Rangan Chatterjee
Yeah
- DUDr. David Unwin
... and, um-
- RCDr. Rangan Chatterjee
Sleep deprivation
- DUDr. David Unwin
... illnesses.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
All various things. But really, in clinical practice, ninety-five percent of the people you see with a high blood sugar have eaten something that put it up. And I broke the rules for Dan. I actually gave him a continuous glucose monitor to say, "Well, why don't you find out?"
- RCDr. Rangan Chatterjee
Hmm.
- DUDr. David Unwin
You need to know what you're eating that puts up your blood sugar. This is years ago. I did this five years ago. You need to know what puts up your blood sugar and eat something else. And he discovered it in-- for him, it was bread and breakfast cereals were really spiking his blood glucose. And then I'm, I'm teaching people about a nutrient-dense diet. So I want you to get your nutrients of the macros and the, and the, and the micros, you know. Uh-
- RCDr. Rangan Chatterjee
Well, for people who don't know what macros and micros mean-
- DUDr. David Unwin
So the macros, you've got, you've got three macros. So that is carbohydrate, which is a problem for me, uh, somebody with type two diabetes, because carbohydrates, uh, digest down into sugar. You've got fats, and then you've got protein. So I was-- I'd be talking about increasing the protein in Dan's diet, avoiding the carbohydrates and whatever you think healthy fats. But for me, that would be butter.
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
And he'd be having, um, dairy, full fat, um, yogurt, that kind of thing, and loads of green veg. Then the micros are vitamins. So for that patient, it's, do you know what's putting your blood sugar up, yes or no? If you do know, then could you eat differently? Could you base your meal on maybe protein and add in loads of green veg? If you were gonna have, I don't know, steak and chips, do you have to have the chips? Could you not have lots of green veg?
- 28:45 – 29:50
‘Teaspoons of sugar’ equivalents: making carbs visible (rice, potatoes, bananas)
- DUDr. David Unwin
And that's what, uh, that's what Dan did. The idea of trying to work out what is putting your blood sugar up. And that brings me just a little segue into the teaspoon of sugar equivalents.
- RCDr. Rangan Chatterjee
Please.
- DUDr. David Unwin
That-- So I had to find a way to help people like Dan understand the consequences in terms of blood sugar for what-
- RCDr. Rangan Chatterjee
Mm-hmm
- DUDr. David Unwin
... what they ate. And so, uh, I looked at the glycemic index and the glycemic load of foods because I had a hunch. I thought maybe if I could tell you in terms of teaspoons of sugar, this could help you understand what foods to avoid. For instance, so a hundred and fifty grams of boiled rice is equivalent approximately to ten teaspoons of sugar. So if you have a curry and you have a small bowl of rice, well, you've just added ten teaspoons of sugar to your sugar load. Could you have your curry, well, I don't know, with frozen green beans or something else?
- 29:50 – 46:08
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- RCDr. Rangan Chatterjee
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- DUDr. David Unwin
So this turned out, this teaspoon of sugar idea that I had, was valid. So I went to the experts on glycemic load, one, a famous one, Dr. Jeffrey Leavey, and we published a paper together-
- RCDr. Rangan Chatterjee
Mm
- DUDr. David Unwin
... looking at many commonly eaten foods and doing a teaspoon of sugar equivalent. So a big baked potato is about nine teaspoons of sugar. Uh, a portion of chips is eight or nine. A banana is five or six teaspoons of sugar.
- RCDr. Rangan Chatterjee
Can I just pause you there, David?
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
Because I think there's a couple of things to tease out here. So first of all, many people believe rice, potatoes-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... bananas, for example, are healthy foods.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
Now, of course, what is healthy depends on the context.
- DUDr. David Unwin
It does, yeah
- RCDr. Rangan Chatterjee
Right? So and, and also, of course, sh- table sugar itself, you know, is not particularly good for your teeth, right?
- DUDr. David Unwin
Yes. Yeah
- RCDr. Rangan Chatterjee
If consumed in excess.
- DUDr. David Unwin
Fair point. Yeah.
- RCDr. Rangan Chatterjee
Um, whereas maybe white rice, you could argue it... Well, I guess what I'm trying to get to, you're talking about, I think, the impact of that food on your blood sugar levels.
- DUDr. David Unwin
Exactly so. Or because if you have type 2 diabetes, your insulin isn't working properly, you're insulin resistant, so that you can't deal with extra glucose, the sugar we're talking about.
- RCDr. Rangan Chatterjee
Okay. So if you were metabolically healthy-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... so, you know, not only do you not have type 2 diabetes, but you have no insulin resistance-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... which is getting rarer and rarer these days.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
Do you think that these kind of foods are also problematic in that category of people, or is it more in the ones as they get closer and closer to type 2 diabetes?
- DUDr. David Unwin
Great point. I think if, if we took children and fed them perhaps like our great-grandparents were-
- RCDr. Rangan Chatterjee
Yeah
- DUDr. David Unwin
... fed from a child, they would be metabolically healthy, as they used to be.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
As they used to be. And for them, uh, bread was all right-
- 46:08 – 51:18
What to eat on low carb: protein-forward meals, adaptation, and keto basics
- RCDr. Rangan Chatterjee
Now, when you-
- DUDr. David Unwin
The majority of what I've done was not with CGMs. That's come recently. So you're right. Sorry, I interrupted.
- RCDr. Rangan Chatterjee
No, no, it's fine. But when you say, you know, cut back on bread-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... and, uh, pasta and potatoes and rice-
- DUDr. David Unwin
They always wonder, "What shall I eat?"
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
Oh my God.
- RCDr. Rangan Chatterjee
So there will be listeners now going, "Well-
- DUDr. David Unwin
Well, what's left?
- RCDr. Rangan Chatterjee
"Well, I'm gonna be hungry all the time, aren't I?"
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
So what have you found in your experience?
- DUDr. David Unwin
Right. So I think one of the main things is more protein. A lot of older people don't have enough protein because you're trying, as you get older, to maintain muscle mass, so it makes sense to eat more protein. So I'm basing meals on fish, on chicken, on eggs, on red meat, and then you're adding loads of green veg and some butter if you want, or some olive oil or full-fat mayonnaise, that kind of thing. And there are loads and loads of recipe books, apps, everything online. So I-- my family, so I've been low carb, my wife, my eight grandchildren, my three children, our entire extended family are low carb, and we do Christmas and birthdays by, uh, learning how to cook low carb. You can actually, you can use almond flour instead of wheat flour, so that doesn't have as much carbohydrate in, hardly any. But you begin with having lots more protein, reducing the carbohydrate, 'cause how much you reduce the carbohydrate by varies depending on how sug- sugary you are. Not everybody has to cut it out altogether. Some just reduce it. Some people are having, when they actually admit to how many chocolate bars, how many, uh, sugary drinks they have, how many crisps, snacks through the day, they're having a lot of carbohydrate. So I just would encourage people to have less carbohydrate, and then how do you feel? How's it going?
- RCDr. Rangan Chatterjee
Is there a transitional period where people, of course, are used to having the rice and the pasta-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... and the potatoes, right? So when you start to cut back on that, what do they complain of? Is it-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... "I don't know why I don't feel full, Dr. Unwin. I feel like I need something more." You know, what, what are some of the common issues-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... that come up?
- DUDr. David Unwin
Right. Well, actually, most people who go low carb would say they feel a lot less hungry. Most of my patients tell you they're surprised not to be hungry.What some people, um, get is what is called keto flu, that's a bit of a strong word, where they don't feel as good for a few days, and that is because it takes up to a week for the enzyme balance in your liver to change. Your body has to think, "Oh, so this-
- RCDr. Rangan Chatterjee
Mm
- DUDr. David Unwin
... I'm gonna start burning fat." I think a point I'd like to make now is, is this idea we are a dual fuel-
- RCDr. Rangan Chatterjee
Yeah
- DUDr. David Unwin
... engine. So we are, gosh, so clever, our design. We can burn sugar or we can burn fat. But what happens is, so if you, if you have a high carbohydrate diet, then your levels of insulin are high, and insulin prevents you from being able to burn your own fat. This is the basis-
- RCDr. Rangan Chatterjee
Yeah
- DUDr. David Unwin
... of the keto diet. So the keto diet is people who are very low carb, under 50 grams of carbs a day. And because they're very low carb, their levels of insulin are very low, and then suddenly they're able to burn fat. And they, fat is turned into ketones as the fuel, that's why it's called a keto diet. And the keto diet is a type of low-carb diet which is becoming incredibly popular across the world. Um, and that shows very well this transition from relying upon carbohydrates to burn, which is what I did until I was 55 years old, to a greater emphasis on burning fat, which now I am actually, um, I've been on the keto diet for about eight years, and I burn fat.
- RCDr. Rangan Chatterjee
Now, some people listening will have heard negative stories about the keto diets.
- DUDr. David Unwin
Yes.
- 51:18 – 54:59
Evolution, ‘perpetual autumn,’ and why modern eating drives insulin overload
- RCDr. Rangan Chatterjee
Do we know, or do you know, how many of our ancestors ate in a way that would be consistent with a ketogenic diet?
- DUDr. David Unwin
Well, I do actually. Um, the, just a little aside. So years, years ago I was giving a, a speech in, uh, in Tel Aviv. And the dinner afterwards, I happened to sit next to, uh, Dr. Miki Ben-Dor, who is a worldwide expert on what cavemen ate. And he spent his life scraping the tartar off caveman's teeth, and also looking at the is- the bone isotopes.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
So we do know what they ate. And his conclusion, and he's published this, is that, uh, our ancestors were, uh, eating about 70% meat, and the isotope scans were about the same as a wolf. So our ancestors were, ate like wolves in terms of the amount of meat in the diet, and they were surprisingly healthy on that.
- RCDr. Rangan Chatterjee
'Cause that's the thing that what people will say, they go, "Okay, well, maybe our ancestors ate that way because they had to."
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
"But do we know what that did to their coronary arteries?"
- DUDr. David Unwin
No.
- RCDr. Rangan Chatterjee
"Do we know what that did to their longevity?" That's, that's the pushback that sometimes comes.
- DUDr. David Unwin
Yeah, it is. And so just to develop that a little bit, I asked him actually, I said, "Well, didn't they all die when they were about 30?" And, uh, the error in that is that the, if you do the arithmetical mean, it is about 35.
- RCDr. Rangan Chatterjee
Yeah, the average.
- DUDr. David Unwin
The average. But the average is skewed very badly by infections killing children.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
So if, as a cave, uh, as a caveman, you lived to be 12 to 15, you'd probably live to be 60 or even 70. If you once got over the childhood infections-
- RCDr. Rangan Chatterjee
Yeah
- DUDr. David Unwin
... they lived surprisingly long lives. Um, and just going back to the distribution of what they, what people ate or what the wolves ate. What, what wolves and people ate was more carbohydrate in the autumn if they could.
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
Because they needed to put on fat. So insulin is, is fat fertilizer. So it makes you fatter, gives you a bigger tummy.
- RCDr. Rangan Chatterjee
Mm-hmm. Yeah.
- DUDr. David Unwin
But that actually is adaptive because if you're going to get through the British winter, you've gotta get fat in the autumn. So you've gotta scoff those berries down. So wolves and humans were eating all the carbohydrate, all the berries they could in autumn to survive the winter. And I, I think we should now see we're, we're almost eating in a perpetual autumn now.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
You can go to the supermarket and buy whatever you like, and have the bananas and the orange juice and the, uh, the waffles and everything. We're eating, uh, in a perpetual autumn for a winter that never comes.
- RCDr. Rangan Chatterjee
Yeah. Not only does the winter not come, certainly in this country, Christmas comes in the winter. So actually it's the opposite-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... isn't it? Whereby we probably get rather gluttonous and overeat-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... in that time where-
- DUDr. David Unwin
In winter. We'd be fasting
- RCDr. Rangan Chatterjee
... we'd be fasting. Exactly.
- DUDr. David Unwin
Yeah. We, we would. And you know, I-It's always, isn't it? It's Father's Day, it's Mother's Day, it's Halloween, it's your holiday. It's, you know, we're eating so much more junk food, so much more sugar than we did when I was little.
- 54:59 – 1:15:43
Real-world NHS data: remission rates, cost savings, and safety outcomes
- RCDr. Rangan Chatterjee
Mm-hmm. Can you talk about some of your data? Because I think your data, the way you've collected it, is so powerful because you're showing real world evidence-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... in your NHS general practice-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... that this, for some people at least, is working incredibly well.
- DUDr. David Unwin
Yeah. Yeah, no, that's a good idea. Data is so powerful and, and you're talking about real world data. That's the difference as well. This is the Brit- sort of cash-strapped British health service with 10-minute appointments. So in our practice, um, if you, if you go low carb, so of, of all the people with diabetes, about 60% of them have, and it's increasing all the time, have gone low carb.
- RCDr. Rangan Chatterjee
In your practice?
- DUDr. David Unwin
In our NHS practice. So we've... As I say, it's a big practice, 10,000 patients. But if you have diabetes in my practice, 60% is likely that you'll have gone low carb. The, the people that go low carb, we know that if they go low carb, 50% of them will achieve drug-free type 2 diabetes remission at three years. So it's not like in the first six months, they still have it three years later. And then you've got to ask, well, what happens, you know, are the other 50% dead? No, they're not. Uh, so we've got 50% improve to a point where they've, they've got drug-free remission. A further 48% have improved their blood sugar significantly.
- RCDr. Rangan Chatterjee
But haven't quite hit the threshold for remission.
- DUDr. David Unwin
Yes, that's right. Or maybe they're on less medication.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
So they're actually-
- RCDr. Rangan Chatterjee
So it's still great.
- DUDr. David Unwin
It's amazing.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
Yeah, yeah. Because the average improvements are 21 millimoles per mole in hemoglobin A1C, which to the doctors out there, that's, that's better than metformin would achieve. So even the ones that don't get remission, they're still getting a significant improvements-
- RCDr. Rangan Chatterjee
Mm
- DUDr. David Unwin
... in, in blood sugar, and only at the end of, uh, three years, only 2% have worse diabetes than when they began. Whereas if you did nothing, of course, diabetes would tend to deteriorate for everybody. So that's just-
- RCDr. Rangan Chatterjee
What, what, what do we get taught? It's a progressive, chronic-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... irreversible-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... condition.
- DUDr. David Unwin
So, so we've act-
- RCDr. Rangan Chatterjee
Which is just not true.
- DUDr. David Unwin
Yeah, no. That, that's exactly... I just like you used to think, well, I'll add one drug and another, and I'm so proud of this data because it proves in the health service we can do-- we have a different way. And another statistic is that we will... There's nationally collected data-
- RCDr. Rangan Chatterjee
Mm
- DUDr. David Unwin
... on what my practice spends on type 2 diabetes. And compared to 20 local practices, all the 20 local practices, we've spent £370,000 less on drugs for diabetes since 2018. So we've saved money.
- RCDr. Rangan Chatterjee
Can-
- DUDr. David Unwin
And there's more. There's more.
- 1:15:43 – 1:26:09
Beyond low carb: Roy Taylor’s low-calorie approach, bariatric surgery, and the liver-fat model
- DUDr. David Unwin
We should mention that, yes. There are-
- RCDr. Rangan Chatterjee
One of the ways, the way that you've used yourself and you-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... recommend to many of your patients is the low-carb approach, but it's not the only way, is it?
- DUDr. David Unwin
No, not at all. And-
- RCDr. Rangan Chatterjee
I think it's an important point
- DUDr. David Unwin
... yeah, it's very, you know-- So, I mean, we must mention the work of, of Professor Roy Taylor-
- RCDr. Rangan Chatterjee
Roy Taylor, yeah
- DUDr. David Unwin
... who's a friend of mine, and he was a senior author on my last paper.
- RCDr. Rangan Chatterjee
And his work's great.
- DUDr. David Unwin
He-- Yeah. So he, he's, he's doing, he's doing it a different way, which is, uh, just over eight hundred calories a day of the soups. Um, and the, the-- you can prescribe those. So he's, he's giving people a low-calorie diet, but actually it is low carb as well, of course. 'Cause it, you know, if it's low calorie, if it's low food, if you're only having eight hundred calories a diet, uh, uh, a day, that has to be low carb. But that's actually on prescription and, and what's interesting is bariatric surgery works really fast as well. Bariatric surgery can have people off insulin.
- RCDr. Rangan Chatterjee
But of course, there is a consequence to bariatric surgery, right?
- DUDr. David Unwin
Well, there are.
- RCDr. Rangan Chatterjee
When you, when you're talking about risk rewards-
- DUDr. David Unwin
You can't reverse it. Yeah
- RCDr. Rangan Chatterjee
... or the pros and cons.
- DUDr. David Unwin
Yeah. It's major surgery, and there's a mortality involved. So again, sharing with patients, which would you like to do? Um, so yeah, bariatric surgery can't be reversed. And it-- Bariatric surgery, for me, doesn't very well address what your problem actually is. And I think one thing you and I haven't talked about is we're both passionate about what-- why is this person suffering in this way?
- RCDr. Rangan Chatterjee
Yeah. Exactly.
- DUDr. David Unwin
What's upstream? And, you know, what's upstream of diabetes is like, why did you eat like that?
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
And one of the reasons that you-- I ate a lot of junk food was I was kind of addicted to it. So, you know, I could have had bariatric surgery, but would that have cured me? Would it have taught me to eat better?
- RCDr. Rangan Chatterjee
Mm-hmm.
- DUDr. David Unwin
I wouldn't have learned. So the drawback of bariatric surgery is it's, it's technically good, but have you learnt how to care for yourself? Have you learnt how to make it a long-term success? And we know that people who have bariatric surgery, after about two years, a significant number of them are gaining weight again by their, their blitzing Mars bars or so- that kind of thing, or some of them are drinking.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
And that's because bariatric surgery did not deal with their actual problem.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
It sort of put them in low-carb jail, and then they'd find a way around that.
- RCDr. Rangan Chatterjee
Yeah. I wanna talk about food addiction in just a moment-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... 'cause I know you've got a lot of thoughts. I know your wife-
- 1:26:09 – 1:36:34
Guidelines, curiosity, and why medicine struggles to adapt
- RCDr. Rangan Chatterjee
Well, some people will say, critics of this kind of approach-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... you, you know, I'm a fan of this approach. I-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... I used this approach on BBC One back in twenty fifteen-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... and helped a lady, I think still to this day, from what I can tell, was the first time that that had ever been done on television anywhere in the world-
- DUDr. David Unwin
Yeah, it was. I watched it
- RCDr. Rangan Chatterjee
... in thirty days.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
Put type two diabetes into remission.
- DUDr. David Unwin
I was cheering to that.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
And I mean, it's, it's a-
- DUDr. David Unwin
You were my hero. I was like, "Wow. Yes."
- RCDr. Rangan Chatterjee
It's, it's-
- DUDr. David Unwin
"Great"
- RCDr. Rangan Chatterjee
... incredible. That was ten years ago, but I remember back then that was so controversial.
- DUDr. David Unwin
It was.
- RCDr. Rangan Chatterjee
Um, that was twenty fifteen.
- DUDr. David Unwin
Yeah.
- RCDr. Rangan Chatterjee
And I'm thinking... You know, I, [chuckles] I remember going back into my NHS practice after that aired, and I actually can still remember a conversation with one of my colleagues who watched the show and said, "You shouldn't have done that." I said, "Why not?" He said, "Well, I've just been to the diabetes conference in Cardiff-
- DUDr. David Unwin
Mm
- RCDr. Rangan Chatterjee
... and you shouldn't have put them on a low-carb diet. That's not the recommended diets." And I remember saying, "Yeah, but did you see what happened? Did you see the results?" "Doesn't matter," she said. You know, "That's not the recommended diet." And I, I remember thinking-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... oh, wow, this is kind of crazy. Like, this patient [chuckles] has had her health transformed. She's in remission.
- DUDr. David Unwin
[chuckles]
- RCDr. Rangan Chatterjee
But such is the conditioning of our training that even a colleague of-- just couldn't see through it.
- DUDr. David Unwin
Yeah.
- 1:36:34 – 1:52:54
Ultra-processed food addiction: cravings, relapse cycles, and long-term maintenance
- RCDr. Rangan Chatterjee
What have you observed there?
- DUDr. David Unwin
I think, so quite a lot of, uh, my female patients have told nobody that maybe they're addicted to bread or that they're secret eating or all sorts of things because they're ashamed or they-
- RCDr. Rangan Chatterjee
Mm
- DUDr. David Unwin
... you know, maybe they have a weight problem and, and that they suffer with stigma because of that. And so they, you know, they, they just think maybe they're weak-willed or something.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
And nobody's ever said to them, you know, "What if, if your problem was addiction?" You know, because so somebody with alcohol, well, then they're not an alcoholic to annoy me. They don't-- People with cigarettes don't smoke cigarettes to annoy me. It's an addiction problem that they can't regulate it.And therefore, moderation doesn't work very well with cigarettes and half a glass of whiskey. There's no doctor I know who would say half a glass of whiskey is okay, uh-
- RCDr. Rangan Chatterjee
If you're a, if you're a dead set.
- DUDr. David Unwin
Yeah. And so I'd started thinking about women, uh, in terms of carb addiction. This is my wife's work 'cause she is a carb addict. I was married to one and didn't even realize.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
So I'd known her for so long. But then, um, just to finish on that, I actually just... I thought it was women, and then I started asking the blokes, and actually, some of them were carb addicts as well. So I, I don't know where that's going.
- RCDr. Rangan Chatterjee
But this topic of food addiction, again-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... has also been quite controversial-
- DUDr. David Unwin
Yes, it is controversial
- RCDr. Rangan Chatterjee
... because for many years-
- DUDr. David Unwin
It's said not to exist.
- RCDr. Rangan Chatterjee
Yeah, they said it doesn't exist and you can't... Be-because of course, you don't need alcohol, you don't need a cigarette to exist. People used to say, well, and I think many people still do, that, well, you know, you need food, so you, you, you know, you can't be addicted to food.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
Or that was one of the lines of thinking-
- DUDr. David Unwin
Yes. Yeah. That's-
- RCDr. Rangan Chatterjee
... which I've always found a little bit problematic because if you look at the way people's behaviors are around foods, some people-
- DUDr. David Unwin
Yes
- RCDr. Rangan Chatterjee
... and you compare it, you're like, well, whether you wanna technically call it addiction or not-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... I think that looks like an addictive behavior for that individual.
- DUDr. David Unwin
Right. Right. I have a few things to say on, a few things to say on that. So yes, we're told officially, uh, ultra-processed food addiction doesn't exist, so the... there are no clinical services for this problem. And what's interesting about this is, well, I've got clinics, I can refer you for, uh, nicotine, I can refer you for alcohol. But how about this? I can refer you for gambling addiction and there is no substance even.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
There are clinics, NHS, that is accepted gambling addiction and, and there is no substance even. And then if we come to, well, what is addiction? How would you diagnose addiction as a doctor? And you're diagnosing addiction when intelligent people do things they know harm their health and cannot stop. So somebody intelligent drinks when they know it will harm their health. They... nicotine when they've had a heart attack. But isn't it the same as intelligent people, and I know so many people do this, cannot stop eating bread or pasta or whatever it is? They get cravings. There's secret eating, and I've got permission from a patient to give you a specific case that illustrates this so well.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
And, um, I've seen this guy in the last week to check that we're, we're fine, and he wants me to tell this story. So this is a successful business person. He runs a business, and he has poorly controlled diabetes, and he's overweight. He has a really, a, a severe orthopedic problem, and he can't have the surgery on his orthopedic problem because his diabetes is so badly controlled. So he's been refused by the anesthetist for surgery.
- 1:52:54 – 2:03:29
Family, budget, and environment: making low carb workable in real life
- RCDr. Rangan Chatterjee
Your children have also gone low carb-
- DUDr. David Unwin
Yeah, yeah
- RCDr. Rangan Chatterjee
... I believe, even though they don't have type 2 diabetes.
- DUDr. David Unwin
Correct.
- RCDr. Rangan Chatterjee
So what was the motivation for them?
- DUDr. David Unwin
That's ri- So we, we struggled in the family. So Jen and I did it first, and we annoyed the teenagers.
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
And, you know, 'cause they felt they had a right to the... So it was a r- it was a real struggle for the first few years. So we, we had to compromise, and I remember we used to have... First of all, we had carbohydrate corner.
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
So that was the, the, there it is. Okay, kids, that's your bit. And then we started thinking a bit, well, that's a bit disappointing because don't we love our children more than ourselves? And is that okay to just let them ruin themselves as I ruined myself? So that was... It was a worry anyway.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
And then we adapted it slightly, which is we did meals. So the protein was okay, the green veg was okay for everybody. If you wanted rice or oven chips, go and fix them yourself.
- RCDr. Rangan Chatterjee
Okay. [laughs]
- DUDr. David Unwin
And they're dead lazy. Teenagers are dead lazy. And they, you know... So they made a fuss, and then they were just too... But we didn't, we didn't corner them.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
We, you know, we didn't corner them. We said, "Listen, we want to be fair. You know, we've, we, we used to get... You can get rice in little things that you put in the microwave." So we bought those for them. "Go and get it if you want it." And that was one approach that worked really well.
- RCDr. Rangan Chatterjee
Wow.
- DUDr. David Unwin
Just like you fix it yourself if, if you want. But the other thing was Jen really went... She majored on delicious low-carb food. So she can make birthday cakes with almond flour.
- RCDr. Rangan Chatterjee
Wow.
- DUDr. David Unwin
She can make pancakes using gram flour. So gram flour has got loads more protein. It's much better in many ways.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
It's a far superior flour to wheat flour. So she's making pancakes. She's making, uh, batter. So what's-
- RCDr. Rangan Chatterjee
So you're not depriving yourself.
- DUDr. David Unwin
No.
- RCDr. Rangan Chatterjee
Right?
- DUDr. David Unwin
So if you can have pancakes with fresh raspberries and double cream, well, that, isn't that okay? Or then I started doing a thing which is I was blending. I'd say, you know, "I'll make you some ice cream." So I would blend double cream with frozen raspberries at the table.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
And they'd kind of think that's fun.
- RCDr. Rangan Chatterjee
Mm.
- DUDr. David Unwin
And it's like no pudding or that. So we were sneaky really. We learnt how, we learnt how to do really tasty low-carb cakes-
- 2:03:29 – 2:15:46
Prevention and policy: taxing ultra-processed foods, planning laws, and better early testing
- RCDr. Rangan Chatterjee
I just wanna finish off, David, talking to you about prevention.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
We started off talking about people who were already sick.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
Maybe they were type 2 diabetic, or they were-
- DUDr. David Unwin
Yeah
- RCDr. Rangan Chatterjee
... pre-diabetic. They were just in that threshold just before.
- DUDr. David Unwin
Yes.
- RCDr. Rangan Chatterjee
But this topic of prevention is really interesting to me. My sense is that the NHS doesn't really have prevention in its DNA.
- DUDr. David Unwin
I agree.
- RCDr. Rangan Chatterjee
And I, I, I'm not saying that to be critical of any of them. The NHS-
- DUDr. David Unwin
Mm
- RCDr. Rangan Chatterjee
... has been wonderful at so many things over the years. But I don't think we really... I think it's very hard to do prevention well because I, I just think the whole model was developed around a different world, and maybe more acute problems that people came in with. So this idea of prevention is not really there. So my question to you is, if you could redesign the healthcare system to be more focused on prevention, what are some of the things you would do? What are some of the tests that you would like to offer people that they don't currently get?
- DUDr. David Unwin
Fabulous. You're going to... Why not make me prime minister for a few weeks?
- RCDr. Rangan Chatterjee
[laughs] Let's do it.
- DUDr. David Unwin
I think I'll do that-
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
... because I think it's bigger than that. I, I think it's beyond medicine now. So with my new power, because you did say I could be prime minister for a minute then-
- RCDr. Rangan Chatterjee
[laughs]
- DUDr. David Unwin
Um, the point you make is so good. The answer cannot be to drug everybody. The answer cannot be that we, what, we give the fat jabs to teenagers. Shall we do them all? Do we even know the long-term consequences?
- RCDr. Rangan Chatterjee
No.
- DUDr. David Unwin
We haven't a clue. It's becoming ridiculous how many sick people there are, and prevention must be... I think the problem has been that we live in a political system, and each government has to get results within a few years.
- RCDr. Rangan Chatterjee
Yeah, exactly.
- DUDr. David Unwin
And so prevention doesn't sound quite as sexy, and yet it's the only way.
- RCDr. Rangan Chatterjee
It's the only way to start.
- DUDr. David Unwin
The health service is breaking. The health service, all my friends, they're breaking through the amount of chronic disease. It's getting worse and worse and worse. And so, um, for me, my big picture is just like cigarettes, why don't we tax ultra-processed food for the damage that it does? We know it affects all-cause mortality.
- RCDr. Rangan Chatterjee
Yeah.
- DUDr. David Unwin
We know that. But what should we do with the money? And I think, should we not... This has been done in Brazil. There was a city in Brazil, and what they did, they taxed, this was Coca-Cola, which was the problem, ultra-processed food, and then they subsidized locally produced food in farmers markets.
- RCDr. Rangan Chatterjee
Right.
- DUDr. David Unwin
So that you, you know, you think how is the food produced, uh, nearby? That deals with your air miles. It also helps local farmers, um, and shopkeepers or, you know, the local economy benefits rather than flying avocados from Brazil, you know. Subsidize locally produced foods, and then also you have to help people learn how to cook again.
Episode duration: 2:15:46
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