Fatty Liver Expert Dr. David Unwin on sugar, insulin resistance, and reversing type 2 diabetes
Steven Bartlett interviews Dr. David Unwin, one of the UK's most influential GPs, on the hidden sugar in everyday foods and how dietary change can reverse type 2 diabetes.
Summary
Steven Bartlett speaks with Dr. David Unwin, a GP from north of Liverpool known for his work reversing type 2 diabetes through dietary change and named NHS Innovator of the Year in 2016. Dr. Unwin opens by describing what he calls a pandemic of poor metabolic health, noting that when he began practising in 1986, type 2 diabetes in anyone under 55 was essentially unknown — a disease then called "maturity onset diabetes" — and that he now sees patients under 25 with poorly controlled diabetes. He describes how a patient confronted him for never telling her that bread, rice, and breakfast cereals convert to sugar in the body, which prompted him to begin a low-carbohydrate programme with volunteers from his own practice in 2013. Over 13 years, he has documented 157 cases of drug-free remission of type 2 diabetes, and presents data showing that 93% of pre-diabetic patients achieve normal blood sugar on a low-carb diet. The conversation also covers his wife Dr. Jen Unwin's published GRIN model for behaviour change, the reality of ultra-processed food addiction, the link between diet and cancer, and the importance of continuous glucose monitors as a tool for individual feedback.
Key Takeaways
FULL TRANSCRIPT
The pandemic of poor metabolic health
Dr. David Unwin: What's front of mind for me is the idea that each of us has a number of different health futures. In your future, there could be cancer, there could be multiple sclerosis, or there could be many other futures. What I'm interested in is how do I get you to pick a lifestyle that will get you the future you want? And I think that's very difficult in the world now, to know what is the best lifestyle, because you're given so much conflicting advice.
The particular focus for me, in terms of picking health futures, is around young people, because they've got the longest time to make a difference. And it's getting harder and harder to make good health choices. I'd say it's a pandemic of poor metabolic health. Yesterday in clinic, I saw two people under the age of 25 who had poorly controlled diabetes, and one of them was too heavy for me actually to weigh. This situation is completely new.
When I was a young doctor just starting off in practice — that was in 1986, a long time ago, just north of Liverpool in the practice I'm still at now — obesity was rare and we didn't have a single case of type 2 diabetes in anybody under 55. Not a single case. It was quite unknown. In fact, type 2 diabetes had a different name. We've had to change the name because of the epidemic. It used to be called maturity onset diabetes — that meant old people. Now we call it type 2 diabetes because we have to include so many young people.
It's really serious because people are losing their life expectancy and I'm witnessing this. We're all sleepwalking into a metabolic disaster, and the people paying the greatest price in my opinion are young people. It's a scandal and I'm hopping mad, really. I think we've started to normalise the dad bod — the big tummy — without realising that maybe that isn't how you're supposed to be. That's what's on my mind: young people and their future, and they don't even know.
Steven Bartlett: You say young people there. Is this advice also applicable to the audiences listening who might be in their 50s now?
Dr. David Unwin: Absolutely. We know from UK government figures that for every year that you have poorly controlled type 2 diabetes, you're losing 100 days of life. That's about a third of a year. So whatever age you are, if you have poorly controlled diabetes, you're losing life expectancy. And maybe a third of all the people in the world with type 2 diabetes don't even know they have it because they haven't taken a test.
What do you think kills people with type 2 diabetes?
Steven Bartlett: Is it some cardiovascular issue?
Dr. David Unwin: Well done. You see, you haven't been to medical school, but that's what most doctors say, because we know that a high blood sugar over time damages your arteries. It's a cumulative thing over time. But what you may not know is that a rising cause of mortality for people with diabetes is actually cancer.
Steven Bartlett: Really?
Dr. David Unwin: Yes. Eight forms of cancer are strongly associated with diabetes.
Understanding insulin and how fat accumulates in the liver
Steven Bartlett: I want to define the term diabetes, because I think I went through a lot of my life assuming that diabetes was a disease that some people are born with, and because I didn't have it, I thought I didn't need to worry about it.
Dr. David Unwin: That's really important. So first of all, there's type 1 diabetes and type 2. But before I can explain about diabetes, I need to explain about insulin. This is absolutely key to our whole discussion.
I've already said that a high blood sugar damages your arteries. There's work to show that a very high blood sugar damages the non-stick lining of your arteries within six hours. It's called the glycocalyx, the non-stick lining. Damage is occurring very quickly.
Steven Bartlett: When you say high blood sugar, I get high blood sugar when I eat lots of sugar?
Dr. David Unwin: We're actually talking about glucose. And glucose comes from many foods — carbohydrate-heavy foods, yes. But you have the hormone insulin to defend you from poor dietary choices. What does insulin do with the sugar you just ate? Insulin, produced by your pancreas gland, pushes the sugar out of the bloodstream and inside cells, where it can be used for energy. But what if you take in more carbohydrate than you need to run around? Well, then that sugar is turned to fat inside cells, because it's safer for you to turn that sugar into fat than to have it damaging your arteries.
I myself have type 2 diabetes, so we can talk about me. I had a really heavy biscuit habit. I was senior partner of the practice and it's stressful, and patients used to bring me biscuits as a gift. In the top drawer of my desk were packets and packets of biscuits. I was taking in more sugar than I needed, and I didn't run around. Gradually my waist got bigger. What was actually happening was that as I took in more sugar than I needed, my insulin was working to get rid of it, and it was giving me two things: one, a belly — I thought it was just middle-aged spread — and the other, which I didn't know at the time, was that my liver was filling with fat.
That is very common now. A third of everybody in the developed world has fatty liver. This is the healthy liver here — look at the colour. And this one is yellow. It's the wrong colour, and it's because of fat. Over years, my liver began to fill with fat because I was taking in too much glucose. Insulin was doing its good job of taking it out of my bloodstream and forcing it inside cells — in my belly, but unfortunately also in my liver.
There's a progressive laying down of fat in the liver. Now, the twist in the story is that fatty liver interferes with the good work of insulin. You develop a thing called insulin resistance, which means your insulin is no longer as powerful as it was. It's becoming difficult for you to deal with carbohydrate and sugar because your insulin isn't working as well. And the only way to deal with that is —
Steven Bartlett: You have to start producing more insulin.
Dr. David Unwin: Exactly. Because it doesn't work as well, your pancreas has to crank up the supply. So now you have two things: insulin resistance, where your insulin isn't working as well, and at the same time you're trying to produce more insulin in the pancreas.
This is called the long silent scream from the liver. This is work by Professor Roy Taylor, a friend of mine at Newcastle University. He pointed out that you've got fatty liver for about 10 years and you don't even know. You wouldn't know that your liver had gone fatty and yellow. But unfortunately, fat is also being laid down in the pancreas gland — the very gland that your life depends upon to produce insulin. Your ability to produce enough insulin collapses, and at that point you can't regulate blood sugar anymore.
But upstream of that, you have a problem you don't even know about. Why are we waiting until you actually have all the problems of type 2 diabetes?
The data from 13 years of low-carb practice
Dr. David Unwin: Since 2013, I've got hundreds of patients and I'm monitoring their baseline and latest follow-up. I have a huge data set that I can interrogate and answer questions with.
Let's think about pre-diabetes — the long silent scream. I can tell you that people with pre-diabetes in my practice north of Liverpool, 93% of them will get a completely normal blood sugar if they go low carb. 93% resolution, and it lasts for years because I've checked.
Now, how about we wait for 10 years and you've got type 2 diabetes? If I can get you early, I've got a 73% chance of you having a normal blood sugar. Let's wait another few years because you don't want to give up bread and chips and pizza — fair enough. But if we wait five years, you only stand a 50% chance. So it goes 93%, 70%, 50%. The chances of you not needing drugs are diminishing. It's a stitch in time. And so much of this you don't even know is going on.
The glycemic load and the sugar in everyday foods
Steven Bartlett: One of the things that shocks me is how little we know about what's in our food. I think we all know that biscuits have a high glycemic index.
Dr. David Unwin: Well done. The glycemic index compares different carbohydrates with pure glucose. Pure glucose is 100, and other sugars come further down. But there's something better than the glycemic index, and that's called the glycemic load. The glycemic load takes portions of food and predicts how that portion will actually affect your blood sugar.
Steven Bartlett: Am I right in thinking the glycemic load would factor in the amount of nutrients in the food — protein, fibre?
Dr. David Unwin: Yes. If you took watermelon, it's mainly water. You have to factor in that you can have quite a lot of watermelon to equal a chocolate bar. You're looking at the density of sugar in it as well. That's why the glycemic load is better.
The patient who changed everything
Steven Bartlett: Was there a moment in your career where you started to question what you had been told?
Dr. David Unwin: Yes. You start as a young doctor wanting to be part of a small community and make a difference. For the first 25 years I was trying to do what's in the guidelines. But I noticed two things. Number one, the health of the population I cared for was deteriorating, not getting better. If I'm the doctor in charge of the practice and health is deteriorating, am I not responsible? And at the same time, I'd always in my heart felt that prescribing lots of drugs felt a bit wrong. How is somebody well if they're taking six tablets a day?
Steven Bartlett: Was there one particular patient that you met?
Dr. David Unwin: Two things happened, both to do with very powerful women. The first was a lady I'd known for over 10 years. She and her husband both had poorly controlled diabetes and were both very heavy. I could monitor how compliant my patients were with their medication, and if I'm to be truthful, in part that was how I was paid. Part of my payment was tied to whether patients were taking metformin, the most commonly used drug for type 2 diabetes.
Steven Bartlett: Part of your payment?
Dr. David Unwin: Yes. The government regards it as good practice that a certain percentage of your patients will be on metformin. So I wrote to her: "Dear Mrs. So-and-so, I'm concerned that you don't seem to be taking your metformin. Please make an appointment at your earliest convenience." Very British, very polite.
Nothing prepared me for what happened that morning. It changed my entire life. The lady — let's call her Mrs. Jones, that wasn't her name — she marched in and said, "You think you're going to tell me off, don't you, Dr. Unwin? Well, I've got news for you. I'm going to tell you off." I was scared. She'd never been like this before.
She went on to explain. She said, "When you do my blood tests, you will find that my blood glucose is completely normal despite not taking your metformin. I'm wondering if you're actually qualified as a doctor, because in the last 10 years, did you ever once tell me that bread was sugar, or that breakfast cereals were sugar? I had to learn online that bread is sugar, that rice is sugar, that breakfast cereals are sugar, and when I cut those foods, I don't need your metformin." And she made it worse. She said, "This is school boy biology. You should have learned that when you were 16."
I was scared because complaints as a GP go on for years and years. But mainly I was scared because every word she said was true. And one thing I'd learned as an older doctor is you've got to listen properly. If they're complaining, don't deny it, don't defend yourself. Take it. So I said, "I want to learn. If this is true, will you meet me again? Let's do the blood test."
We did the blood test. It was true. It was the first case of drug-free type 2 diabetes I had ever seen. I'd never seen a single case in 25 years where people came off medication. I was fascinated. But there was another detail: she was one of 40,000 people online learning from each other how to do it. And when I looked, they were being rubbished by healthcare professionals. People like me were telling them, "You'll die. What you're doing is dangerous." I was ashamed. Really ashamed.
And it's complete coincidence, but in the same month, I have to introduce my wife, Jen. She is a clinical health psychologist who specialises in the role of hope in disease and the difference it can make. She spent her life researching the difference that hope makes to clinical outcomes. It just so happened that she was in a supermarket and saw a discounted diet book — this one. Escape the Diet Trap by Dr. John Briffa. What a lovely guy.
Jen bought that book just around the time I was telling her about this patient. She said, "You have to read this book about the low-carbohydrate approach to insulin resistance and type 2 diabetes." Everything my patient had told me was there, but done in a medical way that I could understand. She said, "David, why are you failing? Why don't you do one cheerful thing before you retire that you really believe in? Why don't you have a go at this low carb?"
She said, "Why don't you and I go on this diet and see if some patients would volunteer to do it with us?" I mentioned it to the partners — the other doctors — and they said no. Low carb was not respectable at the time, and they felt it was a bit self-indulgent, a poor use of practice resources. So I went back to Jen and said the partners say no. She said, "I'll tell you what we're going to do. We're both going to work for free. Why don't we do this in our own time, in the evening, with no resources?"
That's exactly what we did. We found 18 volunteers among the patients, and then Jen and I — 20 of us — started meeting every Monday night, talking about low carb, learning how to cook. One of the nurses, Heather, said, "I'll work for free. I'd love to do this. I want to believe in what I do."
And then the magic began. The results — I couldn't believe it. I'd never seen anything like it. The first thing I saw was the liver function improving. I was doing blood tests because I knew I was doing something weird and I needed to measure whether I was doing harm. I had people whose liver function I'd thought was abnormal due to alcohol — they'd had abnormal liver function for 10 years — and suddenly within weeks it was improving, often by a third or 50%. I was so excited. The laboratory results were coming in and I was thinking, "Wow." And then another, and another.
Then the weight. We were all meeting every Monday night, everyone getting weighed, and the weight started falling off people. Then all sorts of other things started happening, some of which I couldn't make sense of for years. People said, "Are you hungry? Because I'm not." They started saying, "Do you have to eat breakfast?" And I wasn't hungry either. I wasn't bothering with breakfast. My belly went away.
The next thing was I noticed when I stood up from my desk, I felt dizzy. I hadn't told anybody, but I'd had moderately high blood pressure for years and I'd never gone to a doctor about it. When I took my blood pressure, it was low-normal. And on the patients as well — I was measuring all the blood pressures and they were improving.
Liver function improving, weight going down, blood pressure improving. Then the hemoglobin A1C results came in — that's the average blood sugar for the preceding three months — and we were getting really spectacular improvements. That's kind of how it began. That was 2013, 13 years ago, and the rest is history. I was completely blown away and full of curiosity about why all these things were improving.
Steven Bartlett: So in those 13 years, how has your own health changed?
Dr. David Unwin: My mental powers were much greater. I could concentrate better. I wasn't fat anymore. The next thing I noticed was I needed a lot less sleep. In the beginning I used to have a little sleep on my doctor's couch every lunchtime — press do not disturb, put the curtains round, have a 20-minute nap. It was the only way I could get through the day. I didn't need that nap anymore. I needed an hour's less sleep a day. I could think better. I could cope with the same problems and mentally I was stronger. It was like being a younger man. I think you have a sense of mental horsepower.
The sugar content of everyday foods — a live demonstration
Steven Bartlett: Going back to the top of this conversation, you talked about how everybody listening right now has a variety of different health futures, and which health future they end up in is going to be determined by the everyday decisions they make. So I want to zoom in on some of those everyday decisions.
Let's talk about the food we have on this table. We do have some people out walking their dog who can't see, so we'll do a bit of a voiceover. You said wake up in the morning, you have your cereal. Growing up, I thought cereal was a health food.
Dr. David Unwin: Me too. So this is actually a test for you. What you've got is a bowl of cornflakes, a potato — a baked potato, though it isn't baked yet — 150 grams of boiled rice, a very ripe banana, and a chocolate bar. And you've got some cubes of sugar. Each of those cubes represents a four-gram teaspoon of sugar. I'd like you to go along these and put beside each food what you believe to be the equivalent in teaspoons of sugar. Then I'll give you a score.
Steven Bartlett: I'm going to score them as I would have thought two years ago, before I started interviewing health experts. Cereal — honestly, I didn't think there was any sugar in that. I'll give it one, but I didn't really think there was sugar in it. A potato — I didn't think there was any sugar in a potato. Even giving it one feels like I'm lying. Rice — I didn't think there was any sugar in rice. A banana — it tastes sweet, so I'd say one. And this chocolate bar — I'll say three. That's how much sugar I would have thought was in all of these things.
Dr. David Unwin: Right. To be fair, I still kind of do, but I know better. So now I'm going to give you the correct figures, worked out from the glycemic load.
In clinical practice, I had a problem: in 10 minutes I needed to explain to patients how they could eat differently and why. I needed a way of quickly communicating the consequences of dietary choices to children, old people, teachers. So I came up with a new idea — why don't we represent the glycemic load not in grams of glucose, which nobody understands, but in four-gram teaspoons of sugar? That's my teaspoon of sugar equivalent system.
So the cornflakes: one, two, three, four, five, six, seven, eight. Eight teaspoons. With no frosting, no milk, nothing.
The potato — it depends on its size, that's quite a big one — one, two, three, four, five, six, seven, eight, nine. Nine teaspoons.
That chocolate bar is seven and a half. The banana — a ripe one — let's say six, because it's a big banana.
And then the final one is going to be the killer. This is 150 grams of boiled rice: one, two, three, four, five, six, seven, eight, nine, ten. Ten teaspoons. That's the winner. And I would say that's the single fact that has astonished people all over the world.
My teaspoon of sugar charts are available through the Public Health Collaboration, a charity I helped set up with Dr. Rangan Chatterjee 10 years ago. These infographics are available in 35 languages — volunteers have translated them. They're not copyrighted. I want people to steal them, take them, use them.
Steven Bartlett: What about orange juice? A lot of parents, including mine, gave me orange juice and I thought it was a health food.
Dr. David Unwin: There's a lot of sugar in orange juice. Once you take it from the fruit as it was meant to be and juice it, the sugar hit is fast. If we go back to insulin — you drink the orange juice, your blood sugar goes up rapidly, your body responds rapidly with insulin, then your blood sugar falls and you're hungry again. That's what happened to me with the biscuits. I ate biscuits, my blood sugar went up, then insulin came in heavy and too much, and then I thought I was having a panic attack because I had low blood sugar. And what's the answer to that? More biscuits. Round and round you go.
Starting the day with a sugary breakfast without enough protein is driving hunger. Then you wonder why you're ravenously hungry at 10 o'clock.
Steven Bartlett: There were a few others that shocked me. I was in Peru and we went to a chocolate-making class. He told us to make dark chocolate, normal chocolate, and then white chocolate. When I made the white chocolate, he got me a big glass cylinder and said, "Here's some white sugar — pour it in." And I pour and pour and pour and pour. I feel like I poured 80% white sugar into this huge glass cylinder. And then he said, "Put some syrup in." White chocolate is like 80% white sugar. I've never eaten white chocolate since.
Dr. David Unwin: That's so important. Very often people think they're a chocoholic. If you look at how much sugar there is in milk chocolate, there are many teaspoons of sugar in it. If you eat 90% dark chocolate, there's only about two teaspoons of sugar in a bar. And what you find with the chocoholics is I say, "Well, if you're addicted to chocolate, why don't you get a bigger hit and have the dark chocolate?" And they say, "Oh, I couldn't eat that. It's too bitter." What they're actually addicted to is the sugar.
Steven Bartlett: The other one I've got a bee in my bonnet about is smoothies. I thought smoothies were healthy.
Dr. David Unwin: Yes, that fills me with rage. I'm on X quite a lot and I have to take a photo of the sugar content. It fills me with rage.
I've got another question. Why don't we take all the blood out of me — there'd be five litres. How much sugar would be in those five litres of blood if my blood sugar is normal? I'd just like you to estimate.
Steven Bartlett: One cup, like this?
Dr. David Unwin: No. The answer is this. That is all there is — one sugar cube. And I can show you the calculations on X. You see, if I have a banana and I have diabetes, there's too much sugar for me. Glucose is number one vital, but number two toxic if you have too much of it. The level of it in my blood is controlled minutely, to this extent. And I think that single fact immediately shows you how easy it is to have more sugar than you actually need.
I monitor my blood sugar with a continuous glucose monitor and I get my blood sugar up on my phone. If I eat a banana, it doubles my blood sugar because I can't regulate it due to the diabetes. A whole banana is far too much for me.
Why people don't know what's in their food
Steven Bartlett: The average person out there doesn't know how to check if the food they're eating is good or not. The labels on these foods — I've got so obsessed by the marketing. I was looking at a bag of sweets the other day and it said "made with real fruit juice" front and centre, and I was almost tricked. I can't imagine someone who doesn't spend their time interviewing health experts how easily the general public is being tricked. What is your advice for spotting this stuff?
Dr. David Unwin: It's sometimes easier to talk about what you would eat rather than what you wouldn't eat. For somebody with insulin resistance or type 2 diabetes, I'd say base your meal on protein. What have you got in the fridge? Could it be chicken? Could it be eggs? That's your protein — have loads of it. Then think about green veg. What green veg would you tolerate? Might be frozen beans, might be salad. And then how would you make that green veg tasty?
Steven Bartlett: Pour barbecue sauce on the top.
Dr. David Unwin: Ah, no. Full fat mayo, or butter, or olive oil. Because barbecue sauce — there are 30 sugar cubes in a standard bottle of barbecue sauce. It's just pouring sugar on top.
You have to be so vigilant. I think to do it successfully, could you eat real food that's not in a packet? It's Russian roulette with food out of packets. If you're going to eat stuff out of packets, you have to wise up and look at the carbohydrate content. Bear in mind every four grams is broadly equivalent to sugar. If something's got 100 grams of carbs in it, it's very sugary.
The error you made with the cornflakes is there's no sugar listed, but it's all carbohydrate — and it's a very sugary carbohydrate.
Steven Bartlett: I think we need to explain that for people. When I looked at those cornflakes, they're not frosted, so there's no sugar on them. But what the body is doing is converting the carbs into glucose.
Dr. David Unwin: I've got a good way to think about it. Starchy carbs are actually glucose molecules holding hands. Then digestion comes along and breaks them apart — they're no longer holding hands and they become free sugar again. We think if it's not sweet, it's not glucose. When it holds hands, it's not sweet. But when you digest it, it's no longer holding hands.
There's a school experiment where you chew bread for ages and then you can taste it becoming sweet. It turns into sugar. The enzyme in saliva — amylase — turns starch into sugar. Starch is soon-to-be sugar.
And so many patients say to me, "Dr. Unwin, I know not to have sugary things. I've given up sugar in my tea and coffee and I don't understand why my blood sugar is so high." And of course we use the teaspoon of sugar equivalents or a continuous glucose monitor to really show them what's going on.
Steven Bartlett: What about bread? I did some research and it said a single slice of white bread contains about 0.5 sugar cubes, but a full loaf can pack up to 12 cubes of sugar.
Dr. David Unwin: That's true, but it doesn't include the fact that the wheat that makes the bread will turn into sugar as well. On my teaspoon of sugar equivalent, even a small slice of brown bread is about three teaspoons of sugar.
Steven Bartlett: Is there a healthy bread?
Dr. David Unwin: That's a great question, and it depends how well your insulin is working. If you're young and you take a lot of exercise and your insulin is really good, then maybe brown bread is okay. If you're like me with insulin resistance, it would have to be low-carb bread. I wouldn't normally eat bread under any circumstances, but I might have low-carb bread.
Steven Bartlett: I did some research that said sprouted grain bread or 100% whole grain rye are the healthiest options because they contain zero added sugar and high fibre.
Dr. David Unwin: It depends. How much exercise do you take? Have you had your fasting insulin measured? Do you know if you're insulin resistant? If you're healthy and take lots of exercise, sounds good. If you're beginning to develop a tummy, maybe not so good. And if you don't know, I'm a great one for experimenting. That's where I come back to the continuous glucose monitor. I've got one on me now. I could try your bread and within an hour I would know.
The problem with how we eat through the day
Steven Bartlett: You said wake up in the morning, you have your cereal. And then what?
Dr. David Unwin: You wake up and have your cereals for breakfast, then a big glass of fresh orange juice. Then on the way in, you have a little snack — a bar or some crisps. At school, maybe a muffin mid-morning. Then an apple. At lunchtime, sandwiches. Then maybe a cake or some ice cream. Then you go home and have chips or pizza. What you've actually done is have sugar with your sugar with your sugar all day long. There's hardly any protein. Where was the protein to grow you?
That's what's changed over time — the snacking. I come across a lot of young people whose mothers say, "I can't get him to eat any proper food. He just eats snacks all day long and I can't get protein into him." And some of them are actually thin kids. They're not all fat.
The Dragon's Den dried fruit example
Steven Bartlett: There's another example that's really front of mind for me. I'm on Dragon's Den at the moment and someone came in and pitched a fruit snack business — basically dried out fruit pieces. I looked at the back and it said 60 to 70% sugar, because what they've done is taken exotic fruits like mangoes, dried them out, and now you have this little chip that's 60 to 70% sugar. I'm looking at the back of this thing thinking this is candy. But I'm looking around and because it uses the word "fruit," everyone has this halo assumption that if the word fruit is on it, it must be healthy.
Dr. David Unwin: Exactly. And who cares about the consequence — will make a pile of money selling dried up fruit, and people miss what you read on the back. If somebody had type 2 diabetes and you gave them that for kids — you've touched on another thing about what's going wrong. You wake up and have your cereals, then a big glass of fresh orange juice. Great idea. And round you go.
The ketogenic diet and mental performance
Steven Bartlett: What do you think of the ketogenic diet?
Dr. David Unwin: That's a big question. I think we need to begin with what you want — your goals and hope. Are you wanting to lose weight? Are you wanting to sort out type 2 diabetes? Nutritional psychiatry is really growing, and Ian Campbell at Edinburgh University is doing some amazing work with bipolar disorder and other things. So why are you doing it? That's my first question.
I see it as a spectrum of carbohydrate that you're on. I try to find out where you are now, and then I'd say, could you give up bread or reduce it? Then let's measure whatever parameter we want — blood work, weight, whatever. Then we say, how are you doing? Are you happy now, or would you like to go a bit lower? What I've discovered with my patients over 13 years is they tend to go lower over time, because when they experiment and go keto, what they like is the brain thing.
Steven Bartlett: Why would I go keto? I'm going to put the brain thing at the top of the list — the clarity of thought. In my job I have to sit here with very smart people and talk sometimes for three or four hours. I'm on television a lot, cameras rolling on BBC One, and I've got to think of something smart to say to an entrepreneur pitching to me. I'm in meetings about very complicated things — buying companies, meeting founders, interviewing people.
What I've noticed profoundly, because so much of my job centres on speaking and articulation, is there is this wild variance that I hate. Some days I'm on it, and some days I'm almost embarrassed by my inability to string a sentence together. When I'm in keto, I always sound like Buster Rhymes — it's always just working. Then I'd say the aesthetic stuff, because I want to look good for my fiancée. And then being strong. And then I want to live long — a long health span, not just a long lifespan.
Dr. David Unwin: You've got a clear idea about your preferred future, and it's fairly specific. The more specific you are, the more likely you are to be successful. And then you're noticing. Then afterwards comes the feedback.
Steven Bartlett: Do you think most people have even thought about this?
Dr. David Unwin: No.
The GRIN model for behaviour change
Dr. David Unwin: I'd love to tell you something about my wife Jen's work because it relates to changing behaviour fast. She spent two years thinking about CBT — cognitive behavioural therapy — and what were the necessary parts of it and what was junk. She reduced CBT down to something I'll teach you right now.
The first thing is to think about your health goals. Think about what, in a year's time, if what you do is great, how does that look specifically? You might think you'd like to lose weight, but that isn't specific enough. I want to know what difference would that make to you? You said you wanted to be in shape — what do you mean by that?
Steven Bartlett: I think what I'm really scared of is having the same health profile as my dad. We have a lot of the same genetic profile. I remember walking down some stairs in Bali — a long steep set of stairs down to go white water rafting with my fiancée. And I remember those stairs because we had to walk back up. My dad would have lost out on one of the great joys of life — doing enjoyable things with friends and people you love — because his health has gone in that regard. I remember when I was younger, my dad used to play football with us, and he's unable to do that now.
Because I've done this podcast so many times with health experts, I realise that the decisions I make at 30 exist on this really interesting, quite predictable curve of inevitable decline. Not inevitable loss of lifestyle — what I mean is I have this picture in my head of all these graphs where your peak is around maybe 20 to 30 and then you're going down, which we all accept. But how far you go down is determined by decisions you make right now. The decisions I make now will end me at 70 or 80 years old in either the inability to walk or the ability to run.
Dr. David Unwin: Let's just refine that. I've got your goal. Now the next thing is: in the past, what have you done that's worked towards those goals?
Steven Bartlett: I said to myself one year that I was going to go to the gym every single day — terrible idea, because I got five months in, missed a day, and it was over. I said to myself another year that I was going to get a six-pack for summer — terrible idea, because when summer came and I got the six-pack, my question was, what now?
Those two incidents helped me change my idea. The idea I came up with was to set not an achievable thing as a goal, but consistency as the goal. Consistency became, for the last four years, this idea that the goal — my fitness goal — means that every day I wake up I get a shot at it, and if I mess up today, I've got another shot tomorrow.
Dr. David Unwin: Good. So we did the goal, and then we did resources — what do you bring to the consultation that you've done in the past? Intelligence, resources, friends that will help. You come already with expertise in yourself. I'm not the expert to tell you what to do. You've already got some stuff.
Then we go to the next thing. If we had your goal at the beginning, what might be a small step towards your goal today?
Steven Bartlett: One of them is creating a social pact. We made a WhatsApp group, put 10 friends in it, and made a simple rule: whoever's the least consistent every month is evicted and we invite a new friend in. We've done that for four years. I've not been evicted in four years. Every day when we work out, it puts our workouts into the group chat, and every week and every month there's a winner and a league table. I won one year, so I've got this physical massive gold belt on my bookshelf at home that says "Fitness Blockchain World Champion."
The other thing was, as I said, when I set the goal of going to the gym every single day, I set myself up for failure. Now I set myself the goal of consistency, which means I can have bad days where I do 20 minutes or 15 minutes. Yesterday, because I was finishing Dragon's Den late and drove down to London, got home at 1 a.m., I did 18 minutes. Reducing the size of success really helped me keep my feeling of momentum.
Dr. David Unwin: Brilliant. We're nearly at the end of your degree in psychology. The final thing is: when things are going well, what would you notice? If tomorrow is a really good day, what might you notice at the end of it?
Steven Bartlett: The first thing that comes to mind is just how I feel. Emotionally I feel good about myself. Energetically I feel more energetic. And there is this element of identity — I have an opinion of myself and who I think I am. I think I'm a healthy person, someone that's in control. When I'm not performing the consistent behaviours I want to, I start to question that identity in a way that causes a lot of discomfort. "You're not in control of your own life." It links into self-esteem.
Dr. David Unwin: So what we just did: we had the Goals — G. Then we had your Resources — R. Then we had Increments — what little things had you done on the way. And then finally, I invited you to Notice and reflect. And that spells GRIN. That's Jen's published GRIN model. I do it in nearly every surgery, because what I'm trying to do is find out about you. And you didn't find out much about me in that process, did you? But I found out a lot of really useful stuff about you, and it's motivational. Much better to do that than tell you what to do. Motivation, as Jen has taught me, is key in everything we do.
Steven Bartlett: So what do we do with the GRIN model? How does one apply it?
Dr. David Unwin: Otherwise it's possible to spend a lot of time blaming yourself, particularly around weight problems. You can spend a lot of time saying I'm to blame, or I wish, or I shouldn't have had that. After Christmas, everybody feels like this. But what is much better, rather than focusing on guilt and negative stuff — what Jen is trying to do is get you to engage by thinking about a better future. The whole of that five minutes was engaging you in the goal of a better future, then some resources towards your better future, then the first steps, and then noticing what's good.
In medicine, how do you get a doctor's attention? You say, "Oh, it's so bad, my pain is so bad." I realised I had trained my patients to think that moaning was how they got my attention. The result was a very miserable surgery. But if you can talk about hopes and good stuff — even people having a terrible time have got hope if you can find it. They have goals if you can discuss them. You could have somebody with a drug addiction, or somebody dying — every clinic I'm seeing sad stuff — but if you can also investigate hopes and good stuff, as a doctor I'm so much more energetic, so much more hopeful. I'm having a great time. And I wasn't when I was 55.
Dealing with someone you love who is struggling
Steven Bartlett: I bet there are so many people listening now who understand this stuff and are making good progress, but they live with or love someone who they're scared is going down a slippery slope. Do they intervene? Do they hide their sweets? Do they blame? What do they do?
Dr. David Unwin: That's so hard. Weren't you in that position to some degree?
Steven Bartlett: Yes. My first wife had a very severe addiction problem. I lived with that for 12 years and she's unfortunately died now. It was very serious, multiple addictions. Living with that means living with uncertainty. You never know what you'll come home to. It brings chaos into your life. It's very very hard. I have so much sympathy with how hard it is to deal with uncertainty and not be able to do anything. You love somebody and you can't do anything.
Dr. David Unwin: There are things you can do. If you can engage people in talking about goals, that can help. But let's change that conversation to the current Mrs. Unwin. Jen's story is that she actually is an ultra-processed food addict, genuinely. Neither of us understood what that was. Even though she's a consultant psychologist, she didn't realise she was an ultra-processed food addict. What she saw it as was a weight problem. All her life she'd been boomerang dieting — a big woman, then a little woman, then a big woman. There'd be tray bakes, she'd say it's for the children, and then scoff the lot herself.
Because I loved her and wanted to rescue her, I was either throwing the food away or tackling her, and we were having such arguments because she was defensive and cross. I couldn't understand what was going on with such an intelligent woman. But then, only a few years ago, she understood for the first time that this is addiction. When you have highly intelligent people doing stuff that harms their health repeatedly, is this not like cigarettes? Is it not like alcohol? That is ultra-processed food addiction.
Ultra-processed food addiction — a patient's story
Dr. David Unwin: There's a patient I'd like to tell you about who has consented for me to share his story because he wants to help the world. He's a very successful, wealthy person with a successful business. He's not stupid. He has type 2 diabetes. He's 55 and very much overweight. He needs serious surgery because both his knees have been so destroyed by his weight that he can hardly walk. But his type 2 diabetes is so bad, his blood sugar control is so bad, the anaesthetists won't touch him. He's trapped — he can't get the operation because his blood sugar is high, and he can't run his business easily because he can hardly walk.
We say he needs to go low carb. It works for a bit and he loses some weight, but then he gains the weight again. This goes on for four years while I see him regularly every month. Then his wife came to see me and said, "Dr. Unwin, I need to level with you. I find that my husband is getting up at 4 in the morning and eating bread out of the fridge. So what I started doing was putting all the bread in the bin at the end of every day. But then I discovered my husband was going in the bin to eat the bread."
Then she started putting liquid detergent on any bread that goes in the bin. But he still eats it. He's getting up at 4 in the morning, rummaging through the bin to eat the bread with the detergent on. So she tries something else. She says, "The only thing that will stop my husband is if I spray bleach on the bread and leave the can of bleach by the bin so he knows — don't even look."
What I've described to you is addiction. This is an intelligent person. And imagine his self-esteem, living like that, concealing what he was doing and not telling his doctor while I was trying so hard for him for years.
My stories have a happy ending. What I did for him in the end was low carb, plus a continuous glucose monitor so he would get immediate feedback and see the spike, plus a low dose of one of the new GLP-1 drugs. The three together — he managed not to moderate, but to abstain. The GLP-1 helped reduce the noise, the cravings in his head. The feedback from the CGM helped him know how he was doing. The support from me and the low carb pulled together. He's had his operation now. It's a happy story, but he's got maintenance for all his life.
It's a wonderful example because I think we trivialise this. We call it carb creep, like it doesn't matter. But there are many people listening right now who know they're addicted to various foods. They know because when you ask them, they often burst into tears. Someone will say, "I've never told anybody in my entire life, but I can't control how I eat bread." And if you're not addicted to bread, you can't imagine it. But if you are, they say, "This sounds so stupid. I'm so embarrassed to tell you."
My wife has published many papers on this and written a book. She would say about 14% of the population has some aspects of ultra-processed food addiction. It explains so much — why are intelligent people eating foods they know do them harm?
I've got another example. One of my patients with type 2 diabetes — we got drug-free remission. I've done that now 157 times. This guy, we did it. Then he vanished for a while and came back with two dead toes that had to be amputated. They started rotting because diabetes takes the blood supply particularly from your toes. We had to have surgery to remove part of his foot. You call it carb creep and he ended up with half his foot taken off. That's not carb creep. Something far more sinister.
But I never give up. I got him back into remission because this time he and his wife are really determined. He's not a foolish man. He's an intelligent man, and yet various foods called to him. Many people with overweight — and some who are not overweight — are struggling with very significant carb cravings and really struggle to control them.
What to do if you can't control what you're eating
Steven Bartlett: For those people — and some people have seasons where they're in control, then out of control, then in control — what is step one today?
Dr. David Unwin: Step one is acknowledging that it is your problem. If you're not honest about your problem, how are you ever going to sort it out? Honesty. That's very hard for people. Me and my biscuits — it was easier for me to think that was stress and a reasonable reaction to the stress of running a practice than to say I've got a problem. It took me a year to give them up. A whole year.
Steven Bartlett: How did you give them up?
Dr. David Unwin: I did it by weaning myself off, a bit like methadone. I went from chocolate ginger biscuits to digestive plain, then to oat biscuits, then eventually to almonds.
Steven Bartlett: Why didn't you just do it all at once?
Dr. David Unwin: I should have done. Jen is a great believer in cold turkey. I wasn't man enough for that and it took me a whole year.
So the first thing is: be honest with yourself. Even if you can't tell other people, be honest with yourself. Is there an addictive potential there? Number two, specifically which foods are your problem? Be honest. Number three, have a plan for abstinence. Because if you have an addictive potential, it won't be one biscuit. How many of us have said I'm going to give up ice cream or biscuits or pizza, and then you have a bad day and you think, tomorrow, tomorrow, tomorrow.
So it's very important to be specific about the foods and then have a plan for how you're going to do it. And sometimes it's helpful to share with the people around you that love you — that it's important and that you might need some help. Please be tolerant with me, like cigarettes. I might be short-tempered. I'm going to try and do this thing because it's important.
The difficulty depends on whether the person that loves you can be gentle or if they're heavy-handed. If you confess this and then they police you, it doesn't help.
Steven Bartlett: I can think of a time in my life where I was with somebody who was so into their health that it made me start to hide when I was eating badly. I was hiding the wrappers of the things I was eating.
Dr. David Unwin: Thank you for that. That's what happens. If you police somebody you love, the result is deceit. Jen did that with me — she knew I was monitoring, so she started hiding the wrappers. Then I'd find them in the car. And then we have a situation where we can no longer talk about it. If you're forcing somebody to become deceitful, you have to back off a little bit. Because that deceit then affects self-esteem and can make them worse. And then they're lonely because they can't share the bad days.
Jen Unwin's book — Fork in the Road
Dr. David Unwin: Could we show Jen's book at this point? This is Jen's book. The most important thing is Jen doesn't make a penny out of this book. It's called Fork in the Road — the idea that in your journey, which one are you going to pick? Every penny goes to a charity she's set up helping people with food addiction. It's available on Amazon, self-published.
Steven Bartlett: How much does it cost?
Dr. David Unwin: About £10.
Steven Bartlett: I'll buy a thousand of them. I'll put a link below in the comment section. All you've got to do is click below and we'll send a thousand of them out. That's just a thank you from me to both you and Jen, and to the community who tune in for these conversations. It's so great that people can get such simple, accessible information with such rigorous scientific credentials. A simple book like this could change some people's lives. That's such a wonderful thing.
Diet, cancer, and the link to chronic disease
Steven Bartlett: You said something earlier about the link between dietary choices and cancer. I've actually got a friend of mine who used to work for me who is going through a cancer process at the moment. She's very young — actually younger than I am — and was diagnosed with breast cancer. She's called Katie. She's very public about this, posting her journey online. She's been removing a lot of the foods we've talked about today from her diet.
I was looking at some of the stats around the link between our dietary choices and cancer outcomes. A massive French study found that drinking just 100ml of sugary drinks per day — about a third of a can of soda — is associated with an almost 20% increased risk of overall cancer. Women who consume two or more diet drinks daily have over double the risk of early-onset colorectal cancer compared to those who drink less than one a week. High consumption of sugary sweetened beverages is linked to a 78% higher risk of oestrogen-dependent endometrial cancer in women. Drinking 20 ounces of sugary soda daily is linked to shortening your telomeres — the protective caps on your DNA — equating to 4.6 years of extra biological ageing.
Chronic hyperinsulinemia — when insulin levels are high, as I explained at the beginning — can inhibit apoptosis, the natural process where damaged or cancerous cells self-destruct. Fructose is processed in the liver and converted into lipids, which recent studies show certain tumours directly consume to build their cell membranes. And diets high in added sugars chronically elevate C-reactive protein, an inflammation marker that is heavily correlated with tumour progression and metastasis.
Dr. David Unwin: That is so interesting and it brings to mind a really important point. We talk so much around the world about treating cancer, but what about prevention? For your friend, that's a life sentence and she's living with uncertainty and fear. And when I tell patients they have cancer, you feel it right here, because you just took away so much.
Do we try hard enough? If we know that, are we trying hard enough to prevent cancer? Because that's what we should be doing. After smoking, diet is the next most common cause of cancer. How serious does it have to get? Junk food is linked to all-cause mortality. What are we prepared to sacrifice for enjoying treats and snacks? When you look at it like that, it's really bonkers.
Steven Bartlett: This sounds a bit crazy, but sometimes I imagine receiving the diagnosis. I do a bit of a premortem — not a postmortem — where I imagine on that day the decisions I wish I would have made. I'm not saying all cancer is linked to what we eat, because that's not the case. But I'm imagining the worst diagnosis I could ever be given and the doctor telling me that my lifestyle choices contributed to that over the last 5, 10, 15 years. In that moment, is there any sugary drink that is worth it?
Dr. David Unwin: You would just wish with every bone in your body, coming home to tell your fiancée, your partner, your kids that you've got this horrific diagnosis — you would just wish you had made a different decision.
I also think that's a very good strategy for dealing with problems. Your life must be so complicated, and yet all of them are as nothing against a cancer diagnosis. You would look at the problems you have right now and you'd laugh. Yesterday I was worried about the traffic or whatever. Mortality is a leveller. All my life I've been obsessed with death and it worries me. I can't sort out in my head what death means. It really scared me when I was a child. But what it's given me is a drive not to waste time and to think about what's the best use of today.
Steven Bartlett: Through everything you've talked about today, we can both waste less time but also have more time. When I learned about the difference between lifespan and health span, that added to this equation. People still live to 80 years old, but they're only healthy for like 30 or 40 years.
Dr. David Unwin: The idea of health span is very important because we know in the UK it's going down.
Steven Bartlett: In England, the situation is particularly alarming. Health span is actively declining even as overall lifespan slowly creeps up. Recent 2024 to 2026 data from the Office for National Statistics and the Health Foundation paints a stark picture of the UK's widening sick years gap. Over the last decade, healthy life expectancy in the UK has fallen by roughly two years. As of the latest data, men and women in the UK can both expect to spend about 60 years in good health. Because overall life expectancy in England is rising, people are now spending roughly up to 23 years at the end of their lives with poor health and in sickness. The average person spends nearly a quarter of their life managing chronic illness and/or disability.
Dr. David Unwin: That's exactly the point. And it relates to another thing I'd like to tell you about. This is government figures: every taxpayer in England pays an extra £7,000 tax per year for the consequences of ultra-processed food. And this is because it's not just the cost of the drugs — the bigger cost is people not paying tax themselves and not able to work because they're ill. Two-thirds of the cost is the lack of revenue because so much of our population isn't well enough to work. And a lot of it's young people too. It's very serious.
Steven Bartlett: About 30 to 40% of our listeners are in the United States. The US currently holds a rather grim record. It has the largest health span to lifespan gap on Earth. Despite the United States having lower overall life expectancy than almost all of its peer nations, and a premature death rate that is nearly twice the average of comparable countries, its health span stats sit as the worst in the world.
Dr. David Unwin: We're doing our best to catch up.
The waist measurement test
Steven Bartlett: I have this piece of string here, which I guess is a mechanism you use to figure out if people's waist and fat levels are too high.
Dr. David Unwin: I'm interested in low-cost ways for people to find out how they're doing. One recognised way of looking at metabolic health is: your waist should be less than half your height. So if we have a piece of string — I believe you're 6'1" — you've marked halfway. Half of that string should go around the fattest bit of your belly. Will it go around your belly, yes or no?
Steven Bartlett: Okay, so I've cut the string in half. Which part of my belly?
Dr. David Unwin: The fattest part. Be honest about the fat part.
Steven Bartlett: Okay. Can I look? I mean, it's not squeezing in. No, I'm not cheating.
Dr. David Unwin: You've just done it. You've passed. But it's a really simple test for everybody at home. Piece of string, as long as you are tall, cut it in half. Will it or will it not go around your middle?
Insulin resistance tends to put weight on your belly. You may have a very muscular abdomen — let's pretend it's that. But you're just about there. Your weight alone isn't the whole story — it's where the fat is distributed. Fat on your belly is more worrying than fat on your legs or on your arms.
Supplements — magnesium, vitamin D, and the cow story
Steven Bartlett: One of the things people always ask me about is supplementation. What's your point of view?
Dr. David Unwin: My gut reaction is to try and use diet to give you what you need if you can. A real food, lower-carbohydrate diet with plenty of protein and healthy fats is my preferred thing. I'm very interested in farming and regenerative agriculture. What I know is that the nutrient profile of crops grown today is not nearly as good as it was 100 years ago. If you keep just adding nitrogen and harvesting crops, those crops do not contain as much zinc or magnesium particularly. So although my aim would be to have you healthy with a real food diet, there are some things you cannot get in the diet now that your grandparents could. One of them is magnesium.
It's very difficult to get enough magnesium in your diet without supplementation. As you get older, you absorb it less and less. Also, a lot of medication interferes with magnesium absorption, particularly drugs for acidity. Magnesium supplementation for most people — in myself, it was magic at getting rid of muscle cramps, and I sleep a lot better.
Which magnesium? It depends on your bowels. If you tend to be a bit constipated, magnesium citrate is very good — it's more laxative and you absorb some of it. If your bowels are not a problem and you're wanting better sleep or mood, magnesium glycinate or threonate actually crosses the blood-brain barrier but won't help with constipation.
Have we got time for me to tell you about the first cow I ever bought?
Steven Bartlett: Go ahead.
Dr. David Unwin: My wife Jen has this idea that if you love somebody, gifts are about thinking what would that person like. And this is how she tried to get me to grow up. She said to me one day, "Get a coat and a pair of Wellingtons. I'm going to take you out." She drove me into Lancaster and there was a field of cows. She said, "I have bought you any one of those cows." Because I'd always wanted a cow and we had a field. She'd gone to the farmer in advance and prepaid for any cow and said, "I've bought a cow — you just pick which one you like and he'll transport it home."
How does this relate to magnesium? The farmer said, "You can have whichever cow you like, but I've lost 15 cows to a thing called the staggers this year. You cannot have the cow unless you promise me you'll buy magnesium supplements, because the grass is now so short of magnesium that cows die fitting if you don't give them magnesium supplementation."
At the same time, I had a patient I couldn't work out why he was fitting. I kept being called out and admitting him to intensive care. It wasn't a brain tumour. Why was he fitting? It was magnesium deficiency because of medication he was on. That was the first time I ever seriously thought about magnesium.
The modern diet leaves most people magnesium deficient. And the problem is you can't easily measure it — your blood magnesium doesn't reflect what's going on because magnesium is mainly inside your cells. You'd need the intracellular magnesium level. But it's just easier to try a magnesium supplement and see how you feel.
Steven Bartlett: I do take magnesium because the experts on my podcast have told me it's important. I take five supplements a day: vitamin D because I'm inside all the time, magnesium, creatine, a fibre supplement because blood tests said it would help reduce my LDL cholesterol, and a multivitamin to cover everything.
Dr. David Unwin: That sounds okay. One of the clinical things I find is that if you ask people how many supplements they're taking, a carrier bag comes in. It is possible to over-supplement, particularly maybe vitamin D and various vitamins. But broadly, what you've described sounds reasonable.
Continuous glucose monitors and personalised feedback
Steven Bartlett: Am I wise to be looking at the back of packets? I look at the back of everything I eat. I always seem to zoom in on the sugar, the added sugar.
Dr. David Unwin: There is an error there. The sugar is one thing, but you must also look at the carbohydrate content. In the UK, when it says carbohydrate, that turns into sugar. In the States, the carbohydrate figure includes fibre, so it's more complicated — you need to know how much of that carbohydrate you're going to absorb.
You should be interested in protein — how much do you want? The carbohydrate — well, why do you need that? And then fats, which you might need for fat-soluble vitamins. If things have a lot of preservatives, if they have an awful lot of ingredients, I'm immediately suspicious.
Steven Bartlett: One of the things I've come to learn through interviewing people like yourself is that it's not just the direct consequence of having a big glucose spike. It's also the fact that when I eat things like Mars bars or white rice, I then get more hungry later, which means I eat even more sugar that same day and the next day.
Dr. David Unwin: And of course that's what my patients back in 2013 found fascinating — the absence of hunger. I'd been hungry all my life because all my life I'd been carb-heavy. The more carbs you eat, the hungrier you become.
Steven Bartlett: I fast most days to be honest. I haven't eaten today and it's 1 p.m. During Dragon's Den filming, I often don't eat until the evening.
Dr. David Unwin: Isn't that interesting? I used to have a model that if I didn't eat, I was hungry, and if I didn't eat for twice as long, I'd be twice as hungry. And what's surprising is that as you fast, you don't become more hungry, do you?
Steven Bartlett: It's crazy. When I'm on keto, hunger just vanishes. And the remarkable thing — I love those cinnamon roll things. When I started doing the ketogenic diet, I remember walking up to a cinnamon roll concession stand in Cape Town and looking at them, and they were doing nothing to my brain. There was no temptation.
Dr. David Unwin: It's like a superpower. I've had that with Christmas cake. It was my kryptonite — the kind of thing I was sneaking down when they'd all gone to bed and having more. And then one day you can look at it and think, that isn't actually food.
I throw this down as a challenge to men. Are you man enough to resist? Come back in a week and tell me you've not had any biscuits.
Screening, health inequality, and the role of social media
Steven Bartlett: I've got a friend who is going through a cancer process at the moment. She was diagnosed with breast cancer. She's called Katie and she's very public about this. I've been following her and she's removing a lot of the foods we've talked about today from her diet.
Dr. David Unwin: What I'd like to say is that we talk so much around the world about treating cancer, but what about prevention? Because for your friend, that's a life sentence and she's living with uncertainty and fear. Do we try hard enough? If we know that diet is likely the second most common cause of cancer after smoking, are we trying hard enough to prevent it?
Steven Bartlett: I also think about the idea of wasting time. Through everything you've talked about today, we can both waste less time but also have more time. People still live to 80 years old, but they're only healthy for like 30 or 40 years.
Dr. David Unwin: The idea of health span is very important because we know in the UK it's going down. Lifespan is stuttering along, but health span is going down.
Steven Bartlett: I know I think about 30 to 40% of our listeners are in the United States. The US currently holds a rather grim record. It has the largest health span to lifespan gap on Earth. Despite having lower overall life expectancy than almost all of its peer nations, and a premature death rate that is nearly twice the average of comparable countries, its health span stats sit as the worst in the world.
Dr. David Unwin: We're doing our best to catch up. I think social media helps because it doesn't cost much to go on social media and find out things. And people like you who have an increasingly loud voice across lots of podcasts, reaching millions and millions of people, and teaching them.
Steven Bartlett: What's difficult is not to become confused, because you have newspapers saying eggs are good, eggs are bad, and then you have this expert saying this and another saying the other.
Dr. David Unwin: What I've tried to do is base what I say on real-world data, and that's different. I'm very careful to take baseline data from my patients and then update it all the time. The publications I've done are based on the real world — the health service in the north of the UK. I can't cherry-pick my patients. I'm allocated my patients by the state. So part of what I do is proof of concept: if you can achieve this in the north of England near Liverpool, and if other people can replicate it in Australia, New Zealand, North America, maybe it's true.
The importance of checking your own blood sugar
Dr. David Unwin: I think continuous glucose monitors are the cavalry coming over the hill, because we can't be fooled much longer. Let me just look at what my blood sugar is right now. So what that is — that's somebody with type 2 diabetes — but look, my blood sugar is absolutely level. And that's good, because you want it level. That is because I don't eat stuff that puts up my blood sugar. If I were to have some of those foods, you'd get a spike. But that's feedback.
Also, if I get very stressed, it puts up my blood sugar. You've been so kind — I haven't been stressed. So other podcasters are not as gentle and kind as you and I get a horrible spike. You and I have been together for a few hours and my blood sugar — I felt safe. So you've done your job too. No spiking.
Type 2 diabetes in children — a new crisis for paediatricians
Dr. David Unwin: I'll tell you a final story. Type 2 diabetes is brand new as a problem for paediatricians — doctors who specialise in the diseases of children, people under 16 years old. Children everywhere are now suffering from type 2 diabetes. But the paediatricians have had no training because it's a new disease. So a large group of paediatricians sent for me and said, "Please do a keynote and teach us what to do," because although they're specialists, they have no experience in type 2 diabetes. This is a new disease of children. That's what we're doing. Leave it at that.
Closing reflections
Steven Bartlett: Dr. David Unwin, we have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they're leaving it for. The question left for you is: if humanity organised to make contact with a more intelligent species, who should represent humanity and why?
Dr. David Unwin: What about David Attenborough? He's 100 years old and he's spent so long thinking about the planet. Wouldn't he be a wonderful ambassador? I am passionate about biodiversity, I'm passionate about sustainable agriculture and sustainable food. I pick David Attenborough.
Steven Bartlett: I think that's a wonderful choice. I think the aliens would really like him.
Dr. David Unwin: They would. That's my answer.
Steven Bartlett: Thank you so much for what you do. You're really remarkable in a way that's quite rare. The most notable thing is you're a very kind human and the way that you speak is very nice to listen to. You're very natural and good at telling stories. The human brain is really orientated towards stories. You could sit here and say "banana bad" or "magnesium good," but I'll never forget the cow story. The way you tell these stories is so captivating that it enables me to learn in a way that is engaging, and that is rare.
The other thing is your depth of experience, your humility, your willingness to admit when you were wrong, which means that I trust you so much with what you're telling me. And your ability to simplify is remarkable. I sit here all day with super geniuses from Harvard and Stanford and I'm struggling to understand what they're talking about because they don't take a second to build the bridge between the science and the average person. You do that so naturally.
Dr. David Unwin: Coming from you, that means a great deal. It's just what 40 years in general practice does to you. If you wish to be effective and you notice — as in the GRIN model — I'm watching your face, I'm watching an audience, and I'm reading how I'm doing. Are you getting bored? Do I need to move on? That's what I do with patients. I watch very carefully.
Steven Bartlett: It's such a rare skill. Because it's so rare, I would just implore you to do more. It's so rare that you can have such a massive impact.
Dr. David Unwin: We need to talk about how the audience can help. I'm trying to get bigger on Twitter, so this will help me immensely. It's lowcarbgp on X. Please follow me — lowcarbGP.
The other thing that would help very much is to support the British charity I set up, the Public Health Collaboration. It's our 10-year anniversary. We set up — 16 clinicians got together and said, "How are we doing? Rubbish. Can we do better? Can we give clearer public health advice?" So please support our charity. Go online, find out about it, come to our conferences.
Notice each of us is on a journey. Be clear about your goals. Notice what works for you because that's what you're doing — see yourself as an experiment. Don't be frightened of experimenting. But if you're going to experiment, measure something, and then you'll see how you're doing.
One thing that gives me hope is continuous glucose monitors, because you're getting individualised feedback right there. How is my blood sugar? I can check mine right now and see how I'm doing. They're only $20 to $30 on Amazon. If you loved your dad or had somebody and it's Christmas and you could buy a useless ornament, or — would they be interested to find out about their blood sugar? If they've got a mobile phone, they could try a continuous glucose monitor and find out.
Steven Bartlett: I have tried one. And what I learned was that all these things I thought had no sugar in them have loads of sugar in them. I had no idea about ketchup.
Dr. David Unwin: And the point is, once you've seen it on your phone, you can't unsee it. I see them as the cavalry coming over the hill, because we can't be fooled much longer.