Dr. David Unwin - Why You Can't Trust Your Doctor

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Dr David Unwin

Dr. David Unwin & Dr. Eric Westman – Why You Can’t Trust Your Doctor About Medication

Introduction

Dr. Eric Westman: It is my great pleasure to be able to talk to Dr. David Unwin, who is in the UK.

Dr. David Unwin: We have such a lot in common.

Dr. Eric Westman: You have been very influential in the UK collecting data audits from your practice and showing you can save money using a low-carb diet. How did you get started?

Getting started

Dr. David Unwin: I am an elderly GP, 65 years of age. I have looked after the same population for 40 years. That brings with it a lot of insights and good things. Most clinicians in the UK retire when they are 55 years old. I was thinking I should as well because I was fed up with medicine, and I didn’t feel I was making a difference. I thought maybe do something more interesting, something else. The story is that a single patient changed my life, one patient, one day, changed my life. We are paid in the UK, in part, for medicating our patients, which I don’t really agree with. A patient of mine stopped taking her metformin medication for her type 2 diabetes. I wrote to her stating that I had concerns about her diabetic control and would she make an appointment to see me. I was going to tell her off and say, “You are not taking your drugs. You are going to come to harm,” I was in for a shock. She came in and I didn’t recognize her. She looked so fabulous. She had lost two to three stone in weight.

Dr. Eric Westman: How much is a stone again?

Dr, David Unwin: 1 stone is 14 pounds. It was around 42 pounds that she had lost. As a result, she looked different and she dressed differently. I was in for a much bigger surprise than her weight loss and how cross she was with me. She said, “I know you are going to tell me off for not taking the metformin. You need to think again, as I have done my blood sugar and it is normal. I don’t need your metformin anymore because I have gone on this low-carb diet. I know you won’t approve, but I feel wonderful. My blood sugar is normal. My blood pressure is better, and I won’t take your medication no matter what you say. She then said, “You had me on metformin. You never once asked me about dietary sources of sugar, particularly starchy carbs. You didn’t mention that once in 10 years. Do you not realize that bread is sugar, potatoes are sugar, and rice is sugar?”

Dr. Eric Westman: Your patient is telling you this? You are her general practitioner who has treated her for ages.

Dr. David Unwin: I treated her for 20 years at least. She was hopping mad. She explained that she’d never told me, but the metformin had given her diarrhea and she’d found that so embarrassing she’d never told me. She went on to say “Dr. Unwin, I wonder if you are medically qualified because it is so basic, the understanding that starch is sugar.” At that point, I thought I needed to listen. I started asking questions. I was astonished to learn she was online, I think, with 40,000 people on the website diabetes.co.uk

Dr. Eric Westman: Does that still exist?

Dr. David Unwin: It does. And they were teaching each other. I thought the physiological point she made was good. When we did her blood pressure, she had achieved drug-free type 2 diabetes remission, which I had never seen in 25 years of medicine. This was in 2012. The whole of my career was to add a drug and another and another. I had come to hate diabetes as a subject because it was so miserable. I was the senior partner at the time. We had nine doctors and about 10,000 patients. As the boss, I said, I am not seeing people with diabetes anymore and made the junior partner do it.

Dr. Eric Westman: That is an interesting point. This is probably going on in many doctors’ heads today. It is frustrating.

Dr. David Unwin: You become a doctor hoping to make a change, and I wasn’t. What is wonderful now is that those same patients are now my favorites. They are full of hope, and I just love a challenge. Now within the practice, I get all the people with obesity and type 2 diabetes, metabolic syndrome, and I absolutely love the work. I am not retired. I am still there 10 years on. I am absolutely loving it because I see people getting properly well. Not invented wellness. They are shining with health. That is the story. One lady, and then after that many others.

Dr. Eric Westman: Let us pause for a moment. If someone is watching, they have a doctor who doesn’t understand this, they might even be against it. What did you learn? For me, it was someone flippantly saying, “That Atkins book was written before you were born.” It had to be some sort of emotional grab for me to be sucked into learning about it. How can a patient today influence their doctors?

How can a patient influence their doctor

Dr. David Unwin: All over the world, this is a grassroots revolution, and some doctors are sufficiently curious when they see success. They are interested in how it was done. My disappointment is that so many of our colleagues are not curious about success. You can maybe induce curiosity by saying, “Doctor, just humor me, would you? All I ask is that we get baseline data and that you let me have a blood test in a couple of months. Give me a chance to show what I can do with diet and lose weight.” I think you would be a very unreasonable doctor not to give your patient a chance to shine. If your doctor won’t let you do that, I wonder whether that is the best doctor for you because it is not kind. Unless the doctor can explain that you are heading for a certain death for whatever reason.”

Dr. Eric Westman: In my area, the doctors who are most resistant have been brainwashed in the plant-based diet. The only thing they can say is you need to do plant-based. Sometimes doctors think they have a better way to do it. I love that where you just measure or come in with your data like your patient did.

Dr. David Unwin: The other thing I would say to people is between us, we’ve now written quite a few peer reviewed papers, and you could collect your own data. There are now some very good open-access papers that you can print off and say, “I see there has been quite a lot of interest in this internationally,” and that may also help. You don’t want to annoy your doctor, but that can also help.

Dr. Eric Westman: After that initial encounter, and it is similar, I had two patients lose weight on their own without me. They weren’t quite as irritated as your patient. It was that encounter in my curiosity that led me to this. It wasn’t my personal weight loss journey. How did you gravitate in a GP practice and how is that different than it would be in the USA? In the UK I know it is called a surgery and here in the USA, it is a practice.

How is your practice in the UK different to our surgery in the USA

Dr. David Unwin: Our practice had an eightfold increase in the number of people with diabetes. I am an NHS UK GP. That means that patients are allocated to me. I don’t choose my patients. That is the practice. I was a young man in 1986, and because we audit our practice, we are computerized, we know what’s going on. By 2012 we’d had an eightfold increase in the number of people with diabetes in my professional lifetime. If that isn’t a pandemic, an eightfold increase which has now gone to tenfold. When I was a young man, diabetes was quite rare, and it was older people. It was worrying me that they were getting younger and younger, sicker and sicker. I looked online, and I saw that this lady of mine was not an isolated case, around the world there were many people. I thought, “Why don’t I go on the diet, myself?” I had moderate hypertension at the time, and I didn’t know it, but I was actually diabetic. I went on the diet just as an experiment and discovered that my blood pressure improved, my mood improved, and I needed an hour less sleep.

Then we had a problem. I believed in it, but my partners refused to let me do it. We had terrible arguments because I said I believe in this, particularly for the younger diabetics. I would like to do it, and they said no. My clever psychologist wife (Dr. Jen Unwin), who you have already interviewed, came up with a compromise. The first thing she said was, “David, why aren’t you doing this?” I said, “Because we are not paid for it.” She said, “I thought I married a doctor. What is this paid business?” She said, “How many cars have we got? Are we short of something?” She said, “You should do this for free.” She said, “I’ll work with you for free. Why don’t we do this in the evening when the building isn’t being used? Why don’t we do them in groups? Let’s do them in 20 to 30. Let’s do them in groups.” The nurse at the time was so excited by this. She said, “I’ll work for free as well.” I then said to the partners, “Let me do this; I’ll do it for free. If I can show results, can we discuss them in six months?”

We did it for free. After 6 months, I had astonishing results. I thought they were fraudulent. I couldn’t believe they were right. I kept checking the blood work. You must have had this where the liver function improves in weeks, the triglycerides plummet, lipid profiles, and blood pressure. I was deeply prescribing drugs. I had never seen anything like it. I took the data to the partners. What happened was each one of them went low carb gradually and partly. Another amusing thing is that one of several of the partners were runners. I am a runner, but in a sprint, I could beat them when I was low carb. It is so annoying to have an old guy beat you at anything! That also caused them to go low carb. The midwife lost four stone in weight. The practice manager went low carb. We are now a low carb practice with the majority of staff. They all know about low carb, and we’ve done TV programs like you. The media in the UK are fascinated by it. I have just been astonished, and such cheerful medicine as well. It is really fun seeing people who are well. It is like being a magician.

Dr. Eric Westman: Like the surgeon who takes out the appendix, that is what they do. Even though it is amazing, it is life-saving. What is unusual is that most doctors, internists, and GPs, are not reversing things like we can. So it is unusual, but it is replicable, reliable and predictable.

Is low-carb reliable

Dr. David Unwin: You and I know when you see that same pattern in every surgery you do again and again, we now recognize all sorts of patterns. That is why I am so hopeful about this group of patients. I was just doing the data on my practice, and I have got a quarter of everybody with type 2 diabetes into drug-free remission. That is NHS medicine in the UK, and they are not self-selecting because I am allocated patients. It shows what is possible at least and it does.

The UK environment

Dr. Eric Westman: I am assuming your environment is still very carb-heavy, like scones and chips (crisps).

Dr. David Unwin: Yes, Incredibly. The more northern you are in the UK, the more high-carbohydrate you tend to be. London people are slimmer, however, as you go north in the UK, people become heavier, crescendoing in Scotland. We are north of Liverpool so that is a constant battle. One of the advantages in UK general practice is the fact there is continuity of care with the patients. I have been there for 40 years, and although there are 9,000 or 10,000 people, you would be surprised how many people you get to know after 40 years. I know Grandma, I know Auntie so and so, I know the family, and bless them. On the whole, they do trust me. I am doing my best. Many people do well, then you look again, and they’ve gained weight, and they are back to square one. The challenge is maintenance. That is the Holy Grail internationally. What are the best ways to help your patients maintain their improvement in this carby environment? Those are what interest me. What are the best-maintaining factors to rescue people?

Dr. Eric Westman: It is not my practice, it is different. It is an obesity medicine practice where people come knowing they want to focus on this. Not everyone knows what I am going to ask them to do, and I occasionally use medicines, but it is the diet. Do some of your patients think this is a bait and switch, that you are just the GP, so why are you talking about food?

Psychology and behavior change

Dr. David Unwin: I have got better at that. One of the things is the psychology around behavior change, it is so fascinating, and the idea of working collaboratively with my patients so that I am not telling them what to do, but I am offering them choices. One of the things, if I were starting metformin, I would be fair, I would say to a patient, “Today, looking at your blood work. Your blood’s very sugary. I could do one of two things. I could offer you metformin, which has a 30% chance of diarrhea and it would be for the rest of your life, or, I believe I could treat you with just diet.” If you say to patients, would you like lifelong drugs starting today, or are you interested in maybe changing your lifestyle and I could get your blood pressure down, get rid of your belly, and you could feel better, do you want to give me a chance because I would love to do that? Not one person in 12 years has turned me down.

Dr. Eric Westman: When you put the juxtaposition of nausea and diarrhea is lifelong work but going without my fruit, without my bread, it doesn’t take long to get over that.

Dr. David Unwin: If you start saying you need to give up your rice and bread they say I can’t live without bread, I can’t live without rice. If people are motivated and I have piqued their curiosity then what they would otherwise object to, they don’t, and they do try it in every clinic. We have a PhD dietitian working with us looking at what my patients eat and they do cut back on the carbs, apart from all the work and the weight loss.

Sugar and infographics

Dr. Eric Westman: You have not only worked with your own patients, you created materials and worked with other programs. I like your infographics about the amount of sugar in different foods. How do you use that in your teaching?

Dr. David Unwin: In the early days it was a matter of, I have to be so economical with time, so how do I communicate it in 10 minutes? When I trained I had 5-minute appointments. 30 years ago I ran on 5 minute appointments. It is a luxury to have 10 minutes now. I have to be quick. Part of being quick is how you illustrate the consequences of dietary choices. I became interested in the glycemic load but explaining the glycemic load to people is time-consuming and confusing. I thought, why don’t we illustrate the glycemic load of different foods in a way that my patients could understand? I found one of the original guys, Dr Geoffrey Levsey, who had worked on the glycemic load. I said to him, why can’t we divide the glycemic load of various foods by the glycemic load of a teaspoon of sugar? I can then tell you that 150 grams of boiled rice, a small bowl of boiled rice, is exactly the same in blood sugar terms as 10 teaspoons of sugar. Whether you have a pile of boiled rice or 10 teaspoons of boiled sugar, the effect on your blood sugar is the same. We did the calculations on 800 or 900 foods and came up with sugar infographics. They have been downloaded, they are not copyrighted. If somebody here wants to see them, all you do is Google “P H C Unwin Sugar” and you will see them. They are now in 37 languages and have been loaded millions of times. As you were kind enough to say, people find them useful. I hope more of you will take them. There is no copyright – I make no money out of this. It is to help people understand the consequences of what you eat in terms of blood sugar.

Dr. Eric Westman: PHC stands for public health collaboration.

Dr David Unwin: It is a parity, so I am fascinated not by how I make progress in my practice, but how do we make progress both nationally and internationally so it became obvious.

Dr. Eric Westman: For those who don’t know you, you are the humblest world leader that there has ever been in the medical world. Tell me about the other organizations you have been involved in and that you were part of.

The website

Dr. David Unwin: One of the funniest things was diabetes.co.uk. This is the organization that had 40 very good low carbs on their website. I went on there to see all these people. I was so sorry about my colleagues, all the critical comments, that patients were suffering all of this shroud waving of you will die if you go low carb. I went online to say I would like to help you as an organization and to my astonishment the answer to that was to be suspended as a troll instantly because they didn’t trust any doctor to be fair. I didn’t know what a troll was. I had to ask my kids! Not only did they suspect me, they had me investigated and they sent the owners of the website up to Liverpool to see if I was a fraud. We were good friends by the end of half an hour and that was how they could tell I was sincere and that was how the low-carb program was born. They had written this low-carb program but they had not got a single doctor who was prepared to help them. I said medically you could do with a doctor and they gave me a few weeks. They said we want to get it out there, you can say what you like for two to three weeks. 460,000 people have now done that program and we have published results! That was one from diabetes.co.uk.

The media

Dr. David Unwin: I then began to think about the media. The media love before and after photos. I thought let us supply the media with what they love. I would say to patients, “Take a photo of yourself at your fattest, and if what I do works, would you be prepared to share the fattest photo and your thinnest photo? If I fail, you owe me nothing.” Because of that, I have got a whole series of really spectacular before and afters, and the papers love it. I have written 36 articles for our most popular paper, The Daily Mail, but there isn’t a paper I have not contributed to in the UK. I started thinking, what is it the papers want? Before and afters – they like patient stories. Because of the groups, I got a lot of expert patients who said, “I want to thank you, Dr. Unwin. What can I do?” I would say, “Would you talk to the media for me?” and they do. That was another thing, the media.

Twitter

Dr. David Unwin: That led to Twitter. Twitter is great for this; it is where the grassroots revolution is at. On Twitter, I am @lowcarbgp, and that has been very successful and very powerful.

Royal College

Dr. David Unwin: I then set my sights on the Royal College of General Practitioners. I thought, how can the Royal College of General Practitioners get involved? Arjun Panesar and Charlotte Summers of diabetes.co.uk – I never accept cash for things because I like to remain independent, however they owed me because I had done a lot for them – I said, “Would you fund an educational e-learning module to be given to every GP in the UK for free?” they did. I went to the Royal College and said, “I have got a backer. Can we produce this e-learning module and it can be for free?” There are 52,000 GPs in the UK, and that turned out to be the most successful e-learning module the college has ever done on low carb. The badging with the college was good. They then made me a Royal College clinical expert in diabetes.

Enemies

Dr. David Unwin: Another problem I had was enemies. People who tell me I am rubbish and am dangerous. I had enemies who would shout at me in public. When I began, I was heckled as a speaker, and I was shouted out, told that what I did was dangerous and I should be ashamed. I got hate mail, particularly from dietitians. I was mystified, but they did me a favor. I was so scared of what could happen. I thought that I needed to be very careful. I started collecting really careful baseline data and the latest follow-up for all of my patients because I think we stand or fall on our data. I know the average weight loss. I know all of these things after 12 years. That baseline and latest follow-up data was the beginning of starting to publish peer-reviewed papers, which on the whole, GPs do not do. Some of the papers have been very successful. We are trying to change the whole environment of papers where what clinicians notice is important and auditing our clinics is important. Those are all the various ways I am busy on many fronts.

Dr. Eric Westman: Years ago, I did randomized trials with small amounts of funding, and then set up a clinic based on the research that we and others had done. The computer system in the US then started to change, and all the academic programs got into this big monster program that is very difficult to extract information from. In fact, you have to pay someone else to do it. I, at first, set up a clinic. We put all our hand-edited information into Microsoft Access, which is one of these old things. Then things happened. I would love to have the ability to do an in-audit or a clinical review of our patients. What’s happened for my clinic now is that medical fellows and trainees in different areas will come and review certain content areas. For renal failure, people looked at the charts. You have one, too, which debunks the old myth that high-protein diets cause renal failure or kidney problems. This isn’t high-protein, and it doesn’t. We now have someone looking at heart failure patients because the medication world using a drug that causes ketosis thinks now that ketosis might be the reason why the drug prevents recurrent heart attacks. Why don’t we just put people on a keto diet? I have several anecdotes of people reversing their heart failure on the keto diet. Getting into this, through diabetes, have there been any other clinicals since you have different disease loads?

Other clinicals

Dr. David Unwin: First of all, it was liver function, fatty liver. I emphasize fatty liver is reversed rapidly. That is the first thing. Then blood pressure.

Dr. Eric Westman: Has it ever occurred to you that essential hypertension, which means we don’t know the cause, is from carbs?

Carbs

Dr. David Unwin: Yes, I have written a paper on it, I found I was curious about blood pressure improving. I was deprescribing 20% of all the drugs for blood pressure. What intrigued me with these various factors is I noticed the patients needed more salt. I noticed that they got a diuresis when they went low carb, which means they urinated more, curing some people’s heart failure and their blood pressure dropped even though they were having more salt. It was really odd. I found a Professor of cardiology, Professor Brady at Glasgow University. I said, would you look at all my data and can we do a paper together? We went back and discovered that we’ve known that since 1932 insulin causes renal sodium retention, so a high-carb diet is a high-insulin diet and you are retaining salt. When you go low carb, you urinate that salt out, the blood pressure drops, and blood pressure tends to normalize. I went to the partners and said, “Essential hypertension – isn’t that odd that we call it this? Do we not know what it is caused by?” They said it is called essential because we’ll never know. I replied that I don’t really buy into never knowing. That was blood pressure. You could look at my paper on that one, it is a very successful paper.

Renal failure

The next one was renal function. I got heckled by a dietitian. She said, why are you not worried about all that protein and the renal function? At that point, I didn’t know. I had the data, so all I had to do was get that data set. I went into what happens to renal function, and to my astonishment, it improved significantly. I would have missed it because the improvements were small but ubiquitous. It was right across the board, and I didn’t see it because they just improved a little bit, but the GFR (glomerular filtration rate) and creatinine improved. I wrote that up with Professor Wong, Professor of Nephrology. They then looked into the whole history of this protein and renal failure. There is a shocking paper by Brena, I actually bought the paper. When I went behind the paywall, there was no human data in that paper, it was vampire bats, it was guinea pigs, and there was no human data. It had been cited hundreds and hundreds of times and was wrong. That was really interesting. Protein, I don’t worry about that now unless there is really severe renal impairment. But even then with Professor Weimbs and various other nephrologists around the world looking into keto, there are some early signs that even polycystic kidney disease may respond.

Dr. Eric Westman: That is fascinating. It is almost like what people heckle you about are the things that actually improve, but if everyone thinks it’s bad, they can’t accept that it is good, so it is as though people’s psychology has to go through, no, it’s not bad. Wait a few years and then, actually it’s good! But if you come in and say, no, it is not only not bad, it is good for you, it doesn’t sink in.

Dr. David Unwin: That is why I ended up writing all these papers – because my partners were getting scared. It’s a weird thing, if you write a peer-reviewed paper, apparently, suddenly it is true.

Dr. Eric Westman: I had that experience. Years ago I had the luxury to visit a doctor who was doing it. That was Dr. Atkins, in about 1998. I got to see a clinic that was seeing people, and seeing changes occurring. He said certain things but nobody believed it. In 2005, Guenther Boden, a researcher, said the same thing. In fact, he looked like Dr. Atkins. He was on TV being interviewed saying, “Yes, low-carb diets reverse diabetes in our study.” Then everyone believed it. That is the importance of clinical research, and especially with the internet. Who do you believe? For my listeners, I always advise to consider the source. Trust comes from those who are in practice, actually doing it, and that is fantastic. So, heartburn, of course, also gets better on a low-carb diet.

Dr. David Unwin: Psychiatry, certainly, anxiety, of course, sleep, psoriasis sometimes, eczema, irritable bowel syndrome. Very often, you will find it is bread or something like that. What next?

Low carb is better than low fat

Dr. Eric Westman: It was 15 years from our proof of concept study on IBS diarrhea predominant (IBS-D). Within these last few months, the randomized trial of three groups showing low carb is better than low fat map and the drug for IBS. It took 15 years. Often the research is lagging. That is the grassroots thing.

Dr. David Unwin: Yes, it is. One of the things is, I try not to annoy people too much. It doesn’t help much. One less controversial thing is, instead of talking about low carb, I am beginning to say, “Why don’t you just eat nutritionally dense food that does not put your blood sugar up?” How can that be a controversial statement for people with diabetes? Why don’t you just eat nutrient-dense food that does not spike your blood sugar?

Dr. Eric Westman: When I ask trainees coming in what diabetes is, and patients are now even coached, their answer is, I don’t have enough insulin. No, you are measuring the blood sugar – it is too much sugar. We used to call it sugar diabetes. This is fascinating because we are talking about lots of things, but the comfort level of using it, I saw another doctor who had been using it for 30 years, and then Arjun Panesar and diabetes.co.uk, and your group doing it online. I was afraid of that. I didn’t want to lower blood glucose and cause harm. Now decades of diabetes.co.uk being safe teaching people, we finally have our own course that we are launching this spring to help people understand diabetes. Some people think that we are new or early adopters when actually, this has been around a long time. We validated it and put things into the literature, and now you are taking the baton and studying and publishing based on the audit of your practice, which is so great.

Sugar in your blood

Dr. David Unwin: I like to get back to sugar, talking about sugar. From the beginning, hemoglobin A1cs are the average sugariness of your blood. Where do you think that sugar’s come from? In my 10-minute consultation we are talking sugar, you have come about your hemoglobin A1c and you want the result. That is the average sugariness of your blood. If you are very sugary, I am wondering where that has come from. Within seconds, we are discussing sugar, and that is where I stay. In every clinic, you and I are searching for the sugar. In every consultation, where is the sugar in your diet?

Dr. Eric Westman: How much sugar is in the bloodstream?

Dr. David Unwin: Not much. It is one teaspoon.

Dr. Eric Westman: The infographics are perfect.

Dr. David Unwin: We have done the calculations. It is about one teaspoon. If you think, going back to my teaspoon of sugar equivalent, a banana is equivalent, depending on its ripeness, to five or six teaspoons of sugar, That is easy enough, because if you only have one teaspoon of sugar in the whole bloodstream, one banana is more than enough to double your blood sugar, maybe treble it.

Dr. Eric Westman: I have had professors of endocrinology come up to me saying, I never thought of it that way, never thinking about the actual challenge we are facing. Is the five grams of glucose in the blood being maybe seven and a half grams, a very small elevation, and then toes get amputated, you get blindness, and heart failure or heart attacks. The fact that some diabetes organizations actually push more carbs into the diet makes me think that either the context was lost, or the professors and advisers didn’t do middle school, or primary education math, or they are in cahoots with the companies. Since the blood sugar is up and, if you have low blood sugar it means you have too much medication, then if you just pushed carbs, you’ll never have low blood sugar. One time, face to face, I did get to loggerheads with a diabetes educator who was fantastic, loved her patients, and she said you can’t tell people to stop the carbs and food. I told her that I do. It then occurred to me, I reduced the insulin at the same time because she couldn’t. She was faced with doctors pushing drugs that caused the low blood sugar, and she was saving lives by telling people to eat carbs because she was not in control of the medication. That was an aha moment to me, that what we do is we take control of both.

Dr. David Unwin: We are beginning to think about the true causes of chronic disease. I realized I was a fraud. Thinking I am a scientist as a doctor. We never thought about the actual causes. Diabetes is not a failure of your metformin gland – like a mysterious failure and metformin replacement will cure it. With diabetes, most of us, including me, have eaten our way into type 2 diabetes. I worked on that for about 30 years, eating biscuits and so on. On top of that it’s the true causes of essential hypertension and the true causes of fatty liver.

Dr. Eric Westman: Are you ready to collaborate on a paper that says our current medical system hasn’t fixed anything and it is because nobody talks about food being the root cause?

Dr. David Unwin: Now I am getting excited.

Dr. Eric Westman: What I say in my practice and in front of other doctors is that I’m practicing the best internal medicine of my life through using low-carb diets.

Dr. David Unwin: It is a luxury at the end of my career, I will not compromise now. You can’t force me, frighten me, or threaten me, because it is the end of my career. I am loving doing it properly, such a luxury.

The farm and bird reserves

Dr. Eric Westman: Switching gears, you might be able to spend more time on your farm. Tell me about that.

Dr. David Unwin: In my spare time I manage 40 acres of bird reserves and a farm. I have about four or five separate bird reserves, and we manage those in part with regenerative agriculture, producing mutton.

Dr. Eric Westman: What is a bird bird reserve?

Dr. David Unwin: A bird reserve is where wild birds, British wild birds, who are all in decline, can, in areas of wildland, prosper. Also insects. I am the senior trustee of the Three Owls Bird Sanctuary, which is another charity that I do. People leave us money and I buy land and take it out of wheat production then start producing meat, but we do it in a way that generates insects and flowers and more.

Dr. Eric Westman: Then mutton for the rest of us.

Dr. David Unwin: I cannot bring myself to kill a lamb. I discovered that if you let them grow to 2 years it is even tastier and they have a better life. People worldwide ate mutton a hundred years ago, nobody ate lamb. It is not available in the States. It is a connoisseur item and it is so tasty.

Regenerative agriculture

Dr. Eric Westman: Explain regenerative agriculture a little bit.

Dr. David Unwin: If you look after the soil properly you then have more insects, you have grass with a better micronutrient profile and grazing animals are a good part of that because they produce excrement, so they are recycling grass into excrement, and then the excrement, as long as you don’t use insecticides, is great for insects, and the birds eat the insects. Then we produce a hay crop, which is wildflowers. What do birds eat? Seeds, and they are in the wildflowers, and what do insects like? Nectar, they are in the wildflowers. One of my reserves originally grew leeks and only leeks. It was a monoculture of leeks and had been for years on that patch of land, nothing nested, nothing moved, nothing lived, it was sprayed with insecticide four times a year and herbicide three times a year on the same plot of land. On that same plot of land after 5 years, I have got 23 species of nesting bird, not 23 nesting birds, 23 species of bird living on there. It is producing mutton, we’ve got four species of bat and 135 species of moth and previously it was a monoculture, it was dead. When I fly over America, most of America is dead factory farming. So true and tragic what’s happening to the soil, it will all blow away. A lot of it has been done of course, but regenerative farming gives hope. We have to think about the food supply and whether it is sustainable. I am a great believer in eating meat. but you have to show some interest in where that meat came from and whether we are destroying the environment. I decided to climb on board that as well and experiment. Can we produce meat without destroying the environment? The answer is definitely yes, because I have done it. You could look me up on the Three Owls Bird Sanctuary, go to the website and you can see the birds and all of the Three Owls Bird Sanctuary,

Dr. Eric Westman: It is important to bring that up for people watching and reading that, generally, most doctors have outside interests and creativity. I have noticed among people touched by the low carb diet in some way, end up having more interests. For instance, becoming farmers and worried about the quality of the food. It becomes part of a mission even, and we’ve been criticized for being cult or mission-like.

Dr. David Unwin: It is zealots, apparently, the word that they use.

Important points for making change

Dr. Eric Westman: It is about health. We practice the best medicine without medicine. Food is medicine. It was Rob Lustig who said, “Good food is medicine; bad food requires medicine,” which is interesting. You can use those drugs because those people aren’t eating well. What would be the most important things you think we can do to make a change?

Dr. David Unwin: Some of it is happening. The continuous glucose monitors are beginning to help us because that brings us back to talking sugar. Feedback is more effective the more immediately it comes to the behavior. I am using continuous glucose monitors in type 2 diabetes against the British guidelines a lot, and as they get cheaper. They are the cavalry coming over the hill for you and me, because if you have got a continuous glucose monitor, and you have a bowl of cornflakes, you are in for a shock because it will spike, and this is what I am talking about. Let us be curious about where the sugar is in your diet, and if you are curious, for the sake of a few dollars, shouldn’t people who are diagnosed with type 2 diabetes in the UK be given a free month on a continuous glucose monitor? Because you would learn so much. I know that if you come to me with diabetes in the first year, 73% will achieve drug-free type 2 diabetes remission in the first year. So if we used glucose monitors in the first year routinely, I think that could make such a difference. When you look at the cost of the drugs on a nationwide basis, that is a money saver.

My final point is about insurance companies, somebody has to pay for all these drugs and I don’t know of a single country that can afford them. The SGL2 inhibitor drugs will create a real problem for you in the States because of the expense and who is paying for them and that is why I am so excited. I have been working with the second-largest reinsurance company in the world, Swiss-Re, for six years. They are really interested and other insurance companies are interested. I think the combination of continuous glucose monitoring and backing and support from people who have nearly the same power as the drug companies and the insurance companies. We have to move quickly because the drug companies will start buying the insurance companies if we are not careful. Then we get back through glucose monitoring into sugar, where does it come from?

The other thing is this Holy Grail of maintenance. We could chat about that another time. I would love to talk to you about what is effective. Each of us is learning how to protect our patients, how to care for them, and how to rescue them when they go off-plan.

Where to find Dr David Unwin

Dr. Eric Westman: How can people find you? What would you like people to know?

Dr. David Unwin: Follow me on Twitter, @lowcarbGP. The Public Health Collaboration of the UK is the charity we helped set up and in there are all of the diet sheets, the protocols we’ve listed, and all the RCTs. There is loads of evidence for you and it is all free and it is a British charity so none of us make any money out.

Dr. Eric Westman: Keep doing what you are doing and hope to see you soon at a meeting.

Dr. David Unwin: I knew I would enjoy speaking to you and I did, thank you so much.

Watch the full video here.

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