Dr. David Unwin - 'Can we beat T2 Diabetes? HOPE on the horizon'

well here I am Here I am I've come thousands of miles so I want to talk about hope hope with type 2 diabetes it's going to be a very practical approach because GPS are practical people I'm going to think about how can we help the world we've got to do something we must do something so how can we do it in a reasonably simple way that people can understand so let's start with a wonderful patient this is Chris and there he was a few years ago on the left but there he is now on the right he's changed his life completely completely and his story is a story of hope and if we can replicate these stories of Hope we're going to make a difference Chris was previously on multiple medications for his diabetes he was obviously overweight but look at him now he's older but looks so much better now how about if we could do that for many patients and how would we do it I'm going to be talking about two different aspects of how we would start a new revolution and we need help psychological help because so much of modern diseases to do with choices that we make everybody knows that cigarette smoking is a bad choice but not everybody changes their behavior today so we need to think about how do we change behavior so something on psychology and the role of hope and then also I work in Southport as a GP in ten minute appointments and the question is in a very short space of time how are we to explain to ordinary people the role of insulin in diabetes to help them understand their bodies and the changes that you're asking them to make so that's what this talk is about there's a disclosures I think it's very important that you know that nobody pays me to say anything or nobody's paid me yet you know I'm maybe I'm everybody has their price everybody has them so nobody pays me I am a Royal College of General Practitioners clinical expert in diabetes and I'm now national champion in the UK for obesity and diabetes from the Royal College so let's move on but our story has a sad beginning our story has a sad beginning and that is me an old guy an old guy and really my story between 1986 and 2012 was one of increasing misery that many of you must have shared in really who couldn't have seen the world changing and who couldn't have looked around and worried particularly about our young people and I saw in my own practice so when I started as a young man in 1986 we had 57 people with type 2 diabetes and it was broadly an illness of the elderly and I didn't used to think much about type-2 diabetes because it was quite rare and they were older people who usually they weren't so bad really fast forward to 2012 and we'd gone from 57 to 472 in the same population so this cannot be genetic I don't like the talk about it being genetic it cannot these people have not changed genetically in 30 years it's the same population it must be something environmental acting upon genetic system susceptibility but the point was it made me very very unhappy because the patients were so sick and they were getting younger and younger and they were getting fatter and fatter too many of them were under 50 with type 2 diabetes and at the moment the youngest person I found with type 2 diabetes is ten years old what is the future of that ten year old it's appalling it's appalling and we must all fight this we cannot accept it we cannot accept it because when our generation has died out who will remember the world was different obesity was rare so there is some urgency to doing something but in 2012 I didn't have a thought in my head as to what to do apart from I thought I'd probably retire from general practice and cash in the pension and do something cheerful like gardening because what you know escape the misery escape the misery so that's where that's where I was and and many of you will have heard me say before but a single patient changed my life and has changed the life of so many other people and this was the first patient I ever saw who had put her diabetes into type 2 diabetes remission I didn't know it was possible I didn't know it was possible but she had put her diet she had used her diet to put her diabetes into remission and taught me a lot of lessons some of which I'm going to share with you now so are very miserable and now I'm very happy and I'm still working years on so this is a story of that now this is just some evidence that I have changed something because you will have to decide whether I'm worth listening to or not so if we look here is a graph of quality of type-2 diabetes care in my practice against a nature Southport inform B NHS England north of England the okay and when you look at 2012 or 2013 no wonder I was depressed because look how bad we were because up is good and down is bad so nor would surgery there we were languishing it was such a miserable time we'd had all our budgets cut I'd lost district nurses palliative care nurses we had no money for anything certainly no money for diabetes but look what happens over the years and these are nationally collected figures so gradually Norwood Avenue improves and improves and now our results are far better than all sorts of averages we're doing very very well because the next logical question is perhaps perhaps doctor means doing this by prescribing a whole load of drugs why don't we just drug everybody that would be a good idea wouldn't it well no look this it these again are nationally collected figures and if you look that's every practice in my area and it's the prescribing of drugs for diabetes and if you look my practice is in the in the pink there and we prescribe the least of all the practices in our area we are not using drugs for type 2 diabetes and in fact I would say since 2012 I've only actually initiated drugs for diabetes on six occasions only six times have I actually needed to start somebody this is amazing and it's resulting in very substantial drug savings so our practice spends 50 thousand pounds per year less on drugs for diabetes than its average because the pound is dropping inexorably isn't it I don't know how many dollars that is it's probably about 50,000 about the same I would think a pound a dollar something like that brexit Matt did it anyway moving on so we're saving money and this is drawing attention to the low-carb way of living the Treasury are very interested so I've spoken in Parliament now on three occasions I have seen the Treasury because there cause they're fascinating but which country around the world can afford the drugs for diabetes and on top of that the results are so disappointing in the UK we're spending a billion now on drugs for diabetes and look at the results has it been a happy story no it is not a happy story we can do better we can do better moving on this is Roy this is Roy now look at him there before and after he's so proud and his wife is so delighted because she's got like a new husband there she's so happy so I want us all to think about that's his graph of hemoglobin a1c their hemoglobin a1c let's think about that as how sugary have you been in the preceding 120 days so it's no good fasting on the day of your blood test because that will not I will still know what you have been eating but look there so I put the big question mark because that was he came to see me maybe was it April something like that April of this year what happened at the question mark in that ten-minute appointment what happened to make him change and convince him that he should live differently well there was two things one was hope and the other is an explanation of his condition so let's just look into that a bit more psychology the psychology of hope don't you think it's better that we we talk about hope in diabetes instead of fear for so many years and I used to think that scaring my patients was a good idea so I talked about amputations and leg ulcers and if you don't do as I say you will you know it's certain death and it wasn't a great success and there is in fact some research to say we shut people off by scaring them some of my patients wouldn't come back for years and they said well I don't really see why come but to be told off because that is what I did I told people off and I was annoyed and you know I threatened them but I think how much better if we could infuse patience with the idea of hope I think type 2 diabetes remission drug-free type 2 diabetes remission is a wonderful message of hope and when I saw Roy on that day when I saw him on that day I'm talking about okay you've got type 2 diabetes but really what happens next what future you choose depends and if you're up for changing behavior I'm up for supporting you and there's every chance that you will not Dean drugs well he's far more interested in that message than he is do as I say or you know you're going to come to harm people move towards the light and hope is light so it's really worth we all need to talk about this wonderful thing type 2 diabetes remission and we'll be covering that more later but I'm actually now getting in my own practice 50% of my patients are a tree achieving drug-free diabetes for a mission these are people who've been on a low-carb diet for an average of two years 50% and what's really exciting is that my percentage I am getting better and better you'll see my slide in a little while when I did the side I was achieving 46% by I reviewed all my work for coming here and he's come up to 50% because I've seen 12 more since I did the slide so let's think really carefully about how we can do this and do it well hope is part of it there I said 46 but it's now 50 hooray array so back to back to Chris back to Chris let's just have a think about his story from a psychological point of view so he came to me I think in he was one of my very first patients that'd be about 2013 and you'll see there before the low-carb remission there he was high now his goal what he hoped for was he had various problems the medication I was giving him was giving him bowel problems and that was inconvenient and embarrassing and he was hoping to get off that because he had a job driving so his hope was was it possible to come off the drugs and at that point I wasn't really sure but I was prepared to give it to go up and at least he was motivated and interested and he went low carb and did really really well and in fact I wrote his case up in the BMJ so very very popular paper but then look what happened after then he was written up in the BMJ and then he drifted he drifted and that makes a couple of very very good points the first point it makes is so often I see that when patients drift clinicians go your low-carb diet is failing and put you on drugs no it isn't failing you need to look at the goals again think again he was drifting because he's carb addicted we was having a little bit of stuff cheating a little bit and he was there was carb creep coming in he needed ongoing support so he wasn't just abandon outpatients thinking you're now a success if they were on drugs we'd give them ongoing monitoring so you need ongoing monitoring whatever you do because maybe you're going to drift and he drifted and we just had a chat about you know he's saying oh you know I'm a failure saying you're not a failure it's about your future what what what are you going to learn from your position reframe failure about what you what can you learn how could you do Christmas better if that last Christmas was a fail yeah and he said well I suppose I could do what I did before and I said great well that kind of worked didn't it so he just said all right I'll do ya and then you give them feedback and look the second time he did it the remission was better and more sustained and he is still improving all these years of passing that guy is still improving and losing weight and getting fitter and now in my practice he's a champion he's a patient champion and he's wanting to teach other people so within the practice he's gone all the way from being a sick patient to an advocate and a champion and he's recruiting and helping me he's a colleague that is amazing isn't it cuz I'd certainly didn't see him as a colleague if you see the first one I saw him as a heart sync all right a heart sync and now I have such respect such respect he's been on television for me he's been on the radio he's been in papers done so much what a story of success needs all his family baby better is it's so so exciting moving on so for now that psychology done let's have a crack at physiology so I think physiology is so interesting and how about we why don't we try and explain physiology to our patients so they can make informed decisions informed choices so all of us together we're going to go into psychology we're going to look at liver function try great triglyceride levels central obesity and hunger and type-2 diabetes itself we're going to try and do that in a way that I could explain to a 75 year old patient of mine which I would often do or a student or an unemployed person let's try and see can we explain things in an ordinary way and then we'll easily change behavior because people make different choices right little bit of background so I spent a lot of my life kind of mystified by things getting worse and not knowing why so we begin here so I discovered that out of four thousand seven hundred and fifty-three patients of mine if do the liver function tests 24 percent of those patients have abnormal liver function tests so a quarter of all my patients have abnormal liver function tests and until 2012 I didn't know why and in fact many of them I told off for drinking because I thought you know you they'd say I only have a little bit I'd say yes but how much you know are you sure it's just then I was so unpleasant to my patients and I'd refer them to gastroenterologist where they got told off again but can it really be true that 24 percent of my patients are all heavy drinkers and they are they all lying that's would be a bit miserable wouldn't it and of course the answer the answer is non-alcoholic fatty liver disease this is now 20% of the developed world another crisis that we hardly ever talk about we hardly ever talk about another thing that used to mystify me was triglyceride levels so again Sonne met many of my patients had triglyceride levels and I I wonder what the clinicians in the audience do when they get a high triglyceride level I know what I used to do I just used to fudge it is to fudge it so I'd say they say is are my blood tests all right and I said well yes they're kind they're more or less all right you tried list rides up a bit but we'll just recheck that next year the only thing I need to do you could lose a little bit of weight does it matter I didn't really know you know triglyceride and yet triglyceride is central and so important and we need to talk about triglyceride more just as we should talk about type 2 diabetes remission triglyceride is a very important pointer it's not a mystery so how are we going to link how are we going to linked talk of triglyceride and fatty liver and expanding waste lines and diabetes how we're going to link all of those in a way that our patients can understand I think actually we should use insulin as a model now this may I may be wrong I've been wrong very wrong many times before but at least this is a model at least this is a model so what I would explain to my 75 year old patient is I'd say well if you eat a chocolate bar your blood sugar goes up and one of the problems with diabetes is a high blood sugar over time damages the inside of your arteries but nature is designed you in such a genius way that you have a hormone there to protect you the hormone is insulin and the insulin is imperative is to drop that glucose at any cost at all because it's so important so insulin is a hormone produced by a pancreas gland and it has a job to get sugar out of your bloodstream and get rid of it anywhere and in fact insulin does that job by pushing glucose inside cells that's what it does and of course some of the glucose is pushed into your muscles for energy which I think most people have heard about you do need glucose for energy but what about if you take in more glucose than you actually need for energy well insulins imperative is to get rid of that dangerous glucose and it pushes it first of all into your belly fat producing a bigger belly which so many people are familiar with and then the other thing it does it pushes the glucose into the cells of your liver and after a while the only thing your liver can do with extra glucose is turn it into triglyceride so now we can understand if we are a patient why my triglyceride level may be high because a triglyceride level is a reflection of carbohydrate in a way if you have a lot of carbohydrate you will get a fatty liver and of course this is the way some of you will have heard how you'll get a fatty liver in a goose which is for our gras a funnel and carbohydrates is how you get a fatty liver for geese but we are the same so fatty liver there we go so that is triglyceride so excess glucose gets pushed into your belly and into your liver and if we just look here at a patient an individual patient there is the fasting triglyceride level and over the same time there's the hemoglobin a1c look how that triglyceride level which previously was a mystery to me as to what I could do with a high triglyceride level look at that triglyceride level dropping like a stone at the same time as the hemoglobin a1c goes into remission so interesting and when you start looking for these patterns as clinicians you'll see this happen again and again introducing another one of my wonderful patients now this gentleman is 80 years old and he's holding the tape measure around his abdomen where it was two years earlier because he was a very heavy guy but look we reduced the carbohydrate and his belly has just shrunk away I used to have a prejudice about older people and I used to think older people have a slow metabolism you can do very little with them that's wicked that is terrible terrible I now am an older person so you know I'm kind of interested in in older people and but look he said you can do stuff you can do stuff so I'm illustrating there's a triglyceride there's the central obesity dropping away and if you know just look at the speakers this morning where has it gone the speakers this morning we're on a low-carb diet the belly's gone right Oh Yellowcard liposuction let's market this let's market this cheap lipos my patients were paying thousands of pounds for liposuction not now not now here's another thing a patient said to me a very heavy lady actually she said to me dr. Ehrman why why am I constantly hungry because I'm you know I've got months of food stored right here so why am i hungry and you know I was always hungry until I was 55 years old always hungry where's an X biscuit I'm watching my children to see how they finished their ice cream because I could just finish it for them you know where have they hidden the easter eggs because I could just that kind of thing I was always hungry always hungry now why was I always hungry and why is why the lady has a big store she said I've got a big store but I I'm always hungry I think it probably this is a model again and I may be wrong but I think insulin is to blame because if the imperative is to drive down blood glucose at any cost if you carry on having a moderate amount of carbohydrate your insulin prevents you from burning fat because insulin wants you to use glucose as your energy source and while there's some glucose there it won't let you burn fat and I think that explains quite well to patients why moderation in carbohydrate has some problems it has some problems because then you can't become a fat burner patients love the idea of being a fat burner so I explained it to them in this way that the carbohydrates will stop you from burning fat the genius says we are dual fuel engines we could burn fat or we could burn sugar if you have a lot of fat on board you'd quite like to be a fat burner has many many advantages you can miss a meal if you want I don't know whether if I have a meal or I don't doesn't matter before I couldn't even miss a snack I couldn't miss a snack and it explained so well the patient the thing I'm told again and again is I'm not hungry I'm not as hungry do I have to eat breakfast patients or do I have to have breakfast hooray no you don't don't leave it leave it is it the healthiest meal in the day what no so moving on so some of this has it has apart from being a doctrine win anecdote little chat the little little bit of science here which I'm very grateful to Professor Roy Taylor in the UK and he pointed out that as you continue to take in more glucose then you can use in your muscles as I've explained your liver is beginning to fill with fat there it goes and the disadvantage of having a fatty liver one of one of the disadvantages which is very many is that a fatty liver is linked with insulin not working as well but then you have another problem because the pancreas is not the only thing sorry the liver is not the only thing that fills with fat your pancreas look in a minute your pancreas is filling with fat as well and eventually that gets to a point where it interferes with beta cell function and the production of insulin itself very serious but a bit of good news a bit of good news how about you reduce the carbohydrate intake reduce circulating in insulin these things can all go in reverse and this is how type-2 diabetes can be put into remission because if you can empty your liver of fat and if you can see the pancreas so many good things start to happen now we have to be fair low carb is not the only way to do this I think as a movement where we're growing up now we need to be other ways to do it bariatric surgery is another way to do it and it does it very quickly is surgery always what my patients want oh I'd have a crack at this first I'd have a crack at this first before I went for bariatric surgery very low calorie diets in the UK are becoming very popular and this is another way Roy Taylor is also getting good type 2 diabetes remission rates so moving on yeah so I think it's fair to say that if you have type 2 diabetes glucose becomes a sort of metabolic poison and this is again the problem I have with moderation you know who's going to volunteer to be moderately poisoned moderately poisoned now I think I'd rather be completely well actually so I don't really want to compromise very much with with glucose so I find in clinical practice questions are far more powerful than statements and my wife Jen is a clinical psychologist and she's taught me less at home so much better that she asks me a question rather than telling me stuff and vice-versa so a good question for your patients or each other is where do you think your hemoglobin a1c is high how this is a reflection of how sugary you have been in the preceding hundred and twenty days where do you think that sugar came from as a question ask your patients where do you think it came from now that brings you to I think the first priority for doubt people with type 2 diabetes is to get rid of sucrose table sugar because it's got fructose in it as well so that that's a good place to start but really many of my patients quite sophisticated and when I say you should be giving up sugar they say I already did that of course they did of course they did in the olden days what would happen next is I I would say well you've got a high hemoglobin a1c and they too had given up sugar and then I would be mystified why the hemoglobin a1c was high I'd say well seems high I don't really know why because you've given up sugar so there's nothing else to do so we better medicate you you know we'll start metformin anniversary isn't that sad you know I thought you've given up sugar that's all it is and of course that's where the patient came in that one patient because she was the the woman that said to me dr. Irwin you know what what did you learn at medical school what did you learn because you know how about bread is sugar how about rice is sugar and you know I had to be reminded by a patient in 2012 this is awful but how many other doctors need to be reminded by their patients the carbohydrates are an amazing source of glucose now I can't believe I'm saying this but it is true I had forgotten and it was routinely medicating patients who could just so easily give up bread and I never mentioned it not once easily in ten years when I mentioned bread or even think about it that still makes me I'm still sorry really if I'm to be honest that it took me I was 55 before I started thinking that's slow that's very very slow anyway so this is what that wonderful lady reminded me here is the starch molecule and the starch molecule is glucose molecules and they're holding hands they're holding hands to make a big molecule and digestion will break them down again back to the glucose so I became fascinated after that case I became fascinated by the glycemic index because actually carbohydrates vary in how sugary they are they vary a lot so the carbohydrate that makes up cornflakes or rice is much worse than the carbohydrate that makes up bread they vary and the glycemic index predicts the sugar enos of different carbohydrates and from the glycemic index you go to another thing called the glycemic load which tells you how many grams of glucose equivalent really a portion of food will deliver to your bloodstream but I had a problem because I was now fascinating and hooked on the glycemic index my glycemic load because it's so interesting so very very interesting and I was trying to fascinate everybody I knew with the glycemic index and the glycemic load and it didn't go well because people after a while become very bored with talk you know and and one of my partners called cata Schulz lovely lady doctor and and she's brutally honest and she said one day David you're becoming very very boring we're not really interested in the glycemic index or the glycemic load and you seem to it's good but you know you got to do something about this because we you know the patients are not getting it they are not getting it you need to really find a way of communicating this with our ordinary patients I'm so grateful to kotti because she was right I hadn't understood that we must start communicating in 10 minutes in a way that people understand and I worked out that the problem was that there were two problems one is the patient in Southport never use glucose as a cooking they don't know what it looks like they have no concept of what glucose is and in fact no interest in it also they can't think in what is 16 grams what does it look like they've no idea so I had two problems and I came up with probably the only idea I've had in my entire life one idea one idea and that was could you could you reinterpret the glycemic load in terms of teaspoons of sugar because my patients definitely get teaspoons of sugar were all using them every day and and this is where there's an Australian link there is an Australian link and that is that I contacted Jenny brand Miller in Sydney and said have you got an expert on the glycemic index that would help me and she suggested dr. Geoffrey leaves in the UK who actually helped her originally develop the glycemic load and Geoffrey blessin did all the calculations again of 800 foods in terms of teaspoons of sugar and what we see now on the slide is teaspoons of sugar of some common foods to make an infographic that I use to help my patients understand the consequences of their dietary choices so a small bowl of white rice 150 grams is the same in terms of your blood glucose as 10 teaspoons of sugar so it's pretty obvious that white rice is not a great choice if you have diabetes and you care about your future the potato a baked potato I always thought that was a slimming kind of a food a baked potato with tuna no it's not a slimming food you know it's about eight teaspoons of sugar easy well my personal hatred for bananas is well known bananas I hate Mehnaz they're sugar sticks don't have them a banana or a ripe banana is about the same as five or six teaspoons of sugar so it's not a great idea and yes there's potassium in a banana but please there's potassium in other things as well right so there's there's the info grams and under did the info grams and now there are seven of them and the good news is after two years of burrowing away I managed to bring about more acceptance of my info grams and in the UK nice are in charge of all the guidelines and the standards they are very very important in the UK and this February my info grams were shortlisted for a nice prize and have now been linked actually linked for the type 2 diabetes guidelines for adults in the UK so that in the UK so that in the UK all healthcare professionals can use my info grams with complete impunity because they are recognised as an entirely useful source of information to give people a type 2 diabetes and if any of you are interested to get my info grams all you need to do is google nice sugar & Unwin and there are seven of them none of them are copyrighted your I just love it if you use them I'd love it if you use them and I'm showing off here of course because there is the Minister of Health our own mister of health matt hancock and early this year I managed to sow the Daily Mail or our most popular paper and they featured my work as a sort of pull out every day for a week so I had 30 pages in the Daily Mail of recipes and physiology who would believe you could get physiology into the daily but if we try and communicate in a way that ordinary people understand they do care people are interested it's the way if they don't get it it's perhaps our fault we need to really think about how we communicate and if the Daily Mail will do that and they're doing they've done it again only two weeks ago and they want a third one next year so this cause the politicians because they're very sensitive to the media so I get a call from Matt Hancock's aide would I like to go to Parliament would I like yes I'm coming I'm coming he was so fair he was so lovely he loves my Infogrames and he posed there with my Infogrames for me to put on Twitter that's the Minister of Health and the next day he gave maned info grams to every member of his staff in the ministry so we can do stuff but it requires the media it requires politicians it requires us all to work together and there is goodwill politicians you know they want to do good really Matt Hancock's a lovely guy he isn't happy about diabetes and obesity he isn't happy about that but we we have to help him a little we have to help him and the media helped him because of the interest so moving on just another another one of the info grams I've become very sensitive to the idea of fruit and veg are healthy five a day fruit and veg drives me insane because how is a potato like cabbage or how is a potato like a strawberry or fruit and veggie of five a day it's driving me mad we really must be more discerning than that and so I do the info grams just to again your choice is why don't you have cabbage or green stuff if you're going to have veg so if you're gonna have fruit please don't have raisins my patience is so interesting when you find people whose hemoglobin a1c isn't dropping and they don't know and you find they're having healthy raisins or bananas or grapes or orange juice it's really useful to pursue relentlessly where that sugar may be coming from and I've tried to feature within the infographs common areas that I find is where patients accidentally consuming sugar right so we all like to be a bit sciency and and I was challenged a lot in the early days and and so I I put on a freestyle Libre to monitor my own blood glucose and you see they're my own glucose tracing and look how flat it is day after day nothing's going on nothing's going on and then one Friday morning I ate the banana you see they're a single banana and yes look array it doubled my blood glucose one banana so you this is choice okay doctor menu you can have a flat trace or you can enjoy a banana have a banana if you want but take the consequences you know there is that there consequence and we had a lot of fun on on Twitter I hope some of you follow me on Twitter low-carb GP please follow me because it helps politically you see because the more followers I have the more followers I have the the more the politicians think oh well you know I suppose we better listen to him a little really so on Twitter we had a lot of fun what do you want dr. Amin to eat and they were all voting oh I want him to eat a banana had to eat a bowl of rice after two weeks I was quite ill so I had to I had my wife said David please stop this nonsense the next thing is keeping things simple you don't have to to read all of that but that is that the diet sheet that I use in the in the practice because again my patients said can you just keep it simple please so that's our standard - eat at Norwood Avenue that we've been using since 2013 and it kind of boils down I don't really like to talk about grams or weighing if I never do I never talk about portion of society size or grams because I think a diet isn't a very healthy thing a diet is a thing you're on because of a problem and a lifestyle is something you wish to do because you voting for your future one of my patients something called Elizabeth said dr. Amin you should be talking lifestyle and not diets and I haven't needed to talk about grams so I'm often asked about grounds but I don't actually in clinical practice I haven't needed to do that because my patients don't understand grams anyway so it's not a great thing but they certainly do understand the idea of what's white on your plate turn it green okay so you want your eating rice why do you have green stuff those kind of things eating healthily they get that they get that and that's the the the diet there so next thing it isn't just about diabetes it isn't just about diabetes so let's just look at the the results I'm achieving now in North Avenue the first thing there is to look at the hemoglobin a1c how sugary are my patients and of course you like things and percentage here so I pop that in there at the bottom look at the start so my patients began with hemoglobin a1c of 8.6 I am NOT taking easy cases I actually love challenges I love the ones with high hemoglobin a1c because I'm so excited to get those results back people in the early day said oh he's probably just doing easy cases it's not that wouldn't be fair this is a case series at that point there was a hundred and twenty eight patients but of course now there's 135 because I'm updating all the time and at that point they'd been on a low-carb diet for an average of 23 months I'm now up to 24 months because it's a month on since I did this slide so if you look at the drop there so all of the patients but to manage to make a real improvement is only two that didn't and there must be reasons for that but that's a pretty good hit rate where they're all improving but - and bear in mind I'm now at I actually get 50% drug-free type 2 diabetes remission so I'm deep prescribing loads of stuff I'm stopping loads of drugs for diabetes which makes you think they can't have needed those drugs in the first place I must have started those drugs unnecessarily years ago and I'm now cutting my way through them but look it isn't in the in the early days I had many enemies and I know I've met so many of you here seem nervous clinicians seem frightened that some we'll attack you and I would say if you're frightened collect data that's what I did I was frightened I did think you know people were they used to stand up and shout at me in meetings like this or would people what you doing is dangerous what about cardiovascular disease there were very cross people so what I did was start measuring stuff if you're scared collect data have a look have a look at what happens to the lipid profiles and I was so surprised because when I look to what happened to the lipid profiles to my amazement they improved the total cholesterol improved and improved significantly the HDL to the protective cholesterol went down sorry went up which is why it's a negative figure it went up in part it's a reflection of triglyceride look at the triglyceride level on average my triglycerides are dropping by 1/3 who can say that what I'm doing is a terrible thing because we're getting hemoglobin a1c cholesterol triglyceride the weight the average improvement in weight is eight point six kilos over two years I couldn't sustain these are sustained weight losses this is completely new in my clinical practice the blood pressure improvements are particularly interesting and I'll be talking again tomorrow about the blood pressure story because that is so interesting but it includes I am taking out 20% of all the drugs for hypertension and still getting those results you see there so I'm taking drugs away and still getting better results and then the gamma GT is a reflection of liver function and those the liver function improves really fast it's so interesting really really fast so just as I explained in the physiology the patients understand their results because I explained that's what we're hoping for so they they understand that they become really interested in their own results and they want their graphs so you'll see me on Twitter pull graph of the week there's one gone on this morning a graph of the week because the patients are proud and they understand and they consent to sharing their data with everybody because they're so proud how about this that we have proud patients isn't that great the idea that patients should be proud moving on I've tried to do things to to help the world of low carb oh and one of the things is how do we deep prescribe drugs for diabetes safely so some friends and I got together and this is a paper we published in the British Journal of general practice I think a couple of months ago and it's open access for you all because you know if you're gonna start low carb and people on drugs you need to know what's safe and what isn't safe and what to reduce so there's a paper there for you metformin is safe with low carb but other drugs may be a bit more complex so please read the paper evidence let's very quickly move on to evidence so I got so fed up over the years we've been told there's no evidence for what you do dr. on when it's dangerous evidence whereas the evidence show me the evidence hooray hooray so this year in April we had the consensus report from the American Diabetes Dietetics Association in April of this year and look what it says this is a consensus report is so important and it says reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycaemia so let's stop talking about there isn't evidence for reducing carbs they have said in their consensus report it shows the most evidence that most so we can use that I have put that there especially for you all because anybody talking evidence could do worse and start with a consensus report so we mustn't be frightened we mustn't be nervous it's a reasonable choice reducing carbs is a very reasonable thing to do for our patients with type 2 diabetes and we are backed up at the very highest level that it is a reasonable thing it's not the only thing but it is reasonable to do so we're coming to the end now so this is the the final patient again and just a detail about him we were talking working with before so when he came to see me like this two years ago his concern was that he was on insulin and he was worried about his driving because it's insulin was caught and type 2 diabetes getting very erratic control and maybe wasn't safe to drive and his other thing was that he was struggling to walk because his gait was so uneven because his tummy was so enormous so his hope was was it possible in any way to come off insulin because he'd been on it for years and also was it possible to walk better and look at him now so he came to see me two weeks ago and this is so brilliant he was late for his appointment and you know why he'd been doing weights at the gym 80 years old he's doing weights at their gym and look at him look at it a chiseled face he's handsome and lively as a cricket and again proud an eight year old and really you know if if we can do this once twice I've now done it 71 times and I'm not the only way there are lots of doctors in this room I've I've also done it we should all be doing it's a message of hope a message of hope so there we are type 2 diabetes is not necessarily a chronic deteriorating condition please don't say it's a lack of exercise because you know my average patient is 63 years old and weighs a hundred kilos so the idea for them are putting on lycra and going to gin and being told you don't move about enough is it's not kind it isn't kind I find that when they've lost weight then they'll start exercising but again I was telling people often saying if you thought of joining a gym or here's a leaflet here's a leaflet on moving about more how condescending or me really terrible so your type 2 diabetes remission we need to talk about it more I think the best thing also just to leave you with is that improving type 2 diabetes with a low carb approach can improve weight blood pressure lipid profiles liver function and self-esteem and it's not just a self-esteem of the patient it's a self-esteem of the doctors as well thank you so much [Applause]

Channel: Low Carb Down Under

Views: 37,887

Rating: 4.8995171 out of 5

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Gold Coast 2019, #LCGC19, David Unwin, @LowCarbGP, Diabetes.co.uk, Type 2 Diabetes, Diabetes Remission, Diabetes Reversal, NAFLD, Blood Pressure, Obesity, LCHF, Ketogenic Diet, Keto, RGCP, Diabetes Expert

Id: OlKDM3SDHPA

Length: 52min 28sec (3148 seconds)

Published: Sat Oct 19 2019

Reddit Comments

[u/eterneraki]

I feel like we've already proved that it can be beaten, and consistently too.

[u/huligoogoo]

They wanna keep us sick —and to stay on diabetes meds and keep pharma making the big bucks !

[u/cridhebriste]

Change your diet and movement and Type 2 is already manageable not the point of cured

[u/Tigrrr]

I'd already be a diabetic had I not discovered lowcarb 16 years ago.