Dr. David Unwin & Dr. Jen Unwin - 'Behaviour Change 'In a nutshell' & Picking our low carb battles'

[Music] so hello hello we're so excited we're so excited we've had so much this morning about the the science of Medicine and now you've got some homespun art of medicine which i think is just as important the art of Medicine so why Star Wars why Star Wars I think each of us that's been trying to make the world a better place has become aware of a dark side a dark side and really if we are to be effective we need to think about how can we how can we fight the dark side what can we do so Jen and I want to share with you what we have found is effective and so we're going to begin with behavior change because we think hope is absolutely key to this giving people hope and then after that we're going to go on to how can we give people relevant information to the hopes that they have so that they can bring that to bear on on choice so we're really thinking about hope information given in a way that people can understand and then choice so proud and delighted to introduce my husband David and that many of you know anyway he's worked for about 35 years in a small practice in the north of England and let me tell you that six years ago he'd never written a single paper collected any data spoken to probably more than 20 people at a time and he'd certainly never heard of Twitter [Laughter] but about six years ago we had a conversation a conversation about our the twilight's of our careers and what might be fun to do and we've never worked together and we thought that might be fun to combine our kind of expertise and see what we could achieve and what we wanted to do was to have some fun but also to bring a little hope to the patients in David's practice who had type 2 diabetes so you'll hear a bit about that today so now I need to introduce my wife Jen so Jen she's clever she's a clinical health psychologist and when I first began in medicine I had the idea that I was the important one and that the drugs I used were vital and oh I had a lot to learn so much of it from Jen because she spent her life interested in the in the change that can be brought about by hope in chronic disease and how that bears on behavior because if you think about the disease's we're all dealing with so often it's to do with behavior and the choices that people make and it's Jen's work which later on impacted so much on what I was doing in the practice when we came to work together what's so humbling for both of us is that so first of all I thought medicine was really important or at least the drugs I was using was really important and then Jen convinced me that psychology was important and little did we know that we were both going to be humbled because it turned out that nutrition may well Trump both psychology and medicine [Applause] so this is a graph and up is good and down is bad these are national figures collected on every GP in the UK and my practice is the Norwood practice and we were below the standard for just about everything that was back in 2013 and so this is quality of care for people with type 2 diabetes so my practice was beleaguered really because we'd had an 8 fold increase in the incidence of type 2 diabetes in the first 25 years of my practice so we were battling with 8 times more people with type 2 diabetes and we weren't doing very well if you look now to 2017 it's the source of immense pride to show you that we are now top of the national of the north of England of this south bottom for me so we've we've done well we've changed something and I hope you're interested to find out what we did and could this be reproduced could some of you be be doing this so here's another thing you know it could be maybe we started prescribing loads of drugs it wouldn't be like me would it but you know it may be we've prescribed loads of drugs but look at this this is also national data collected by the University of Oxford on every GP in the country and my practice of all the practices in my area spends by far the least on drugs for type 2 diabetes by far and in so we're spending about 42,000 pounds per year less than you would expect on type 2 diabetes so we're doing something right in fact last year we actually were unable to spend our NHS drugs budget we sent 57 thousand pounds of unspent money back to the Treasury [Applause] see but the tragedy is we didn't get to keep any of that money at all but never mind never mind it was worth it so this is my first message of hope because this is me of Tuesday of last week I was with the UK Secretary of State for Health and Social Security and that is amazing that is absolutely amazing that the GP the old GP from nowhere is sitting with the Secretary of State and if you look carefully he's holding one of my teaspoon of sugar equivalent cards and that's amazing isn't it and he actually twittered next day on Twitter one of his ministers said that matters handed every member of the ministry one of my teaspoon of sugar equivalent cards so so what a long way what a long way we have come and there is there must be hope if we can get into the if we can get into the house of power into the houses of parliament now this this is I hope is you'll think is a fascinating slide this is a hemoglobin a1c this is a patient that presented with diabetes quite a high hemoglobin a1c and then something happened something happened to that question mark on that day to that patient something changed because within 38 days his diabetes was put into remission 38 days is the fastest I have ever seen remission of type 2 diabetes in general practice so really this talk that we're both going to give you is around what happened on on that day what happened to that question mark and we're going to divide it up into two things one is we found a way to give that person hope that man came in without hope and he left the room burning to do something better how do we do that and that's Jen's Department and then later on I also gave that person some relevant information and it was in a context that he could understand it is so important that we communicate with people in a way that they understand and we need to be able to do it rapidly I only have ten minute appointments so I haven't got long to chat on so I have to convince you really fast to to make a change and we did with with that guy so I'm going to hand over I think now to Jen yes so okay and I died a little inside when I hear doctors and nurses and other people saying yes but they're not motivated they need to be motivated how can we you know get people to make a change I think everybody is motivated I think human beings are motivated creatures and it's our job as practitioners to uncover that motivation so everybody has hope for something and I think we have to start at that point as practitioners otherwise why are we there what are we trying to do so everyone has hoped for something and they have hoped for some sort of a preferred future and that's a very unique thing all of our preferred futures are very different and very unique this is why I like what Sarah was saying this morning about being relentlessly patient focused it's it's not our life it's their lives and we're there to uncover that so the other thing that makes me die inside a little bit is that psychologists often really complicate things so if you ask us psychologists to explain something about behavior change make it really complicated doctors and nurses can't do it in ten minutes they don't understand what you've said the theories are too complicated so what I've really tried to do is to make something that you can really implement in your own lives you're not as practitioners but just in your own lives and very simply and in a short amount of time there's kind of two stages really mostly uncovering that that motivation that somebody has and then Fanning the flames of that motivation so it becomes a bit of a fire and the person goes away and take some steps towards their preferred future so hope is about having goals but it's having about also having the confidence and the understanding the steps that you're going to take towards those goals hope is just those those two things and it can be very simply done in a brief conversation so what we're going to do next is to compare and contrast in a roleplay because we know you love our roleplay it's those who haven't seen them before we're going to compare firstly there's sort of typical consultation that people do which is dig around and find a problem and then give a heavy dose of advice put a big dollop of advice right in the person's lap and then send them away and of course we all know that if advice and information worked nobody would smoke for example would they we've all got information we've all been given advice it doesn't necessarily lead to behavior change so we do the traditional model first and then we'll replay it in the way that David would now do it where we're trying to not uncover the problem but in a sense uncover the solution uncover the hoped for future and then you'll see him fan the flames and then I'll explain afterwards the actual model that he's using so we're going to do the roleplay now right so welcome to my surgery here we are I'm going to sit down now and mrs. Jones is going to come in and we'll find out what she's come for so here she comes so what what brings you here mrs. Jones I went to see the nurse and she said I was morbidly obese and she said I had to come and see you morbidly obese right well that sounds serious doesn't it really so what do you think of the other health risks of being obese what in your experience what do you think well my knees really or so I'm sure that's it I'm sure that I guess that's down to it yeah yeah yeah I'm real tired and you think that the obesity might be leading to that probably I would think so well I mean that's a couple of things I actually think there are some more serious things that obesity can lead to I don't know had you heard that it could lead to type 2 diabetes because of my mom was tied to what she well that could be really important if she had diabetes because you're you know with this morbid obesity that could be something we should worry about but you know it's also linked with several forms of cancer and how to look pressure have you got any other family history so I've heard about your mum any other family history of cancer or high blood pressure high blood pressure yet yeah really so you see this this morbid obesity is a significant problem and we need to work together to try and sort this out so before you leave I'd like to wear you again because I'd like to know exactly what you were and I'm gonna write down the weight for you so you know and really and and then I you know I really feel you need to see our our practice nurse perhaps every two weeks I'm gonna book you some appointments with the nurse and then we got the question what you're going to do meanwhile so I've I've got you some leaflets here is a leaflet oh and look I've got yeah and don't I've got more leaflets there's another leaflet there and and another leaflet you see so you've got the leaflets now and and I'll make the appointment but do remember what I said about the significant risks of being morbidly obese and clearly we need to do something so anyway thank you so that's mrs. Jones sorted out walked it out thoroughly depressed she's she's sorted out so let's let's do mrs. Jones again so what brings you here mrs. Jones it's a bit embarrassing but I went to see your nurse and she said I had to come and see you because of my weight problem oh that's interesting so we're going to talk about weight loss perhaps so hey I've got a question for you if I could make losing weight easy for you well that would be great that would be great but what would your goal weight be how much would you like to lose oh wow well I felt pretty good when I was about ten and a half 11 stone long time ago okay so you felt that yeah now what really interests me is what difference in your life would that weight loss may help me understand how would your life be changed if you could wave if we could do that miracle and you could weigh ten and a half stone well I've got the painful I've got reidman absolutely wrecks me walking around so painful knees I'm sure they would be better and I'd feel a lot I'm so tired all the time I used to feel a lot more energetic so that would be really nice yeah yeah what else what else you know if you wake ten and a half stone house line that would be amazing so I've got a new granddaughter coming so it would be nice to do more things I feel so embarrassed you know going swimming or anything else it would be lovely to be able to do more you know talking Aaron hmm you mentioned have you have you lost weight before ever yeah yeah put it all back on did you but when you lost weight can you remember back to any things that went well anything that seemed to help you lose weight dude I did Weight Watchers and quite an organised person for stuck to it really thoroughly yeah yeah so you're an organized person and being organised helped you get that another just casting round for things that might help with this anybody at home that might help you were Oh home but my sister's she's put on a lot of weight recently where we were only saying the other day we need to get really good to get her on board that sounds like yeah a good idea so we had the idea you you were mentioning you'd like three ten and a half stone but clearly that would be a big ask wouldn't it so if we were to take just before you meet me the next time just one small step that you think might help you lose weight is there something you could think now that you might do I used to take my lunches to work mm-hmm and then I took you know like healthy stuff which is much better than going to the canteen where I end up just eating muffins and stuff like that so do you think you could commit to that would that be reasonable and next time I see you good just my next thing is you know when you said you lost a lot of weight did you notice I mean how did that feel for you can you think back how did it feel to have lost weight Oh amazing yeah full of energy full of cheerfulness love buying clothes yeah it's great yeah yeah okay well that'll do just for now but I hope you could see that that conversation went in such a different way and Jen's now going to talk us through some of the specifics to draw your attention to the the tricks that we were playing he probably needed to lookin out I'll be the clickable okay so four really simple steps to uncovering motivation and helping people to travel towards their preferred future and change change their behavior in a positive way and we've called the model grin because it will make you happy it will make your patients happy and also you're gonna see it's an acronym so that you can remember the different stages we're actually writing this up as a paper for the Journal of holistic healthcare which should be coming out later this year and there be more examples of the kinds of questions in that but this is just to give you a quick really quick taste okay so number one I've got a fantastic colleague and he always says it's a very long day on the golf course if you don't know where the hole is so if you can remember that when you meet your patients you have to have to have to start with the patient's goals and preferred future exactly as Sarah was also saying this morning so can you agree on a health goal and you saw us do that can I interrupt yes yeah thank you it really helps if a patient ever has a goal never accept that goal always say what difference would that make to you because in that way you're going to understand the patient better and also the patient in describing what difference that makes to them is beginning to inhabit a preferred future so the more you make that preferred future real by getting detail about it the more likely they are to move towards their goal yes that's that's really important you get to understand something about a person's life and their values by asking about their goals okay so G is for goals ah it's for resources and people have lots of strengths they have lots of friends off hopefully often not always the case they have jobs they have character strengths and they have resilience they've been through other stuff in the past so you heard David explore that who else is around that might help you have you had success in the past focusing on the sort of positive things that might give somebody the confidence that they can make a change that's you Fanning the flames of their confidence to take some steps in a different direction pointing out the things that they can already do are already doing it's human nature to focus on the negative and what we're trying to do is shine a light onto people's positive abilities so and you heard David do that I think so often doctors and certainly I was guilty of it kind of look at a patient as a blank slate like they have no history no resilience nothing till the point they come to me for help and actually people have intelligent and resilience and it's we're missing so much if we don't explore these things okay ger I its increments or small goals and the important thing about these is it's not you that setting them as a practitioner you're not telling the person what the next step is that they need to take to look that towards their preferred future but you're asking them you know you're kind of you've we've kind of agreed right here's the goal over here you know you're already doing this stuff what's what's the next little step towards the goal because because that step is generated by the person themselves they obviously think it's doable otherwise it wouldn't they wouldn't have said it and also because it's a very small kind of proximal step it's easy for them to take okay and then finally n is for noticing and of course what healthcare professionals have been trained to do is to notice problems symptoms and difficulties and what you're trying to reach this is where you must unlearn what you have learned because you're trying to notice what's going well what's going better complimenting the person on that encouraging them and also encouraging the person to focus on what's gone better what they've noticed is better so in a second appointment this would particularly come into play the lady comes back she's taken her lunches she's come back in and you're gonna say what's better what if you noticed you feel any different you know you're gonna get weighed if you have you noticed anything else so there we have it that is behavior change and motivation in a nutshell grin and David's just gonna talk yeah just to talk a little bit more about noticing one of the things that nearly destroyed me in in clinical practice and nearly led to me retiring years ago now was how miserable it was because people come in and and I say how bad is it and they say it's worse how depressed are you out of ten I'm ten or fifteen and my paying you know how's your pain oh it's worse the tablets are not working we constantly concentrate and ask patients to notice what is worse because they think the only way to get dr. Ehrman's attention is by moaning but how about you turn that round my patients now cuz I've been doing this part I've actually been doing this probably about fifteen years now and what happens is my patients know that I'm really fascinated to know things are going well so they come in starting straight off with I've noticed this is good I'm doing that I'm changing it the model I'm changing the paradigm to celebrate success and look for it and it can work in ten minute appointments and it is such a lovely environment to work so that's one thing about noticing I'm going to just illustrate this with a brilliant patient a wonderful wonderful patient so this is her her weight graph now feedback is a vital part isn't it to motivation and this feedback comes in different ways by some of you on Twitter will have seen my graph of the week and this is one of my graph of the week my patients love being graph of the week because they go yeah I'm graph of the week and so this this wonderful lady is graph of the week and you say see there look at that she's lost about a third of her body weight and she sustained that weight for years she really doesn't want to spoil that graph she loves her graphs but she's done another thing in terms of noticing on the on the right there that is the lady and we do group work she brought her jeans along and that's her in her jeans that she was wearing a few years ago and how's that for feedback how's that for feedback look at those jeans look how she is now and she is a shining example of what somebody can do that has changed her life it changed her life her goal interestingly her goal at the beginning was she was so tired when she was heavy and her goal was to have more energy that's a really common one but goodness me her life has changed so much she's so well she it she's amazing amazing right moving on so Jen's going now goodbye Jen [Applause] krikey so back to the dark side back to the dark side and how are we to be effective how are we to to you we've got the idea of hope now but what might be relevant pieces of information that we could help our patients with what could we explain to them what could we talk about with them so we've got a bit of a pick list that we're going to go through and and that's that cells look because little Jedi Knights fighting for a better world so we're going to go through the whole list date to the glycemic index etc all of those things so you'll know when we get to cancel that I'm about finished and you've nearly got your break so let's let's start with data so this is at the moment I have a case series of 127 patients as it is now I update it twice a week and at the moment there that we're about on average they've been on a low-carb diet for somewhere around 21 months that was where I was up to last December I want to talk about data with with the clinicians you know when I started I was so vulnerable because a lot of people hated what I did the partners did nobody liked it nobody liked what I did and I felt so vulnerable and I started keeping data because I realized we kind of if you're gonna do a wacky thing you stand or fall by your data and I thought that keeping data might keep me safe and how right I was and I'd say to all of the clinicians in the room I know it's a I know it's difficult but keeping data you can then demonstrate effectiveness and it makes us far more formidable and also reasonable then I can just have a reasonable chat about what what might be what's happening to my patients I know what is happening so data this is slide really is about data we're going to actually cover nearly everything on that slide in a piecemeal way but before we move off this slide I just point out look at what happened to the cholesterol there so the total cholesterol for these patients on an average time of to one point two months the total cholesterol dropped so they're all having cream cheese full fat milk and people worry a lot about cholesterol and that's why I've done an awful lot of blood tests on this actually that's a significant drop if you do the stats on it the HDL cholesterol is there as a law the loss is a negative figure and that is because it actually went up so the protective cholesterol went up and that again is significant and you'll see the ratio did the same so very early on this keeping of data gave me confidence because I was being criticized by people at what I did was dangerous and they particularly threatened me that the lipid profiles would soon deteriorate and you know I would rule the day that I started this bonkers thing but I pretty soon had the data to say well it's funny because that isn't what's happening and then they don't know what to say clearly so let's move on and let's move on right so my big thing how we're going to type 2 diabetes well I've come to understand that really for most patients type 2 diabetes is kind of about sugar really but I soon learned that people come in and say well that's weird because I've cut the sugar out and my diabetes is terrible I I wonder why that is and really that's what I'm guilty of I didn't have much to say to those people for 25 years other than yeah I don't know either your diabetes is rubbish I don't wonder why that is this complete mystery because they're not having sugar I'd no idea I've forgotten something and this is what I'd forgotten the starch molecule do you know we could do to remind the world about the starch molecule every day and you will see any of you who follow me on Twitter will see that I I pop that starch molecule up with monotonous regularity because I think it's a great reminder that starch will be sugar starch will be sugar and I think for patients they get that they absolutely get that starchy sugar it's not a surprise to them but they don't actually know how much sugar it is and I we heard one of the speaker's earlier on today mentioned the glycemic index and the glycemic load I think that's really important and the science is pretty sound but I really struggled to explain the glycemic index and the glycemic load to patients and also to fellow professionals I'm so grateful to my partner dr. Katya Schultz I hope she's watching this because she said one day she said David you've become so boring on the glycemic index and the glassy low please no more at coffee time about this she's why don't you go away for say a year and come up with a way that you could explain the glycemic index and the glycemic load to our patients and even to me and she was making a really good point because I wasn't communicating the lycée McLeod very well so I came up with with this thing which is what why is it we can't understand the glycemic index and glycemic load I think it's because patients and even doctors are not very familiar with glucose my patients have no they don't use glucose in cooking they don't really know what it is they have no idea what 10 grams of glucose looks like so telling them that the glycemic load is 10 grams of glutamine z' nothing so I contacted professor Jenny bland Miller from Sydney University you came up with a glycemic index and the glycemic load and I said I've got this idea can we reinterpret this in terms of teaspoons of sugar something we all understand teaspoons of sugar and she said maybe we can and she put me in contact with dr. Jeffery lead see it was one of the original designers really or what he did all the maths for the glycemic index and he's a really great man because he did all the calculations again for 800 foods and we published it we published it and then we used that to produce some of the info grams that I hope some of you have seen on Twitter so what we're doing we're looking at different foods in terms of what is the the load in teaspoons of sugar so I can tell you that a very small portion of cornflakes thirty grams is the same as 8.4 teaspoons of sugar so whether you have corn flakes or 8.4 teaspoons of sugar the result is pretty well the same so when patients are wondering what to eat this really helps them if their goal is to improve diabetes if we've established that goal these impho grams really help them understand what choices might be a good idea because it's about information and choice here's another one I you know that for me I would have thought that a breakfast of cornflakes milk brown toast and some pure apple juice seven years ago I would have said that's fine I might even advised it I might possibly have swapped the cornflakes for some bran flakes but that'd be what I do but look at that breakfast is in about the same as 21 teaspoons of sugar that info graham has been seen by at least a quarter of a million people on Twitter so the idea that if we could communicate effectively and briefly now there may well be errors in that there may well be some errors but it really helps patients understand the consequences and broadly it's not far wrong a very famous day I went on Twitter for a while and I I wore a continuous glucose monitor and Twitter used to vote for dr. Amin to eat things and then they'd see what happened they'd see what happened because it was continuous glucose me so they had me eat all sorts of things but one of the there's a special thing I absolutely hate and everybody knows is that I hate bananas I hate bananas and why do I hate bananas because a banana is about the same as five or six teaspoons of sugar and people are eating bananas my patients are eating maybe two at a time because it's her healthy food and you get potassium from bananas dr. Ron Wayne well yes but you could eat something else and really so I Twitter said eat a banana so I ate a banana a banana actually doubles my blood glucose it doubles it it puts it into double figures so I went from 5.3 to about ten point six so bananas are not a great food and that is predicted perfectly well by the glycemic index it was just I didn't know how to tell patients and now I do so we're coming back to two diabetes if you look at the results there you'll see they're actually what I have done what we have done is so similar to Verta I have picked if you look at the beginning I I like I love a challenge I like the people with really bad diabetes so I'm not cherry-picking easy cases the average hemoglobin a1c was 71 millimoles per mole or 8.6 very similar to Verta because I love a challenge and they these people you know they are wonderful to help they used to be my least favorite patient the overweight person with terrible diabetes now they're my favorite patient because the potential to change their lives is so wonderful and then that makes you feel great because you became a doctor to do that so look at those that the average person has very poor diabetes and then 21 months later I'm getting really significant drops in hemoglobin a1c and I don't actually talk about reversing diabetes because it makes me anxious because I think if they if they went back to eating the old way then they'd get the diabetes back again so I actually call it remission but I'm getting a remission rate of about 45% at it's now I think about 23 months so that means I've actually done 60 patients I have 60 patients who have put their diabetes into remission without drugs yeah and if you if you if you think that I hadn't seen a single case of type 2 diabetes remission in 25 years of clinical practice not one case I did not know it was possible not a single case I really felt diabetes was just about adding the drugs adding the drugs but not now not now we're often told well is is it is it sustainable so our critics say quite rightly well what's your data is it sustainable the longest remission I've got actually isn't the patient on the slide there there was one patient who had has done it for nine years now so it I think it is sustainable that is another graph of somebody else and she has maintained her remission of diabetes as you see there for six years now and imagine for her how proud she is of that her particular goal was to avoid medication and she was on metformin as you see and she wanted to come off metformin because you know 20% of all the people on metformin get abdominal bloating and many of them get diarrhea so for that patient coming off metformin was her goal which as you see we've ER we've achieved if you look at towards the end of the graph she little blip last year people have blips and what's interesting you know that was feedback that blip so she said just watch doctor I mean let's have a blood test in six weeks I'll show you and that people need to say that we have to support them ongoing you don't just do this and then let go they need to support and she needed a little bit of support but she's bang on there bang on right triglycerides I you know I don't think we talk about triglyceride nearly enough nearly enough and I'm constantly mentioning it on Twitter because I don't think we mention it nearly enough so for many years I in fact I never mentioned triglyceride if I could avoid it because I didn't really understand triglyceride you'll see there I did a survey of all the patients that we've done a lipid profile on in three years and a third of them had a high triglyceride and again for the clinicians in the room I wonder what you say to patients I have a high you know for years and years I didn't know what to say I hadn't got a thought in my head triglyceride well there's no drug for it so what you do I don't know kind of lose a bit of weight and you know what I used to do I just fudged it I said let's do the blood test again in say a year let's just roll it along let's just do that in C maybe it'll come down next time and if I I think if our doctors are being honest many of us just roll it along and kind of hope is somebody else just an X blood test right so that's that's triglycerides and a third of them are high what is going on what is that's kind of serious we measure this thing and it's high Y so just leave that for now then I had another problem liver function tests liver function tests again out of 4700 patients in my practice 24 percent had an abnormal liver function test and again I'm so ashamed what did I do about these patients I thought they probably all drank probably and you say well are you sure you how much do you drink how much and they sound glass of wine twice a weekend are you sure are you sure because you know and this is terrible this is awful medicine because they were telling me the truth the patients were telling me the truth I didn't understand the physiology enough do you know why was it well of course we know now you all know that 20% of the entire developed world have non-alcoholic fatty liver disease this is really serious 20% of everybody in this room 20% of all our friends have something wrong fatty liver disease is important we don't talk about it nearly enough I wonder why we don't talk about it I think it's because we're not sure what we can do about it so we'll move on we'll move on so just hold those two things we're thinking about we are worrying about triglyceride and we're aware of fatty liver this is a slide I use a lot in talking to patients in trying to help them understand what does insulin do so we're a really kind of clever machine aren't we because if I eat chocolate and my blood glucose goes up my body recognizes that a high blood glucose is a bad idea and we're designed well the hormone insulin gets rid of that glucose because our body knows that high glucose is dangerous so I explained to patients that insulin is there it's a great thing it gets rid of glucose but here's the question what does it do with the glucose where does the glucose go and they say well you need unique look hosts for energy for muscles so you do so some of the glucose is pushed by insulin into your muscles great but so many of us taking more glucose day after day after day than our muscles need what happens to that glucose well as other places it can go the insulin again is diligently doing its job and it's pushing that glucose into the liver now most of the what's the liver going to do with with glucose well actually most of it will be turned into triglyceride so we just came there triglyceride it got mentioned triglyceride may reflect somebody who's having far too much glucose so when we find a high triglyceride level even if the hemoglobin a1c is normal this is somebody in metabolic trouble they need to understand this if they understand it maybe they take in less glucose and if you look at the triglyceride levels there in my practice triglycerides improve on average by 1/3 over 21 months improved by 1/3 that's huge how many drugs improve things by 1/3 not a lot that's an enormous improvement and it's so then the patients can help understand glucose in terms of insulin and in terms of the goals the other thing under there the gamma GT is a measure or it's one of the liver enzymes and looked again the liver enzyme would start high and it drops by what I don't know what's that there's probably 50 percent or something it's massive in fact the improvements of liver function shocked me when I started this work nothing prepared me for the drops in the liver function proves in I don't know certainly weeks maybe days I found I could predict who was going to do well with they're ones whose liver function improved and improved way before they lost weight people say lose weight to improve liver function it's not like it's not related I find the liver function improves very very rapidly and this helps explain why the final thing there is fat so glucose is also being pushed into your belly fat so you know I I thought I was just getting a bit full of here and that was age an inevitable thing so many patients say well it's just age except it it's just age I wonder I wonder if it tastes really I wonder if it is oh my goodness only five quick hurry triglycerides look they drop loads loads look look so that's the same patient okay and that's his triglyceride so I reverse the diabetes his triglyceride drops like a stone angel in Oh blood pressure this is so important who knew who knew insulin puts up blood pressure and you know how through salt insulin causes you to retain salt at the kidneys I kept finding people started feeling faint when they stood up and then I had to take them off their blood pressure medication loads of them and look at the average improvements in blood pressure their massive insulin is related to blood pressure and who knew the references for all this are at the end galloping galloping central obesity oh I love this guy this guy's 80 years old eight years old feedback that tape measure is where his belly was two years ago imagine how proud he is he lost that weight because he wanted to walk better because he was so heavy he couldn't walk straight and he was struggling to drive and get in the car saying oh yeah low carb liposuction yay galloping galloping listen this guy he's 80 who would have helped an 80 year old before the direct study excludes everybody over 65 he's 80 but look he was on insulin that's really bad for him that's horrible being on his genes difficult he's come off insulin he's come off gliclazide and he's come off his blood pressure thing how proud is that guy I am proud of him he's proud of me this is good medicine this is cheerful stuff Oh insulin and hunger Hunger patients are often saying look I am this big why am i hungry this is ridiculous why am I always always hungry and the answer is insulin because insulin means you can't burn fat you've got lots of fat there you can't burn it explain to patients that you could become a fat burner that's a great thing to be I am a fat burner I have been a fat burner for five years now he's great being a fat burner lots of your fat burners but you can't be a fat burner if there's a lot of insulin hanging around quick racing I'm racing cancer oh gosh yes cancer well that we never talk about cancer enough but actually what if we can do something about it wouldn't that be great if if the patients are really worried about cancer maybe there's something they can do about it let's be cheerful and that's the weight thing again so my patients on average over 21 months they're losing in my case eight point seven kilos that's an average weight loss this is such an important slide this is such a what is going on here this is a patient I've been helping for years and look three times it looks like he's failed so the first time his weight came down oh and then Christmas happened and it goes up down again he keeps failing what how do we handle failure with our patients and we need to reframe it it isn't failure at all he learned something the first time the second time the third time because every time the next time he learnt it he did better this is about when you grow older you learn stuff all people know things life our mistakes teachers yeah we we learn they're not failing the patients are not failing it's an opportunity reframe and say okay well what tell me let's swim upstream what would you do differently what would you do differently and look that guy did cuz every time he did it he did better I've got I love these triple dip I've got a few of these triple dick patients so now what's really going on there though I think that is a graphic depiction of his struggle with carb addiction carb addiction how many of the people in this room asked struggle with cravings for bread whatever we're struggling aren't we with carb addiction my patients away a lot so many of them are struggling and then they feel shamed and they struggle I'm finding all the time this particular guy said he said tell people that moderation is not possible if you are carb addicted it is not possible the only way this patient his message to you is the only way to deal with this is abstinence and that's what he's done and now this guy his his goal was more energy because he's struggling to earn a living he now has two jobs two jobs and he does yoga and those are things and he's come off Prozac he was on prozac for ten years this is wonderful cheerful medicine addiction it's so common so the low-carb program I think three hundred and eighty thousand people have done the low carb program that diabetes digital media Jen and I helped design this low-carb program 280,000 people this is insane we were looking at them about a quarter were classified as having food addiction according to the Yale food addiction scale we need to talk about food addiction far more because then we can help people if we never talk about it well we're not going to help are we and it is such a problem for people and it's also the reason I am sick to death of being told about moderation I cannot be moderate with chocolate biscuits I can't do it I can't eat a half or one I'll eat six and the thing is people who are not carb addicted and my mother is not carb addicted so she says have a little bit of cake it's fine for me it a little bit of cake is not fine so if if moderation works would be planned so please for them but also a bit jealous cuz it doesn't work for me so oh look we've got to the end yes yes so there is sir there there's no carb there he is low-carb Yoda little Jedi Knight little person what what are we thinking about which we I hope we're thinking about Jen and the role of of patience goals the role of hope I hope we're thinking about can we give people information in a form they understand can we support them in their choices that they make and the choice doesn't have to be low-carb I'm I love people who achieve anything anyhow I'm so pleased for them and this is it this is the thing hope it's about relevant information and it's about support and I think somewhere in there I am hoping that you will agree we must also talk about the wonderful magic the art of Medicine the art of Medicine we have the science which is so important but it's this is yin and yang there is also the art of medicine and a lot of what I'm showing you there I believe he's the art of medicine so oh oh look you've got a bit more music but listen thank you so much I am so grateful so grateful [Applause] [Music]

Channel: Low Carb Down Under

Views: 31,804

Rating: 4.9437938 out of 5

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Denver 2019, #LowCarbDenver, David Unwin, Jen Unwin, Type 2 Diabetes, Obesity, Weight Loss, NHS Innovator, Relevant Information, General Practice, LCHF, Low Carb High Fat

Id: kTDaWkwIpuo

Length: 50min 34sec (3034 seconds)

Published: Thu Apr 04 2019

Reddit Comments

[u/aintnochallahbackgrl]

This was a really good talk. Habit and patient centered conversations are huge.

[u/Doris_Tasker]

Thank you. I think it was a good presentation. Now I’m going to look for his published papers.