Four years of low carb primary care: “It’s a lifestyle not a diet” - Dr David Unwin & Dr Jen Unwin

[Music] next speakers are an incredible couple there have been another source of absolutely inspiration for myself and many within this room for everything that they do I don't think that they need too much more of an introduction is dr. David and Jen Unwin Wow amazing what an amazing bunch of people you all are it's fantastic to see everybody here on the this puppies summer it's the hottest day of the year you're missing summer to be here and also big shout out to all the dads in the audience I think that just shows doesn't it the passion in the room and how much we're all loving what we're doing and the difference it's making to people don't if they see me still here but I think that's the point isn't it that those individual stories add up and add up and they touch our hearts and we carry on and we feel better too so that keeps us all going so I'm going to introduce David and he's going to introduce me so five years ago dr. David Unwin was a semi burnt-out semi depressed provincial GP and the high the highlight of his week all day was was a little afternoon snooze loved a little afternoon snooze and it was it was a bit fed up waiting to retire and then we had a conversation about that and about maybe maybe there was maybe there was a more positive way to retire maybe there was things that could be achieved and stuff that could be done and also we had a conversation about working together because I also introduced me so you'll hear about that but we thought that might be fun anyway here we are just about four and a half five years later and so much has happened the main thing being that I'm now his PA so rather than snoozing he's he's often up late in tonight into the night emailing people making up presentations he speaks all over the place he's a fantastic speaker as you'll see and I'm so proud of him oh and also he's got loads of badges and stuff from the Royal College of General Practitioners anyone NHS innovator of the year Oh Lavar have happened all of that happened in the last four years he never he's never written a paper before then or kind of he didn't know how to do PowerPoint four years ago I can't I can't tell you the transformation I'm so proud of him so yeah it's true I did actually often in an afternoon I had a little Kip on my own doctors couch so I I just I just put like you know busy with a patient and just just curl up on the couch I really did often have to do that in an afternoon because carbs made me just soso sleepy but now to just introduce so this is Jen so Jen is she's a clinical health psychologist and psychologists are they specialize really in changing behavior that's what they do they help us look at how do we change behavior and Jen has a particular thing so she's fascinated by the role of hope and the difference of that makes two people's decision-making and it would be true to say that's absolutely underpinned everything that we have done is thinking about the role of hope and how that impacts on the choices that you make so just moving on to why we're here this is kind of a showing off session for both of us it's very nice really because it's like we've got a family you're all indulgent and you're going to let us show off because we're showing off about what we've done over the last the last four years and and some of the differences it has made so you can see up there there's a lovely team so I have a practice forty miles from here we've got 9,000 patients and we've been implementing a low-carb approach across a whole practice and you can see everybody there and it's interesting to first of all show you the results of what you can achieve and then perhaps when we finished showing off we could share some of the things that have have worked and made a difference and go a bit into some of the tricks that some of you might maybe take home and have a go with and then finally it's quite interesting too to think I wonder where next what next what can we what can we achieve together what we gonna do next so I think that's that's what we're doing we didn't realize we're doing anything controversial when we first started and we were surprised when when we were told it was unusual what we're doing and people told us it wouldn't work and then then they said oh well it might it does work oh it seems to work a little bit but people won't stick to it it won't last and then of course they said that well it's you know it it's not going to roll out other people wouldn't be able to do it in that way so we're that's sort of partly how we're structuring things and the the results we're presenting are all the results for the for the last four years so we're ought to now yeah and those those results we have published other papers but the results for all of this are out at peer review so we hope they'll be published quite quite soon for you all so the start of the the showing off if we just begin talking about hemoglobin a1c for perhaps not everybody knows about that but it gives it gives you an idea of how sugary have you been it's a blood test and it says how sugary have you been in the preceding three months before you had the blood test so hemoglobin a1c is a very good indicator of quality of diabetic control and it's used as a national indicator of quality so that practices can be ranked as to how they are how they're doing and on this you want the maximum number of patients to have achieved the quality if you look at Norwood which are where the blue the blue one there so we started off in 2013 as below average for Southport and sadly below average nationally but the show-off bit comes as you see over we've overtaken first of all local results and then we're doing better now than the national results so when we end up over here nobody's winning yay we're we're near and that is a source of such such pride but it's also important because we can use this data to convince other people that what we do is just isn't just an anecdote that those anecdotes roll out and deliver deliver results so politicians are quite interested in this kind of thing so does the effect last this is a very remarkable patient obviously and we're looking again at the hemoglobin a1c so this this lady up here had fairly poor diabetic control that was in 2011 so at that point she came off metformin went on the low carb diet and look what happened so her diabetic control improved and improved she went through the threshold there so she became officially pre-diabetic and then some years ago her hemoglobin a1c was in the normal range and what's wonderful is so at the beginning I was often told well it won't last because they won't keep it up it's very annoying and patronizing isn't it that but look she did keep it up and the latest result was only a few weeks ago an was the best she's ever had so that person what a journey and what a comparison to what could have happened if she hadn't done that because she would have been on a lot of medication this is a bit complicated but it's a big show off really again so if if you look here we're looking now at I've got a study group within the practice of cohort it's actually a hundred and fifty of them now but at that point I think it was about 125 these are patients who volunteered to have an awful lot of blood tests these are patients who will work with me and who have violent they've consented to share their data with you and the world and the important point is that we've been doing it for four years so you'll see there the average was 15 months that's because people are still joining the program all the time the the sort of range is of the data is represented between about six months and four years and three months so we just look what has happened to those people I've done it the hemoglobin a1c in percent for you as well as millimoles per mole so the the cohort start off with pretty poor diabetic control that is poor diabetic control a look at that on average they end up as only just diabetic at all and the average loss is twenty two point three million moles per mole that is huge that is immense and actually what is happening underneath that figure now about a quarter of all of the people with type two diabetes that start this end up in full remission a quarter of them and bear in mind that for the first 25 years of my career I never saw anybody going to remission not one and now I'm getting a quarter of them into it and yet and the majority are seeing great improvement so that's a source of very great pride to me but also the patient's imagine how they they feel about that they're so proud and they don't let it go moving on that the point also it isn't just about type 2 diabetes it really isn't people worry a lot about the lipid profile so I put the averages up there for you this is what happened to that group of people so the total cholesterol dropped a bit although that is a significant drop statistically it is significant look at the HDL that's the protective cholesterol that so the reason that's a minus is because it went up and most of us doing low-carb see that that the HDL tends to rise even better still look at that triglyceride that drops a lot that really goes down a lot so if you look at that the ratio triglyceride against the HDL that improves loads and it's a very good indicator of risk of heart disease it's probably far better than the LD I'm not just that and not just that the weight loss so the average weight loss I redid the figures the other day jumped up it's now nine point nine point one kilos but I mean eight point six there that's the average weight loss we have people still losing weight after four years I don't know what they're gonna weigh really at the end and I've also got people I'm having to say you know you've lost enough now we need to you know but in my career I mean if that's never happened before where I've said to people you've lost too much weight and now it is it's really very very weird anyway not just the way look at the blood pressure so these are again significant amounts of systolic and diastolic blood pressures improving and so many of the patients came off medication for blood pressure so that if you you have to factor that in because these are people on less drugs as well so that again very significant now gamma GT is a liver function and this was a surprise during the four years because I didn't really know much about non-alcoholic fatty liver disease but we discovered the liver function was improving so rapidly and so amazingly and you see there a very significant improvement in liver function and we have published a paper on that moving on yet yet more showing off you see if if over four years you keep offering patients a choice like you know you have type-2 diabetes do you do you want to take the lifelong medication or are you up for a lifestyle and they keep opting for lifestyle you've probably heard me say before not a single patient in four years given that choice not one patient has said give me the drugs they don't say that doctors think it isn't worth involving patients in the decision-making process but it is because they'll surprise you every time given the choice the patient's of optic I'll give it a go I'll give it a go and if you keep doing that look what happens just look what happens so we are obviously the red practice there and so we are now by far and away the cheapest practice in our area thank you [Applause] [Music] thank you and so it's there you know we're spending about 38,000 pounds less than you would predict every year on drugs for diabetes alone this has to be of national interest it has to be of interest moving on so what this what this is what is this this is if you look at the British national formulary that's how we classify all the drugs we use and it's a wonderful system that Bennett Goldacre is set up called open prescribing which is an independent thing which is monitoring every GP in the country and monitoring our prescribing so you can go on there and find out what is happening to your prescribing but they've actually done me a special here this is a special for me which is looking at what has happened in this case confusingly know what avenues it's red and the average of my localities there so this is looking at over time what has happened to our practice compared to locally and you can see it's true we were cheapest practice before but look at the difference every year since we started that the difference between ours and the rest is growing and growing and growing so that is immense really when I saw that I was so very very thrilled because people keep saying oh it's just a few patients is not making that much difference producing evidence like this it is part of showing off but we do it for a purpose because it helps it helps convince all the doubting people that what we do is is is worthwhile moving on all right that's me so we talked about the importance of the patient's experience and of course we're talking and we run groups all the time so we we hear these amazing stories but we thought it would be nice to have some independent inter qualitative interviews done with some of the patients so that they could tell someone who didn't know anything about this also didn't have any kind of vested interest in in in hearing a good a good story so we're very grateful to Laura O'Brien King who knew who knows about qualitative interviews and who interviewed some of our patients who'd been doing this for at least three years and she used this technique called thematic analysis which I probably won't bore you with but if anyone wants to know a little bit more about it there is a paper there all you can talk about in the break but for the sake of a kind of time but it's quite time intensive and she had to she interviewed people for about an hour each and asked them about their experiences how they got her did they come to get started what they've experienced what's better and what what's worse and what's what's helped them keep going etc and she transcribed all those interviews so it's quite time intensive and look for codes and so on so we're going to use some of the direct quotes from the patients as we illustrate what it is that that we do and we think that works I'm going to explain it it isn't really so the the main themes are in the dark blue so these are sort of major themes that came out across all the interviews if you like so people talked about the impact that they'd noticed from following this the low-carb approach they noticed both the physical improvements that we've talked about but also improvements in their in their well-being and I think that's incredibly powerful it's what a lot of us notice and I think is part of the reason that people do keep going because it's a bit of a no-brainer isn't it feels so much better so then they mention these and we'll be giving you some quotes around that well please really to notice that people did mention about their motivations and what had helped them because that gives us clues to and you Clues if you want to implement this sort of stuff in your work you know the sort of things that that really make a difference to people so in terms of getting started it seemed really important that the GP was interested and and gave his time and support and also the practice nurses and also this this monitoring this feed links into here as well as feedback and also that people really want to be healthier and they and they did want to keep off medication and that's why they may choose to do this and then in terms of keeping going the low-carb group which we'll talk a little bit about we spoke about last year people spoke about the importance of changes you know this new knowledge that he had on the new information and we'll be talking about that as well and I think this is a really vital part of keeping going the feedback and support the the regular monitoring the group and the sort of social aspects of supporting each other and having that available to people life long really and this is really a major thing that came out that people were saying it's a way of life it's a way of life because they can kind of tailor tailor the information to their own lives make it their own make it their own way of life they loved supporting others and sharing the information with other people and we often found didn't we that whole families would get involved and people would say oh you know I I told my mom and she's lost three stone and you know people love sharing this information and love sharing their positive stories if if they get their graphs tweeted by by dots wrong weird they they absolutely love that and they ask how many retweets did I get you know for my graph a Superstars and they volunteered to be interviewed by andreas and his team and so on and also this idea of really I don't I don't want to go back I'm gonna move forwards with this almost immediately I started to feel better the GP reduced the medication I was on for diabetes high blood pressure and cholesterol within maybe six months I was off all medication lost my weight rapidly and felt a lot better over two years I've lost four stone so that's amazing really and I've gone down to clothes sizes and a four ring sizes before before I went on this diet I had terrible indigestion stomach problems as soon as I stopped carbs that stopped I don't get it you can't explain it till it happens my moods really really good you know I don't get depressed or anything now because I had been overweight still going up and up and up in weight while my mind was going down and down the turnaround in making me more alert and quicker on the uptake in things made it so much easier to handle my new situation of caring for people I don't think I'm as anxious you know without all the sugar that's the big thing for me we live in a house with three flights of stairs I can walk up and down no problem where you know I was really starting to struggle it just happens to be um I don't know like a miracle really the graph just went down with with all the readings down in a month it was amazing we're not actors obviously always there we are some quotes about what's better and then of course it's important like it seemed says you know what what it's important to know what's worse for people when they're following stuff that we advise isn't it [Applause] tumbleweed and Laura who did the interview said to me afterwards she was so inspired she knew nothing about all this then she said she did try really hard for people to give her some stuff that was difficult or worse no there was there was nothing okay so yeah so now you've had that that's the end of the showing off it went on a long time didn't it the short end of the showing off we're going to share with you now some of the nuts and bolts of how we did it and basically it's psychological and we've divided this up so Jen's kind of a psycho bit she's definitely the psycho babe and I'm the logical bait so we're going to do it in the psycho logical way okay so as most of you know now I'm all about motivation and hope so I I think I think that has that has to come first and people people mention that in the interviews importantly importance of motivation and and the hopeful side so we're going to talk about that but also people need new information so motivation plus information plus feedback how are you doing you know how you're gonna tweak that and you know that the fact that people are doing so well is incredibly then motivating and the support the ongoing support because we're all human we all slip up we all fall off the wagon spectacularly at times and having that support to to come back so we think those are the ingredients of success and as you saw that's what people also said so that's that's quite validating so I'm gonna start with with golden opportunities my cholesterol levels were really high and also I was pre-diabetic which I couldn't understand because I thought I was sort of healthy I was a bit taken aback by my results so I said yes and then just responded fantastically I suppose I've had a weight problem for quite a number of years although I wasn't really concentrating on losing weight I went on the diet mainly because of my liver readings so in general practice there's some absolute kind of key points and key conversations where these kinds of things can be brought up and so that illustrates from the the patient point of view that they were kind of ripe and ready to do something different really so we think that motivation is made up by by these two things really their timing of it the golden opportunity and then what's important to you so I just want to say so often a bad result we can flip it because you can turn it into an opportunity you know so it is I I have type 2 diabetes and that isn't great but then again I've got a choice so you can flip it and then I was really determined to do something about it and really I find patients so often a result is an opportunity for the patient and also for the doctor even even a bad result so some of the best things we ever did were with people type 2 diabetes with really bad hemoglobin a1c something like 130 and you're beginning then to think about insulin and that really focuses the mind and represents an opportunity and some of those patients have done so well and made the most of that opportunity okay so the other really important component and I suppose this is this is really really my bit that I'm really passionate about is that it's really important to get out what people's personal goals are and what's really important to them what their personal values are because if they can make emotional connection to that and what they're trying to do it gives them the the pole if you like into the into this sort of preferred future that they want to be in that we spoke a bit about last year and for those of you that we're here last year or watched online we we know you love the role play I hope you love the role a because I hate it so but we're going to do a role play where we're going to compare and contrast two different kinds of consultation and kind of building on what we did last year really so we're going to compare and contrast a traditional sort of advice-giving type consultation with I would say a more Hope enhancing consultation which focuses on what's important to someone and their and their personal goals so you'll see those two and more kind of commenting on them at the end did you want to say something else so you I'm just gonna say so you remember mrs. Jones who had a consultation a year ago and she just been diagnosed with type 2 diabetes well she's coming back for another appointment unfortunately doctor I mean he's very busy so it has taken a year to get a review appointment with dr. Amin but anyway we're doing it now we're doing it now so we're going to sit down to make it more realistic I hope I need the leaflets so mrs. Jones we we met last year to chat about your new diagnosis of type 2 diabetes and I left you with a choice really we were going to look at the low carb diet and lifestyle or medication what are you thoughts well it was a shock as you know and I was upset but I've had a good think and good chat with my husband and I'm gonna I'm gonna try the lifestyle I think I want to try that first I think it's a good idea great because in my opinion that's the best way to start I know you were worried about amputation and vision things like that you know this but there's a lot of evidence around if we can improve your diabetic control these things they they don't have to happen there's so much evidence to really moving on cutting out sugar starch that kind of thing can make a lot of difference and I've brought you a leaflet for that there's a leaflet and actually talking of lifestyle you know I advise exercise so really you should think about maybe joining a gym running weights that kind of thing cycling you know any any of that and I've got your leaflet on that as well yeah and then of course you know I I remember that you were concerned about your feet and we've produced a like a leaflet for feet as well and then of course on the way out there are other leaflets we've got Mental Hygiene you know looking after your bladder we've got loads of stuff so and and then if you'd like to take the leaflet on the low carb diet which as I say I really advise you that you should do and then when we next meet you know we can chat again about that thank you okay hopefully this will be better we'll see we'll see I think so mrs. Jones we we met last year to check up a chat about your new diagnosis of type 2 diabetes and I left you with a choice around the low carb diet and lifestyle or maybe you know medication so I'm interested to know what you think yeah I've had a good thing and I'm keen to try the lifestyle first I'd like to try great great so you've obviously given that some thought before we move on to the details of it given that we're going to start a process together what are your best hopes for what might happen oh gosh well the main thing will be to not start on the medication I don't like the idea of being on medication every day forever now and I you know you read stuff in the paper don't you about side effects well I'm sure you can do that I'm sure but what else Oh what else well um I have been putting on a bit of weight so it would be nice to certain you're not support anymore maybe maybe lose a bit of weight will be nice yeah yeah well be you know most of the people going through this do lose a lot of weight but what interests me is that weight loss what helped me understand your life what difference would it make in your life to lose that way oh wow well let's think well I don't know if you know my daughter's having a having a baby so it would be nice to you know feel fit and healthy to help to help her out really like my mom helped me so I'd like to be a fit fit nan and the husband we're just retiring now so it'd be nice to get off and you know nice to have some holidays together wouldn't it and enjoy enjoy our retirement that would be nice to have a healthy retirement that would be important so those are some really great goals you're hoping to stay off medication you'd like to lose weight and you're hoping that that could positively impact on your life and there's loads of fun stuff yeah that you could do well I've known you for a long time we we can do that really we can the only thing is we've got to go through the sugar and the starch thing so my next thing is to help you understand the difference that sugar and starch can make and we'll have another appointment on that [Applause] [Music] [Applause] [Music] that'll be next year no doubt yeah so I hope you can did you see the it was a massive contrast and you know even City Bay huh bombarded by information and leaflets and you know maybe I already go to the gym you know maybe maybe I run Madison last year the doctor didn't didn't know that didn't really show any interest in in my own kind of concerns and I now feel I felt totally connected to my fit nan you know kind of helping with daughter out some positive hopeful motivating and I felt we were kind of in it together so that was good I've discovered that actually the more I am talking the less I am learning about the patient so you saw me in the first one was a parody obviously but I didn't learn anything about that human being nothing at all because I was so busy with me the big doctor I know what to do here's the leaflet and then the second one although that was a role play that happens to me every day where patients surprise me with details hopes things they're doing in their lives but if you never asked you never will find out if you can incorporate those hopes and aspirations into a ten-minute appointment which really you can it's so powerful but so interesting and so rewarding because that's the that isn't that that's kind of why we became doctors in the first place to link with people and make a difference so we do so we've done we've talked about motivation and if you remember it went motivation information so information we're just going to run through information you've heard it all before really so sugar it's really bad idea if you've got type 2 diabetes it's a really really bad idea well some people cut out sugar and they still have terrible diabetes and that can be because they lack information they often lack information around starchy carbohydrates and I'm going to give you some information about starchy carbohydrates just an aside for a minute is we're all really worried about being something going wrong and officialdom coming down upon us and it I just want to show you this is from the the nice old not that I want to show you this is from the nice guidelines 2015 and it absolutely instructs doctors to be talking about low glycemic index low glycemic index sources of carbohydrate and individualizing care so it's completely fine for doctors to do that exactly that the trouble I found partly was that doctors don't actually understand the glycemic index and to be honest I didn't really either and one of my partner said you know it's just too complicated can't you just simplify it so what what we did which is another paper I got together with a carbohydrate expert and really looked into the glycemic index but reinterpreted it in a form that we can all understand which is teaspoon of sugar equivalents so that everybody is familiar with what a teaspoon of sugar looks like whereas I found that nobody really knew what four grams of glucose looked like so that that was trying to reinterpret the glycemic index which talks about glucose in two teaspoons of sugar and some of you on Twitter may have seen some of these but if we if we look at the these this shows you as it were the glycemic consequences of some of these foods so these are breakfast cereals oh my goodness we've got to speed up so look low they're sugary they're very they're all they're all sugary don't look what's this Oh bread oh my god it's all sugary don't have a bread they're all sugary they're our next one what's this fruit well some of its sugary and some of it isn't and I hate bananas and that's why okay that there's the banana but feedback can I can I have a minute for the last one right right there you are so fruit berries raspberries strawberries at the bottom hardly sugary at all but compare them to oh my goodness a sugar stick a banana look what that does and the people the people with monitors know this with blood sugar monitors they know this very important information in advising choice and these are all on Twitter but we'll also put the slides up on the website as well so people can yeah so we talked about motivation information yeah give people information we run little quizzes like how many teaspoons of sugar in this banana and people get prizes it's a fun bit like John and Trudy was talking about so feedback so people mention that it's really important they really value it because you know you've got to go and get weighed and it helps you keep on the straight and narrow we don't make people get weighed by the way we didn't force them onto the scales but we offer that at the group and a lot of them do choose to to do that we've got five minutes we've got five minutes okay all right so feedback is really important and people just really value that you want to just want to show the graphs yeah I just want to show the graphs show the graphs Wow oh my goodness look at these graphs so the patient's the the EMS computer system general practice generates amazing graphs for patients so easy it's feedback and they take it home and they become so proud but look at this look at this so we've got there at the top this was somebody that went low-carb obviously they went low-carb there that triglyceride look how that dropped like a stone like his stone serum HDL that's the protective cholesterol best for 13 years hemoglobin a1c oh look in remission diabetes in remission wait so this person is the lightest they've been for 25 years how's that for feedback how's that for feedback they love those and they take them home and stick them on the fridge and they just loved it people love the feedback okay and then finally help and support which really mentioned so we run a group but it's it's easy it's it's it's not we only do it once every eight weeks now people come in coming for four years they come we cook food and we talk about this the information and we support each other usually after Christmas is the main time we have to support each other to get back on track and people have said yeah I felt like here's the GP giving me this time and particularly it was an opportunity for me Last Chance Saloon really as a man in his early 50s to turn his life around as a group you can talk about and share the solutions that other people are finding that you haven't got the imagination for yourself more graphs now you remember the beginning was will it will it roll out I remember Simon Stephens talking to me once and and he was very complimentary but he said you're so charming it's no wonder people do what you want and that was nice but really we need this to roll out we need this to roll out but so just look at this this person this is an 85 year old lady she lives in her own home and her hemoglobin a1c was a hundred and thirty five I think one of the worst I've ever ever seen you don't feel well if you have that kind of thing look how it drops look at her weight on the other side so this woman goes dancing once a week now really she does she lives in her own home it's so clean and tidy she's such a smart woman but she's not my patient and that wasn't my work this is somebody I've taught this is one of my partners and he's getting better results than me yeah let's give him credit Simon Tobin is getting better results than me but locked but look something even better is happening something even better I think vipin and Helen you're here somewhere where are you yay yay Thunder oh come on so this is so important because they've done this wonderful work there those are their results and they're so similar to mine part of evidence-based medicine is can you reproduce something so important can you reproduce something is it generalizable to the population is it useful so they were hundreds of miles away from me and they've done just the same amazing so if we can we can do this again and again and that's not the end it's not the end oh this is another thing look it's kind of snap it looks like my drug prescribing thing but it isn't they've done it again so they're drug prescribing just the same is hard evidence moving on moving on it's not even about doctors really it's not really about doctors so we heard Charlotte hi Charlotte there we are what so they've done what is it a quarter of a million quarter of a million we got I felt and he's gonna tell us probably that I don't know he's done hundreds of thousands you go on go on to Amazon just just Google no car book if there's eighteen thousand choices for you this is huge this is huge you know never mind will it roll out it will never roll back it will never roll back never roll back and really quickly honestly this is exciting so you take you take one of my average patients and you ask an insurance guy how about the premiums there they are at the bottom the premiums my average patient he wants life insurance the premiums increased by 50% he wants critical illness 75% he wants to insure it against cancer 50% that is because this patient of mine has got diabetes and high blood pressure and all the rest of it you put them through the low carb miracle and look the insurance premiums dropped to standard for life standard for critical illness standard for cancer that's amazing these insurance people they know about hard facts they really do they are not to be fooled when they tell us this kind of data quickly quickly oh my goodness yes the effect on the practice is what we were going to tell you about and it's kind of rolled out all right so it's no longer about low-carb because oh my goodness we're run door Jetstar so we've started a walking group for people who who really only just starting to take a little bit of activity and we get out in the sunshine and that's us and also with Simon Tobin who you heard about is involved in part run which is in the same park so those patients who are able to come down it's so cheerful we all run together as families and it's it's about the whole package really it's not just about low-carb and the impact on the practice has been huge in terms of our enjoying medicine and carrying on so I should have gone years ago and I'm still there and recently lively so it's wonderful to enjoy medicine that's why we went into medicine it wasn't have a miserable time it wasn't to become exhausted and fed up we were hoping to make a change and enjoy ourselves and I am and I'm speeding on this is the last slide but you've got you've got to see it because this is one of our it's one of our favorite guys I'll just dip yes so this is Chris is such a superstar we just wanted to finish just some final quotes about why it's a lifestyle not a diet it's quite staggering when I think of what I used to eat and drink to where I've come now because it's four years on and it's just a lifestyle really like I say it's a way of life I think if I went back to having all those carbs regularly I'd just go back to as I was before I say it's not a diet it's a lifestyle I just don't want carbs anymore

Channel: Public Health Collaboration

Views: 27,021

Rating: 4.8958783 out of 5

Keywords: diabetes, diet, nutrition, health, public health, low carb, obesity

Id: 3WTY74j3DAg

Length: 45min 6sec (2706 seconds)

Published: Sun Nov 12 2017