Diary Of A CEO: w/ Fatty Liver Expert Dr David Unwin (Transcript)

DAVID UNWIN: Yeah.

STEVEN BARTLETT: When you say high blood sugar, I get high blood sugar when I eat lots of sugar.

DR. DAVID UNWIN: Okay, so first of all, we’re actually talking about glucose.

STEVEN BARTLETT: Yeah.

DR. DAVID UNWIN: And sugar can mean table sugar, or it could mean many different things, but we’re actually talking about blood glucose.

STEVEN BARTLETT: Which comes from lots of foods.

DR. DAVID UNWIN: Which comes from many foods.

STEVEN BARTLETT: Carbohydrate-heavy foods.

DR. DAVID UNWIN: Yes, yes, it does. So that’s right. But you have the hormone insulin to defend you from poor dietary choices. So the question is, what does insulin do with the sugar you just ate? And here’s the answer. Insulin, the hormone insulin produced by your pancreas gland, it pushes the sugar out of the bloodstream inside cells where it can be used for energy for you to run around.

But what if you take in more carbohydrate than you need to run around? Well, then that sugar is turned to fat inside cells, because it’s safer for you to turn that sugar into fat than it is to have it damaging your arteries.

So I am somebody with type 2 diabetes, so we can talk about me. I had a really heavy biscuit habit. I was senior partner of the practice, and it’s stressful. Patients used to bring me biscuits all the time as a gift because they want the doctor to be happy. So in the drawer at the top of my desk were packets and packets of biscuits. So I was taking in more sugar and I didn’t run around, and gradually my waist got bigger.

What was actually happening was, as I took in more sugar than I needed to run around, my insulin was working to get rid of that sugar. And it was giving me two things. One, a belly. I thought it’s just middle-aged spread. And the other was, I didn’t know, but my liver was filling with fat. And that is very common now. It’s a third of everybody in the developed world that has fatty liver now.

Fatty Liver: The Silent Epidemic

DR. DAVID UNWIN: Here we have the wonderful props. Let’s talk about these. So, fatty liver. This is the healthy liver here. And you see the color. Look at this one. It’s yellow. It’s the wrong color. And it’s because of fat. So in that case, like has happened to me over years, my liver began to fill with fat because it was essentially overworked and glucose was being stored there. I was taking in too much glucose. Insulin was doing its good job of taking it out of my bloodstream and forcing it inside cells in my belly, but unfortunately in my liver.

STEVEN BARTLETT: Okay.

DR. DAVID UNWIN: And so there’s a progressive laying down of fat in the liver. So if we look at actually some proper liver — put on your seat belts now, because this is —

STEVEN BARTLETT: Oh gosh.

DR. DAVID UNWIN: Somebody’s actual liver. So that’s the normal liver. But look at this, it’s larger.

STEVEN BARTLETT: That’s a real human liver?

DR. DAVID UNWIN: Yes, these are human livers and that’s as it should be. But this liver, it’s larger. And it’s larger because there’s so much fat in it. Now the twist in the story is fatty liver interferes with the good work of insulin. So you develop a thing called insulin resistance, which means your insulin is no longer as powerful as it was. It’s beginning to become difficult for you to deal with carbohydrate and sugar because your insulin isn’t working as well. And the only way to deal with that is the next twist in the story. You have to start producing more insulin. Because it doesn’t work as well.

STEVEN BARTLETT: Yeah.

DR. DAVID UNWIN: So your pancreas has to crank up the supply. We need more insulin. So now you have two things. You have insulin resistance — your insulin isn’t working as well — but at the same time you’re trying to produce more insulin in the pancreas.

The Long Silent Scream from the Liver

DR. DAVID UNWIN: This bit’s called the long silent scream from the liver. This is work by Professor Roy Taylor, a friend of mine at Newcastle University, and he pointed out that you’ve got fatty liver for about 10 years and you don’t even know. You wouldn’t know that your liver’s gone fatty and yellow like that. But unfortunately, this is another twist. Fat is being laid down in the pancreas gland, the very gland that your life depends upon producing insulin. And your ability to produce enough insulin collapses. And at that point, you can’t regulate blood sugar anymore.

But upstream of that, you have a problem. You’ve got that, but you don’t even know. You’re talking about what’s in my mind. Why are we waiting until you actually have all the problems of type 2 diabetes?

So since 2013, I’ve got hundreds of patients and I’m monitoring the baseline and latest follow-up. What happens to them? It’s really important. And now I have a huge data set that I can interrogate and answer questions.

Number one question — let’s think about prediabetes. So this is in the long silent scream. I can tell you that the people with prediabetes in my practice north of Liverpool, 93% of them will get a completely normal blood sugar if they go low-carb. 93% resolution, and that will last for years because I’ve checked.

Okay, how about we wait for the 10 years, until you’ve got type 2 diabetes, and then you go low-carb. At that point, if I can get you early, I’ve got a 73% chance of you having a normal blood sugar. Let’s wait another few years because you don’t want to give up bread and you don’t want to give up chips and pizza. Fair enough, I’ll wait. But if we wait 5 years, you only stand a 50% chance. So do you see, it goes 93%, over 70%, 50%. The chances of me not needing drugs and being able to do a good job for you are diminishing. So really, it’s a stitch in time. And so much of this you don’t even know. You don’t even know it’s going on.

Glycemic Index vs. Glycemic Load

STEVEN BARTLETT: One of the things that shocks me is how little we know about what’s in our food.

DR. DAVID UNWIN: Yes.

STEVEN BARTLETT: Because I think we all know that biscuits are a food that has a high glycemic index.

DR. DAVID UNWIN: Well done.

STEVEN BARTLETT: Which is a term that I’ve learned from this podcast, which means —

DR. DAVID UNWIN: Some carbohydrates are more sugary than others. And that’s the glycemic index. What that is doing is comparing different carbohydrates with pure glucose. So pure glucose is 100, and then other sugars come further down. But there’s something better than the glycemic index, and that’s called the glycemic load. The glycemic load takes portions of food and predicts how will that portion of food actually affect your blood sugar.

STEVEN BARTLETT: And am I right in thinking the glycemic load would factor in the amount of nutrients in the food?

DR. DAVID UNWIN: Exactly.

STEVEN BARTLETT: So like protein, fiber.

DR. DAVID UNWIN: Yeah, because if you took watermelon, well, it’s mainly water, isn’t it? So you have to factor in, you can have quite a lot of watermelon to equal a chocolate bar. So you’re looking at the density of sugar in it as well.

STEVEN BARTLETT: Okay.

DR. DAVID UNWIN: So that’s why the glycemic load is better.

STEVEN BARTLETT: Was there a moment in your career where you started to question what you had been told?

The Patient Who Changed Everything

DR DAVID UNWIN: Yeah, you know, so you start as a young doctor. I wanted to be part of a small community and stay there and make a difference. And then comes the sad bit, really. So I, for the first 25 years, I was trying to do what’s in the guidelines. I was trying to be a good doctor. But what I noticed, I noticed 2 things.

Number 1, I noticed what I’ve already said to you, that the health of the population I cared for was deteriorating. It wasn’t getting better. So if I’m the doctor in charge of the practice looking after these people and health is deteriorating, am I not responsible? And where’s — where is all this difference I was hoping to make? It just wasn’t panning out.

At the same time, I’d always in my heart felt that prescribing lots of drugs felt a bit wrong. It felt like a mini failure because how is somebody well if they’re taking 6 tablets a day?

STEVEN BARTLETT: Was there one particular patient that you met?

DR DAVID UNWIN: There were two. Two things happened, both to do with very powerful women. The first powerful woman was a lady I’d known for over 10 years. She and her husband — I’d cared for them both. They both had poorly controlled diabetes, and they were both very heavy. At the time, I could monitor how my — how compliant my patients were with their medication. And if I’m to be truthful, in part, that was how I was paid. So part of my payment was to do with all the patients having, in this case, metformin, the most commonly used drug for type 2 diabetes.

STEVEN BARTLETT: Part of your payment?

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Yeah. How would you mean?

DR DAVID UNWIN: Well, because there’s a — you’re supposed to — the government approve of the fact that we give drugs that are needed for type 2 diabetes. So that you’re given a sort of quota where it’s regarded as good practice that such a certain percentage of your patients will be on metformin. What? Yeah, it’s true.

STEVEN BARTLETT: So is it fair to say that you were somewhat incentivized to give people metformin?

A Confrontation That Changed His Life

DR DAVID UNWIN: Yes, that would be true. But I think we should also be fair to say that the body of evidence at the time would say that it’s good practice to give metformin to people with type 2 diabetes and conversely poor practice not to use metformin, but we’ll develop that.

So the backdrop is we’re monitoring the patients who stopped taking their metformin. Because that is number one, poor practice, and number two, actually costs me. So I wrote to the person, “Dear Mrs. So-and-so, I’m concerned that you’re not — you don’t seem to be taking your metformin. Please make an appointment with me at your earliest convenience.” Very British, very polite.

Anyway, nothing prepared me for what was going to happen that morning, and it’s changed my entire life. On that point. So the lady — well, let’s call her Mrs. Jones. That wasn’t her name. She marches in and she said to me, “You think you’re going to tell me off, don’t you, Dr. Unwin? Well, I’ve got news for you. I’m going to tell you off.”

I was scared, like, what’s going on? She’s never been like this before. She’s a polite person. Anyway, she went on to explain. She said, when you do my blood tests, you will find that my blood glucose is completely normal despite not taking your metformin. And she said, I’m wondering if you’re actually qualified as a doctor, because in the last 10 years, did you ever once tell me that bread was sugar? Or breakfast cereals were sugar.

“I had to learn online that bread is sugar, that rice is sugar, that breakfast cereals are sugar. And when I cut those foods, I don’t need your metformin now.”

And she made it worse. She said, “This is schoolboy biology. You should have learned that when you were 16.”

I was dead scared because, you know, complaints as a GP, it’s really bad. They go on for years and years. But mainly I was scared because every word she said was true. And one thing I had learned about when you’re an older doctor is you’ve got to listen to people properly. If they’re complaining, don’t deny it, don’t defend yourself, take it.

So I said, okay. I’ve got — I want to learn what you’ve — you know, if this is true, will you meet me again? Let’s do the blood test. So we did the blood test. It was true. It was the first case of drug-free type 2 diabetes I had ever seen. I’d never seen a single case in 25 years where people came off medication.

I was fascinated because she’d done it like a miracle. But there was another detail I just share with you. She was one of 40,000 people online learning from each other how to do it. And when I looked, they were being rubbished by the healthcare professionals. So people like me were telling them, you’ll die, what you’re doing is dangerous. And I was ashamed, really ashamed.

And it’s complete coincidence, but in the same month, we have to introduce my wife Jen. Is there a photo? Come on, let’s see Jen.

STEVEN BARTLETT: This is Jen.

Enter Jen — The Woman Behind the Low-Carb Revolution

DR DAVID UNWIN: Oh, she’s probably the cleverest woman in the world. She’s so clever. I love that woman. So Jen — so her back — she is a clinical health psychologist, and she specializes — she’s fascinated by the role of hope in disease and the difference it can make. And she spent her life researching the difference that hope makes to clinical outcomes.

So it just so happened that she was in a supermarket and she saw some — a discounted diet book. That one, that’s the book.

STEVEN BARTLETT: Escape the Diet Trap by Dr. John Briffa.

DR DAVID UNWIN: Yeah, Dr. John Briffa. What a lovely guy. So Jen bought that book. Just around the time I’m telling her about this patient. So she said, “You have to read this book about a low-carbohydrate approach to insulin resistance, to type 2 diabetes.” And in the book, everything that my patient had told me was there, but it was done in a medical way. And I understood.

She said, “David, why are you sort of failing? Why don’t you do one thing before you retire? Why can’t you do a cheerful something you really believe in? Why don’t you have a go at this low-carb?”

STEVEN BARTLETT: Yourself?

DR DAVID UNWIN: Yeah. She said, why don’t you and me go on this diet, see if some patients would volunteer and do it with us? And I mentioned it to the partners and they said no.

STEVEN BARTLETT: These are other doctors?

The Monday Night Low-Carb Club

DR DAVID UNWIN: Yeah. So I’m senior partner. I’m supposedly the boss. But at the time, low-carb was not respectable and they didn’t like it. And they said, we don’t want you to do this. And partly because they said, well, how, you know, is that a good use of the budget? The resources of the practice. Because if you’re doing this, David, maybe you’re not treating chest infections or other things, and there’s pressure on the health service. So this felt a bit — they felt it was a bit self-indulgent.

So go back to my wife and said, the partners say no. And she said, I’ll tell you what we’re going to do. We’re both going to work for free, and we’ll do it — why don’t we do this in our own time in an evening when the practice has no resources.

So that’s exactly what we did. We found 18 volunteers who were interested amongst the patients and then Jen and I, so that was 20 of us, we started meeting every Monday night talking about low-carb, learning how do you cook stuff, how do you do it? We did it together. And one of the nurses was so excited. Heather is her name. Let’s give her a thumbs up to Heather. Heather said, “I’ll work for free, I’ll help you, I’d love to do this, I want to, I want to believe in what I do.”

And then the magic begins. The results — I couldn’t believe it. I could not, you know, I’d never seen anything like it.

And the first thing I saw was the liver function improving. You see, because I’m doing blood tests, because I know I’m doing something weird. I’m doing something that I would be criticized for. So if you’re going to do a weird thing, you need to measure stuff. You can’t, you know, these are patients, so you can’t just experiment and not be — am I doing harm? What’s happening to the cholesterol and the lipid profiles? So I was monitoring stuff really closely.

The liver function though, Steven. I got people who I thought they were drinking alcohol and I thought the liver problem was due to alcohol and they’d had abnormal liver function for 10 years and suddenly within weeks the liver function was improving often by a third or 50%. I was so excited. Can you imagine? I’m sitting there and the laboratory results are coming in and they’re like, wow. And then another and another.

So that was the first thing. Then the weight. So we’re all meeting every Monday night and we got the scales and everybody gets weighed every Monday night. And the weight started falling off people. It really did.

And then all sorts of other weird stuff started happening, some of which I couldn’t make sense of for years. The first one was people said, “Are you hungry? Because I’m not.” And they started saying things like, “Do you have to eat breakfast?” And I also — I wasn’t hungry. I wasn’t hungry. They were telling me the truth because I was experiencing this with them. Why are we not hungry? That’s so odd. And I was starting — I’d not bothering with breakfast, so I didn’t eat it. You don’t have to have it. And my belly went away.

Next thing was I noticed when I stood up from my desk, I felt dizzy. Weird. Now, I hadn’t told anybody, but I had moderate high blood pressure for years. But I didn’t like to be a patient. So I never went to a doctor. I just put my head in the sand. So I had high blood pressure for years. When I took my blood pressure, it was low normal. Why? I didn’t know. But on the patients as well, I’m doing that as well. I’m measuring all the blood pressure and it’s improving.

So it’s getting weirder and weirder. Liver function improving, weight going down, blood pressure improving. In those days, the blood test that we did was a thing called a hemoglobin A1c. The A1c in America. This is the average sugariness of your blood for the preceding 3 months. So the results take a while. But then when the hemoglobin A1c came in, there it was. We were getting really spectacular improvements in average blood sugar.

And that’s kind of how it began. So that’s 2013, so that’s 13 years ago. And the rest is history. But that — I was completely blown away, and I was full of curiosity about all these other things. And how was it? Why were these things improving?

A Personal Transformation

STEVEN BARTLETT: So in those 13 years, how has your fitness, your health changed?

DR DAVID UNWIN: My mental powers were much greater. I could concentrate better. I wasn’t fretty, so I noticed that. The next thing I noticed was I needed a lot less sleep. So yeah, in the beginning I used to have to have a little sleep on my doctor’s couch every lunchtime. So I was senior partner, so you press do not disturb and you put the curtains round and have a little nap on my own couch for 20 minutes. It was the only way I could get through the day.

I didn’t need that nap anymore. I was less sleepy. I needed an hour’s less sleep a day. I could think better. I was — I could cope with the same problems. And this is so weird, but mentally I was stronger. It was like being a younger man — the way — I don’t know, I think you have a sense of mental horsepower.

STEVEN BARTLETT: Going back to the top of this conversation, you talked about how everybody listening right now has a variety of different health futures.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And which health future they end up in is going to be determined by the everyday decisions they make.

DR DAVID UNWIN: Yes, yes.

STEVEN BARTLETT: So I want to really zoom in on some of those everyday decisions. We talked about you and your biscuits, and at the time you said you were probably quite sedentary as a doctor.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Sitting in a chair, patients coming in.

DR DAVID UNWIN: All day long, yeah.

STEVEN BARTLETT: You weren’t doing exercise.

DR DAVID UNWIN: No. I didn’t fundamentally believe it would make that much difference. And this is such a great point — a really great point. So let’s think about weight loss. So I would give advice on weight loss to my patients, and I would say eat less and move more. And I’d even sometimes say that Belsen thing, you know, the no-fat people came out of Belsen. I’ve never heard that before. But it’s a horrible thing to say to a patient, isn’t it?

STEVEN BARTLETT: What’s Belsen?

DR DAVID UNWIN: Well, that’s in World War II where they all starved, poor things.

STEVEN BARTLETT: Oh, okay.

DR DAVID UNWIN: So the point is you’re saying to somebody with an obesity problem —

STEVEN BARTLETT: It’s their fault.

The Sugar Illusion: What’s Really in Your Food

DR DAVID UNWIN: Yes, you’re blaming them. That’s exactly the point. And that’s what I did. And it’s worse than that because I give them that advice and it just about never works. I did a horrible thing. I used to say to them, right, so why don’t you just have 2 tablespoons of All-Bran a day?

STEVEN BARTLETT: Oh, breakfast cereal.

DR DAVID UNWIN: Yeah, with skim milk. And I would advise a few multivitamins and a couple of pints of skimmed milk a day. That was my advice. And then when it didn’t work, who do you think I blamed?

STEVEN BARTLETT: Them.

DR DAVID UNWIN: Yeah. And this was all part of my epiphany. I never joined the dots that the failure was not theirs, it was mine. And that’s horrible, isn’t it? Imagine 25 years of— I was blaming patients for their failure to lose weight, and it was my failure because I didn’t give them advice that worked.

And if you keep giving the same advice to people and it doesn’t work, shouldn’t I have questioned — but is that happening in society overall? How are we doing? How are we doing with health? How’s it going? It’s a disaster, isn’t it? So we need to do something different.

But for me, for 25 years, I did not believe that lifestyle was key, and now I do. And that’s why I didn’t think that the biscuits made that much difference. Obviously, I knew basic nutrition, so I made sure there’s protein and there’s iron and stuff. I fundamentally believed that drugs is what I should be using, medication, and that lifestyle was a sort of add-on. Isn’t that terrible?

The Knowledge Gap: What People Don’t Know About Food

STEVEN BARTLETT: I think this is so important because it really gets to what I believe the average person thinks as well.

DR DAVID UNWIN: Yeah. Yeah.

STEVEN BARTLETT: We were talking before we started recording about some of my friends. There are two friends I mentioned. One of them is a very, very successful businessman. Everybody knows who this person is. And they asked me this weekend, is pizza healthy? And I just couldn’t believe it — it shook my—

DR DAVID UNWIN: It’s gobsmacking. It was like, oh, what pizza? What?

STEVEN BARTLETT: Because they were trying to choose between — they usually have a big 12-inch pizza for lunch. And he was asking me, “What’s healthier, Steven? Nando’s chicken or this 12-inch pizza he was going to get?” And I literally looked at him like I was looking at a ghost. I was like, are you winding me up? And he was genuinely serious. He’s almost 60 years old now, and he doesn’t know if a chicken breast is healthier than a 12-inch pizza.

And the other example that I mentioned to you before we started recording is a very famous Premier League football superstar legend who you would assume had gone through those sort of 15, 20 years of being an academy player and then a pro athlete. Knows what has sugar in and what doesn’t. And he was asking me, “Is a big spaghetti carbonara, is that healthy? Is that health food?” Because he said to me, during his football years, they were told always to carb load.

And again, this gave me a huge amount of empathy because it made me realize how, even though there are podcasts like this where we talk so much about health, and even though there’s the internet now, the apps — this information is not getting through to the average person for some reason. And they too, I believe, think exactly what you just said, that health is this sort of accessory where my fate is determined anyway. And if I do this health stuff, which is a bit of an inconvenience because these Percy Pigs taste great—

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Or these candies taste great, then I might be able to look a little bit better, a little bit more aesthetically pleasing. But my fate is determined.

DR DAVID UNWIN: The simple point. Yeah, nutrition — we’re not teaching it. So there are only 3 macronutrients. There’s only protein, fats, and carbohydrate. And yet your friends there haven’t even got the 3 macronutrients, and they are successful, intelligent people. So somewhere we’re going badly wrong, aren’t we?

The Fruit Snack Deception

STEVEN BARTLETT: There was another example that’s really front of mind to me, which was — I’m in Dragon’s Den at the moment and someone came in and pitched a fruit snack business. And it’s basically dried out fruit pieces. Now I looked at the back.

DR DAVID UNWIN: Okay, I’m loving this already.

STEVEN BARTLETT: Yeah. I looked at the back.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: And it said, in the range of 60 to 70% sugar. Because what they’ve done is they’ve taken exotic fruits like mangoes—

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Dried them out. And now you have this little chip, which is this piece of mango. 60, 70% sugar. So I’m looking at the back of this thing thinking, this is candy. This is basically candy.

DR DAVID UNWIN: Thank you.

STEVEN BARTLETT: But I’m looking around and every — because it uses the word “fruit”—

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: People have this sort of halo assumption that if the word fruit is on it — fruit juice, fruit snack—

DR DAVID UNWIN: It’ll sell.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: And also it’s a sort of “who cares about the consequence, but we’ll make a pile of money” — selling dried up fruit, and they miss what you read on the back.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: And it’s 67% sugar.

STEVEN BARTLETT: I was like, this is not healthy. Is that okay?

DR DAVID UNWIN: How’s that? What if somebody had type 2 diab— what? For kids, we’ll just give them, yeah.

And you’ve touched on another thing about what’s going wrong. So when we look at my practice and this epidemic — and really, as I’ve said already, it’s not an epidemic, it’s a pandemic. It’s everywhere. I go all over the world and obesity, type 2 diabetes, poor metabolic health — it’s everywhere. It’s everywhere.

And I think one of the things, touching on what you just said, is — so you wake up and you have your cereals for breakfast.

A Day of Hidden Sugar

STEVEN BARTLETT: Which you’ve got some here.

DR DAVID UNWIN: Which we have some cereals there. And then you’ll have — why don’t you have a big glass of fresh orange juice as well? Great idea. And then, okay, that’s your breakfast. But then on the way in, you have a little snack and people do. They buy a bar or some crisps or something like that. And then even at school, they might get a muffin mid-morning. It’s fair enough. They might then have an apple.

At lunchtime, you’re going to have some sandwiches, and then you’ve eaten your sandwich. So you’ll — I don’t know — you might have a cake or something, or some ice cream. Then you’ll go home and then it’s time for, you know, maybe your chips or your pizza.

What you’ve actually done is had sugar with your sugar, with your sugar — sugar, sugar, sugar, sugar, sugar all day long. There’s hardly any protein going back then to those macros. Where was the protein to grow you?

And that’s the thing that’s changed over time — the snacking. So I come across a lot of young people and their mother is saying, “I can’t get him to eat any proper food. He just eats snacks all day long and I can’t get protein in them.” And some of them are actually thin kids. They’re not all fat.

STEVEN BARTLETT: Let’s talk about what you just said there, and we can walk through the day using—

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: The food we have on this table. Now I just want to caution that we do have some people that are probably out walking their dog listening and can’t see. So we’re going to have to do a bit of a voiceover as to what’s going on.

But you said wake up in the morning, you have your cereal. Now cereal growing up, I thought was a health food.

DR DAVID UNWIN: Me too.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: Me too.

STEVEN BARTLETT: How much sugar is in the average standard bowl of, let’s say, frosted cereal?

The Teaspoon of Sugar Test

DR DAVID UNWIN: Well, we can do this different ways, Steven. This is actually like a test for you laid out here.

STEVEN BARTLETT: Oh gosh, is that for—

DR DAVID UNWIN: Yeah, this is a test for you and I’ll describe it. So what you’ve got — you’ve got a bowl of, we’ll call them cornflakes. Then you’ve got a potato, a baked potato. It isn’t baked yet, but you could bake it if you want. You’ve got 150 grams, and this is boiled rice. So it’s not dry, it’s boiled rice. You’ve got a very ripe banana. And at the end there, you’ve got a delicious looking chocolate bar.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: So you’ve got there some cubes of sugar, and this is the test bit. You see, I’m going to give you a score in the end. So what I’d like you to do is consider these relatively, and each of those cubes of sugar represents a 4-gram teaspoon of sugar.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: So if you could now just go along these and put beside each food what you believe to be the equivalent in terms of teaspoons of sugar, and then I’ll give you a score and see how you do. And those are the answers, so I’m going to turn it down so you don’t cheat.

STEVEN BARTLETT: Okay, so I’m going to score them as I would have thought 2 years ago.

DR DAVID UNWIN: Thank you. Yes.

STEVEN BARTLETT: Because I’ve interviewed a lot of experts, so I’m generally quite shocked by all these things. But I’m going to score them as I would have thought when I was 31 years old, 2 years ago. So — cereal, honestly.

DR DAVID UNWIN: Yeah. And there’s no sugar on it. It’s not a sugared cereal. It’s just the dry flakes.

STEVEN BARTLETT: I honestly didn’t think there was sugar in that.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: So if you had pushed me, I would’ve—

DR DAVID UNWIN: Well, give it one, eh?

STEVEN BARTLETT: I’ll give it one.

DR DAVID UNWIN: Thank you.

STEVEN BARTLETT: But I didn’t think there was sugar in that.

DR DAVID UNWIN: One.

STEVEN BARTLETT: Again, a potato — I didn’t think there was any sugar in a potato. So even giving it one feels like I’m lying because I didn’t think there was sugar in potatoes. And I’ll be honest, rice — I didn’t think there was any sugar in rice.

DR DAVID UNWIN: Okay.

STEVEN BARTLETT: A banana—

DR DAVID UNWIN: Ah.

STEVEN BARTLETT: It tastes sweet.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: So my brain would’ve said one.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: But this chocolate bar that’s in front of me — I would’ve said, I’m going to say 2.

DR DAVID UNWIN: Okay.

STEVEN BARTLETT: 2 or — I’m going to say 3.

DR DAVID UNWIN: Right.

STEVEN BARTLETT: I’m going to say 3. I actually think it was 2, but—

DR DAVID UNWIN: Right.

STEVEN BARTLETT: That’s how much sugar I would’ve thought was in all of these things here. Cereal, a potato, white rice, a banana, and a chocolate bar.

DR DAVID UNWIN: Right, well—

STEVEN BARTLETT: To be fair, I still kind of do, but I know better.

Revealing the Answers

DR DAVID UNWIN: Okay. So now I’m going to give you the correct figure. This is worked out from the glycemic load that we already discussed. So I explained about the glycemic load. And then, in clinical practice, I had a problem. My problem was in 10 minutes trying to explain to you how you could eat differently and why you should eat differently. And so I needed a way of quickly communicating with children, with old people, with a teacher — the consequences of dietary choices.

So I came up with a new idea, which was, why don’t we represent the glycemic load? And instead of using grams of glucose, which nobody understands — and what’s glucose anyway? Instead of doing that, we redid the calculations, redoing it for 4-gram teaspoons of sugar. And that’s my teaspoon of sugar equivalent system. And I’m using that now to give you the correct answer.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: Right. So the Corn Flakes is 1, 2, 4, 5, 6, 7, and 8. 1, 2, 3, 4, 5, 6, 7, 8.

STEVEN BARTLETT: With no frosting.

DR DAVID UNWIN: No frosting. No milk. Nothing. The potato — obviously it depends on its size. That’s quite a big one. So that one is 1, 2, 3, 4, and there’s more — 5, 6 — is 9. There they go.

STEVEN BARTLETT: Equivalent of 9 sugar cubes.

The Sugar Content in Everyday Foods

DR DAVID UNWIN: Is that 9?

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: Right. I’m going to leave the rice till last. That chocolate bar is actually— you could do it for me— is 7 and a half. So you can give it 7. 7. 7. Now the banana depends on the size and how ripe it is. A ripe banana has more sugar in, as you probably know when you eat it, but that— let’s say that banana is quite a ripe one. It looks quite ripe. Let’s say that’s 6 because it’s a big banana.

STEVEN BARTLETT: Oh my gosh.

DR DAVID UNWIN: Okay, then the final one obviously is going to be the killer, isn’t it?

STEVEN BARTLETT: I thought rice was healthy. Well, I thought white rice was really healthy.

DR DAVID UNWIN: Depends. So 1, this is 150 grams of boiled rice. 3, 4, 5, 6, 7, 8, 9, and 10. So that’s the winner. And I would say that’s the single fact around the world. So my teaspoon of sugar— there we are, that’s one of my teaspoon of sugar charts. So what you’ve got there is the food, the glycemic index, the serving size, and then the teaspoons of sugar there.

So this is available. The Public Health Collaboration is a charity I helped set up with Dr. Rangan Chatterjee 10 years ago. It’s our 10th anniversary tomorrow. These infographics, there are actually far more than this. There are 7 more. They’re available in 35 languages. Volunteers have translated this to go all over the world. It’s not copyrighted. I want people to steal it, take it, use it. So the white rice fact, I would say, has astonished people all over the world and led to me becoming far better known.

The Hidden Sugar in Orange Juice and Smoothies

STEVEN BARTLETT: What about orange juice? A lot of parents, including my parents, gave me orange juice. And I used to think that orange juice was a health food. So I would literally, I’d go to the fridge, I’d get open the Sunny Delight or whatever it was.

DR DAVID UNWIN: Sunny Delight.

STEVEN BARTLETT: And I would drink that and I’d think I’m going to be strong and big and my body’s going to love me.

DR DAVID UNWIN: Well, let’s— so there’s a lot of sugar in orange juice. And once you take it from the fruit as it was meant to be and you juice it, the sugar hit is fast. So what that does is— if we go back to insulin again— you drink the orange juice, your blood sugar goes up rapidly, so your body responds rapidly with insulin. Then what happens? Your blood sugar falls, but then you’re kind of hungry again.

And that’s what happened to me with the biscuits, wasn’t it? I ate biscuits, my blood sugar is up, then insulin comes in heavy and slow, but too much. Then I thought I was having a panic attack because I had low blood sugar. And what’s the answer to that? More biscuits. And round you go, round. And that’s how, without thinking, you’d start the day. Starting the day with a sugary breakfast without enough protein in it is driving hunger. And then you wonder why you’re ravenously hungry at 10 o’clock.

The Shocking Truth About White Chocolate

STEVEN BARTLETT: There were a few others that shocked me. One of them was, I was in Peru.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And obviously Peru’s quite famous for chocolate because of the cacao and all that stuff.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And so we went to a chocolate making class and he told us to make dark chocolate, normal chocolate, and then white chocolate.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And when I made the white chocolate, this guy got me this big glass cylinder and he goes, “Here’s some white sugar.” He goes, “Pour it in.” So I get it and I pour some in and he goes, “No, no, no, no, my friend. Pour it in.” And I pour it and pour it and pour it and pour it and pour it and pour it and pour it. And I’m not kidding you, I feel like— and I have to check the facts here, so community note me on the screen, bar overseer team— I feel like I poured into this huge glass cylinder 80% of white sugar.

DR DAVID UNWIN: Yes, you would.

STEVEN BARTLETT: And then—

DR DAVID UNWIN: It’s true.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: I know this is true.

STEVEN BARTLETT: And then he said, “Put some syrup in.” I was like, “What?” Syrup? This is white sugar. It was like some syrupy stuff, some oil stuff. And I was like, so white chocolate is like 80% white sugar. I’ve never eaten white chocolate since.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Ever.

DR DAVID UNWIN: That’s so important. So very often people think they’re a chocoholic. That’s really common that people say to me, “I’m addicted to chocolate.” If you actually look at how much sugar there is in milk chocolate, there are many teaspoons of sugar in milk chocolate. If you eat 90% dark chocolate, there’s only about 2 teaspoons of sugar in a bar. And what you find with the chocoholics is I say, “Well, if you’re addicted to chocolate, why don’t you get a bigger hit and have the dark chocolate?” And they say, “Oh, I couldn’t eat that, it’s too bitter.”

What they’re actually addicted to is the sugar. There is, for the folks at home, one of these sugar infographics on chocolate on that subject of chocolate, because I want people to understand the consequences of what they do.

STEVEN BARTLETT: So just to illustrate this, I’ve just looked up the stats. I think this is what I saw. I’ve just looked up the facts to make sure what I’m saying is true. When I made that bar of white chocolate in Peru, this was the total ingredients and this is how much sugar they asked me to put into it.

DR DAVID UNWIN: Blimey.

STEVEN BARTLETT: I looked at it and thought, okay, so white chocolate is basically like 70-odd percent just pure white sugar.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And nobody knows.

DR DAVID UNWIN: Yes, exactly.

STEVEN BARTLETT: Nobody knows.

DR DAVID UNWIN: Exactly.

Smoothies, Blood Sugar, and the Insulin Cycle

STEVEN BARTLETT: The other one I’ve got to be in my bonnet about is smoothies.

DR DAVID UNWIN: Yes, I have one too.

STEVEN BARTLETT: I thought smoothies were healthy.

DR DAVID UNWIN: No. I’m on X or Twitter quite a lot and that’s the kind of thing that fills me with rage and I have to take a photo with like my— look at the sugar. It fills me with rage. I’ve got another thing. This is fun. I’ve got a question, right? Steven, why don’t we— we could take all the blood out of me, right? There’d be 5 liters. We could bleed me out right now. There would be 5 liters of blood in me. Let’s get it in a bucket. All right, 5 liters of blood. How much sugar would be in that 5 liters of blood?

STEVEN BARTLETT: I have no idea.

DR DAVID UNWIN: It’s an interesting question, isn’t it? Because it relates to the consequences of eating some of these things. So I would just like you to estimate. So if, let’s say my blood sugar is normal. If you have a normal blood sugar, I would like you to guess how much sugar is there in my entire blood system.

STEVEN BARTLETT: One cup like this.

DR DAVID UNWIN: Thank you. No, the answer is this. Let me show you. That is all there is.

STEVEN BARTLETT: You’re joking.

DR DAVID UNWIN: I am not. And you see immediately, one sugar cube, that’s all. And I’ll do it on Twitter for you, X. I can show you the calculations. So you see, if I have a banana and I have diabetes, there’s too much sugar for me. Because glucose is number one vital, but number two, toxic if you have too much of it. The level of it in my blood is controlled minutely.

STEVEN BARTLETT: Wow.

DR DAVID UNWIN: It’s controlled to this extent. And I think that single fact— you didn’t know that, did you?

STEVEN BARTLETT: No, I did not at all.

DR DAVID UNWIN: And it immediately shows you how it’s so easy to have more sugar than you actually need, given that.

STEVEN BARTLETT: And if your insulin stops working.

DR DAVID UNWIN: So for me, I’ve done an awful lot of this, so I monitor my blood sugar with a continuous glucose monitor, and I get my blood sugar up on my phone so I can check at any time what my blood sugar is. And we’ll do it in a minute and see. But you see, if I eat a banana, it doubles my blood sugar because I can’t regulate my blood sugar because of the diabetes. So a whole banana is far too much for me and will double my blood sugar because, you see, if I’m only supposed to have this much and I have that much.

STEVEN BARTLETT: Gosh, yeah.

DR DAVID UNWIN: It’s too much for me and I feel ill.

How to Read Food Labels and Make Better Choices

STEVEN BARTLETT: You know, I go out into the world and I speak to the people that listen to the show and they’re like taxi cab drivers. I wonder— I’ve got this bias towards thinking that everybody that listens is a taxi cab driver because I really only spend my time in the office or in a taxi. So I get lots of feedback from these cab drivers and the average person out there listening now, they don’t know how to check if the food they are eating is good or not because the labels on these foods— I’ve got so obsessed by the marketing.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: And I was looking at this bag of sweets the other day and it said, “Made with real fruit juice,” and they put it front and center. And I was almost tricked. So I can’t imagine someone who, like me, doesn’t spend their time interviewing health experts, how easily the general public is being tricked. So what is your advice in terms of spotting this stuff? Because right now I spend a lot of time looking at the sugar part.

DR DAVID UNWIN: Yeah, that’s great. There are different ways we can do this. And obviously this is how I spend every clinic. I’m trying to help people understand. It’s sometimes easier to talk about what maybe you would eat rather than what you wouldn’t eat. So for somebody with insulin resistance or type 2 diabetes, I would tend to say, “Well, why don’t you base your meal on protein? So what have you got in the fridge? Could it be chicken? Could it be eggs? What would it be?” So that’s your protein. Have loads of it. Then I’m thinking, right, green veg. What green veggies do you like? What would you tolerate? What green veg could you buy? It might be frozen beans or it might be salad or whatever. And then I’m saying, how would you make that green veg tasty?

STEVEN BARTLETT: Pour barbecue sauce on the top.

DR DAVID UNWIN: Ah, no, full fat mayo, full fat mayo or butter or olive oil or whatever. So that—

STEVEN BARTLETT: I say barbecue sauce because when I looked at the back of mine, I had the shock horror of realizing that there’s—

DR DAVID UNWIN: It’s a common one.

STEVEN BARTLETT: Sugar cubes in a bottle. A standard bottle of barbecue sauce. It’s just pouring sugar on top.

DR DAVID UNWIN: It is, it is. You have to be so vigilant. And I think to do it successfully, I’m quite interested in the idea of could you eat real food that’s not in a packet? It’s Russian roulette, food out of packets. And yet I understand my patients north of Liverpool, where are they going to buy the stuff? So I try and help them with, “You could do it that way.”

If you’re going to eat stuff out of packets, you have to wise up and you have to look at the carbohydrate content. And bear in mind, every 4 grams is broadly equivalent to sugar. So if something’s got 100 grams of carbs in it, it gives you an idea it’s very sugary. So you see the area made with the cornflakes— there’s no sugar there, but it’s all carbohydrate and it’s a very sugary carbohydrate.

STEVEN BARTLETT: I think we need to just explain that for people, which is when I looked at those cornflakes, the question I asked you is they’re not frosted, so there’s no sugar on them. But what the body is doing is it’s converting the carbs into glucose.

Starchy Carbs Are Just Sugar in Disguise

DR DAVID UNWIN: Right, I’ve got a good way. So we have to think of starchy carbs as actually glucose molecules holding hands.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: And then digestion comes along and breaks down— they’re not holding hands anymore, and they become free sugar again.

STEVEN BARTLETT: Because we think if it’s not sweet, it’s not glucose.

DR DAVID UNWIN: Exactly, exactly. I don’t know whether when you went to school, was this thing where you chewed bread for ages and then you could see if it became sweet or turned into sugar.

STEVEN BARTLETT: I didn’t know that.

DR DAVID UNWIN: It’s a schoolboy experiment that’s done a lot to prove that the amylase, the enzyme in spit, turns starch into sugar. But that’s the point. Starch is soon-to-be sugar.

STEVEN BARTLETT: It’s glucose holding hands. Yeah. And when it holds hands, it’s not sweet, but then when you digest it— it’s no longer holding hands.

DR DAVID UNWIN: Perfect. And that is broadly what— and you’re not alone because didn’t I make that error? Isn’t that what the lady in 2012, that’s what she was so furious that I was making. So here we are, senior partner of a large practice, had forgotten that starch was sugar.

And we come full circle because so many other people— patients say to me, “Dr. Unwin, I know not to have sugary things. I’ve given up sugar in my tea and coffee, and I don’t understand why my blood sugar is so high.” People say that very often. And then, of course, we use the teaspoon of sugar equivalence or a continuous glucose monitor to really show them what’s going on.

The Truth About Bread and Blood Sugar

STEVEN BARTLETT: Something that a lot of people have is bread.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: White bread. So I did some research and it said a single slice of white bread contains about 0.5 sugar cubes, but a full loaf can pack up to 12 cubes of sugar in it.

DR DAVID UNWIN: That’s true, but it doesn’t include the fact that the wheat that makes the bread will turn into sugar as well. So on my teaspoon of sugar equivalent, even a small slice of brown bread is about 3 teaspoons of sugar.

STEVEN BARTLETT: Is there a healthy bread?

DR DAVID UNWIN: That’s a really great question. And of course, it depends how well your insulin’s working. So if you’re young and you take a lot of exercise and your insulin’s really good, then maybe brown bread is okay. If you’re like me though, with insulin resistance, it would have to be low-carb bread. So I wouldn’t normally eat bread under any circumstances, but I might have low-carb bread.

STEVEN BARTLETT: I did some research, said sprouted grain bread— never heard of that before— or 100% whole grain rye are the healthiest options because they contain zero added sugar and high fiber.

DR DAVID UNWIN: I mean, what I’d say to people, again, it depends. How much exercise do you take? Have you had your fasting insulin measured? Do you know if you’re insulin resistant or not? If you’re healthy, take lots of exercise, sounds good, fair enough.

If you’re beginning to develop a tummy, well, maybe not so good. And if you don’t know, I’m a great one for experimenting. And that’s where I come back again to consider buying a continuous glucose monitor. The thing you wear on— I’ve got one on me now and it tells my phone how my blood sugar is, so I can experiment. Then I could try your bread. And within an hour I would know.

Reading Food Labels the Right Way

STEVEN BARTLETT: Am I wise to be looking at the back of packets? I look at the back of everything I eat. And I’m building, I guess, a mental model of the different levels of carbohydrates and sugar content and fiber and all these other things and proteins, et cetera. But I always seem to zoom in on the sugar— the added sugar.

DR DAVID UNWIN: Ah, right, there is an error there.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: So that’s brilliant, and the fact you’re interested and trying is great because you’ll learn so much more. Because of course, the sugar is one thing, but you must also look at the carbohydrate content.

Now, this is done differently in the United States from here, confusingly. Here we talk about carbohydrate separately from fiber, so that in the UK when it says carbohydrate, that turns into sugar. In the States, you’ve got the carbohydrate including fiber, so it makes it more complicated for you because you need to know how much of that carbohydrate you’re going to absorb.

Well, let’s go back to the 3 macronutrients. So you should be interested in protein— how much you want. You want to be a muscly kind of guy, so you want your protein. The carbohydrate— well, why do you need that, I’m wondering? And then fats— well, you might need those for fat-soluble vitamins. So those are the 3 things, so that you become more sophisticated. And if things have a lot of preservatives, if they have an awful lot of ingredients, I’m immediately suspicious.

The Hunger Cycle: Why Sugar Makes You Eat More

STEVEN BARTLETT: I think one of the things that I’ve come to learn through interviewing people like yourself is that it’s not just the direct consequence of having a big glucose spike or having high blood sugar. It’s also the fact that when I eat things like Mars bars or the white rice here, I then get more hungry later.

DR DAVID UNWIN: Exactly.

STEVEN BARTLETT: Which means I eat even more sugar that same day. And the next day. And the next day.

DR DAVID UNWIN: And of course, that’s what my patients, right back in 2013— it was the absence of hunger they found fascinating. And I did, because I’d been hungry all my life. Because all my life I’d been carb heavy. And I didn’t realize that the more carbs you eat, the hungrier you become. I don’t know, have you ever tried fasting? I bet you have.

STEVEN BARTLETT: Oh my gosh, yeah.

DR DAVID UNWIN: Right.

STEVEN BARTLETT: I fast most days, to be honest. I haven’t eaten today. And what time are we— I don’t know, 1 PM. And during the Dragon’s Den filming, I don’t eat often until the evening, so.

DR DAVID UNWIN: Great. So isn’t that interesting? So I used to have a model which was that if I didn’t eat, I was hungry. So if I didn’t eat for even twice as long, I’d be twice as hungry. And it would rise exponentially until I went mad. And what’s surprising— that you must have found— is as you fast, you don’t become more hungry, do you?

STEVEN BARTLETT: Yeah, it’s crazy.

DR DAVID UNWIN: Well, isn’t that interesting that actually the more I eat, the hungrier I become.

STEVEN BARTLETT: Same as when I’m on keto.

DR DAVID UNWIN: Pardon?

STEVEN BARTLETT: When I’m on keto.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: I can’t believe it— hunger just vanishes. And do you know the other remarkable thing— I love, what are those cinnamon roll things? I love those cinnamon rolls usually. And when I started doing the ketogenic diet, which is very, very, very low carb, I remember walking up to this cinnamon roll concession stand in Cape Town and looking at them and they were doing nothing to my brain. There was no temptation, no craving.

DR DAVID UNWIN: I’ve had that.

STEVEN BARTLETT: It’s like, where’s the craving?

DR DAVID UNWIN: It’s like a superpower.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: Honestly, I’ve had that with Christmas cake. It was my kryptonite. It was the kind of thing I was sneaking down when they’d all gone to bed and having more. And then one day you can look at it and you think it’s not actually food. Your brain knows that isn’t food.

STEVEN BARTLETT: Yeah, exactly.

DR DAVID UNWIN: And I’m the same with buns as well and all sorts of things that a lifetime of— and they’re no longer food. And it feels like a superpower. I’m such a man. In fact, I throw this down as a challenge to men. “Are you man enough to resist, you know, whatever it is? Let’s do a challenge. Come back in a week and tell me you’ve not had any biscuits.” It works. It works.

The Ketogenic Diet: Finding Your Place on the Spectrum

STEVEN BARTLETT: What do you think of the ketogenic diet?

DR DAVID UNWIN: That’s a big question, isn’t it? Don’t you think we need to begin with what you want? So I think we need to begin with your goals and hope. Are you wanting to lose weight? Are you wanting to sort out type 2 diabetes? I mean, Dr. Georgia Reed is a close friend, and nutritional psychiatry is really growing. And Ian Campbell at Edinburgh University is doing some amazing work with bipolar disorder and other things.

So why are you doing it? That’s my first thing, because I see it as there is a spectrum of carbohydrate that you’re on. So I try and find out where are you now? And then I’d say, “Could you give up bread or reduce it?” And then I’d say, “Let’s measure whatever parameter we want,” which might be blood work or weight or whatever. Then we say, “How are you doing? Are you happy now? Or would you like to go a bit lower?”

And what I’ve discovered with my patients over 13 years is they tend to go lower over time, because when they experiment— when they go keto, what they like is the brain thing.

STEVEN BARTLETT: Oh gosh, yeah.

DR DAVID UNWIN: And that’s right. So I would say to you now, because I’m interested, “Why would you go keto? What are you after?”

STEVEN BARTLETT: So I’m going to put the brain thing at the top of the list, which is just the clarity of thought. Obviously in my job, I have to sit here with very smart people like you.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: And I have to talk sometimes for 3, 4 hours, whatever it might be. But also I’m on television a lot now and I’m speaking— cameras, 9 cameras rolling, BBC One. And I’ve got to think of something smart to say to this entrepreneur stood in front of me pitching. Interesting to me.

And then also I’m in meetings— I’ll leave this conversation now and I’ll go straight downstairs and I’ll have 2 hours of straight meetings about very, very complicated things like buying companies. I’ll be meeting founders, interviewing people. And what I’ve noticed profoundly, because so much of my job centers on speaking and articulation, is there is this wild, wild, wild variance that I hate. And what I mean by that is some days I’m on it.

The G.R.I.N. Model and Behavior Change

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And some days I’m almost embarrassed by my inability to string a sentence together. Today I’m almost testing myself now by trying to speak really, really fast and seeing if my brain is connected to my mouth. That’s actually like what I do. I try and see if it flows out. Today I’m okay. But there are days where I’m stumbling over myself and I go, what’s causing this? What’s the causal factor and how do I prevent this?

So that’s one. Keto, when I’m in keto, I always sound like Busta Rhymes. It always just, it’s always working. And then I’d say the aesthetic stuff, because I want to look good as well, especially for my fiancée. So I want to be in shape, and then I’d say the third is being strong. And then the fourth is I want to live long.

DR DAVID UNWIN: Exactly.

STEVEN BARTLETT: I want to have a long health span, not just a long lifespan, but I want to be able to do things as I age.

DR DAVID UNWIN: So you see, that’s exactly what I began this meeting with. You’ve got a clear idea about your preferred future. And it’s fairly specific too. And the more specific you are, the more likely you are to be successful. And then you’re noticing. Then afterwards comes the feedback.

STEVEN BARTLETT: Do you think most people even have thought about this?

DR DAVID UNWIN: No.

STEVEN BARTLETT: I was just thinking about my listeners and I was thinking, yeah, they’re listening right now. I wonder if they have written down their top 4.

DR DAVID UNWIN: Yeah. Do you know what I’d love to do now is tell you something about my wife’s work because it relates to changing behavior fast, and she won’t mind. So we’re back to Jen now. We have a woman, she spent 2 years thinking about CBT. And what were the necessary parts of it and what was junk? And she reduced CBT down to something I’ll teach you right now.

All right, so off we go. So the first thing is to think about your health goals. So to think about what, in a year’s time, if what you do is great, how does that look specifically? So I’ll give you an example. You might think you’d like to lose weight, but that isn’t specific enough. I want to know what difference would that make to you. So you will do it now. So if you said you wanted to be in shape, yeah, what do you mean by that? Do you want to lose weight? Tell me more.

STEVEN BARTLETT: Hmm. What I’m really, I think, scared of — I’m just going to be completely honest — is I’m scared of having the same health profile as my dad.

DR DAVID UNWIN: Ah, right.

STEVEN BARTLETT: Because I’ve seen we have a lot of the same genetic profile.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: So I think a lot of us look at our parents and go, is that my future?

DR DAVID UNWIN: Yes. Yeah.

STEVEN BARTLETT: And to make it even more specific, I remember walking down some stairs. I’ve said this once before, but I remember walking down some stairs in Bali, long steep set of stairs down to go whitewater rafting with my fiancée. And I remember as I walked down those stairs, recalling that my dad can’t walk up a single flight of stairs without problems. And I remember thinking, “Oh, my dad wouldn’t have been able to come whitewater rafting because we’ve got to walk back up these stairs.”

And so my dad would have lost out on one of the great joys of life, which is doing enjoyable things with friends and people you love, because his health is now, in that regard, is gone. So I’ve always thought of that. And then generally, I remember when I was younger, my dad used to play football with us and all these things. He’s unable to do that now.

And so because I’ve done this podcast so many times with health experts, I realized that the decisions I make at 30, which is where I am now, exist on this really interesting, quite predictable curve of inevitable decline. However, not like inevitable loss of lifestyle. What I mean by that is I just have this picture in my head of all these graphs I’ve seen where your peak is around maybe 20, 30, and then you’re going down, which we all accept. But how far you go down is determined by decisions you make right now.

DR DAVID UNWIN: Absolutely.

STEVEN BARTLETT: The decisions I make now will end me at 70, 80 years old in either the inability to walk or the ability to run.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And it’s all about what I do now.

DR DAVID UNWIN: It is. So let’s just refine that. I’ve got your goal now. So let’s park your goal. Now the next thing we’ve got is, in the past, what have you done that’s worked towards those goals? So you probably tell me some stuff you’ve done that’s worked.

STEVEN BARTLETT: Things like going to the gym?

DR DAVID UNWIN: Yeah, anything. Anything quickly that you did that worked, that you remember worked. So tell me anything.

STEVEN BARTLETT: So I said to myself one year that I was going to go to the gym every single day. Terrible idea. Because I got 5 months in and then I missed a day, then it was over. I said to myself another year, I think it was 2017, that I’m going to get a six pack for summer. Terrible idea. Because when summer came, I got the six pack.

DR DAVID UNWIN: My question was what did work in the past, not what didn’t work. So what has worked for you in the past?

STEVEN BARTLETT: So those two incidents helped me change my idea. And the idea that I came up with was I set, not an achievable thing as a goal, but consistency is the goal. And consistency became, for the last 4 years, this idea that the goal, my fitness goal is consistency, means that every day I wake up, I get a shot at it. And if I f* up today, then I’ve got another shot tomorrow.

DR DAVID UNWIN: Right. Leave it there. That’s good. So we did the goal and then we did the next thing. What I just — the next thing is resources. So it’s what do you bring to the consultation that you’ve done in the past? Intelligence, resources, friends that will help.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: You come already with expertise in yourself. So it’s not — I’m not the expert to tell you what to do. You’ve already got some stuff. Then we go to the next thing. So if we had your goal at the beginning, which was the fitness and the so-and-so, today, what might be a small step towards your goal, a realistic small step towards the goals we’ve already established?

STEVEN BARTLETT: So I can think of two.

DR DAVID UNWIN: Good.

STEVEN BARTLETT: One of them is creating a social pact, which again was one of the things that helped. So we made a WhatsApp group. This is quite funny. We made a WhatsApp group, we put 10 friends in it and we made a simple rule. Whoever’s the least consistent every month is evicted and we invite a new friend in.

DR DAVID UNWIN: Wow.

STEVEN BARTLETT: We’ve done that for 4 years. I’ve not been evicted in 4 years, which means that I’m doing enough. I’m consistent enough over those 4 years to not be evicted. Every day when we work out, it puts our workouts into the group chat. And every week and every month there’s a winner. And there’s this league table and you get these little emoji medals and there’s actually, I won one year, so I’ve got this physical massive gold belt on my bookshelf at home.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: It says Fitness Blockchain World Champion.

DR DAVID UNWIN: Brilliant.

STEVEN BARTLETT: So I’ve done that for 4 years. The social pact really helped me, the sort of accountability to others. And the other, honestly, was just, as I said a second ago, when I set the goal of going to the gym every single day, I set myself up for failure. Now I set myself the goal of consistency, which means that I can have bad days where I do 20 minutes or 15 minutes. Yesterday, because I was finished Dragon’s Den late, drove down to London, got home at 1 AM, I did 18 minutes. And reducing the size of success really helped me to keep my feeling of momentum.

DR DAVID UNWIN: Brilliant. We’re nearly at the end of your degree in psychology.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: And I’m going to pull it together. The final thing is, when things — if you — what would you notice for you when things are going well? What would you notice? So you’ve done some of these things. What is it you actually notice?

STEVEN BARTLETT: As in the benefit to me?

DR DAVID UNWIN: Yes. What do you notice? So if tomorrow is a really good day, what might you notice at the end of it? Because you’ve much experience in this now. What would you notice?

STEVEN BARTLETT: I mean, the first thing that comes to mind is just how I feel.

DR DAVID UNWIN: Do you mean emotionally or energetically?

STEVEN BARTLETT: All of it. Emotionally, I feel good about myself.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Energetically, I feel more energetic. And there is this element of identity in there where I have an opinion of myself and who I think I am. And I think I’m a healthy person and I think I’m someone that’s in control. And when I’m not performing the consistent behaviors that I want to, I think I start to question that identity in a way that causes a lot of discomfort and say, well, you’re not in control of your own life. Like, how? That’s crazy.

DR DAVID UNWIN: So I think it links into self-esteem.

STEVEN BARTLETT: Yeah, it really —

DR DAVID UNWIN: So what we’ve just did, we had the goals, G. Then we had your resources, R. Then we had increments. What things had you done, little things on the way? And then finally, I invited you to notice and reflect, and that spells GRIN. And that’s Jen’s published GRIN model.

I just did it for you right there, and I could do it faster than that. I do it in nearly every surgery I do, because what I’m trying to do is find out about you. And you didn’t find out much about me in that process, did you? But I found out a lot of really useful stuff to you, and it’s motivational, and much better to do that than me tell you what to do. And I’m not a talking leaflet, but motivation — this is what Jen has taught me — is key in everything we do. And the GRIN Model isn’t bad. Clever woman.

STEVEN BARTLETT: So what do we do with the G.R.I.N. model? And so this is really helping me figure out how to change my behavior. How does one apply it? Or are you saying that everyone listening now should answer those 4 questions themselves?

Helping Loved Ones and Understanding Food Addiction

DR DAVID UNWIN: Yes, I do. Because otherwise it’s possible to spend a lot of time blaming yourself, and particularly around if we’re discussing weight problems and so on, you can spend a lot of time saying, “I’m to blame,” or “I wish,” or “I shouldn’t have that.” After Christmas everybody feels like this. But what is much better, rather than focusing— you’re wasting energy if you start thinking about guilt and negative stuff.

What Jen’s trying to do is getting you to engage in thinking about a better future. And what the whole of that 5 minutes was engaging you in, first of all, the goal of a better future, then some resources towards your better future, then the first steps towards the better future, and then noticing what’s good.

Because I think in medicine, what we’ve done— how do you get a doctor’s attention? You get a doctor’s attention by saying, “Oh, it’s so bad. It’s so, so bad. My pain is so, so bad.” And I realized I had trained my patients to think that moaning was how they got my attention. And if you do that, the result is a very miserable 2-hour surgery.

But if you can talk— even people having a terrible time have got hope if you can find it. They have goals if you can discuss them. And you can have somebody with a drug addiction, or— I see people dying, people also— every clinic I’m seeing sad stuff. But if you can also investigate hopes and good stuff, as a doctor, I’m so much more energetic, so much more hopeful. I’m having a great time, and I wasn’t when I was 55. And that’s the process.

STEVEN BARTLETT: I bet there’s so many people listening now that maybe they, because they listen to this show and they’ve got the sort of basics, they go, “Do you know what, I understand this stuff and I’m making good progress, but I live with or love someone—”

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: Who I’m scared they’re going down a slippery slope.

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: And I don’t know what to do. Do I intervene? Do I hide their sweets? Do I blame?

DR DAVID UNWIN: What do I do? So hard, isn’t it? That’s so hard.

STEVEN BARTLETT: Weren’t you in that position to some degree?

DR DAVID UNWIN: Yes. So my first wife had a very severe addiction problem, so I lived with that for 12 years, and she’s unfortunately died now. So I lived with very, very serious addiction for 12 years, and what you’re doing then is you’re living with uncertainty. Serious uncertainty. You never— you cannot say what you’ll come home to. You have no idea. No idea. It brings chaos into your life. It’s very, very hard.

STEVEN BARTLETT: Addiction?

DR DAVID UNWIN: Yes.

STEVEN BARTLETT: Are you able to say what kind it was? A food addiction or a drug addiction?

DR DAVID UNWIN: It was— nearly everybody concerned has died now, so I don’t know whether I can say or not, but it was very serious multiple addictions, I will say that. And she died some years ago. It actually wasn’t food addiction, but it brings— I have so much sympathy with dealing— how hard it is to deal with uncertainty and not be able to— you love somebody and you can’t do anything. It’s very hard.

Ultra-Processed Food Addiction: Jen’s Story

There are things you can do, I think. If you can engage people in talking about goals, that can help. What we will do now is we’ll change that conversation to the current Mrs. Unwin, which is what we laughingly say. This is Jen. So we’ve been together for 30 years now.

And Jen’s story is that she actually is an ultra-processed food addict. Addict, genuinely. And what that means is neither of us understood what that was. Even though she’s a consultant psychologist, she didn’t realize that she was an ultra-processed food addict. What she saw it as was a weight problem. And all her life she’s been boomeranging dieting, so she’d be a big woman and then a little woman and a big woman. And I used to watch it all. What’s going on?

And then there’d be tray bakes, like she’s trying to lose weight and making tray bakes, saying it’s for the children, and then scoffing a lot herself. So then— because I loved her, and I think blokes, we try and solve problems, don’t we? We’re like cavemen. I wanted to rescue her. So I’m either throwing the food away or I’m tackling her. And then we’re having such arguments because she’s defensive and cross. I couldn’t understand with an intelligent woman what’s going on.

But then, this is only a few years ago, she understood for the first time that this is addiction. When you have intelligent people, highly, highly intelligent people, doing stuff that harms their health repeatedly— is this not like cigarettes? Is it not like alcohol? That is ultra-processed food addiction.

The Patient Who Ate Bread from the Bin

And there’s a patient I’d like to tell you about that explains it even more clearly. And this patient has consented for me to tell you because he wants to help the world. So this is a guy who’s a very successful guy. He’s a wealthy person with a successful business. He’s not stupid. He has type 2 diabetes. He’s 55. He’s very much overweight. Unfortunately, he needs really serious surgery because both his knees have been so destroyed by his weight that he can hardly walk because he’s in real agony.

But his type 2 diabetes is so bad, his blood sugar control is so bad, the anaesthetist won’t touch him. So he’s trapped. He can’t get the operation because his blood sugar is high. He can’t run his business easily because he can hardly walk.

So obviously what we do is we say, “You need to go low carb.” And it works for a bit and he loses some weight, but then he gains the weight again. And this goes on for 4 years while I see him so regularly, every month. What’s going on? What’s going on? Oh, excuses— the grandchildren, I’ve got a holiday, Christmas. It goes on.

Anyway, then his wife came to see me and she said, “Dr. Unwin, I need to level with you. You need to understand what’s going on. I find that my husband is getting up at 4 in the morning and eating bread out of the fridge. So what I started doing was at the end of every day, I put all the bread in the bin if it hasn’t been eaten that day.”

“But then I discovered my husband was going in the bin to eat the bread.”

Then what she does— she’s a very formidable woman— she started putting detergent, liquid detergent, on any bread that goes in the bin. But he still eats it. He’s getting up at 4 in the morning, rummaging through the bin to eat the bread with the detergent on.

So then she tries something else, and she says, “This is the only thing that will stop my husband from eating bread if it’s there. I spray bleach on the bread,” and leave the can of bleach by the bin so he knows, don’t even look.

Okay, what I’ve described to you is addiction. This is an intelligent person, and imagine his self-esteem, how it was to live like that, concealing what he was doing and not telling his doctor. Because I’m trying so hard for him for years, and he’s so sweet to me now, and he often shakes my hand and gives me a hug. He said, “You tried. You really tried.”

Anyway, my stories have a happy ending always. What I did for him in the end, he needed everything. So low carb. Then I got him using a continuous glucose monitor.

STEVEN BARTLETT: Mm-hmm.

DR DAVID UNWIN: So that he would get feedback immediately and see that spike. And also I could see the spikes as well, because he had to come and show me his tracings. And on top of that, I did something unusual. I gave him a low dose of the new GLP-1 drugs. Ozempic, one of those.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: And the three together, he managed to not— he couldn’t moderate, but he could abstain, and then he could do it. The Ozempic helped reduce the noise, the cravings in his head. The feedback from the CGM helped him know how he was doing, and the support he got from me and the low carb pulled together. And all three— and he’s had his operation now, and so it’s a happy story, but he’s got maintenance all his life. He’s going to have to sort that out.

And it’s a wonderful example because I think we trivialize this. We call it carb creep, like it doesn’t matter. But there are many people listening to us right now, and they know they’re addicted to various foods. They know because when you ask them, they often burst into tears. Often somebody will say, “I’ve never told anybody in my entire life about—” and bread is a common one.

And if you’re not addicted to bread, you can’t imagine it. But if you are addicted to bread, they say, “This sounds so stupid, I’m so embarrassed to tell you, I can’t control how I eat bread.” So it’s not great for your self-esteem, is it? But people might be addicted to many things.

And my wife’s published many papers on this and written a book and this, that, and the other. And she would say about 14% of the population has some aspects of ultra-processed food addiction. And it kind of explains so much. Why are intelligent people eating foods they know do them harm?

When Carb Creep Costs You Your Toes

I’ve got another example. One of my patients with type 2 diabetes, we got drug-free remission. Hooray! I’ve done that now 157 times. So every one of them, I’m cheering when it happens. So this guy, we did it, drug-free remission. Then he vanished for a while and came back with 2 dead toes and he had to have them amputated.

STEVEN BARTLETT: Toes?

DR DAVID UNWIN: Yeah. They started rotting because diabetes takes the blood supply, particularly from your toes. So we had to have surgery to have part of his foot removed. And so you call it carb creep, and he ended up with half his foot taken off. That’s not carb creep, something far more sinister.

But I never give up. And unfortunately, the wounds took a long time to heal because he was sugary. So we do it all over again. I got him back into remission because this time he and his wife are really determined, but it’s a struggle and he needs help and support to achieve that. He’s not a foolish man, he’s an intelligent man, and yet various foods call to him, “Eat me, eat me,” and it’s very difficult for him to not.

And that’s a very extreme example, but many people with overweight and some who are not overweight are struggling with very, very significant carb cravings and they really, really struggle to control them.

Step One: Honesty

STEVEN BARTLETT: For those people, and I assume there’s a lot of people, and actually some people have seasons where they’re in control, they’re out of control, they’re in control. I’ve been there. What is step 1 today? So they’re listening to you, they go, “F* no, I don’t want to lose my toes and all of these problems.” What is step 1 now?

DR DAVID UNWIN: Now, are we talking about for somebody with type 2 diabetes or somebody who can’t control what they’re eating?

STEVEN BARTLETT: Someone that can’t control what they’re eating.

DR DAVID UNWIN: Right. So step one, we just did it. I think step one is acknowledging that is your problem. Because if you’re not honest about your problem, how are you ever going to sort it out?

STEVEN BARTLETT: Honesty.

DR DAVID UNWIN: So the first thing is honesty. And that’s very hard for people. All of us have made excuses. Me and my biscuits— I believed that it was easier for me to think that that was stress and a reasonable reaction to the stress of running a practice than it was to say, “I’ve got a—” biscuits, for me, it took me a year to give them up. A year! How pathetic is that? I was so driven that it took me a whole year.

STEVEN BARTLETT: How did you give them up?

DR DAVID UNWIN: I did it by weaning myself off, a bit like methadone. So I went from— I like chocolate ginger biscuits— and then I went to digestive plain, and then I went to oat biscuits, and then eventually I went to almonds.

STEVEN BARTLETT: Why didn’t you just do it all at once?

Breaking Food Addiction: Honesty, Planning, and Support

DR DAVID UNWIN: I should have done. And Jen’s a great believer in cold turkey, like, what is the thing? Stop it. I wasn’t man enough for that, and it took me a whole year.

So the first thing is be honest. Truth. Be honest with yourself, even if you can’t tell other people. Be honest with yourself. Is there an addictive potential there? Could that be? Does that fit?

Number 2, specifically which foods is your problem? And be honest. Because if you’re not honest, then number 3 is have a plan for abstinence. Because if you have got an addictive potential, it won’t be one biscuit. And we all — who, you know, how many of us have said, I’m going to give up ice cream or biscuits or pizza or whatever it is, and then you have a shit day, and you did — well, you have a drink or whatever, you think tomorrow, work stresses you out. Yeah, tomorrow, tomorrow, tomorrow, tomorrow.

So it’s very important to be specific about the food and then to have a plan for how you are going to do it. And another thing is sometimes it’s helpful, you know, the people around you that love you, maybe share with them that it’s important and that I need, I might need some help. Please be tolerant with me, like cigarettes. Please be tolerant if I’m short-tempered. I’m going to try and do this thing because it’s important.

The difficulty depends whether the person that loves you can be gentle or if they’re heavy-handed. If you confess this and then they police you —

STEVEN BARTLETT: Judgmental —

DR DAVID UNWIN: Yeah, it doesn’t help. Yeah, yeah. What you’re asking for is gentle support and tolerance.

STEVEN BARTLETT: I can think of a time of my life where I was with somebody.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And they were so into their health.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: That it made me start to hide when I was eating bad. I would —

DR DAVID UNWIN: Exactly. Yeah, thank you for that. That’s what happens. And you see that people become deceitful.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: So if you police somebody you love, the result is deceit.

STEVEN BARTLETT: I was hiding the wrappers of the things I was eating.

DR DAVID UNWIN: Jen did that with me. She would — she knew that I was monitoring, so she starts hiding the wrappers, or then I’d find them in the car. But then we have a situation we can no longer talk about it. Because if you’re forcing somebody to become deceitful, you have to back off a little bit.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: Because that deceit then affects self-esteem and that can make them worse. And you didn’t want to make them worse.

STEVEN BARTLETT: And then they’re lonely because they can’t share the bad days.

Jen’s Book: Fork in the Road

DR DAVID UNWIN: Yeah, it’s really good. I wonder, please, could we show Jen’s book at this point?

STEVEN BARTLETT: Of course.

DR DAVID UNWIN: So can I just explain the book. So this is Jen’s book, and the most important thing is Jen doesn’t make a penny out of this book. So it’s Fork in the Road with the idea in your journey, which one are you going to pick? Do you see? So it’s Fork in the Road. She doesn’t make any money from this. Every penny goes to a charity that she’s set up helping people with food addiction. It’s available on Amazon and self-published on Amazon.

STEVEN BARTLETT: How much does this book cost? It’s not a lot, is it?

DR DAVID UNWIN: It’s about £15. Oh no, it’s less. I think it might be £10. £10 quid.

STEVEN BARTLETT: Okay, I’ll tell you what I’ll do.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: I’ll buy 1,000 of them.

DR DAVID UNWIN: Fabulous.

STEVEN BARTLETT: And I’ll put a link below in the comment section. And so all you’ve got to do is if you’ve really enjoyed this conversation and you’d like to get Jen’s book, Fork in the Road. A fork in the road. Maybe we can even get some of them signed. Not all of them, because that would be great to hand, but we could get a couple of them signed.

DR DAVID UNWIN: Oh, that is brilliant.

STEVEN BARTLETT: Click below and we’ll send 1,000 of them out. And that’s just a thank you from me to both you and Jen, but also to the community who tune in for these conversations. And it’s so great that people can get such simple information that’s so accessible and so rigorous in its scientific credentials. In a way like this that they can — that could change some people’s lives.

DR DAVID UNWIN: Great.

STEVEN BARTLETT: Isn’t that a wonderful thing? You know, like a simple book like this, which isn’t long either.

DR DAVID UNWIN: It’s only 100 pages. No, it’s not a big read.

STEVEN BARTLETT: Could change some people’s lives. That’s such a wonderful thing.

Sugar, Cancer, and the Cost of Dietary Choices

STEVEN BARTLETT: You said something earlier on about the link between your dietary choices and cancer. I’ve actually got a friend of mine who used to work for me who is going through a cancer process at the moment. She’s very, very young. She’s actually younger than I am.

DR DAVID UNWIN: Wow.

STEVEN BARTLETT: And she was diagnosed with breast cancer. She’s a really good friend of mine and she was actually my manager for a couple of years. She’s called Katie. She’s very public about this, so she’s posting her journey online so I can say her name. And I’ve been following her and she’s, you know, she’s removing a lot of the foods we’ve talked about today from her diet. So she’s very front of mind for me at the moment.

And I was looking at some of the stats around the link between our dietary choices and cancer outcomes, and I’m going to read them now. My team might cut some of them out, but I think they’re worth hearing because hearing them, I think, is quite enlightening.

A massive French study found that drinking just 100ml of sugary drinks per day, which could be, you know, a third of a can of soda, is associated with an almost 20% increased risk of overall cancer. Women who consume 2 or more dietary drinks daily have over double the risk of early onset colorectal cancer compared to those who drink less than one a week. High consumption of sugary sweetened beverages is linked to a 78% higher risk of estrogen-dependent endometrial cancer in women. Drinking 20 ounces of sugary soda daily is linked to shortening your telomeres, which are the protective caps on your DNA, equating to 4.6 years of extra biological aging, which is a major risk factor for cancer.

High sugar intake causes chronic hyperinsulinemia —

DR DAVID UNWIN: Chronic hyperinsulinemia. Can I — so that is what I’m saying when the insulin levels are high.

STEVEN BARTLETT: High insulin.

DR DAVID UNWIN: Which I explained at the beginning.

STEVEN BARTLETT: Which can inhibit apoptosis, the natural process where damaged or cancerous cells self-destruct. Yes. Wow. Fructose is processed in the liver and converted into lipids, which are fats, which is what we were talking about earlier, which recent studies show certain tumors directly consume to build their cell membranes. And lastly, diets high in added sugars chronically elevate C-reactive proteins called CRPs, an inflammation marker that is heavily correlated with tumor progression and metastasis.

DR DAVID UNWIN: Yeah, so what I’d like to — this is so interesting, and it brings to mind a really important point. We talk so much around the world about treating cancer. What about prevention? Because for your friend, that’s a life sentence, and she’s living with uncertainty and fear. And when I tell patients they have cancer, you know, you feel it right here because you just took away so much.

And it’s interesting, do we try hard enough? If we know that, are we trying hard enough to prevent cancer? Because that’s what we should be doing. Because we know a lot that I think after smoking, diet is the next commonest cause of cancer. And, you know, how serious does it have to get when you just gave all those references, and I know that junk food is linked to all-cause mortality. It’s linked to so many things. What are we prepared to sacrifice for enjoying, you know, treats and snacks? It’s kind of — when you look at it like that, it’s really bonkers. Really bonkers.

The Pre-Mortem: Imagining the Diagnosis

STEVEN BARTLETT: This sounds a bit crazy, but sometimes I imagine receiving the diagnosis.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And I do a bit of, I guess, what you might call it a pre-mortem — a pre-mortem, not a post-mortem — where I imagine on that day the decisions I wish I would’ve made. And I’m not saying all cancer is linked to what we eat because that’s not the case, but I’m imagining like the worst diagnosis I could ever be given and the doctor telling me that my lifestyle choices contributed to that over the last 5, 10, 15 years. And in that moment, is there any sugary drink that is worth it? There’s just no — you would just wish with every bone in your body when you come home and tell your fiancée, your partner, your kids that you’ve got this horrific diagnosis, you just wish that you had made a different decision.

DR DAVID UNWIN: I also think that’s a very good strategy for dealing with problems. You know, your life must be so complicated. I can’t begin to imagine how many problems you’re solving and the complications and the people you deal with. And yet all of them are as nothing against the cancer diagnosis, aren’t they? So that you would look at the problems you have right now and you’d laugh. Yesterday I was worried about the traffic or whatever.

And I think it’s a leveler. Mortality is a leveler. All my life I’ve been obsessed with death, and it worries me. I can’t sort out in my head what does death mean? Or, you know, it really scared me when I was a child, the idea of death. But what it’s given me is a drive to not waste time and to think about what’s the best use of today. And you seem to have that kind of energy as well.

Lifespan vs. Healthspan

STEVEN BARTLETT: Interesting thing about this idea of wasting time as well is through everything you’ve talked about today, we can both waste less time but also have more time. And when I learned about the difference between lifespan and healthspan, that also added to this equation. People still live to 80 years old, but they’re only healthy for like 30, 40 years.

DR DAVID UNWIN: And that’s a very — the idea of healthspan is very important because we know in the UK it’s going down.

STEVEN BARTLETT: Oh, is it? Yes.

DR DAVID UNWIN: They’re looking at that now. Lifespan is hanging out there as sort of stuttering along, but healthspan is going down in the UK and it’s worth thinking why that is.

The Healthspan Crisis

STEVEN BARTLETT: Well, I would hazard a guess it relates to all the things you’ve talked about today.

DR DAVID UNWIN: I think it may do.

STEVEN BARTLETT: In England, you’re totally right. It says in England, the situation is particularly alarming. Healthspan is actively declining even as overall lifespan slowly creeps up. Recent 2024 to 2026 data from the Office of National Statistics, the ONS, and the Health Foundation paints a stark picture of the UK’s widening sick years gap. Over the last decade, healthy life expectancy in the UK has fallen by roughly 2 years.

As of the latest data, men in the UK can expect to spend about 60 years in good health, and women about 60 years of good health as well. Because overall life expectancy in England is rising, people are now spending roughly up to 23 years at the end of their lives with poor health and in sickness. This means the average person spends nearly a quarter of their life managing chronic illness and/or disability.

DR DAVID UNWIN: And that’s exactly the point, isn’t it? That’s exactly the point. And it relates to another thing I’d like to tell you about as well. This is government figures. Every taxpayer in England pays an extra £7,000 tax per year for the consequences of ultra-processed food. Everybody’s paying tax, extra tax, £7,000 a year.

And this is because it’s not just the cost of the drugs. The bigger cost is the people not paying tax themselves and not able to work because they’re ill. And that’s two-thirds of the cost, is the lack of revenue because so much of our population isn’t well enough to work. And a lot of it’s young people.

STEVEN BARTLETT: People too.

DR DAVID UNWIN: It’s very serious.

STEVEN BARTLETT: I know, I think about 30-40% of our listeners are in the United States, so I’ve got some bad news for everybody in the United States as well. The US—

DR DAVID UNWIN: How is it there?

STEVEN BARTLETT: The US currently holds a rather grim record. It has the largest healthspan to lifespan gap on Earth. Despite the United States having lower overall life expectancy than almost all of its peer nations and a premature death rate that is nearly twice the average of comparable countries, its healthspan stats sit as the worst in the world. So if you’re in the United States, as things stand, you will be sicker for longer or have less health.

DR DAVID UNWIN: We’re trying to catch up though, aren’t we? We’re doing our best to be okay.

STEVEN BARTLETT: We’re doing our best. Yes. We’re doing our best to catch up.

The String Test for Metabolic Health

STEVEN BARTLETT: I have this piece of string here, which is, I guess, a mechanism you use to figure out if people’s waist and I guess fat levels are too high on the belly.

DR DAVID UNWIN: I think it’s bigger than that.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: I’m interested in low-cost ways for people to find out, well, how are you doing? How are you doing? And so one recognized way looking at metabolic health is your waist should be less than half your height. So if we have a piece of string, which we have there, I believe you’re 6’1″.

STEVEN BARTLETT: Yes.

DR DAVID UNWIN: And you’ve marked halfway. So half of that string should go around the fattest bit of your belly.

STEVEN BARTLETT: People come up to me all the time and they go, “Oh my God, you’re so much taller than I thought.” Because they’ve only ever seen me sat down. My entire career is people watching me sitting down.

DR DAVID UNWIN: So that’s right. Cut it in half.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: And then let’s see, will it go around your belly? Yes or no?

STEVEN BARTLETT: Okay, so I’ve cut the string in half. Yes. Which part of my belly? Because the—

DR DAVID UNWIN: The fattest part.

STEVEN BARTLETT: The fattest part, okay.

DR DAVID UNWIN: Yeah, so be honest about the fat part.

STEVEN BARTLETT: Okay.

DR DAVID UNWIN: Can I look?

STEVEN BARTLETT: Yeah. You did it. Yeah.

DR DAVID UNWIN: Is that— Are you squeezing in though?

STEVEN BARTLETT: No, I’m not.

DR DAVID UNWIN: Are you cheating? Let me see.

STEVEN BARTLETT: I mean, it’s not—

DR DAVID UNWIN: Yeah, you’ve just done it. You’ve passed.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: Okay, thank you. It’s so interesting and so funny, but that is a very interesting thing for you. And as I say, insulin resistance tends to put weight on your belly, but you may have a very muscular abdomen. Let’s pretend it’s that, you know. Yeah, you’re just about there. You’re just about there. But it’s a really simple test for everybody — a piece of string, as long as you are tall, cut it in half. Will it or will it not go around your middle?

STEVEN BARTLETT: Okay, so everybody at home go buy some string.

DR DAVID UNWIN: Yeah, I mean, there’s lots of other things you can do, but that’s a simple way because your weight alone, as I said, it’s where the fat is distributed. Fat on your belly is more worrying than fat on your legs or on your arms, really.

Supplementation: What Actually Works

STEVEN BARTLETT: So one of the things people always ask me about is supplementation. How much good, bad, and different. What’s your point of view?

DR DAVID UNWIN: Right. So my point of view is, if you can, my gut reaction is to try and use diet to give you what you need, if you can.

STEVEN BARTLETT: Which diet?

DR DAVID UNWIN: A lower, a real food, lowish carbohydrate diet is my preferred thing, with plenty of protein in there and healthy fats. I’m very interested in farming and regenerative agriculture and all that kind of thing. And what I know is that the nutrient profile of crops grown today is not nearly as good as it was 100 years ago. So we have some problems and it’s to do with the soil. If you keep just adding nitrogen and harvesting crops, those crops do not contain as much zinc or magnesium particularly.

And so the tragedy is that although my aim would be to have you healthy with a real food diet, there are some things you cannot get in the diet now that your grandparents could, and one of them is magnesium. It’s very, very difficult to get enough magnesium in your diet without supplementation. And as you get older, you absorb the magnesium less and less. Also, a lot of medication interferes with magnesium absorption, particularly drugs for acidity. So magnesium supplementation for most people.

In myself, it was magic at getting rid of muscle cramps. I sleep a lot better. I think we also need to talk about magnesium — which magnesium — because it varies a hell of a lot. And this bit’s embarrassing. It depends on your bowels. Have you got fast or slow bowels? You don’t need to tell me. If you tend to be a bit constipated, magnesium citrate is very good. It helps. It’s more laxative. And you absorb some of it anyway. If your bowels are not a problem, and particularly if you’re wanting better sleep or mood, magnesium glycinate or threonate actually crosses the blood-brain barrier but won’t help with constipation.

So that’s a very quick thing on magnesium. Have we got time for me to tell you about the first cow I ever bought?

STEVEN BARTLETT: Go ahead.

DR DAVID UNWIN: And it’s relevant to magnesium.

STEVEN BARTLETT: Go ahead.

The Cow, the Farmer, and the Fitting Patient

DR DAVID UNWIN: Right. So my wife and I, my wife Jen, we have this idea that if you love somebody, then gifts — you should try and think, what would that person like? Don’t buy somebody a present you would like.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: And it was Jen trying to get me to grow up.

STEVEN BARTLETT: Yeah.

DR DAVID UNWIN: Right. And this is how she did it. So she said to me one day, “Right, get a coat and a pair of Wellingtons, I’m going to take you out.” And she drove me into Lancashire, and there was a field of cows. And she said, “I have bought you any one of those cows,” because I’d always wanted a cow, and we had a field. What a woman is this! She knew I wanted — she went to the farmer in advance and prepaid for any cow and said, “This field, I’ve bought a cow, you just pick which one you like and he’ll transport it home.”

How does this relate to magnesium, you’re wondering? Well, it does, because the farmer said, “You can have whichever cow you like, but I’ve lost 15 cows to a thing called the staggers this year, and you cannot have the cow unless you promise me you’ll buy magnesium supplements because the grass is now so short of magnesium that cows die fitting if you don’t give them magnesium supplementation.”

But it’s better than that. At the same time, I had a patient that I couldn’t work out why he was fitting. I was really fond of this guy, and I kept being called out and admitting him to intensive care. Fitting. And we couldn’t work out — it wasn’t a brain tumor. Why was he fitting? And I expect you’ve joined the dots. It was magnesium deficiency because of medication he was on. And that’s the first time I ever seriously thought about magnesium. It’s a most interesting subject, very important. And the modern diet — most people are magnesium deficient.

And a problem is you can’t measure it. So your blood magnesium, serum magnesium, doesn’t reflect what’s going on because magnesium is mainly inside your cells. So you have to get the intracellular magnesium level. But do you know what? It’s just easier to try a magnesium supplement and see how you feel. So do you take magnesium?

STEVEN BARTLETT: I do, because the guests, the experts on my podcast have told me that magnesium is one of my 5. For me, I’ve said to myself, I’ll take 5 supplements a day.

DR DAVID UNWIN: 5?

STEVEN BARTLETT: Yeah, I’ll take 5. So vitamin D because I’m inside all the time.

DR DAVID UNWIN: Vitamin D. So yes, definitely.

STEVEN BARTLETT: And I’m black. So that, you know.

DR DAVID UNWIN: Well, that combined, but everybody — and particularly most people just don’t get enough sunshine. It’d be better if you could do it with sun. But yeah, vitamin D is very, very important.

STEVEN BARTLETT: I take magnesium.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: Because people like you have told me how important it is.

DR DAVID UNWIN: Which magnesium do you take?

STEVEN BARTLETT: That’s a great question. I think it’s citrate.

DR DAVID UNWIN: Right.

STEVEN BARTLETT: But I actually think it varies depending on what my team get me.

DR DAVID UNWIN: Yeah. Yes. Yeah.

STEVEN BARTLETT: But that’s good to know because I’ll think about my bowels. I take creatine. There’s this fiber supplement that I take because I did a couple of blood tests and they said that fiber would help, this particular fiber supplement would help reduce my LDL cholesterol.

DR DAVID UNWIN: Yeah.

STEVEN BARTLETT: And multivitamin.

DR DAVID UNWIN: To cover everything.

STEVEN BARTLETT: To cover everything.

DR DAVID UNWIN: That’s probably — I mean, that sounds okay really, yeah. I mean, one of the worries, or one of the clinical things I find is honestly, if you ask people how many supplements they’re taking, there’s a carrier bag comes in and there’s a blue one and a yellow one, and it is possible to over-supplement quite easily. Particularly maybe vitamin D — you can know various vitamins. So I think that’s — I would agree with you basically.

Blood Testing and Nico Health

STEVEN BARTLETT: Mine’s also going off my blood test results. So I’ve done 2 blood test results in the last month. One with Function Health, who are a partner of ours, a sponsor of ours, and another one with Nico Health, which is actually a company that I’ve just invested a couple of million quid into, which is this health testing company. Have you heard about Nico?

DR DAVID UNWIN: Nico Health.

STEVEN BARTLETT: Nico Health, you walk in, $299, whatever. You lay down, you get all of your sort of blood tests done. You get all of these incredible tests done on your body. They show like how good your circulation is from your neck to your toes. You stand in front of this scanner. It takes like 2,000, 3,000 photos of your body, tracks all of your moles, tracks your heartbeat, does all of these incredible things. And then instead of waiting 2 weeks for the results, you walk into a room and your entire body is on this screen.

DR DAVID UNWIN: Yes.

Health Inequality and the Value of Accessible Screening

STEVEN BARTLETT: And you can look at all these different parts of your body. They do the blood tests at the very start and then literally like, it felt like 20 minutes later, I’m in a room, I’ve got my blood test results back, I can see my entire body. They’re going through my LDL, my this, my that, the other. They’re showing my heartbeat, they’re showing every single mole on my body and it costs £299 and you get the results then.

And my alternative — and this is me really plugging — the alternative that I used to do every year was this, honestly, I’ll be honest, it was this £7,000 health screening where I’d take — it would take me 6, 7 hours and I’d get the results back in 2 weeks. So what Nico have tried to do, it’s actually a company started by the founder of Spotify, Daniel Ek.

And yeah, so I did my blood test the other day and both my Function Health test and my Nico Health test said the same thing. And then I took those results and I processed them using some AI tools and said, what am I deficient in? And one of the things I was deficient in was omega-3. Omega-3, that was the other one. Omega-3, vitamin D. I had high LDL. And so they said this fiber thing would be really good for you. And yeah, those are the main things. Otherwise I was great, but yeah, high LDL.

DR. DAVID UNWIN: I think one, just, that makes me think of something. When you’re screening, I think the important point is that you don’t just scare people. That it has to be linked to what can you do about it.

I’ve had a lot of experience of scared patients. So GPs, we worry about screening because what happens is people do that and then people get scared and use up loads of appointments in the health service trying to sort out. So what’s good is if you do screening that relates to actionable points and then you help the people understand what they can do and avoid leaving them as just worried.

Because that is — for you, if I can, I might be able to tell you accurately you’re going to die aged whatever of whatever. But if you can’t do anything about it, you don’t want to know. What you do want to know is what can I take action on? It’s about optimizing, isn’t it?

STEVEN BARTLETT: The things that I hate about the health checking process before Nico was how expensive it was. And that’s quite a privileged thing to be able to get a full body health scan. But now you can do it for £299. And then I walked into a room straight away with a doctor, and the doctor sat me down, beautiful screen of my body and was like, do this, this, this, this is fine, this is fine. And she was so nice about it.

But yeah, I say that because I’m so passionate about it because I realize there’s a certain privilege that people that are able to access private healthcare have that I think is really, really unfair.

DR. DAVID UNWIN: Well, obviously I think that’s unfair because I only work in the health service. I don’t do anything other. I won’t take private patients because I think it would be wrong. And don’t you think health inequality is getting really bad?

STEVEN BARTLETT: Yes, exactly. Really, really bad.

DR. DAVID UNWIN: And it kind of troubles me. And also if you start in the UK and you go northwards, it just gets worse and worse. And the States is the same where you — it’s not like the same nation.

STEVEN BARTLETT: Oh my gosh, it’s unbelievable.

DR. DAVID UNWIN: You go to California, there’s one kind of a thing, and then you go elsewhere and it’s not the same.

STEVEN BARTLETT: But hopefully this is changing.

DR. DAVID UNWIN: I think social media helps because it doesn’t cost much, does it, to go on social media and find out things.

STEVEN BARTLETT: Exactly. And people like you who have an increasingly loud voice across lots of podcasts and who are reaching millions and millions of people. And teaching them.

Basing Advice on Real-World Data

DR. DAVID UNWIN: What’s difficult though is not to become confused. Because you have the newspaper saying eggs are good, eggs are bad. And then you have this expert who’s saying this and another expert saying the other. I think what I’ve tried to do is base what I say on real-world data. And that’s different.

So I’m very careful to take baseline data from my patients and then update it all the time. The publications I’ve done are based on the real world, the Health Service in the north of the UK. I can’t cherry-pick my patients. I’m allocated my patients by the state. So I can’t just pick wealthy people or people that will live longer. Allocated people and that’s that.

So part of what I do is proof of concept, because if you can achieve this in the north of England near Liverpool, and if other people can replicate it in Australia, New Zealand, North America, maybe it’s true. Perhaps.

Closing Tradition: A Question for the Next Guest

STEVEN BARTLETT: Dr. David Unwin, we have a closing tradition on this podcast where the last guest leaves a question for the next, not knowing who they’re leaving it for. And the question left for you is — I’m sure the guests will figure out who left this one — “If humanity organized to make contact with a more intelligent species, who should represent humanity and why?” Funny.

DR. DAVID UNWIN: Oh God. That’s a brilliant question. Who should? The first person — this is a person I’m going to nominate. What about David Attenborough? He’s 100 years old and he spent so long thinking about the planet. And wouldn’t he be a wonderful ambassador? And because I am passionate about biodiversity, I’m passionate about sustainable agriculture and sustainable food. I pick David Attenborough.

STEVEN BARTLETT: I think that’s a wonderful choice. I think the aliens would really like him.

DR. DAVID UNWIN: They would. They would. That’s my answer.

Closing Reflections

STEVEN BARTLETT: Thank you so much for what you do. You’re really remarkable in a way that’s quite rare. And listen, I would know because I interviewed you.

DR. DAVID UNWIN: Oh, give me the feedback. I love feedback.

STEVEN BARTLETT: No, you really are remarkable. You’re really remarkable in a way that’s very rare. And I don’t say this to all of my guests, but you are for a variety of reasons. Okay, I’m going to give you all of the feedback.

The first, the most notable is you’re a very kind human and the way that you speak is very nice to listen to. And again, rare. The other thing that I noticed is you’re very, very, very natural and good at telling stories. And listen, why does this matter? Because the human brain, from what I’ve discovered from doing this podcast, is really orientated towards stories.

Now you could sit here and say, “Nonna bad,” or you could say, “Magnesium good,” but I’ll never forget the cow story. I could have forgotten that magnesium good, magnesium bad. But the way that you tell these stories is so captivating that it enables me to learn in a way that is engaging. And that is rare. Very, very rare.

And the other is just your depth of experience, your humility, your willingness to admit when you were wrong, which means that I trust you so much with what you’re telling me because you’re saying, listen, I’m an imperfect human too. I’ve made mistakes both in myself, with my patients, and this is what I’ve learned from it.

And the other thing is just your ability to simplify. It’s remarkable. Listen, I sit here all day with super geniuses from this university and Harvard and Stanford and whatever else, and I’m struggling to understand what the hell they’re talking about because they don’t take a second to build the bridge between the science and the average person. And you do that so naturally. So I have no surprise.

DR. DAVID UNWIN: Coming from you, that means a great deal. It really does. Thank you. It’s just what 40 years in general practice does to you, because if you wish to be effective — and if you notice, as in the Grin Model, I’m watching your face, I’m watching an audience, and I’m reading how I’m doing, or you’re getting bored, or I need to move on, or whatever. And that’s what I do with patients. I watch very carefully.

But coming from you, because you really do know, because you’ve had all sorts, so that means such a lot.

STEVEN BARTLETT: It’s a really rare skill. And actually, because it’s so rare, I would just implore you to do more. And I know you’re already doing so much, but it’s so rare that you can have such a massive impact.

DR. DAVID UNWIN: We need to talk about how we — so I’m trying to get bigger on Twitter. So this will help me immensely.

STEVEN BARTLETT: Well, how can the audience help? How could the audience help you with your mission?

How to Support Dr. David Unwin’s Mission

DR. DAVID UNWIN: @lowcarbgp on Twitter. Please follow me on X, @lowcarbgp. The other thing that would help very much is to support the British charity that I set up, the Public Health Collaboration. It’s our 10-year anniversary. We set up — these were clinicians who got together, 16 clinicians said, how are we doing? Can we do better? Can we give clearer public health advice? So it’s called the Public Health Collaboration. So please, please support our charity. Go online, find out about it, come to our conferences.

I’d also say notice each of us is on a journey. Be clear about your goals. Notice what works for you because that’s what you’re doing. And each of us, see yourself as an experiment. Don’t be frightened of experimenting. But if you’re going to experiment, notice, measure something, and then you’ll see how you’re doing.

And one thing I think that gives me hope is continuous glucose monitors, because you’re getting individualizing right there. How is my blood sugar? I can check mine in a minute and see how I’m doing.

The Power of Continuous Glucose Monitors

STEVEN BARTLETT: I think continuous glucose monitors — which, by the way, are only $20, $30 on Amazon or a website.

DR. DAVID UNWIN: Yeah, you know what, if you loved your dad or you had somebody and it’s Christmas and you could buy a useless ornament or something they don’t need it anyway, but would they be interested to find out about their blood sugar? You could maybe consider — you’d ask them first — but if they’ve got a mobile phone, they could try a continuous glucose monitor and find out. Have you tried one?

STEVEN BARTLETT: I have, I have.

DR. DAVID UNWIN: What did you learn?

STEVEN BARTLETT: I mean, so much. I learned that all these things I thought had no sugar in them, have loads of sugar in them.

DR. DAVID UNWIN: Exactly.

STEVEN BARTLETT: I had no idea about ketchup. I thought it was — and the point is, once you’ve seen it on your phone, you can’t unsee it.

DR. DAVID UNWIN: No. And I see them as the cavalry coming over the hill because we can’t be fooled much longer. I’m just going to look at seeing what my blood sugar is right now. I did this for you. So can I just show you?

STEVEN BARTLETT: Oh, well.

DR. DAVID UNWIN: So what that is, that’s somebody with type 2 diabetes, but look, my blood sugar is absolutely level. And that’s good because you want it — but look how level it is. And that is because I don’t eat stuff that puts up my blood sugar. If I was to have some of those, you’d get a spike. But that’s feedback. It also means if I get very stressed, it puts up my blood sugar.

STEVEN BARTLETT: Oh, really?

DR. DAVID UNWIN: And you’ve been so kind, I haven’t been stressed.

STEVEN BARTLETT: Oh, great. Thank God for that.

DR. DAVID UNWIN: So other podcasters are not as gentle and kind as you, and I get a horrible spike. So here’s some feedback for you, Steven. You and I have been together for a few hours and my blood sugar — I felt safe. So you’ve done your job too. And there’s some feedback for you. No spiking.

I’ll tell you a final story. So type 2 diabetes is brand new as a problem for pediatricians.

STEVEN BARTLETT: What is a pediatrician?

DR DAVID UNWIN: So a pediatrician is a doctor who specializes in the diseases of children. People under 16 years old. And the international problem is that children everywhere are now suffering from type 2 diabetes.

But the pediatricians have had no training because it’s a new disease. So a large group of pediatricians sent for me and said, “Please do a keynote and teach us what to do,” because although they’re specialists, they haven’t experience in type 2 diabetes. This is a new disease of children. What we’re doing. Leave it at that. We didn’t show the foie gras, but I’ll eat some of that later.

STEVEN BARTLETT: Dr. David Unwin, thank you. We’re done.

DR DAVID UNWIN: Fabulous. I enjoyed that.

Related Posts

• Diary Of A CEO Interview: Neurologist Dr. Stasha Gominak (Transcript)
• Dr Stephen Porges Interview on Polyvagal Theory: Why You Feel So Anxious All The Time (Transcript)
• Transcript: Activate Your Ultimate Inner Doctor – Dr. B M Hegde
• Thomas Seyfried Interview on Cancer Origins: Diary Of A CEO (Transcript)
• Making Sense #485: w/ Siddhartha Mukherjee – The New Science of Cancer (Transcript)