TRANSCRIPT: Reverse Type 2 Diabetes Naturally (Avoid 20 Foods): Dr David Unwin

Cancers like prostate cancer, colorectal cancer, particularly I’ve seen, and breast cancer. So that’s a third of the loss of life.

And then two thirds is cardiovascular. Essentially, if you have a high blood sugar, it’s damaging the lining of your arteries. In fact, we know that your arteries have a non-stick lining called the glycocalyx. And a high blood sugar damages the glycocalyx quite rapidly.

If the lining of a very small artery is damaged, that influences things like your eyes and your kidneys. So those are small vessel damage and also the nerves that supply your feet. So that’s why people get blindness, kidney problems, and they numb hands and numb feet because they can’t feel their own feet. So that’s that category.

Then you’ve got large vessels, which is the vessels like your aorta, huge vessel or coronary artery, the coronary arteries, or indeed the arteries that supply your brain. So that’s heart attacks and strokes. That’s really miserable, isn’t it? And that’s in a way what motivates me to prevent all that misery. And the earlier in the disease you do it, the less likely you are to have those things.

RINA AHLUWALIA: Absolutely. I know from you being a doctor, how long have you been a doctor for?

DR. DAVID UNWIN: I’ve been a GP now for 38 years.

The Journey to Becoming an Expert in Diabetes Management

RINA AHLUWALIA: 38 years. But you weren’t so interested of being an expert in diabetes management and diet for those whole 38 years.

DR. DAVID UNWIN: It was quite the opposite, actually, because my experience of looking after people with obesity and type 2 diabetes was really miserable because at that time, so this would be about 20, up until 2012, I saw type 2 diabetes as a chronic deteriorating condition. And so my experience was you’d add one drug and then another and another. And they got sicker and sicker.

So that for a doctor, that was an unpleasant experience, very depressing experience. So at the time, I was senior partner of quite a large practice. And so I just called him a junior partner and said, “I’m not doing diabetes anymore.” So I just gave the whole portfolio of obesity and type 2 diabetes to a younger doctor.

And what’s fascinating is now those very same people are my absolute favorite patients, really are my favorite, that I get my best results. The people with obesity and type 2 diabetes, my absolute favorite patients. And they were before my least favorite. Isn’t that interesting?

RINA AHLUWALIA: So how did you make that shift towards wanting to be an expert in type 2 diabetes and using diet and food as a way to, as a medicine basically, what was the motivation?

DR. DAVID UNWIN: Yeah, what was the motivation? Well, I suppose all doctors become, all healthcare professionals wish to make a difference. So as a young man, I wished to make a difference. And then I got to be, I was about 55, and I hadn’t really made a difference. I prescribed a lot of drugs. And my experience of medicine was, in a way that I couldn’t define, it was depressing.

And it’s my wife, really. So my wife is a consultant in psychology, in health psychology, Jen. And I was 55, and I was thinking of retiring and leaving the profession. And she said, “Why?” And I said, “Well, I think it’s time to do something else.” And she said, “Well, is there one last thing you’d quite like to do before you retire? Is there anything you’d enjoy doing?” And at that time, I’d become just intrigued by low-carb and its potential. So this is 2012. It was very, quite unusual at that time.

And so she asked the question, “Is there one thing you’d like to do?” And I was worrying about people with prediabetes, because I thought, what a shame. These young people with prediabetes were not actually doing anything in the practice for them at all. So she asked me the question, and I said, “Well, I’d quite like to see if we can reverse people with prediabetes, particularly the young ones.” And then she said, “Well, why don’t you do it then?” And I said, “Because we’re not paid to,” which is true.

And she said, “I think that’s a very disappointing answer, because I thought I was married to a doctor.” And then she said, “How many houses do we have? How many cars do we have? And why don’t we do it? What’s stopping you?” And she actually volunteered to work for free. So she said, “Why don’t we do this in our own time, using the clinic rooms in the evening when we don’t need them for the usual clinics?” And then we started. So that’s how it began.

Reversing Diabetes with a Low-Carb Diet

DR. DAVID UNWIN: We began with our first 18 patients in 2012, 2013. They actually had prediabetes. And we went low-carb with them. So it was an essentially collaborative experience between us and the patients, many of whom I’d known for 20 or 30 years.

The results were astonishing, absolutely astonishing. I’d never seen anything like it. I’ll give you an example of how exciting the results were. One of the most boring jobs in general practice is going through all the blood work, all the results, hundreds and hundreds of results every day, clicking on each one.

But the results, the blood results for low-carb were so astonishing that I started looking forward like it was a treat doing the blood work. And I kept looking at liver function, some of the lipid stuff, the triglycerides dropping like a stone, the liver function was improving, and the diabetic control, some of the best I’d ever seen. It was really amazing.

So these were people with prediabetes. And then one or two people with actual type 2 diabetes snuck in. And we found very quickly some of them were achieving drug-free remission of their diabetes very quickly. And this is not a thing I’d seen in 25 years of medicine.

RINA AHLUWALIA: And this is all from diet.

DR. DAVID UNWIN: Oh, yes. Of course. It’s just that.

RINA AHLUWALIA: And so it’s all from the food that somebody’s eating. So even if somebody out there has type 2 diabetes, it’s a lifestyle disease. And we’re going to talk now about what is diabetes and what are the differences between the types of diabetes that we hear. Because you mentioned prediabetes. And we’re also going to talk about worst foods to eat, best foods to eat.

We’re going to talk about all of it. But Dr. Unwin mentioned low-carb as a way of eating that can actually help reverse type 2 diabetes. Let’s first understand, what is diabetes?

Understanding the Types of Diabetes

RINA AHLUWALIA: What is the difference between type 1, type 2 diabetes? And if we can touch on type 3 diabetes a little bit, because that’s something that we’re hearing about a lot.

DR. DAVID UNWIN: Yeah. So people really get mixed up between type 1 and type 2. And there’s a fundamental difference. It’s all about insulin. It’s all about insulin.

Now, insulin is an absolutely vital master hormone because it has a job to do, which is getting blood sugar down. If a high blood sugar is damaging the lining of your arteries and glycocalyx quickly, then it makes sense to be designed to be able to get blood sugar down rapidly. So insulin’s job is to get sugar out of the bloodstream. And it does this by pushing it inside cells.

Now, one of the questions is, what does insulin do with the sugar? What it actually does, if you consume more sugar than you need to run around, that extra sugar is turned into fat inside the cells. I’m going to come back to that in a minute.

So just hold for now the idea that insulin is very important. And it’s there to reduce blood sugar. There are two conditions. One, type 1 diabetes is where you’re no longer able to produce the hormone insulin from the pancreas gland. So in type 1 diabetes, you’re not producing any insulin. You cannot regulate your blood sugar at all. And in fact, you need insulin or you may well die. So as a group, they’re injecting insulin. And they need to do so because they’ll die without it.

Then we have type 2 diabetes, which we used to call maturity onset or old age. But we don’t anymore because now it’s young people too. In this case, your insulin doesn’t work as well as it used to. It’s called insulin resistance. Your insulin isn’t working as well as it would have done. And so you need more insulin to get the same effect.

So you have two things. You’re hyperinsulinemic, which means you’ve got more insulin. But it doesn’t work as well. So somebody who is type 2 diabetic has probably got more insulin on board. But it’s not working as well. So they are very different disease entities. Most people with diabetes have type 2. And a smaller number have type 1. Are you ready for another complication?

RINA AHLUWALIA: Sure.

DR. DAVID UNWIN: Right. So people with type 1 diabetes are treated with insulin, quite rightly. But over the years, if they use the insulin and if they continue to have a high-carbohydrate diet, some of them get a very difficult mixture because they become insulin-resistant, like the type 2s. So they get a mixture of type 1.

They were already type 1. And then their control becomes brittle and difficult because they also become resistant to insulin. So their lives become very complicated. And they’re a third class of people with diabetes. It’s easy to stick with type 1 and type 2 because most people are one or the other. And some become a mix. But mainly I’m talking about type 2 diabetes. And there’s something I wanted to just go back to the fat.

The Importance of Early Intervention

DR. DAVID UNWIN: So if you continue to consume too much dietary carbohydrate, your body has no choice but to use insulin to drive that sugar out of the bloodstream and in the cells. A lot of that sugar is turned into fat, either around the central organs, which is a big belly and central obesity, or in the liver.

And we have a situation now where 38% of the entire developed world have fatty liver. It’s a pandemic on an enormous scale. And in fact, we audited all my patients. And it’s true about a third of them have fatty liver. And interestingly, it’s fatty liver that’s interfering with the good work of insulin. So you tend to get fatty liver maybe for 10 years before you’re type 2. During that time, your insulin sensitivity is dropping. But the blood sugar is still normal because you compensate by producing more insulin.

So although it doesn’t work as well, you produce more. But unfortunately, your liver is failing with fat, but also the pancreas. So that your ability to produce insulin over time is diminishing. And at some point, you can no longer regulate blood sugar. And then you have type 2 diabetes. And we don’t think nearly enough about fatty liver because looking at that, you could find the problem 10 years earlier.

Can I say something about that?

RINA AHLUWALIA: Sure.

DR. DAVID UNWIN: Right. So we were looking at, does it make a difference how old you are? And the answer is no, which is really interesting. So old people did slightly better than young people when we were looking at what would you achieve if you went low carb? What makes the difference is how long you’ve had diabetes.

The longer you’ve had diabetes, the harder it is to get drug-free diabetes remission because your metabolism is more damaged. So the figures are, for people with pre-diabetes, so they’re not yet type 2 diabetic, they have pre-diabetes, going low carb in our practice, 93% of them will get a normal blood sugar. That is an amazing conversion rate. 93%.

So that’s so easy to do. If you wait until you have type 2 diabetes, in the first year of type 2 diabetes, we published on this in the BMJ Nutrition, in the first year of type 2 diabetes, those who choose to go low carb, 73% of them will achieve drug-free remission. So it dropped from 93% to 73%. If you wait five years, we’re only getting 50%. And if you wait longer, and so it drops. So that means that logically, it would be a good idea to know earlier on in the natural history of type 2 diabetes because it’s so much easier to sort.

RINA AHLUWALIA: Absolutely.

DR. DAVID UNWIN: And you don’t have to go as low a carb. So the worse your diabetic control is, then you tend to have to go lower carb to achieve good results. So it’s so much easier with pre-diabetes.

RINA AHLUWALIA: As Dr. Unwin mentioned, the earlier that you get diagnosed with pre-diabetes or type 2 diabetes, the better the outcomes you will have.

The Prevalence of Untreated Mental Illness

RINA AHLUWALIA: And this is not just diabetes. A very common problem that is a silent disease in our society is mental health illnesses like ADHD, anxiety, and depression. In fact, the World Health Organization estimates that two-thirds of the population has untreated mental illnesses.

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The Root Cause of Type 2 Diabetes

DR. DAVID UNWIN: That was a long answer.

RINA AHLUWALIA: No, it’s fine. I think so many people are wondering because you mentioned the pre-diabetes, the addition of the fatty liver incidents which could happen even 10 years or even earlier prior to a diagnosis.

DR. DAVID UNWIN: We have children with fatty liver now. If you talk to Robert Lustig, there are children with fatty liver.

RINA AHLUWALIA: So this is before a diagnosis of type 2 diabetes.

DR. DAVID UNWIN: Oh, yeah.

RINA AHLUWALIA: I think a lot of people when they think about type 2 diabetes, which is coming from insulin resistance.

DR. DAVID UNWIN: Correct.

RINA AHLUWALIA: Coming from what you were eating. I think a lot of people are thinking, well, I can just manage that with some medications. I can still have my rice. I can still have my bread. I can still have my bananas every day. What’s the problem with that?

DR. DAVID UNWIN: That’s a really good question. There are various problems with that. I’ve really become fascinated by the true causes of illness. Why are you ill?

So the commonest drug we use for type 2 diabetes is metformin. But you haven’t developed type 2 diabetes because your metformin gland is packed up. It’s like we’re giving metformin replacement, you see. So it generally works better in medicine. If you find out the cause, then you could be confident about the remedy.

So for me to treat somebody so they don’t need drugs convinces me that I’ve found the true cause. But there’s much more to it than that. So if you take the commonest drug for type 2 diabetes, which is a good drug, metformin, over time you’ve got something like a 30% chance it’s going to give you diarrhea.

And I’ve had a lot of patients who were too embarrassed to tell me that they had diarrhea. And it’s only when they came off the metformin that they said, “Do you know the diarrhea has stopped?” And I say, “What diarrhea?” They say, “I’ve had it for years, but I was too embarrassed to tell you.”

And we were sending a lot of people in the practice for colonoscopies who thought they had carcinoma bowel. And actually it was the metformin all along.

Offering Patients a Choice Between Medication and Diet

DR. DAVID UNWIN: So what I’m saying to patients, there’s a choice point. When I diagnose type 2 diabetes, I’m saying your hemoglobin A1c, the average sugariness of your blood is high. We know now you have type 2 diabetes. You’ve got an alternative. We could start lifelong medication, for instance, metformin, but that has pros and cons. And people on metformin may not absorb vitamins as well. And they, some of them, about a third eventually end up with loose motions.

So shall we do that? Start the metformin, which you could start today and then we’ll monitor it and we’ll look after you. Or are you interested in changing your diet? Because if diabetes is about the average sugariness of your diet, if maybe you could have less sugar in your diet or the sources of sugar, I find that at least 50% of everybody who reduces the carbohydrate in the diet is going to get drug-free remission.

And I’m asking patients which they prefer at that point. And if you do that, I haven’t been turned down a single time since 2012. Not one patient has said, “I’ll take the drugs.” Not one.

RINA AHLUWALIA: So is it that you’re giving the patient a choice? And I think many people, when they see their doctor, their local doctor, is the doctor going to say, “You are on the verge of getting type 2 diabetes because your HbA1c, your blood sugar, is quite high. You have an option here of medication or diet. Let’s explore the diet part and what that means.” Do you think most doctors give patients that option?

DR. DAVID UNWIN: Well, I didn’t.

RINA AHLUWALIA: You didn’t?

DR. DAVID UNWIN: Before, no. That was the big change, you see. Up till 2012, I didn’t believe people were capable of changing their diet. And it’s a funny thing really, but for years and years I told them about diet and they never did it. And I blamed the patients.

What I realise now is my advice was poorly explained and the wrong advice. And so I blamed the patients for what was my poor explanation and poor advice. And then when, if you explain what you’re doing to patients and it makes sense to them, they’re quite likely to do it.

And as I say, not a single patient has said, “Give me the drugs.” Not one. And for that reason, my practice saves significant money out of the drug budget every year. Because year after year, it’s not just me, there’s eight other doctors and three nurses.

So if we’re offering that choice, we’re beginning to save money because people are interested. They’re interested in good health, if you explain it. They are interested in not requiring lifelong medication. They’re very sensitive to the idea of side effects. And I didn’t know that because I never gave patients the chance. And now I do.

RINA AHLUWALIA: How much money have you saved? It’s the NHS, right? In the UK? National Health Service.

DR. DAVID UNWIN: So that, yeah, ours is an NHS practice, so I can’t choose my patients. They’re allocated to me, more or less, till they die or I die.

RINA AHLUWALIA: You can’t choose your patients?

DR. DAVID UNWIN: No.

RINA AHLUWALIA: Why not?

DR. DAVID UNWIN: They’re allocated so that I’m obliged, within a certain geographical area, to take on anybody that has to be my patient. So, in a way, it makes my work more credible because I haven’t cherry-picked upper-middle-class, educated, wealthy people. It’s north of Liverpool. I cannot pick my patients. They’re allocated, as it were, and then I’ve looked after some of them for 35, nearly 40 years now, and whole families, but I don’t pick my patients. They live in the area where I work, and that’s the end of it.

So it’s so different from the States or Australia, where people are shopping around. But it gives me the great advantage of the continuity of care. So I’ve looked after many of my patients for 20 to 30 years, and that means there’s a high level of trust, of, I trust them and they trust me, and that’s a great gift, a great gift, and also I’ve learned so much from them.

Because of the continuity of care, I’ve learned a great deal about communicating from them, and I know now that giving them choice and them understanding that choice is key to compliance. You don’t just, don’t tell people what to do and then be cross when they won’t do it.

RINA AHLUWALIA: You know, I think so many people would love to see for you to spend the time with patients and explain to them why they should eat low-carb. What other yummy variations can you eat, apart from the bread and the rice and the pasta and all these different things, and make it exciting for them? That is so important if they want to make lifelong changes.

Group Consultations and Cooking Demonstrations

DR. DAVID UNWIN: Well, what we do, so for the full 12 years, we’ve been running group consultations, maybe doing 30 at a time, and that’s wonderful because we can get to do cooking demonstrations, so we make things quickly. Generally, whatever we make has to be made in less than five minutes and not be too expensive.

So a good example we did, a month ago now, was I have six grandchildren, lucky me, and they’re all low-carb. They’re all low-carb from birth.

RINA AHLUWALIA: So do you think that children should be on a low-carb diet?

DR. DAVID UNWIN: That’s a really good question. I think there are two populations. I think once your metabolism is damaged in terms of insulin resistance, then you have to go lower-carb, low-carb. I think if you have a healthy, if you’re young and healthy, avoiding junk foods and seed oils and sugar itself and squash might be enough.

Just a whole food diet is probably okay for children because they are not metabolically damaged. It just so happens that we all eat together, so they eat with me and I’m low-carb and we’ve learned how to make things they like.

So a quick thing is frozen raspberries blended with double cream. It’s instant ice cream that they love or berries, different frozen berries. You make that in three minutes. That’s really tasty and it’s a great alternative to the ice cream that you normally buy. So that would be a thing. We spend a long time really helping. So if you start with you, you’re trying to improve the average sugariness of your blood. So the first question is, where do you think sugar comes from in your diet?

The Teaspoon of Sugar Equivalent Infographic

DR. DAVID UNWIN: In the early days, I was very interested in glycemic index and the glycemic load. The glycemic index is very good because it ranks carbohydrates in terms of how sugary are they compared to glucose, which is 100%. But it’s quite complicated and also it doesn’t compensate for the fact that some foods by weight have a lot of water in them.

So then you start being interested in the glycemic load. The glycemic load takes a portion of a specific food and tells you in that portion of food about how much glucose is there or how much will it elevate your blood’s glucose by. So initially I was using glycemic index to explain to my patients, and I went to glycemic load. And then I realized in a 10-minute appointment the glycemic load, the explanation of it is too complicated. And it’s complicated or difficult for my patients because they don’t really understand what glucose is because they don’t cook with it.

So telling them that something produces 15 grams of glucose is problematic because they don’t really cook with glucose so they don’t know what that’s like and nor do they understand grams. So this led, I was so time pressured, it led me to think about how we can communicate quickly with people the glycemic consequences, the blood sugar consequences of the dietary choices that they make. And I came up with the teaspoon of sugar equivalent idea that I know you know.

RINA AHLUWALIA: Can you show that one? I can. We can show you that. Let me just show them. I don’t know. Can you see that? You can’t see it, but this is absolutely brilliant. Where can they find this?

DR. DAVID UNWIN: Right. So these are available. They’re in 35 languages. There are seven infographics. They help you understand where the sugar comes from in your diet. If you Google “PHC, Unwin and sugar”, they’re free. They’re not copyrighted. You can steal them and use them. They’ve been downloaded millions of times.

And just to explain what they are, we took the glycemic load of 800 foods, specific portions of specific foods and divided the results by the glycemic load of a four gram teaspoon of sugar. And so what you end up with is the teaspoon of sugar equivalent of 800 foods.

So I can tell you that 150 grams of boiled rice is more or less equivalent to 10 teaspoons of sugar. So whether you have a bowl of boiled rice or 10 teaspoons of boiled sugar, sorry, of sugar, the effect on your blood sugar is about the same.

RINA AHLUWALIA: If you have prediabetes or type 2 diabetes, you can reverse both with an animal-based diet. But 90% of people, when they start an animal-based diet, they’ll fail because their family and friends and even their doctor don’t understand this lifestyle.

The Importance of a Teaspoon of Sugar

RINA AHLUWALIA: So can we put that into context? Yeah. How many teaspoons of sugar can the body handle?

DR. DAVID UNWIN: That’s a genius question.

RINA AHLUWALIA: Because it’s very important. It is important. When you said 10 teaspoons of sugar.

DR. DAVID UNWIN: I think you know the answer already, but we will go into it. So if we drained a normal person of blood, about five liters of blood, we drained it and boiled it down. Surprisingly, there would only be about one teaspoon of sugar in the whole body. You knew that, didn’t you?

RINA AHLUWALIA: You’re the doctor. But listen, this is very important.

DR. DAVID UNWIN: It is.

RINA AHLUWALIA: Because I get a lot of questions about fruit. And we’re going to talk about the fruit. It’s coming up, it’s coming up. But it’s very important because we’re talking about white rice, brown rice, and they all break down to the same thing, which is sugar. So how many teaspoons of sugar in 150 grams? And how big is that? About this big?

DR. DAVID UNWIN: Yeah. So 150 grams of boiled rice is a small bowl. So that’s way more than if you’re diabetic and you can’t deal with sugar, you’re going to overwhelm your system and your blood sugar will inevitably climb. You won’t be able to control it. And even if you can control it, of course, all that sugar is going to be turned, a lot of it, into fat and your liver worsening in position.

Let’s just go down to a few other foods.

RINA AHLUWALIA: Sure, that’s fun.

DR. DAVID UNWIN: So a bowl of mashed potatoes is about nine teaspoons of sugar. A single slice of brown bread, a small slice of brown bread is about three teaspoons of sugar. A ripe banana can be six teaspoons of sugar.

Are Bananas Healthy?

RINA AHLUWALIA: So let’s talk about the banana thing because people are fascinated about fruit. Even if you do, you know, like a carnivore keto or low-carb diet, you know, sometimes we think of fruit as being healthy. So do you think a banana is healthy to have a banana a day?

DR. DAVID UNWIN: Not for my patients, no, because there’s too much sugar in it. And of course, sugar has another interesting effect, which is, so if you have a low blood sugar and you eat a banana and then you have a high blood sugar, insulin comes in and drives you down again and then you’re hungry again.

So you end up very easily in a cycle of low blood sugar, high blood sugar, low blood sugar, eating high blood sugar, and bananas kick off appetite. I think they’re a reasonably fattening food.

Fruits and Photosynthesis

DR. DAVID UNWIN: We discuss fruit a lot in our groups and I think it helps to think about photosynthesis. So as a general guide, photosynthesis, of course, is green leaves fixing carbon and turning it into sugar. So the fruits that live in hot countries and get more sunshine are sweeter. So the banana, the citrus fruits, grapes have a lot more sugar. In Scotland, we grow raspberries. The Scottish raspberries are delicious.

RINA AHLUWALIA: Are you saying that raspberries are not good?

DR. DAVID UNWIN: They’re great. Oh, good. No, they’re good because in Scotland there’s very little sunshine. So the fruit that grows there is raspberries that likes a lot of rain and doesn’t need much sunshine. And so the berries on the whole are a fraction of sugariness compared to tropical fruits.

And there is another thing to be said about fruit as well. It depends the form you eat it in. So if you make a smoothie with bananas, if you blitz fruit, then you’ll absorb the sugar even faster. So the rules are eat whole fruit. If you have diabetes, type 2 diabetes, my advice to my patients is stick with berries. Blueberries, raspberries, strawberries are on the whole a fraction of sugar. And if you do Google “Unwin PHC and sugar”, there is an infogram specifically on fruit to explain that and lay it all out for you.

RINA AHLUWALIA: Those infographics are fantastic and I’m going to leave the link for everything in the description of this video so you can look at different foods, whether it be fruits, I think it was common foods.

DR. DAVID UNWIN: There’s breakfast cereals, there’s vegetables, there’s fruit. An interesting one actually is different types of chocolate and the difference between milk chocolate, dark chocolate and very dark chocolate is really interesting. So most people who say they’re a chocoholic, they’re actually addicted to the sugar in milk chocolate. And if you have a look at the infogram anyway, it explains that.

Worst Foods for Diabetics

RINA AHLUWALIA: Absolutely. I think chocolate’s going to be a hot topic. Let’s go through the worst foods to eat. Now, you mentioned some foods, but we’re going to go through some categories so that people can understand, right, I shouldn’t eat this, I shouldn’t eat this, especially if I want to lower my blood sugar and reverse type 2 diabetes. Of course, you need to consult with a physician.

DR. DAVID UNWIN: If you’re on medication, yes, of course. Who’s prescribing and you need to discuss dietary changes.

RINA AHLUWALIA: You need to talk about dietary changes. You need to have a healthcare professional that understands what you’re doing alongside with any changes with diet. But I think it can be useful to go through this.

DR. DAVID UNWIN: Yeah, yeah, yeah. One of the things, a general thing I’d say, is turn the white stuff green. So if you were having a curry, you’ve just learned that the rice is possibly a very poor choice. Instead of the rice, could you find some green veg that you really enjoy and how would you cook it and add that to your curry instead?

RINA AHLUWALIA: Absolutely.

DR. DAVID UNWIN: Instead of steak and chips, again, what green veg could you enjoy with that? Instead of bread, what might you have?

So that’s very broad. More green veg generally. Get rid of the white stuff, turn it green. And then when you’re talking about green things or vegetables, in general, go for leafy green veg above ground because things under the ground, that tends to be where the plant stores sugar. So we go for above ground. So people ask me about parsnips. They ask me, which are sugary because it’s storing under the ground. Sweet potato, sugary, stored under the ground.

RINA AHLUWALIA: And sweet potato is something that people think is very healthy, but you know it’s very high in oxalate as well.

DR. DAVID UNWIN: Yeah, is it? I didn’t know that. But for me, as somebody with diabetes, I know that sweet potato is going to put up my blood sugar. Tasty, but not a great improvement on a potato. So for me, we’re trying to avoid things that rapidly break down into a lot of sugar, which is starchy, starchy foods.

RINA AHLUWALIA: So I have categories here just to make it very easy. So you can think, right, don’t eat this, don’t eat this. The first one is fruits. Now you’ve mentioned some fruits, but we have bananas, grapes.

DR. DAVID UNWIN: No.

RINA AHLUWALIA: Cherries, no means don’t have it.

DR. DAVID UNWIN: Yeah.

RINA AHLUWALIA: Pineapple.

DR. DAVID UNWIN: Definitely not.

RINA AHLUWALIA: Okay. Watermelon.

DR. DAVID UNWIN: Not really. It’s quite sweet still.

RINA AHLUWALIA: Yeah. Mangoes.

DR. DAVID UNWIN: Terrible. Very sweet.

RINA AHLUWALIA: Okay. This is a funny one. So my next fruit one, I had an interview with a heart surgeon and I said, do you think we should be eating an apple a day? What do you think, Dr. Unwin?

DR. DAVID UNWIN: I can tell you what happens with me. An apple actually contains quite a lot of sugar and I can only, if I’m wanting to eat apple without putting my blood sugar up, as somebody with, I have diabetes, I can only eat a quarter to a third of an apple. That’s my limit.

Any more than that, my blood sugar starts climbing and I don’t feel as good. So I personally am not, there’s more, there’s more sugar in apples than you think. Have a look at my Instagram. And apple juice itself, goodness me, a glass of apple juice is easily 10 teaspoons of sugar.

Why Apples are Bad for Diabetics

RINA AHLUWALIA: So can we explore that in terms of, because people would think, they’ve heard it a lot, an apple a day keeps the doctor away. In the context of somebody that is diabetic, type 2 diabetic, insulin resistant, metabolically damaged, why is that the case, that an apple a day is not good for you?

DR. DAVID UNWIN: It’s because it delivers. We’ve just said that in your entire bloodstream, there will only be one teaspoon of sugar. And an entire apple is going to deliver several teaspoons of sugar to a system that is struggling to deal with sugar.

So in a way, somebody like me, I have type 2 diabetes. So for me, sugar is a kind of metabolic poison. And I’ve often said it, do I want to be very poisoned or medium poisoned, a little bit poisoned or not poisoned at all? So I don’t eat apples because I know that if I’m not poisoned at all, I’m more vigorous, I need less sleep. Life is just better. I’ve done it for 12 years now. So I don’t eat apples.

However, if you were talking about children, should they have an apple or ice cream, an apple is a far better choice. They’re not insulin resistant. So for children, apples is probably a great choice. Not for somebody like me, who’s older with type 2 diabetes.

RINA AHLUWALIA: So can I ask you, and we’re going to get back to food, but as a side question, so when you’re a young adult or a child, what’s the tipping point to when it becomes too much sugar and too much carbs that you become insulin resistant? How can you have an apple a day when you’re a child, but it becomes too much when you’re an adult?

DR. DAVID UNWIN: The model I have for this is the fact that we have a chronological age, but we also have a metabolic age. And so the more refined carbs you have eaten, then you lose the springs in the metabolism to deal with it faster. And we see now, if you see children who are beginning to develop a belly, that’s a worry. It isn’t the idea of popping fat and so on. Our children are fatter than they have ever been, and they’re getting fatty liver.

And so for me, it’s whole foods for children. But not orange squash and really not junk foods.

Worst Vegetables for Diabetics

RINA AHLUWALIA: Next one is vegetables. Now you mentioned the vegetables, the roots that are above the ground, below the ground.

DR. DAVID UNWIN: Tend to have sugar in. Apart from celeriac. It’s good stuff. Just that you can, the carbohydrate content of celeriac is a lot less than…

RINA AHLUWALIA: Is that celery?

DR. DAVID UNWIN: No. It’s a big bulbous thing. So sort of, we grow it in Europe. So it’s a European thing. It grows under the ground, but it’s not starchy and it’s delicious. You need to try it. Tastes a bit like celery though.

RINA AHLUWALIA: Okay. But you mentioned potato, sweet potato. Squash.

DR. DAVID UNWIN: Squash isn’t so bad. I mean, that isn’t so bad, really. That’s a better one.

RINA AHLUWALIA: Okay. This is interesting, because I know this is a very British thing. Green peas, mushy green peas.

DR. DAVID UNWIN: A bit sugary. More protein. I mean, it’s a spectrum, isn’t it? It’s a spectrum. So you’ve got the potato and rice over there, and you’ve got lettuce leaves over here. And in between that is a spectrum. Things like legumes, the peas and so on, have some sugar in, but they also have protein in. So it’s a bit like I’d say, particularly for Asian people, think about using gram flour instead of wheat flour, because gram flour is made from chickpeas, another legume, and you’re getting less sugar than you would from wheat flour and more protein.

So particularly for people on a vegetarian diet, using gram flour can be useful. And chickpeas and hummus and things like that aren’t that bad.

Worst Juices for Diabetics

RINA AHLUWALIA: Now, the next one is, you mentioned juice. Apple juice. Green juices.

DR. DAVID UNWIN: I worry about them a bit, really. I wonder about what makes them green and could there be a hell of a lot of oxalate in there. And we don’t, in the north of England, we’re not doing a lot of green juices. So it’s a bit weird if you’re north of Liverpool.

RINA AHLUWALIA: You know, they add so many different things to green juices. Some people think that they’re healthy.

DR. DAVID UNWIN: I’m not so sure. I’m not having them, really.

RINA AHLUWALIA: I don’t either. Orange juice.

DR. DAVID UNWIN: Very sugary.

Whole Fruit vs. Juice

DR. DAVID UNWIN: And when I think back, my children used to drink litres of the stuff and I never thought about the amount of sugar that was there. So my grandchildren, they have oranges, but I don’t give them orange juice.

RINA AHLUWALIA: So can you explain the difference between a whole fruit versus the juice?

DR. DAVID UNWIN: If you eat a whole fruit, it takes longer. You have to chew it and then it’s in little compartments mixed with fibre that mean the absorption of the sugar is delayed by the matrix that the juice is in.

If you blitz it, you take all of that away. You make it super absorbable and there you’re getting really big sugar spikes. So there is a significant difference between eating an orange with my grandchildren and blitzing it because it’ll be drunk in a moment and all of that sugar becomes a spike. You absorb it faster than you can deal with it. So that for me is… And drink water for children.

RINA AHLUWALIA: Absolutely.

DR. DAVID UNWIN: They don’t die of thirst because, you know, I don’t believe that. All my grandchildren drink water. And I think particularly if you start with young children, start them on water, don’t get them into juice because you’re giving completely unnecessary sugar which will affect their dental health and so many other things. So water for children.

RINA AHLUWALIA: So they don’t drink milk?

DR. DAVID UNWIN: My grandchildren do actually. Although of course milk does have sugar in it. But it has protein as well and they of course… I don’t drink milk.

RINA AHLUWALIA: So if you are a type 2 diabetic, you would advise not to have milk? Even the whole fat milk?

DR. DAVID UNWIN: Yeah, I would because what’s not understood is that even a hundred mils of milk contains a teaspoon of sugar. So a common thing for me is people who can’t work out where the sugar is in their diet and having a latte or something like that which is all milk and that’s giving them a spike. And I can tell you a story.

My mother is 85. She has type 2 diabetes and we were both measuring our blood sugars and it was annoying because she was beating me. The old lady was beating me and it was for me because of the amount of milk I was having in my coffee. And when I gave up milk in coffee my blood sugar was as good as hers.

So for me it was a mark. I used to use the Freestyle Libra a bit continuous glucose monitoring device to find out how bad is my blood sugar.

RINA AHLUWALIA: So it was just from milk in your coffee?

DR. DAVID UNWIN: That was all. I didn’t eat any breakfast, nothing else. The only thing I had was milk in my coffee in the morning and that was enough to put my blood sugar up. And going black coffee took me about a week to get used to it. Now I like it, it’s fine.

RINA AHLUWALIA: I think people are going to ask about milk alternatives. Like almond milk, oat milk. What other milks are there? Cashew milk?

DR. DAVID UNWIN: I don’t really like any of them.

RINA AHLUWALIA: Oh, okay.

DR. DAVID UNWIN: So what I would say is if as a treat and what I enjoy is double cream. Pouring cream, what do you call it in the States?

RINA AHLUWALIA: A heavy cream.

DR. DAVID UNWIN: Heavy cream, yeah. So you don’t need as much so that the sugar burden is less. So I have heavy cream or double cream.

RINA AHLUWALIA: I had that in my coffee as a treat at lunchtime today. So if I want a white coffee, I’m using cream, not milk. I also add a bit of butter to my coffee and I whisk it up.

DR. DAVID UNWIN: Yeah, you can do that. There’s various things like that.

The Sugar Content of Honey

RINA AHLUWALIA: Okay, the next one is honey. Now that has 17 teaspoons of sugar per 100 grams.

DR. DAVID UNWIN: I used to be a beekeeper. I actually have hives now. I still keep bees for the honey, but not for the honey. I leave the honey with the bees instead of robbing them. I love to watch them, but I never eat honey because, again, the amount of sugar is so great for me with type 2 diabetes. It’s just going to make me ill.

Wholemeal vs. White Bread and Rice

RINA AHLUWALIA: Going back to the worst foods, now you mentioned rice and bread. So, wholemeal versus white. Why are they the same thing in terms of sugar?

DR. DAVID UNWIN: There’s a slight advantage to brown, but it’s not very much because, essentially, there is still almost the same amount of sugar in them. We call it brown bread in the UK, and it varies greatly in terms of what’s in it and whether brown is actually wholemeal. Sometimes it’s just brown. Sometimes it is wholemeal, which would be an improvement, but even then, it only improves it by about a third.

So, the difference between brown rice and white rice is only a third, and brown bread to white bread is a third or less. So, again, for me, it’s do I want… How poisoned am I prepared to be so I’m not eating brown bread and I wouldn’t normally have brown rice either?

There are so many wonderful green veg to eat, and really, rice is just a vehicle for the sauce. Well, cauliflower rice can be every bit as tasty, so I don’t need to compromise, really.

RINA AHLUWALIA: Absolutely. When I was keto, I would have a lot of cauliflower rice. I would have zucchini noodles, all these different variations, and you don’t even miss the pasta or you don’t even miss the rice.

DR. DAVID UNWIN: No. A lot of my patients would say they actually prefer cauliflower rice. You can do it in very different ways and add herbs and spices. You can fry it in butter. It’s a very versatile thing.

RINA AHLUWALIA: Okay. Well, that was all the worst foods. I think I’ve got them all because you mentioned the chocolate as well. Don’t have milk chocolate, opt for the dark chocolate. There is an issue with oxalates. I’m sure people are going to be thinking, oxalates, if you can’t tolerate it, don’t have it.

DR. DAVID UNWIN: Correct.

The Need for Carbohydrates

RINA AHLUWALIA: Let’s talk about carbohydrates because although we’re mentioning to a low-carbohydrate diet, which is very doable, quite healthy, is there a need for the human body to consume carbohydrates?

DR. DAVID UNWIN: No.

RINA AHLUWALIA: Why?

DR. DAVID UNWIN: Because, again, when we were designed, we designed such a genius thing, the human body. Would it make sense to design caveman so that if he didn’t eat carbs for a few weeks, he died? Because he would have died every winter, wouldn’t he? Because there’s no carbs for you through the winter.

You’re eating meat or nuts that you’ve stored. And so, yes, you need carbohydrate for some vital functions, but of course, this has been worked out and you can manufacture your very own carbohydrate from either protein or fats. And the word triglyceride has a hint in it because the glycerate is the sugar bit. And so you actually need about 140 grams of carbohydrate a day for vital functioning. And you can easily produce that from gluconeogenesis.

It’s called gluconeogenesis and it’s the way you can produce glucose from fat or protein and it’s done in the liver. And I’ve done fasting very often and I’ve been very low carb and keto, so plainly gluconeogenesis has kept me alive and better than just alive well.

So I’m not concerned about the fact that I don’t have carbohydrates in my diet. Of course, I have little bits because I do have green veg, but I have had times in my life when I’ve done carnival or straight fasting and nothing happens.

RINA AHLUWALIA: Why do you think people don’t do a carnivore diet?

DR. DAVID UNWIN: Well, the other question is, why do some people do it and some people not do it? So some people get such amazing benefits in terms of their health, particularly if they’ve had terrible irritable bowel syndrome or colitis, that kind of thing, or rheumatoid arthritis, or mental health changes.

Some do so well on the carnivore diet, they don’t want to try anything else. Many people though, where I’m working, find that after a while it seems restrictive and a bit boring and it’s so far away from what other families are eating, that the addition of some green veg makes it a lot more fun than a few raspberries.

Then the world of cooking is open to you again. So I personally have a fairly meat-heavy diet, but there’s green veg, there’s nuts, there’s berries and dairy in there as well.

RINA AHLUWALIA: I wanted to make that distinction because I think that when people think about diet, they think, well, this is the best diet, but as we spoke about earlier, it’s about what can you do and what can you do in the long term.

DR. DAVID UNWIN: Certainly, it’s what you can sustain.

RINA AHLUWALIA: Absolutely.

DR. DAVID UNWIN: So you can do things, but will you? And again, I was talking about my long-term relationship with patients for decades. So for me, I’m very interested in, is it sustainable, is it affordable, does it fit in with your beliefs, whatever they may be, does it fit in with the foods?

I want people to enjoy food, we can’t just take away the joy of food. So all of that needs factoring in. So then the question is, how low do you need to go? And of course, if you look now at the standard American diet, it is so terrible, but almost anything is an improvement on that.

So the standard American diet, or for me, the standard North of England diet, there could be as many as 300 to 400 grams of carbohydrate in that. And most diets are an improvement on the junk that’s in there. And that helps explain why. So the vegetarian diet may work, but it does work for some people with diabetes. It’s an improvement of what they ate before. Going carnivore is an improvement from what they ate before. Maybe you just don’t need to go lower carb.

All sorts of things are an improvement. The diet, the standard American diet is now so bad, I’m shocked when I go to America, I’m absolutely shocked by the breakfast. I just can’t believe the sugar and the whole family sitting around, and some of them are so enormous, there must be such… What must it be like to be that heavy?

So anyway, all sorts of diets work relatively, it’s an improvement.

RINA AHLUWALIA: It’s what you can do for the long term.

DR. DAVID UNWIN: Yeah, yeah. And what you enjoy.

Total Carbs vs. Net Carbs

RINA AHLUWALIA: So let’s talk about in the context of type 2 diabetes, people are going to be thinking, right, got to lower my carbohydrates, got to not eat those worst foods that we just spoke about. We have to eat some of the good foods. But there’s something that people want to know, do you have to count total carbohydrates or net carbs?

DR. DAVID UNWIN: Well, it’s easy for us in the UK, because the food labeling is net carbs.

RINA AHLUWALIA: Oh, that’s good. Yeah, it’s better. That’s much easier.

DR. DAVID UNWIN: So my patients don’t have that. Obviously, I prefer net carbs, and that’s what we get in labeling, probably in the whole of Europe, actually, so that net carbs is easier. So in the States, you probably have to do some sort of mental gymnastics.

RINA AHLUWALIA: I think it’s the total carbohydrates minus the fiber.

DR. DAVID UNWIN: Yeah, we do it net here.

RINA AHLUWALIA: But some people say, well, net carbs is a bit rubbish. You have to look at total carbohydrates, because I don’t know why.

DR. DAVID UNWIN: Well, I don’t know why either. I think the fiber, like… Well, maybe, but you’re going to get plenty. For me, it’s a well-formulated diet. So that includes loads of green veg, or even dark chocolate’s got fiber in it, and the nuts definitely do. Anyway, for us here in the UK, fiber is listed separately, and your net carbs are there, and that system works really well.

Best Foods for a Low-Carb Diet

RINA AHLUWALIA: Okay. Let’s talk about best foods to eat, because this is what people want to know, what should I eat. But low carb does not mean that you must do zero carb in a carnivore diet.

DR. DAVID UNWIN: Nope.

RINA AHLUWALIA: And it doesn’t mean that you have to do absolutely high protein. What does it mean to do low carb?

DR. DAVID UNWIN: It’s a relativity thing. So if you have a problem, you’ve got diabetes or whatever, if you go relatively lower on that spectrum, that might be it. So I’ve got patients who’ve achieved drug-free remission of their diabetes on as much as 160 grams, 180 grams of carbohydrate a day, because relatively for them, that’s so much better than what they had before.

So it’s about reduce the amount of carbohydrate, and then you need feedback. How am I doing? And what are your goals? I think clarity of goals. So my goal for myself is I don’t want to be poisoned at all. I want a normal hemoglobin A1C. I don’t want to go blind or whatever. So my goal is I want a normal hemoglobin A1C, no drugs.

In my case, I have to go low carb, 50 grams of carbs per day or less. And it’s taken me a few years to work that out. But there are people, as I say, who don’t have to go as low as that. I would say the important thing is monitor your weight, monitor your waist circumference, monitor your blood sugars, and then you will find out, well, how am I doing? And if you’re failing to progress in one of the parameters that you wish, then you may need to go low carb. And some people do have to go keto.

RINA AHLUWALIA: But you need to add in the fat, enough fat as well.

DR. DAVID UNWIN: Well, you do, because if you’re going to take out carbs, you’re going to take the carbs You’re going to take the carbs. You’ve only got three macronutrients. So what are you left with? What’s a veg? Well, they’re kind of vitamins and fiber mixed up, aren’t they? And a little bit of carb, but they’re not mainly water. So you’re inevitably then talking about the ratio. Your carbs are reduced. You’re going to increase the protein. You’re going to increase the fat. What are you going to do? And I think that varies.

And there are different people around the world, aren’t there? There are people saying increase the fat. And there are people saying increase the protein. There are people saying increase the protein. I think every person is different. And I come back to I’m not too prescriptive with my patients. I come back to what is the goal? Is it a normal hemoglobin A1c? Is there a particular weight?

So some people increase the fats for the satiety. And they enjoy it. They enjoy butter. But then they gradually start gaining weight, particularly with dairy, full-fat dairy. And you can’t get away from the fact that fat is nutritionally very dense, calorifically very dense. So those people sometimes have to increase the protein and reduce the fats because their weight was more than they wanted.

And then you’ve got, I’ve got patients who want to build muscle. Well, then they would be, they’re on a higher protein. And so for me, I’m individualizing it because my patients vary greatly. I’ve got people in remission between the ages of 92 and 23. So their requirements are very, very different. And their goals are very different. And some of them are on high fat and some are on high protein and some are mixture.

RINA AHLUWALIA: Okay.

Eggs: A Nutrient-Dense Superfood

RINA AHLUWALIA: Okay. Well, as long as they probably eat these best foods, then they’re going to be okay. Let’s go through these lists. First one is eggs. What do you think about eggs?

DR. DAVID UNWIN: I love them. I love them. Good. Nutrient-dense. Great idea. Eat loads.

RINA AHLUWALIA: Eat loads. So how many can people eat a day?

DR. DAVID UNWIN: I’m not aware of a limit. I’m not aware. I am aware of research that says that eggs are healthy. And I know I gave terrible advice on eggs for years, which was have two as a treat in a week.

RINA AHLUWALIA: Two as a treat in a week?

DR. DAVID UNWIN: Yeah, that was what we were saying in the UK in 2005. And what we’ve missed was there is no link between dietary cholesterol and serum cholesterol. There is no link. And in fact, the British Heart Foundation very quietly dropped cholesterol as a nutrient of concern in 2016. They did it very quietly. So I personally have loads of eggs. I keep hens. I produce my own eggs. Eggs are nutrient-dense. Very good.

Choosing High-Quality Meat

RINA AHLUWALIA: Next. All meat. Beef, lamb and chicken.

DR. DAVID UNWIN: Yes, I eat all that. I am interested. I am interested how those animals are kept. Because, so I’ve been running about five or six bird sanctuaries for years and years. I’m very conscious of animal welfare. And so really, is the chicken you’re eating, how is it kept? Because on average, it was kept terribly. And is the pork you’re eating, how did that? Pigs like, I keep pigs myself. They’re about as intelligent as a dog. They get bored. They should be cared for.

Is the animal cared for well? Interestingly, in the UK, if you want to eat responsibly, lamb is a great thing because you can’t intensively rear it. So actually, eating British lamb or New Zealand lamb, that animal probably had a better life. If I’m eating beef, I’m interested where did it live? How is it sourced? I don’t like the lots that you use in America very much. So I’m interested in the source of the meat. And how was the animal kept?

Carry on. Nutrient-dense. Nutrient-dense. I don’t actually enjoy… I like red meat more than I like chicken.

RINA AHLUWALIA: So from the point of view of a type 2 diabetic or pre-diabetes or blood sugar or just overall health, lamb, chicken, beef…

DR. DAVID UNWIN: It’s all fairly neutral. Yeah, good stuff.

RINA AHLUWALIA: As much as you can afford to buy the highest quality possible…

DR. DAVID UNWIN: Yes, with a view to how it was kept. Absolutely. And the same applies to salmon, actually. If you think of farmed salmon, it’s not great for the planet. But wild salmon is really good. Nutrient-dense.

The Benefits of Fatty Fish

RINA AHLUWALIA: Fatty fish. Salmon, sardines, and mackerels.

DR. DAVID UNWIN: All brilliant. Brilliant.

RINA AHLUWALIA: And why are they brilliant?

DR. DAVID UNWIN: We’re coming there to the old omega-6, omega-3 story. That the modern diet is… So there’s a ratio of omega-6 to omega-3. Omega-6 tends to be pro-inflammatory. Omega-3 tends to be anti-inflammatory. The modern diet has got 20 times more omega-6 in it now than it had in the year 1900. And so we’re trying to rectify that balance because the modern diet tends to be pro-inflammatory, which is why there’s so much joint pain and so on.

And so foods that improve the omega-6, omega-3 ratio, of which oily fish is a very good one, but actually lamb is another one. They call it lamb-salmon because the ratio is good on that as well. And if it’s pasture-raised beef, that improves that. So that’s a complicated answer, but I love all the oily fish. Eat them a lot, yes.

RINA AHLUWALIA: Absolutely. And it’s got EPA and DHA in the omega-3s.

DR. DAVID UNWIN: Good. Good for your brain.

RINA AHLUWALIA: Very important. Prevents Alzheimer’s as well.

The Best Fruits for a Low-Carb Diet

RINA AHLUWALIA: Let’s talk about best fruits because people like to eat something a bit sweet. Blueberries.

DR. DAVID UNWIN: For me, it’s raspberries, blueberries, possibly strawberries. Did I say blackberries? That’s another one.

RINA AHLUWALIA: Do you consider avocado a fruit?

DR. DAVID UNWIN: Do you know, it is a fruit, isn’t it? I just thought it is.

RINA AHLUWALIA: It is. I mean, I eat avocado. I like it. And an olive is said to be a fruit as well.

DR. DAVID UNWIN: Absolutely. In which case, olives are very good, yes.

RINA AHLUWALIA: So there’s lots of options. That’s what I’m trying to get at.

Full-Fat Dairy: Healthy in Moderation

RINA AHLUWALIA: Okay. Full-fat dairy. Cheese. Green beans. Beef. Greek yogurt. Butter.

DR. DAVID UNWIN: Yeah, yeah. And in fact, the most recent evidence on full-fat dairy is that it’s probably associated with improved outcomes for cardiovascular health, particularly stroke, I believe.

The only question is, it can be a bit addictive, so that if you’re trying to lose weight, I often find that people are having too much cream or too much full-fat yogurt or too much butter or cheese. But it’s healthy enough, yes.

But how is your weight? Mind you, I have patients who are underweight for the first time ever as a clinical problem where they say, “I’ve lost too much weight.” And then I’m using full-fat dairy because they can enjoy using cream and get back.

RINA AHLUWALIA: It’s quite interesting that we always focus on people that are morbidly obese or obesely prone because that’s the population that we’re seeing across the world. But there are some people that suffer with being…

DR. DAVID UNWIN: There are. I mean, older people particularly, we know that muscle mass is linked to how long you’re likely to live. And so many older people don’t eat enough protein.

So it’s a common thing for me with older people is they’re losing muscle mass partly because they’re aging, but also partly because they’re not eating enough protein. I’m always surprised when I say, “How much protein are you having? You could double that.”

I’ve had older people who are underweight who I have doubled the protein and put them on some isometric exercises and they get far stronger and they’re delighted over time.

RINA AHLUWALIA: So isometric exercises is like, for example, a leg extension.

DR. DAVID UNWIN: Yes.

RINA AHLUWALIA: So a bicep curl. Yes. And the compound is multi-joint exercises.

DR. DAVID UNWIN: So this is just something that anybody could actually do, which is doing exercise along with what you’re eating to improve your blood sugar, your health, the probability of heart disease and stroke. It’s a holistic approach, isn’t it?

RINA AHLUWALIA: Absolutely.

DR. DAVID UNWIN: Yeah. And what’s interesting is a lot of people, when they go low-carb initially, they’re not interested in exercise. But after a while, of course, if you’re low-carb, you’re likely to become a fat burner.

And at that point, you have more energy. And then they’re walking, then they’re going to the gym, then they’re taking exercise. And then the combination of diet and exercise can be very powerful for optimizing health.

The Controversy Around Animal Fats

RINA AHLUWALIA: Okay. Next one is fats and oil. So fat, we mentioned the butter, but animal fats like ghee, butter, lard. Do you think they’re healthy for a type 2 diabetic?

DR. DAVID UNWIN: Oh, so contentious, isn’t it? It’s so contentious.

RINA AHLUWALIA: Well, I had to ask the question.

DR. DAVID UNWIN: Well, I mean… People look at it and think… They do. … do they have that?

Well, it’s interesting because in the beginning, I worried about that so much that I collected all the data for all my patients. And I’ve got now detailed data going back to 2012.

And what’s interesting is so my patients eat more meat and the butter and the lard and all that, and the lipid profiles, all of the cardiovascular risks have improved. And we published that in the article in BMJ Nutrition, January 2023, where we looked at cardiovascular risk factors, blood pressure, cholesterol, triglyceride levels, and they all improved on the low-carb diet that my patients were eating.

RINA AHLUWALIA: By eating more butter and lard and animal fats and meat.

DR. DAVID UNWIN: Certainly, that was part of what they were doing. And they improved every measure of cardiovascular risk. So that I personally don’t worry about butter. I enjoy it. I don’t eat margarine under any circumstances.

RINA AHLUWALIA: Yeah, I heard that was the worst invention that they did.

DR. DAVID UNWIN: Possibly. Possibly. It’s interesting the debate over seed oils is a debate. So I believe that I personally don’t consume seed oil ever. And I believe the model is, as it being dangerous, is probably correct. But the actual quality of evidence for that isn’t that great.

RINA AHLUWALIA: Really?

DR. DAVID UNWIN: No. I’d love it to be. I would love the evidence to be terrible on seed oils. And there is some evidence, but I haven’t. It’s not that good. But I believe it enough. So I don’t eat it at all. So I’m just being fair to both sides there. But I did look into it. And the evidence against seed oils is not as good as the evidence against sugar, for instance. I’d like it. Maybe they’re going to do it.

RINA AHLUWALIA: Well, it’s good to know people to what you prioritize. Because we can’t prioritize everything. But if we could prioritize lowering the carbohydrates and the sugars and do the best that you can.

DR. DAVID UNWIN: Yeah. For me, it’s eat nutrient-dense food that doesn’t put up your blood sugar. And if you can afford a Freestyle Libra and pop that on your arm for two weeks, you’ll find out.

RINA AHLUWALIA: We’re going to talk about CGM in a second.

DR. DAVID UNWIN: Oh, fine. Yeah.

RINA AHLUWALIA: Okay. So the next one is, with the oils, is it okay to have extra virgin olive oil and coconut oil?

DR. DAVID UNWIN: The virgin olive oil, definitely. Coconut oil, probably. I don’t know as much about coconut oil because it’s not something we use a lot of in the north of England.

RINA AHLUWALIA: Okay. So I just don’t. I prefer not to say stuff I don’t know.

DR. DAVID UNWIN: That’s fine. Just put it down there.

RINA AHLUWALIA: Yeah, yeah.

Green Leafy Vegetables: It Depends

RINA AHLUWALIA: Okay. Next one is, green leafy vegetables. Eat them in large quantities.

DR. DAVID UNWIN: That’s a good question, isn’t it? It depends. It depends. What about oxalates? What about Irritable Bowel Syndrome? You may be having too much fiber.

So Irritable Bowel Syndrome is so common. And it’s mainly always due to something you ate. And some people are having too much fiber.

So, again, that, it depends. If you’re eating a diet, and you are the weight you want to be, and your blood sugar is fine, and your blood pressure is all right, and your waist is all right, and your liver function is fine, and there’s loads of edge in it, and you’re happy, don’t stop. That sounds okay to me.

If you’ve got a problem, then you’d always be curious as to why that problem was. Because I’m interested in the true causes of illness. Why is my patient unwell? And some of them with Irritable Bowel have a lot of green veg, particularly some of the green smoothies, where they’re putting kale in there. They’re making the situation worse.

RINA AHLUWALIA: And spinach, which we’re finding spinach is really not that great for you.

DR. DAVID UNWIN: Yeah, yeah.

Nuts: Nutritious but Don’t Overdo Snacking

RINA AHLUWALIA: Okay. Next one is nuts. Macadamias, walnuts, and pecans.

DR. DAVID UNWIN: Nuts. On the whole, I like them. Yeah, I like the macadamias, I like. And they’re useful, and they can be very useful. I prefer that my patients don’t snack. I’d much rather people ate in a smaller window. The idea of snacking, that just generates more appetite.

So I’m trying to wean my patients off snacks. But I’d rather they snacked on almonds, or pecans, or macadamias, rather than biscuits. And sometimes the nuts can be quite useful, particularly in a vegetarian diet. There are people who want to be low-carb vegetarians. Well, nuts are really important to them.

RINA AHLUWALIA: So if you have a patient that says that they’re vegetarian, do you try to encourage them to eat meat? Or do you accept them where they are?

DR. DAVID UNWIN: I ask why they’re vegetarian. Why? You know, because they may have a religious belief, in which case you have to work with that. And I don’t want to change a belief, that’s not my job.

Some people are vegetarian for maybe thinking about animal welfare, in which case I will debate that. Because if you… So one of my interests is regenerative agriculture, or the use of land.

So if you took a single acre of land, and you just grew leeks on it, to grow leeks on a single acre of land, you will have to use herbicides and pesticides three or four times a year. What you will have then is a monoculture, and you prevent all life in that acre.

So whether you murder animals, or you prevent them from existing, is to me the same. So that acre of land will not, there will be no voles there, there will be no moths, there will be no bats, there will be no birds. It’s a silent acre. And that monoculture is as worrying for me as other injustices.

And so I’m interested in the consequences of what I eat. Because if it was a monoculture, with all those herbicides and pesticides, and also the fossil fuels required for the machinery and so on, that’s a worry. That’s worrying.

We’ve been experimenting, so you can look up the three hours bird sanctuary, because I’m a senior trustee, and we’ve been experimenting. So we actually took over a three acre field of leeks, and now on that same, so that three acres, nothing was on it but three acres of leeks.

And now I’ve got 23 species of nesting bird, I’ve got 133 species of moth, four species of bat, and I’m producing meat. So actually the meat on that land is helping regenerate the soil because of the feces from the sheep bringing in insects. So that actually you can eat.

Eating Meat Sustainably Can Benefit the Environment

DR. DAVID UNWIN: I can eat that meat completely. I’m doing something wonderful for the environment because before that was a sterile leek field. So for me, the debate, the interesting debate about the food supply and sustainability and care of the soil can be done with patients. And sometimes they become vegetarian just wanting to help the planet.

And they could actually eat a small amount of meat produced sustainably and benefit some areas of land, particularly in the north of England where we get lots of rain and we have to grow grass.

RINA AHLUWALIA: Absolutely. It can be a bit controversial, especially when somebody has a belief system, and they feel vegan, vegetarian, and meat. And when you understand the nutrients that you do get from meat, the impact on the blood sugar. The nutrient density, I agree.

DR. DAVID UNWIN: The liver, goodness me, that’s so rich.

RINA AHLUWALIA: The commonest one is I find people having chicken, like it’s red meat, evil.

DR. DAVID UNWIN: Really?

RINA AHLUWALIA: Yeah, that’s so common. People say, “I don’t eat red meat, but I do eat chicken.” That’s better.

DR. DAVID UNWIN: Yes. On the spectrum.

RINA AHLUWALIA: So that’s really odd. The white meat versus the red meat.

DR. DAVID UNWIN: Yeah. Yeah. Very odd. So I’d say lamb or venison in the UK, if you can get it.

The Impact of Red Meat on Diabetes and Kidney Function

RINA AHLUWALIA: So if patients are diabetic, pre-diabetic, red meat is completely healthy for you? Healthy for your kidneys?

DR. DAVID UNWIN: It’s fine. Yeah. We looked at kidney function on my patients because the idea was they’re eating more protein. So was I harming my own patients’ renal function by encouraging them to have more protein?

And in fact, over time, and we published the results, their renal function improved.

RINA AHLUWALIA: So eating red meat, their renal function improved.

DR. DAVID UNWIN: Well, you can’t quite say that, can you? I can’t correlate. It’s tempting to say that. I have noticed.

So my patients eat a lot of red meat, and I have certainly measured baseline renal function and latest follow-up, and the renal function has improved significantly. And you can Google that if you Google “UNWIN”, and that was with Professor Wong, a nephrologist. So if you Google “UNWIN, Wong, and renal function”, the paper’s there.

The Importance of Salt on a Low-Carb Diet

RINA AHLUWALIA: Okay. Why is it important for people when they go to a low-carb diet, why is it important for them to consume more salt?

DR. DAVID UNWIN: That’s a lovely question. Very important question. I didn’t know why initially, but it fascinated me.

So I noticed that when I went low-carb, my blood pressure dropped significantly, really significantly. I used to have high blood pressure, now I have low. The patients, generally, I was having to deprescribe a third of all their drugs for blood pressure. So going low-carb was improving blood pressure. That’s the first thing.

The second was, I’m a runner, and I noticed I was getting muscle cramps. I needed more salt in my diet to prevent the muscle cramps. So this is odd, because I was having more salt, but my blood pressure was better. How can that be right?

So I was really fascinated on what that is. And with Professor Brady, a professor of cardiology from Glasgow University, we researched that and published the data again from my practice.

And we’ve actually known since 1933 that insulin causes renal sodium retention. So if you have a high-carb diet, that’s a high-insulin diet, you will hoard the salt that you would otherwise wee out. You see, God didn’t design us to die because we were eating seafood. There was inherently a regulation of sodium, and you just weed it out. But what was never anticipated was the high-carb environment. So insulin goes up and prevents you weeing out salt.

Then when you go low-carb, you wee out loads of salt. Your blood pressure comes down. And in some circumstances, particularly if you sweat a lot because you’re running, you need more salt. And particularly in the early days of going low-carb, that is why you can get keto flu, and you might just need more salt.

RINA AHLUWALIA: How much salt?

DR. DAVID UNWIN: I don’t really count, because I know my blood pressure is so good, so I just have plenty.

RINA AHLUWALIA: I think people just wonder…

DR. DAVID UNWIN: I don’t measure stuff. I’m not a great measurer, because I don’t think… So we don’t weigh… I’m not getting my patients to weigh food or measure food. I’m just getting them to enjoy healthy whole food, and let’s see if that works.

Because I don’t think family life should have a weighing scale, and you weigh every… I don’t think that’s normal. So I’m measuring your blood pressure, measuring your fasting lipids, and your hemoglobin A1c. And if all those are normal, I don’t ask any questions, because you’re obviously doing it right.

Warning Signs and Blood Tests for Type 2 Diabetes

RINA AHLUWALIA: So those are things that we have to look at. Now, let’s talk about warning signs and blood tests. You just mentioned all of them.

DR. DAVID UNWIN: Okay. Very, very good. Yeah.

RINA AHLUWALIA: How does somebody know if they have type 2 diabetes or pre-diabetes?

DR. DAVID UNWIN: Tiredness, I’d say, is one thing. So I noticed that when I was 55, after food particularly, I was very tired. And I used to have a little nap every day on my doctor’s couch after lunch. So I just pressed, “Do not disturb”, 20 minutes nap. That wasn’t normal. That wasn’t normal.

Increasing belly size, it isn’t age. So I thought that my middle age, my tummy, was what normally happens to 55-year-old men. It isn’t. And so if you’re getting a pot there, central obesity is another factor. So there are things you can measure like waist circumference. Your waist circumference should be less than half your height. So you could do that calculation.

If your blood pressure’s going up, that’s another sign. So there’s things you can measure at home. Waist circumference, I suppose your weight overall. You can notice tiredness. You could notice if you’re weeing all the time, if you’re starting to get up a lot at night and pass urine.

Then there’s things your doctor can measure. So that is liver function. In the fasting lipid profile, particularly triglycerides, a high triglyceride is a real harbinger of the metabolic syndrome.

And it’s because, I told you right at the beginning, insulin turns sugar into fat, and that fat is triglyceride. So if you’re carrying a high triglyceride, then that’s an early warning. And then there’s blood sugar itself. But a rise in blood sugar is a reasonably late indication of insulin resistance.

RINA AHLUWALIA: What about your HbA1c?

DR. DAVID UNWIN: Well, that’s the average sugariness of your blood. And so that’s very useful. And the thing, doctors do it all the time. And that’s how we diagnose type 2 diabetes and also pre-diabetes. And then, of course, we’ve got thermometers, something like continuous glucose monitors, which are genius because you’re getting feedback. You know what’s happening when you eat.

The Role of Continuous Glucose Monitors

RINA AHLUWALIA: So do you think it’s important for patients if you’re not diabetic, do you think that patients should wear to try a continuous glucose monitor?

DR. DAVID UNWIN: That’s contentious again, isn’t it? So for people with diabetes, they’re really useful. And those are the people I’m experimenting with.

I mean, there was a study. There was an RCT in Malaysia on offering, I think they were obese young Malaysians, just a month of what was probably a freestyle Libra. And what’s interesting, the ones wearing the freestyle Libra reduced the carbohydrate they ate and lost weight.

So there is beginning to be some evidence. But that’s quite contentious. Certainly, it’s interesting.

RINA AHLUWALIA: I wore one. It was quite interesting.

DR. DAVID UNWIN: Yeah, it’s interesting. But it’s still, it’s a place I don’t know yet. I don’t know what the place is.

RINA AHLUWALIA: So I wear one. I buy myself one every now and then just because I learned so much. And for me, the point is, in behavioral terms, the feedback comes hard on the behavior. So you learn really fast.

There’s a hint of anyone sees an average sugar in this over three months. You don’t learn specifically what foods did that. Because you’ll see it. When you see a big spike, you know you just ate the cornflakes. It was that.

Optimal Blood Sugar Levels

RINA AHLUWALIA: So let’s talk about numbers. I know we’re going to talk about UK numbers. Maybe we can convert it to the US numbers. When it comes to blood sugar, so let’s just say that someone using a continuous glucose monitor, what should the blood sugar levels be?

DR. DAVID UNWIN: Yeah. So that’s a bit complicated because it kind of depends a bit. In general, I mean, if you have Freestyle Libra, and this makes it more international for you, they’ve actually pre-calibrated it so you’re in the green zone.

And that in the UK is somewhere on the whole. It’s running you between probably 4.5 or 5 and 9. And then you’re in the green zone. And in America, it’ll be different units. But if you’re in the green zone.

RINA AHLUWALIA: I think in America, it’s roughly 70 to 100.

DR. DAVID UNWIN: Yeah. So, but of course, all carbohydrate foods may give you a spike, but we don’t. If you’re a person with normally functioning insulin, we don’t know whether that spike is related to any health outcomes.

So that’s where I’m a bit vague because I’m using it for people with type 2 diabetes, and it’s really great in them. They learn a lot.

RINA AHLUWALIA: And pre-diabetes too, I would include.

DR. DAVID UNWIN: Yeah. Pre-diabetes. For the normal population, I actually don’t know.

RINA AHLUWALIA: It was just interesting to see, like, when you’re having you getting

DR. DAVID UNWIN: Yeah. Even though I’m not a diabetic

RINA AHLUWALIA: Yeah. or pre-diabetic, you know, stress is something that increases my blood sugar.

DR. DAVID UNWIN: Yeah, me too. Public speaking puts mine up.

RINA AHLUWALIA: Me too. Yeah. It’s probably up right now.

DR. DAVID UNWIN: Yeah. So I get some of my worst blood sugars when I’m on stage. Not because stress does that. Interestingly, I need more magnesium if I’m stressed. We have magnesium. It’s another story.

RINA AHLUWALIA: Magnesium is important, and you need more if you’re stressed.

DR. DAVID UNWIN: Yeah. Magnesium is important, and you need more if you’re stressed for certain. And it’s important the type of magnesium.

RINA AHLUWALIA: It is. Can you mention what’s the type?

DR. DAVID UNWIN: I can. Well, it all depends really on your bowel function. So do you want, are you hoping that the magnesium is constipating or laxative?

So if your bowels are a bit stubborn, then you’ll use citrate, probably. If your bowels are normal or loose anyway, and you don’t want that to happen, glycinate or taurate work very well.

So depending on the patient. So magnesium is actually great for insulin resistance because there are RCTs on that. So then I’m saying “How are your bowels?” “Well, I’m a bit constipated.” “Use citrate.” “They’re normal.” “Use taurate or glycinate” and get it on Amazon. Easy.

The Public Health Collaboration Conference

RINA AHLUWALIA: Last question for you. Your contribution towards the health of your bowel function has been a small contribution towards a public health collaboration. Can you explain what that is and why it’s important? And it’s happening this weekend.

DR. DAVID UNWIN: It is happening this weekend. So I think it was about 2016. There were 12 clinicians in the UK and we were so distressed by the quality, the poor quality of public health advice. We felt it was confusing. We thought it was often conflicted.

And so we set up a UK charity to try and bring clarity in the area of public health advice and that we would not take sponsorship from drug companies or from vitamin supplement providers or any of that.

So we tried to do a clean UK charity and I usually donate my speaker’s fees or I write a lot of I’ve written lots of articles for the Daily Mail our communist paper. So I usually do a conference every year and we rotate it around the UK and there are loads of videos on YouTube from that.

I’ve spoken every year and this year it’s in London and it starts on May and your podcast will come out after that.

RINA AHLUWALIA: After? But it happens every year.

DR. DAVID UNWIN: It happens every year and the YouTube stuff’s all there but anyway it’s every May and it’s happening this weekend and we as we’ve become more successful we’re getting more nutrition from all around the world and it’s a great privilege to be able to meet these people.

Last year we had Sean Baker he came to stay with me for two weeks.

RINA AHLUWALIA: Really? In Liverpool?

DR. DAVID UNWIN: Yeah. I drove him just to finish on Sean Baker. He’s big isn’t he? He’s six foot five.

RINA AHLUWALIA: He’s huge and I drive a Mini which is a little tiny car and I took him to our dry stone walls and took him to the north of England. I wanted him to see a British cathedral and things like that but then while I wanted what are all these walls and it’s our countryside is divided with ancient stone walls but he couldn’t believe the sheep.

He asked me to stop the car because he wanted to see the sheep because in America you don’t have them wandering around and I didn’t want him to feed because he eats a lot of meat.

RINA AHLUWALIA: A lot of meat. But if you give him enough he’ll eat once a day and get it over and done with.

DR. DAVID UNWIN: Absolutely.

RINA AHLUWALIA: Well Dr Unwin thank you so much for your time. It’s been a pleasure. If people want to find you more where can they find you?

DR. DAVID UNWIN: Twitter is my favourite thing. @lowcarbGP please.

RINA AHLUWALIA: Thank you for joining me today on this episode with Dr David Unwin discussing how we can reverse pre-diabetes and type 2 diabetes in our lives. If you want to learn from or enjoy these episodes please feel free to hit the subscribe button that is an excellent zero cost way to support our mission of root cause healing.

If you have a recommendation of a guest speaker that you would like to see on this health podcast please feel free to leave that in the YouTube comments as I check every single one. You can also follow me on Facebook and Instagram as well as my Facebook group.

And finally if you love this episode you will also love a different episode I did with Dr Tony Hampton. He discusses the number one way to reduce blood sugar and reverse diabetes. Dr Hampton helped reverse his wife’s diabetes and also his patient’s diabetes with diet.

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