Diet & Weight Magazine

Diet Doctor Podcast #33 – Dr. David Unwin

By Dietdoctor @DietDoctor1

He is a general practitioner taking care of patients and that's what he does and that's what he loves. And during this discussion you're going to see his journey, the journey he took from being sort of the standard general practitioner to noticing and implementing a low-carb lifestyle and the joy that brought back to him in his practice because he was seeing the improvement in this patients. It is a wonderful journey and I hope you can pick up on his joy and how this process led him to see medicine in a different light.

And how not only has he been helping the patient he sees, but now he has been taking on leadership roles and advisory roles to try and help others implement this. And it's a lesson we can all learn and hopefully you will take away from this the type of physician you should be looking for, but also how to interact with your physician if he or she is not of the caliber of Dr. Unwin.

It's a wonderful journey and I hope you will enjoy this discussion. For the transcripts please go to and you can also see all our past podcast episodes there as well. Thank you very much and enjoy this interview with Dr. David Unwin. Dr. David Unwin thank you so much for joining me on the DietDoctor podcast.

It's not really about money. You have a shining thing that you want to make a difference and then the years pass by and you sometimes wonder whether you are making much of a difference. And patients didn't look really very much better and during my time we'd had an eightfold increase in the number of people with diabetes so that didn't look... really a good reflection on me.

But she confronted me with, you know, "Dr. Unwin, surely you know that actually sugar is not a good thing for diabetes." "Yes, I do." But then she said, "But you've never once in all the years mentioned that really bread was sugar, did you." And, you know, I never did. I don't know what my excuse was. So this this lady had done this wonderful thing and she'd also changed her husband's life as well.

She'd sorted his diabetes out and she'd done it with a low-carb diet and that really made me think I didn't know much about it. I didn't know much about it. So I found out what she'd been on... on the low-carb forum of and to my amazement there was 40,000 people on there, all doing this amazing thing. And I was blown away but then I was very sad because the stories of the people online were full of doctors who are critical of these people's achievements.

And so I thought people with obesity and type 2 diabetes. It would be a great challenge and if we could help them that would be brilliant. And the next thing she said was, "Why don't we do this?" And I said, "Because we're not paid." And she's a great woman, she said, "So, we are not paid "and that's why you won't do this thing?

Shall we not just think our way around this?" So it was Jen's idea. She said, "First of all, why don't we work for free?" So we came up with the idea on a Monday night. The practice wasn't being used very much and my wife would work for free and I would work free. The partners wouldn't mind. And another idea was, why don't we do the people in groups of 20? We were very cautious at the beginning. So it wasn't just people with diabetes.

I was really concerned about the people with pre-diabetes. Because we'd just started screening for them, so we knew who they were, but we weren't doing anything for them so it was ridiculous, because we knew who they were and we were just sort of waiting until they would develop diabetes.

So we bought each one of them a book on low-carb and then we did cookery lessons together on a Monday night. I remember we did like- how fast can Dr. Unwin make leek soup? So it's about three and half minutes, that sorts of things. So we did it in a group with the patients. And I was so surprised because I had such fun.

And they were very kind to me and then I started seeing them improve which happened quite rapidly.

And I thought what I was doing was not really part of the guidelines, but you know I hadn't really read the guidelines, not all of them, because they go on pages and pages. So because I felt vulnerable, I thought I'd read every word of the guidelines. And then inside the NICE guidelines in the UK I found some pure gold.

So why don't you go away and come back when you can really explain-" Yeah, she said, "When you can really explain it to a plumber, to a student to other GPs." So I am very grateful to Cottee because she was absolutely right. I was a low-carb bore and GI and all this. So I really started thinking about how would you communicate the effects on your blood glucose of eating foods with carbohydrate in.

How can we help people understand the glycemic consequences of their dietary choices? And I came up with an idea. The first thing really was why was it so confusing? Why did people not understand it? Now I decided it was because people are not really familiar with glucose, because a glycemic index and the glycemic load always works out to grams of glucose. So this amount of food is equivalent to so many grams of glucose as a glycemic load. And really I don't think doctors or patients are very familiar with glucose as a substance.

They wouldn't know what it looks like. So I was looking for something that patients and doctors would understand and would be familiar to them. So I thought I wonder whether it would be valid to redo the calculations in terms of something we are familiar with which is a 4 g standard teaspoon of table sugar.

And I was asking for help... "Is my idea valid and will you help me?" And she said, "I don't know, but I know somebody that will help you." And that was Dr. Jeffrey Livesey who was one of the academics who would work with her on the glycemic index and glycemic load and Jeffrey has helped me. And so he redid the calculations for 800 foods.

And they don't know how- and previously I didn't know how to explain this, but now I can say, "Well, let's look at what you're eating." And then if you are having a takeaway the rice would- no wonder, or if you take boiled potatoes, 150 g, that's about 90 spoons of sugar. Or even a small slice of healthy whole meal brown bread is the same as three teaspoons of sugar. So you can begin to see that some items in your diet may not be a great choice if you have type 2 diabetes.

And that original case that showed me you could put into remission; if you could repeat that, how wonderful for people... And when I now- because I think we've done 60 patients who put their type 2 diabetes into remission. So I'm able to say with confidence to people, you know, you stand a good chance. In fact I can say that of my patients who take up low-carb, about 45% of them will put their diabetes into remission which is amazing.

And I was discovering that I could take- I could stop lots of drugs that I had them on for hypertension. So every week I was stopping amlodipine, perindopril, lots of drugs that they were on to keep them safe because I worried that they would faint if they stood up. So imagine how that is for a doctor after 25 years... it wasn't just about diabetes, it started broadening out. So we had their blood pressure, the weight, they were losing significant weight particular off the belly, they really liked that, their belly was going down.

Triglycerides were another thing. I had worried about triglycerides for years and I never knew what to say to patients, because you did the blood test and the triglycerides were sky-high, but I never really knew why. And of course there's no real drug for triglycerides, so what would you say? And I'm embarrassed to say I used to fudge it. I'd say, "It's a bit high.

You probably need to lose a little bit of weight. And we'll redo again in six months and hope another doctor did the test in six months. Why did triglyceride matter? But I found it dropping significantly. And another thing, I don't know whether you've noticed this. Have you noticed? The first change I see in people is that their skin improves. That's nearly one of the first things within a couple weeks sometimes. Their skin improves and another thing is their eyes look bigger.

If you go down the street, how many would strike you as a really strikingly healthy animal? Not very many... Isn't that odd? And yet wild animals on the whole do look healthy and you could say, "Maybe it's because the wild animals are all just young and the people I'm seeing in the street are mainly old", but that's not true because I started to notice even 30-year-olds who should be in the prime of life who were looking obese, with poor skin, they didn't look healthy and didn't look happy either.

And so I used to think that this is really odd because human beings are not looking healthy. And suddenly I had this thing that they were looking healthy and not only did they look healthy, they felt healthy. And another thing I noticed at the beginning was people- So the average patient I'm dealing with weighs 100 kilos and they are not exercising.

And now human beings were beginning to look pretty good and I thought, "I'm onto something here." But one of the things was I didn't know any other doctors who were like us. Completely alone at the beginning.

And then I knew that what I was doing was making some health professionals uncomfortable and I remember one meeting- after I got my first paper published I went to a big diabetes convention and the doctors stood up and absolutely shouted at me and said that what I was doing was dangerous and people would come to harm and I should stop it. He was shouting at me. And other people when they heard my name would just turn their back on me.

So if you can convince the Royal Colleges what you do is reasonable and if there is published evidence for this then they are going to listen to you. One of the things I'd say to other doctors right at the beginning is keep data. So one of the things I did at the beginning knowing that what we did at Norwood Avenue, that's the practice, was a bit odd, was I felt I owed it to the patients, really the patients, you can't experiment on them, you really got to do blood tests and keep the data.

So I started with an Excel spreadsheet. It's funny really, I owe all of this to Prof Roy Taylor who is very famous in the world of diabetes. Should I tell you the story of Roy Taylor?

But we need to do the statistics." I didn't know how to do statistics. And he said, "You need an Excel spreadsheet." I didn't know how to do an Excel spreadsheet. And I had to get my accountant to do an Excel spreadsheet for me because I didn't know how to do it. But that started me with the data. So I'd say to anybody if you collect data- so now I know on average with the patients I'm doing, I know what's happening to them.

When you start doing data is a bit laborious and time-consuming on top of your day job but soon it becomes addictive. I love doing it now. So about twice a week I am loading my data to see how they are doing and see how the averages are coming on. But that really helped convince the Royal College. And then the other thing was we started making drug savings. I think I should know we were doing this.

It was actually... it was one- so we are organized in the UK... GPs are organized into groups of about 20. They are called CCGs. But then our CCG pharmacist contacted me one day and said, "Do you realize you're way below average for our CCG? "Not only are you way below average, you are the cheapest practice per 1000 head of population in our CCG." And she said, "I think you're spending about £40,000 less every year on drugs for diabetes and is average for our area."

So I say, "Right, we could do this two ways. "I believe that I can help you with this with diet "and we need to start talking sugar and starchy carbs, or if that isn't your thing we can start drugs, lifelong medication." But, you know, not a single patient, not one in all these years has asked for the drugs.

And that is... the first thing is giving patients hope. It's a really interesting subject, the subject of hope and how do we give people hope of a better future and asking about their goals. The next thing is feedback is absolutely central to behavior change, isn't it? So I don't know any of the listeners who have seen my Twitter stuff but I do this graph of the week.

So the computer systems generate graphs; so weight, hemoglobin... So every week- this is the patient that has done the best and those patients are so proud. So I always put it on Twitter. But what wonderful feedback that is!

Because that feedback is like oxygen to that patient and the doctor too, because you're wondering whether you're doing a good things so I think it's worth doing a few more blood tests. So as part of the contract for the patient with me... okay, you don't want to have drugs... great. Would you mind having a few more blood tests? And generally on the whole they don't.

And that involves really taking on board behavior change and people's personal goals. Now what is their goal? You've got to talk to patients to find out what are they hoping for. And again the Royal College of Gen. practitioners is really committed now to collaborating with patients because you can't solve- One of the big things we've got is multiple morbidity.

People then got not one thing wrong or two or three, they've got four or five things. You can't possibly sort out multiple morbidity without working with patients and their goals. And as I say I think the British Royal College of Gen. practitioners is way ahead in the world because they are the only people talking about collaborating with patients, working with patients.

And then this doctor comes along and starts saying, "What are you doing? You should be doing it this way. And why don't you do this as well and why don't you run groups as well?" I really understand how difficult it is if you're very tired to start taking on because equally, how about heart disease, how about so many other subjects on that? So any GPs out there that I've annoyed I'm sorry, I apologize.

Insulin pushes glucose into cells to get rid of it and it pushes glucose into your muscle cells for energy, which is fair enough. But maybe you're taking in more glucose than you need for energy. What happens to the rest of it? And that glucose is being pushed into your belly fat to make you fatter and it's being pushed into your liver to make into triglyceride and could give you fatty liver.

And anybody with a big belly in middle-age is beginning to understand that maybe the toast, the rice, whatever, might have something to do with the big belly. And so what I'm saying to them... They've got a little hook in their own lives to think, "Maybe he is telling the truth."

And then if they take my advice and the belly gets smaller they think, Dr. Unwin might have made a good point. So I think this idea of really thinking about communicating with people in 10 minutes, to give them information that is relevant to the goals that they have. So if you want to get rid of your belly I can talk about getting rid of belly fat, or people want all sorts of different things but let's talk about physiology. And particularly if you relate diet to physiology, it becomes more powerful.

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