Fatty Liver Expert: Your Liver Is Filling With Fat Right Now - Dr David Unwin

Your waist should be less than half your height. So half of that string should go around the fattest bit of your belly. And this is a really simple test for everybody at home. I mean, it's not police. Just any of past. But fat on your belly is more worrying than fat on your legs or on your arms. And unfortunately, we've started to normalise things like the dad bod without realising that isn't how you're supposed to be. And maybe a third of all the people in the world with type 2 diabetes don't even know they have it. But every year that you have poorly controlled type 2 diabetes, you're losing 100 days of life. And it's because people don't know the truth being fooled with the packaging and advertising. So let's talk about the food we have on this table. Because this is how much sugar I would have thought was in all of these things here. Serial, potato, white rice, a banana and a chocolate bar. So now I'm going to give you the correct figure. The cornflakes is 1, 2, 3, 4, 5, 6, 7, 8. That chocolate bar is 7 and a half. The banana, that's 6. And then the potato is actually. Oh my gosh. And then 150 grams of boiled rice is... Oh, f***. I thought rice was healthy. But each of us has a number of different health futures. And what I'm interested in is how do I get you to pick a lifestyle that will get you the future you want? Because my job is about behavior change. The floor is yours. Alright, so off we go. Guys, I've got a favor to ask before this episode begins. The algorithm, if you follow a show, will deliver you the best episodes from that show very prominently in your feed. So when we have our best episodes on this show, the most shared episodes, the most rated episodes, I would love you to know. And the simple way for you to know that is to hit that follow button. But also, it's the simple, easy, free thing that you can do to help us make the show better. I would be hugely grateful if you could take a minute on the app you're listening to this on right now and hit that follow button. Thank you so, so, so much. Dr. David Unwin. You were named in 2018 among the top 10 most influential doctors in the United Kingdom. You've got an incredible list of accomplishments and you're held in the highest regard. Maybe of all the doctors I've ever had the chance to speak to by many people that I've spoken to. We were talking before we started recording about what's on your mind and what's been bothering you. And so the floor is yours. What is front of mind for you, Dr. David? What's front of mind for me is the idea that each of us has a number of different health futures. So you have. So in your future, I don't know, there could be cancer. There could be multiple sclerosis or there could be many futures. What I'm interested in is how do I get you to pick a lifestyle that will get you the future you want? And I think that's very difficult in the world now to know what is the best lifestyle because you've given so much conflicting advice. And the particular focus for me in terms of picking health futures is around young people because they've got the longest time to make a difference and it's getting harder and harder and harder to make good health choices in your lifestyle. It's really hard. I'd say it's a pandemic of poor metabolic health. Yesterday in clinic, I saw two people under the age of 25 who had public controlled diabetes and one of them was too heavy for me actually to weigh. And this situation is completely new. So when I was a young doctor and just starting off in practice, that was in 1986. Wow. A nice and long time ago, just north of Liverpool in the practice I'm still there now. The obesity was rare and we didn't have a single case of type two diabetes in anybody under 55. Not a single case. It was quite unknown. And in fact, type two diabetes had a different name. We've had to change the name because of the epidemic used to be called maturity onset diabetes. That meant old people, right? Now we call it type two diabetes because we have to include so many young people. It's really, really serious because people are losing their life expectancy. And I'm witnessing this. We're all sleepwalking into a metabolic disaster and the people praying the greatest price in my opinion are young people and it's a scandal. And I'm hopping mad really. I think we've started to normalize the dad bod. You know, the big tummy and ha ha without realizing that maybe that isn't how you're supposed to be. So that's what's on my mind. Young people and their future and they don't even know. You say young people there because they've got the biggest opportunity to change the trajectory of their future. Yes. But for the audience who's listening, that might be in their 50s now. Is this advice also applicable? Absolutely. So we know from government figures, UK government figures that for every year that you have poorly controlled type two diabetes, you're losing 100 days of life. That's about a third of a year, isn't it? So whatever age you are, if you have poorly controlled diabetes, you're losing life expectancy and maybe a third of all the people in the world with type two diabetes don't even know they have it. Because they haven't taken a test so they don't know. What do you think kills people with type two diabetes? Is it some cardiovascular issue? Yeah, well done. You don't mean to medical school, you don't know. That most doctors, that's what they'd say because we know that a high blood sugar over time damages your arteries. So it's a cumulative thing over time. But what you may not know is that actually a rising cause of mortality for people with diabetes is cancer. Oh really? So eight forms of cancer are strongly associated with diabetes. I want to just define that term diabetes because I think I went through a lot of my life assuming that diabetes was a disease that some people are born with and because I didn't have it, I thought I didn't need to worry about that. That's really important. So first of all is type one diabetes and type two. But before I can explain about diabetes, I need to explain about insulin. This is absolutely key to our whole discussion. So I've already said that a high blood sugar damages your arteries. And in fact, there's work to show that a very high blood sugar damages the non-stick lining of your arteries within six hours. Oh wow. Really quick. Call it glyco-calix, the non-stick lining. And damage is occurring very quickly. I'm going to ask you a really stupid question. When you say high blood sugar, I get high blood sugar when I eat lots of sugar. Okay. So first of all, we're actually talking about glucose. Yeah. And sugar can mean table sugar or it could mean many different things. But we're actually talking about blood glucose. Which comes from lots of foods. Which comes from many foods. Carbohydrate heavy foods. Yes. Yes, it does. It does. So that's right. But you have the hormone insulin to defend you from poor dietary choices. So the question is, what does insulin do with the sugar you just ate? And here's the answer. Insulin, the hormone insulin produced by a pancreas gland, it pushes the sugar and it pushes it out of the bloodstream inside cells, where it can be used for energy for you to run around. But what if you take in more carbohydrate than you need to run around? Well, then that sugar is turned to fat inside cells. Because it's safer for you to turn that sugar into fat than it is to have it damaging your arteries. So I am somebody with type 2 diabetes so we can talk about me. So I had a really heavy biscuit habit. I was a senior partner of the practice and it's stressful. And I had patients used to bring me biscuits all the time as a gift, because they want the doctor to be happy. So in the drawer in the top of my desk was packets and packets of biscuits. So I'm taking in more sugar and I didn't run around. And gradually my waist got bigger. And what was actually happening was, as I took in more sugar than I needed to run around, my insulin was working to get rid of that sugar. And it was giving me two things, one, a belly. And I thought it's just middle-aged spread, you know? And the other was I didn't know, but my liver was filling with fat. And that is very common now. Well, it's the third of everybody in the developed world has fatty liver now. Here we got the wonderful props. Let's talk about these. Great. So fatty liver, this is the healthy liver here. And you see the colour. Look at this one. It's yellow, it's the wrong colour. And it's because of fat. So in that case, like has happened to me over years, my liver began to fill with fat. Because it was essentially overworked and glucose was being stored there? Yes. So I was taking in too much glucose. Insulin was doing its good job of taking it out of my bloodstream and forcing it inside cells in my belly, but unfortunately in my liver. And so there's a progressive laying down of fat in the liver. So if we look at actually some proper liver, so this is the, put on your seat belts now, because this is somebody's actual liver. So then that's the normal liver. But look at this, it's larger. That's a real human liver. Yes, these are human livers, and that's as it should be. But this look at this liver is larger. And it's larger because there's so much fat in it. Now the twist in the story is fatty liver interferes with the good work of insulin. So you develop a thing called insulin resistance, which means your insulin is no longer as powerful as it was. It's beginning to become difficult for you to deal with carbohydrate and sugar, because your insulin isn't working as well. And the only way to deal with that is the next twist in the story. You have to start producing more insulin. Do you see? Because it doesn't work as well. So your pancreas has to crank up the supply. We need more insulin. So now you have two things you have. Insulin resistance, your insulin isn't working as well. But at the same time, you're trying to produce more insulin in the pancreas. This bit's called the Long Silence Scream from the liver. This is worked by Professor Roy Taylor, a friend of mine at Newcastle University. And he pointed out that you've got fatty liver for about 10 years. You don't even know. You wouldn't know that you've liver's gone fatty and yellow like that. But unfortunately, this is another twist. Fat is being laid down in the pancreas gland, the very gland that your life depends upon producing insulin and your ability to produce enough insulin collapses. And at that point, you can't regulate blood sugar anymore. But upstream of that, you have a problem. You've got that. But you don't even know. You're talking about what's in my mind. Why are we waiting until you actually have all the problems of type 2 diabetes? So since 2013, I've got hundreds of patients and I'm monitoring the baseline and latest follow-up. So what happens to them? It's really important. And now I have a huge data set that I can interrogate and answer questions. So number one question. Let's think about prediabetes. So this is in the Long Silence Scream. Well, I can tell you that the people with prediabetes in my practice north of Liverpool, 93% of them will get a completely normal blood sugar if they go low carb, 93% resolution, and that will last for years because I've checked. Okay. How about we wait for the 10 years until Steven, you've got type 2 diabetes and then you go low carb? At that point, if I can get you early, I've got a 73% chance of you having a normal blood sugar. Let's wait another few years because you don't want to give up bread and you don't want to give up chips and pizza. There enough. I'll wait. But if we wait five years, you only stand a 50% chance. So do you see it goes 93% over 70%, 50%, so the chances of me not needing drugs and be able to do a good job for you are diminishing. So really, it's a stitch in time. And so much of this, you don't even know. You don't even know it's going on. One of the things that shocks me is how little we know about what's in our food. Yes. You know, because I think we all know that biscuits are a food that has a high glycemic index. Well done. Which is a term that I've learned from this podcast. Yes. So that's the glycemic index. What that is doing is comparing different carbohydrates with pure glucose. Oh, okay. So you see pure glucose is 100 and then other sugars come further down. But there is something better than the glycemic index. And that's called the glycemic load. The glycemic load takes portions of food and predicts how will that portion of food actually affect your blood sugar? And am I right in thinking the glycemic load would factor in the amount of nutrients in the food? Exactly. So like protein fiber. Yeah. Because if you took watermelon, well, it's mainly water, isn't it? So you have to factor in. You can have quite a lot of watermelon to equal a chocolate bar. So the density, you're looking at the density of sugar in it as well. Okay. So that's why the glycemic load is better. Was there a moment in your career where you started to question what you'd been told? Yeah. You know, so you start as a young doctor. I wanted to be part of a small community and stay there. And make a difference. And then comes the sad bit really. So for the first 25 years, I was trying to do what's in the guidelines. I was trying to be a good doctor. But what I noticed, I noticed two things. Number one, I noticed what I've already said to you that the health of the population I cared for was deteriorating. It wasn't getting better. So if I'm the doctor in charge of the practice looking after these people and health is deteriorating, am I not responsible? And where is all this difference I was hoping to make? It just wasn't panning out. At the same time, I'd always in my heart felt that prescribing lots of drugs felt a bit wrong. It felt like a mini failure because how is somebody well if they're taking six tablets a day? Was there one particular patient that you met? There were two. Two things happened. Both to do with very powerful women. The first powerful woman was a lady I'd known for over ten years. She and a husband I'd cared for them both. They both had poorly controlled diabetes and they were both very heavy. At the time, I could monitor how compliant my patients were with their medication. And if I had to be truthful, in part, that was how I was paid. Part of my payment was to do with other patients having, in this case, metformin, the most commonly used drug for type 2 diabetes. I think that's a good payment. Yeah, I would be honest, because you're supposed to, the government approve of the fact that we give drugs that are needed for type 2 diabetes, so that you're given a sort of quota where it's regarded as good practice that such a certain percentage of your patients will be on metformin. What? Yeah, it's true. So is it fair to say that you were somewhat incentivized to give people metformin? That would be true. But I think we should also be fair to say that the body of evidence at the time would say that it's good practice to give metformin to people with type 2 diabetes. And conversely, poor practice is not to use metformin, but we'll develop that. So the backdrop is we're monitoring the patients who stop taking them at forming, because that is number 1, poor practice and number 2 actually costs me. So I wrote to the person, Dear Mrs Son, so I'm concerned that you don't seem to be taking your metformin, please make an appointment with me at your earliest convenience, very British, very polite. Anyway, nothing prepared me for what was going to happen that morning and it's changed my entire life on that point. So the lady, let's call her Mrs Jones, that wasn't her. She marches in and she said to me, you think you're going to tell me off, don't you, Dr. Unring? Well, I've got news for you. I'm going to tell you off. I was scared like what's going on. She's never been like this before. She was a polite person. Anyway, she went on to explain, she said, when you do my blood tests, you will find that my blood glucose is completely normal despite not taking your metformin. And she said, I'm wondering if you're actually qualified as a doctor, because in the last 10 years, did you ever once tell me that bread was sugar or breakfast cereals were sugar? I had to learn online that bread is sugar, that rice is sugar, the breakfast cereals are sugar. And when I cut those foods, I don't need your metformin now. And she went, she made it worse. She said, this is schoolboy biology. You should have learnt that when you were 16. I was dead scared because you know, complaints as a GP, it's really bad, they gone for years and years. But mainly I was scared because every word she said was true. And one thing I had learned about when you're an older doctor is you got to listen to people properly. If they're complaining, don't deny it, don't defend yourself, take it. So I said, okay, I want to learn what you, you know, if this is true, will you meet me again? Let's do the blood test. So we did the blood test, it was true. It was the first case of drug-free type two diabetes I had ever seen. I've never seen a single case in 25 years where people came off medication. I was fascinated because she'd done it like a miracle. But it was another detail I just share with you. She was one of 40,000 people online learning from each other how to do it. And when I looked, they were being rubbish by the healthcare professionals. So people like me were telling them you'll die, what you're doing is dangerous. And I was ashamed, really ashamed. And it's complete coincidence. But in the same month, we have to introduce my wife, Jen. Is there a photo? Come on, let's see Jen. She's probably the cleverest woman in the world. She's so clever, I love that woman. So Jen, so her back, she is a clinical health psychologist. And she specializes, she's fascinated by the role of hope in disease and the difference it can make. She spent her life researching the difference that hope makes the clinical outcomes. So it just so happened that she was in a supermarket and she saw a discounted diet book. That's the book. Escaped the diet book to John Griffith. Yeah, Dr. John Griffith, what a lovely guy. So Jen bought that book just around the time I'm telling her about this patient. So she said, you have to read this book about a low carbohydrate approach to insulin resistance, to type 2 diabetes. And in the book, everything that my patient had told me was there. But it was done in a medical way and I understood. She said, David, why are you sort of failing? Why don't you do one thing before you retire? Why can't you do a cheerful something you really believe in? Why don't you have a go at this low carb? You're self. Yeah, she said, why don't you and me go on this diet for see if some patients would volunteer and do it with us? And I mentioned it to the partners and they said no. These are other doctors. Yeah, so I'm senior partner. I'm supposedly the boss. But the time low carb was not respectable and they didn't like it. And they said, we don't want you to do this. And partly because they said, well, how is that a good use of the resources of the practice? Because if you're doing this, David, maybe you're not treating chest infections or other things. It's pressure on the health service. So this felt a bit, they felt it was a bit self-indulgent. So I got back to my wife and said, the partners say no. And she said, I'll tell you what we're going to do. We're both going to work for free and we'll do it. Why don't we do this in our own time in an evening when the practice no resources? So that's exactly what we did. We found 18 volunteers who were interested amongst the patients. And then Jen and I, so that was 20 others. We started meeting every Monday night, talking about low carb, learning, how do you cook stuff, how do you do it? We did it together. And one of the nurses was so excited. Heather is her name. Let's give her a thumbs up to Heather. Heather said, I'll work for free. I'll help you. I'd love to do this. I want to believe in what I do. And then the magic begins. The results, I couldn't believe it. I could not, you know, I'd never seen anything like it. And the first thing I saw was the liver function improving. You see, because I'm doing blood tests, because I know I'm doing something weird. I'm doing something that I would be criticized for. So if you're going to do a weird thing, you need to measure stuff. You can't, you know, it's these patients. So you can't just experiment and not be, am I doing harm? What's happening to the cholesterol and the lipid profiles? So I was monitoring stuff really closely. The liver function though, Stephen. I got people who I thought they were drinking alcohol. And I thought the liver problem was due to alcohol. And they'd had abnormal liver function for 10 years. And suddenly, within weeks, the liver function was improving often by a third of 50%. I was so excited. Can you imagine I'm sitting there? And the laboratory results are coming in. And they're like, wow. And then another and another. So that was the first thing. Then the wait to all meeting every Monday night. And we got the scales and everybody gets weighed every Monday night. And the wait started falling off people. It really did. And then all sorts of other weird stuff started happening, some of which I couldn't make sense of for years. The first one was, people said, are you hungry because I'm not? And they started saying things like, do you have to eat breakfast? And I also, I wasn't hungry. I wasn't hungry. They were telling me the truth because I was experiencing this with them. Why are we not hungry? That's so odd. And I was not bothering with breakfast, so I didn't eat it. You don't have to have it. I'm a belly went away. The next thing was, I noticed when I stood up from my desk, I felt dizzy, weird. Now, I hadn't told anybody, but I had moderate high blood pressure for years. But I didn't like to be a patient, so I never went to a doctor. I just put my head in the sun, so I had high blood pressure for years. When it took my blood pressure, it was low normal. Why? I didn't know. But on the patients as well, I'm doing that as well. I'm measuring all the blood pressure and it's improving. So it's getting weirder and we don't live a function improving. Weight going down. Blood pressure improving. In those days, we were, the blood test that we did was the thing called a hemoglobin A1C. This is the average sugariness of your blood for the preceding three months, so the results take a while. But then, when the hemoglobin A1C came in there, we were getting really spectacular improvements in average blood sugar. And that's kind of how it began, so that's 2013, so that's 13 years ago. And the rest is history, but I was completely blown away. And I was full of curiosity about all these other things and how was it? Why were these things improving? So in those 13 years, how has your fitness, your health changed? My mental powers were much greater. I could concentrate better. I wasn't fretty, so I noticed that. The next thing I noticed was I needed a lot less sleep. So yeah, in the beginning, I used to have to have a little sleep on my doctor's couch every lunchtime. So I was seeing your partner, so you pressed, do not disturb, and you put the curtains around and have a little nap on my own couch for 20 minutes. There was only way I could get through the day. I didn't need that nap anymore. I was less sleepy. I needed an hour's less sleep a day. I could think better. I could cope with the same problems. And this is so weird. But mentally I was stronger. It was like being a younger man. The way... I don't know, I think you have a sense of mental horsepower. Going back to the topic of this conversation, you talked about how everybody listening right now has a variety of different health futures. And which health future they end up in is going to be determined by the everyday decisions they make. Yes, yes. So I want to really zoom in on some of those everyday decisions. We talked about you and your biscuits. And at the time you said you were probably quite sad and triaged a doctor sitting in a chair, patients coming in. You weren't doing exercise? No, I didn't fundamentally believe it would make that much difference. And this is such a great point, you have a really great point. So let's think about weight loss. So I would give advice on weight loss to my patients. And I would say eat less and move more. And I'd even sometimes say that belson thing. You know, no fat people came out of belson. I've never heard that. But it's a horrible thing to say to a patient, isn't it? What's belson? Well, that's in World War II where they all starved. Oh, okay. So the point is you're saying to somebody with an obesity problem. It's awful. Yes, you're blaming them. That's exactly the point. And that's what I did. And it's worse than that because I give them that advice and it just about never works. I did a horrible thing. I used to say to them right. So why don't you just have two tablespoons of all-brand a day? Oh, breakfast cereal. Yeah. With skimmed milk. And I would advise a few multivitamins. And a couple of pints of skimmed milk a day. That was my advice. And then when it didn't work, who do you think I blamed? Yeah. And this was all part of my epiphany. I never joined the dots that the failure was not theirs. It was mine. And that's horrible, isn't it? Imagine 25 years of I was blaming patients for their failure to lose weight. And it was my failure because I didn't give them advice that worked. And if you keep giving the same advice to people and it doesn't work, shouldn't I have questioned, but isn't that happening in society overall? How are we doing? How are we doing with health? How's it going? So disaster, isn't it? So we need to do something different. But for me, for 25 years, I did not believe that lifestyle was key and now I do. And that's why I didn't think that the biscuits made that much difference. Obviously, I knew basic nutrition, so I made sure there's protein and there's iron and stuff. I fundamentally believed that drugs is what I should be using, medication, and that lifestyle was a sort of add-on. Isn't that terrible? I think this is so important because it really gets to what I believe the average person thinks as well. We were talking before we started recording about some of my friends. There's two friends I mentioned. One of them is a very, very successful businessman. Everybody knows who this person is. And they asked me this weekend as pizza healthy. And I just couldn't believe... It's my... Oh, what pizza are we? Because they were trying to choose between... They usually have a big 12-inch pizza for lunch. And he was asking me, what's healthiest, Steven? Nando's chicken or this 12-inch pizza he was going to get. And I literally looked at him like I was looking at a ghost. I was like, you winding me up. And he was genuinely serious. For me, 60 years old now. And he doesn't know if a chicken breast is healthier than a 12-inch pizza. And the other example that I mentioned before we started recording is a very famous Premier League football superstar legend who you would assume had gone through those sort of 15, 20 years of being an academy player and then a pro athlete knows what has sugar in and what doesn't. And he was asking me, is a big spaghetti carbonara is that healthy? Is that a health food? Because he said to me during his football years, they were told always to carload. And again, this... It gave me a huge amount of empathy because it made me realize how... Even though there's podcasts like this where we talk so much about health and even though there's the internet now, this information is not getting through to the average person for some reason. And they too, I believe, but think exactly what you just said. That health is, you know, it's this sort of accessory where my fate is determined anyway. And if I do this health stuff, which is a bit of an inconvenience because these Percy pigs taste great or these candies taste great, then I might be able to look a little bit better, a little bit more aesthetically pleasing, but my fate is determined. The simple point here in nutrition, we're not teaching it. So there's only three macronutrients. There's only protein, fats and carbohydrate. And yet your friends there haven't even got the three macronutrients. And they are successful, intelligent people. So somewhere we're going badly wrong, aren't we? There was another example that's really fun to mind to me, which was, you know, I'm in drag and stand at the moment and someone came in and pitched a fruit snack business. And it's basically dried out fruit pieces. Now I look back. I'm loving this already. Yeah. I looked at the back. Yes. And it said, in the range of 60 to 70% sugar, because what they've done is they've taken exotic fruits like mangoes, dried them out, and now you have this little chip, which is this piece of mango, 60, 70% sugar. So I'm looking at the back of this thing, thinking, this is candy. Yeah. This is basically candy. Thank you. But I'm looking at around and every, because it, because it uses the word fruit. Yes. People have this sort of halo assumption that if the word fruit is on it, fruit juice, fruit snack. It's a little sell. Yeah. And also it's a sort of who cares about the consequence, but we'll make a pile of money selling dried up fruit. And they miss what you read on the back. Yeah. It's 60 to 70%. Is that okay? How's that? You know, what if somebody had typed you that? What for kids will just give them? Yeah. And you've touched another thing about what's going wrong. So when we look at my practice in this epidemic, and really, as I've said already, it's not an epidemic. It's a pandemic. It's everywhere. I go all over the world. And obesity, type 2 diabetes, poor metabolic health is in it. It's everywhere. It's everywhere. And I think one of the things, touching on what you just said, is so you wake up and you have your cereals for breakfast. If you've got some here. Which we have some cereals there. And then you'll have, why don't you have a big glass of fresh orange juice as well? Great idea. And then you're okay. That's your breakfast. But then on the way in, you have a little snack and people do. They buy a bar or some crisps or something like that. And then even at school, they might get a muffin mid-morning. It's firey enough. They might then have an apple. A lunch time, you're going to have some sandwiches. And then you've eaten your sandwich so you'll, I don't know, you might have a cake or something or some ice cream. And then you'll go home and then it's time for you know, maybe your chips or your pizza. What you've actually done is has sugar with your sugar, with your sugar, sugar, sugar, sugar, sugar all day long. There's hardly any protein going back then to those, where was the protein to grow you? You know, and that's the thing that's changed over time, that we are the snacking. So I come across a lot of young people, and their mother is saying, I can't get him to eat any proper food. He just eats snacks all day long. And it won't, I can't, they can't get protein in them. And some of them are actually thin kids. They're not all fat. Let's talk about what you just said there. And we can walk through the day using the food we have on this table. Now I just want to caution that we do have some people that are probably out walking their dog listening and can't see. So we're going to have to do a bit of a voiceover. Okay. As to what's going on. But you said wake up in the morning, you have your cereal. Yeah. Now cereal growing up, I thought was a health food. Me too. Yeah. Me too. How much sugar is in the average standard bowl of, let's say, frosted cereal? Well, we can do this different way, Steven. This is actually like a test for you laid out here. Oh gosh, is that for you? Yeah, this is a test for you, and I'll describe it. Okay. So what you've got, you've got a bowl of, we'll call them their cornflakes. Then you've got a potato, a baked potato. It isn't baked yet, but you could bake it if you want. You've got 150 grams, and this is boiled rice. So it's not dry, it's boiled rice. You've got a very ripe banana. And at the end there, you've got a delicious looking chocolate bar. Yeah. So you've got there some cubes of sugar. And this is the test bit, you can see, as to how I'm going to give you, we'll score you in the end. Okay. So what I'd like you to do is consider these relatively, and each of those cubes of sugar represents a four gram teaspoon of sugar. Yeah. So if you could now just go along these and put beside each food, what you believe to be the equivalent in terms of teaspoons of sugar, and then I'll give you a score and see how you do. And those are the answers, so I'm going to turn it down so you don't cheat. Okay. So I'm going to score them as I would have thought two years ago. Thank you. Yes. Because I've interviewed a lot of experts, so I'm generally quite shocked by all these things, but I'm going to score them as I would have thought when I was 31 years old two years ago. Yes, that's great. Serial, honestly. Yeah. And there's no sugar on it. It's not a sugar cereal, it's just the dry flakes. I honestly didn't think there was sugar in that. Yeah. So if you had pushed me, I wouldn't... Well, give it one, eh? I'll give it one. Thank you. But I didn't think there was sugar in that. One. Again, a potato. I didn't think there was any sugar in a potato. So even giving it one feels like I'm lying because I didn't think there was sugar in my state. And I'll be honest, rice. I didn't think there was any sugar in rice. Okay. A banana. It tastes sweet. Yes. So my brain would have said one. Yeah. But this chocolate bar that's in front of me, I would have said, I'm going to say two. Okay. Two or... I'm going to say three. Right. I'm going to say three. I actually think it was two, but... Right. That's how much sugar I would have thought was in all of these things here. Serial, potato, white rice, a banana, and a chocolate bar. Right. Well, to be fair, I still kind of do. But I know better. Okay. So now I'm going to give you the correct figure. Now, this is worked out from the glycemic load that we already discussed. So I explained about the glycemic load. And then, so in clinical practice, I had a problem. My problem was in ten minutes trying to explain to you how you could eat differently and why you should eat differently. And so I needed a way of quickly communicating with children, with old people, with a teacher, the consequences of dietary choices. So I came up with a new idea, which was, why don't we represent the glycemic load? And instead of using grams of glucose, which nobody understands, and what's glucose anyway, instead of doing that, we re-did the calculations, re-doing it for T-4 gram teaspoons of sugar. And that's my teaspoon of sugar equivalent system. And I'm using that now to give you the correct answer. Right. So the corn flakes is one, two, four, five, six, seven, and eight. One, two, three, four, five, six, seven, eight. With no frosting. No frosting, no milk, nothing. Potato, obviously it depends on its size. That's quite a big one. So that one is one, two, three, four, and there's more. Five, six, is nine. There they go. Nine. Is that nine? Yeah. Right. I'm going to leave the rice to last. That chocolate bar is actually, you could do it for me, is seven and a half. So you can give it seven, seven, seven. Now the banana depends on the size and how ripe it is. A ripe banana has more sugar in as you probably know when you eat it. But let's say that banana is quite a ripe one. It looks quite ripe. Let's say that's six because it's a big banana. Oh my gosh. Okay. Then the final one obviously is going to be their killer, isn't it? I thought rice was healthy. Well, I thought it was really healthy. It depends. So one, this is 150 grams of boiled rice, three, four, five, six, seven, eight, nine and ten. So that's the winner. And I would say that's the single fact around the world. So my teaspoon of sugar, there we are. That's one of my teaspoon of sugar charts. And what you've got there is the food, a glycemic index, the serving size and then the teaspoon of sugar there. So this is available. The public health collaboration is a charity. I help set up with Dr. Rangan Chatterjee. Ten years ago it's our 10th anniversary tomorrow. These infographics, they're actually far more than this. This is the seven more. They're available in 35 languages. Volunteers have translated this to go all over the world. It's not copyrighted. I want people to steal it, take it, use it. So the white rice fact I would say has astonished people all over the world and led to me becoming far better known. What about orange juice? A lot of them parents, including my parents, give me, gave me orange juice. And I used to think orange juice was a health food. So I would literally, I'd go to the fridge, I'd get open the sunny delight or whatever it was. Yeah, sunny delight. And I would drink that. And I think I'm going to be strong and big and my body's going to love me. Well, let's, so that there's a lot of sugar in orange juice. There's a lot of sugar in orange juice. And you've taken away all the, once you take it from the fruit as it was meant to be and you juice it, the sugar hit is fast. So what that does is if you think if we go back to insulin again. So you drink the orange juice, your blood sugar goes up rapidly. So your body responds rapidly with insulin. Then you, what happens, your blood sugar falls. But then you kind of hungry again. And that's what happened to me with the biscuits, wasn't it? I ate biscuits. My blood sugar is up. Then insulin comes in heavy and slow. But too much. Then I thought I was having a panic attack because I had no blood sugar. And what's the answer to that? More biscuits and round you go, round. And that's how without thinking you'd start the day, starting the day with a sugary breakfast, without enough protein in it, is driving hunger. And then you wonder why you're ravenously hungry at 10 o'clock? There was a few others that shocked me. One of them was, I was in Peru. And obviously, Peru is quite famous for chocolate because of the cocoa and all that stuff. And so he went to a chocolate making class. And he told us to make dark chocolate, normal chocolate, and then white chocolate. And when I made the white chocolate, this guy got me this big glass cylinder. And he goes, here's some white sugar. He goes pour it in. So, you know, I get it and I pour some in and I, and he goes, no, no, no, no, no, my friend pour it in. And I pour it and pour it and pour it and pour it and pour it and pour it and pour it and pour it and pour it. And I'm not kidding you. I feel like, and I have to check the facts here. So, community, you know, me on the screen, Barbs your team. I feel like I poured into this huge glass cylinder. Yeah. It 80% of white sugar. Yes. And then it's true. Yeah. And then he put some syrup in. What? This is white sugar. It was like some syrupy stuff. Yeah. And I was like, so white sugar. And so white chocolate is like 80% white sugar. Yeah. I've never eaten white chocolate since. Yeah. Ever. That's so important. So very often people think they're a chocolate. Like, that's really common that people say to me, I'm addicted to chocolate. If you look at, if you actually look at how much sugar there is in milk chocolate, you know, there's many teaspoons of sugar in milk chocolate. If you eat 90% dark chocolate, there's only about two teaspoons of sugar in a bar. And what you find with the chocolate, is I say, well, if you're addicted to chocolate, why don't you get a bigger hit and have the dark chocolate? And they say, oh, I couldn't eat that. It's too bitter. What they're actually addicted to is the sugar. What they're at. So I've done it. There is, for the folks at home, there is one of these sugar infographics on chocolate on that subject of chocolate because I want people to understand the consequences of what they do. So just to illustrate this, because I've just looked up the stats. I think this is what I saw. Yeah, just looked up the facts to make sure that everything is true. When I made that bar of white chocolate in Peru, this was the total ingredients. And this is how much sugar they asked me to put into it. I looked at it and thought, okay, so white chocolate is basically like 70% just pure white sugar and nobody knows. Yes, exactly. The other one I've got to be in my bonnet about is smoothies. Yes, I have one too. I thought smoothies were healthy. No, they're the, you know, I'm on X or Twitter quite a lot. And that's the kind of thing that fills me with rage. And I have to take a photo with like my... Look, there is sugar. There was, yeah, it fills me with rage. I've got another thing. This is fun. I've got a question. Right, Stephen. Why don't we take all the blood out of me? Right? There would be five liters. We could bleed me out right now. There would be five liters of blood in me. Let's get it in a bucket. All right, five liters of blood. How much sugar would be in that five liters of blood? I have no idea. But it's an interesting question, isn't it? Because it relates to the consequences of eating some of these things. So I would just like you to estimate. So if, let's say my blood sugar is normal, if you have a normal blood sugar, I would like you to guess how much sugar is there in my entire blood system? At one cup like this. Thank you. No. The answer is this. Let me show you. That is all there is. You're too keen. I am not. And do you see immediately... One sugar cube. And I'll do it on Twitter for you X. I can show you the calculations. So you see, if I have a banana, and I have diabetes, there's too much sugar for me. See, because glucose is number one vital, but number two toxic, if you have too much of it, the level of it in my blood is controlled minutely. Wow. It's controlled to this extent. And I think that single fact you didn't know that did you? It immediately shows you how it's so easy to have more sugar than you actually need. Given that. And if you're insulin stops working. So for me, I've done an awful lot of this. So I monitor my blood sugar with a continuous glucose monitor. And I get my blood sugar up on my phone. So I can check at any time what my blood sugar is and we'll do it in a minute and see. But you see, if I eat a banana, it doubles my blood sugar, because I can't regulate my blood sugar. Because of the diabetes? Yeah. So a whole banana is far too much for me, and will double my blood sugar. Because you see, if I'm only supposed to have this much, and I have that much, it's too much for me, and I feel ill. You know, I go out into the world and I speak to the people that listen to the show, and they're like taxi cab drivers. It's a lot of taxi. Do you know what? I've got this bias towards thinking that everybody that listens is a taxi cab driver. I've got this bias towards thinking that everybody that listens is a taxi cab driver, because I really only spend my time in the office or in a taxi. So I get lots of feedback from these cab drivers. And the average person out there listening now, they don't know how to check if the food they are eating is good or not, because the labels on these foods, I've got so obsessed by the marketing. Yes. And, you know, I was looking at this bag of sweets the other day and it said, made with real fruit juice, and they put it front and center, and I was almost tricked. So I can't imagine someone who, like me, who doesn't spend, I can't imagine someone who doesn't spend their time interviewing health experts, how easily the general public is being tricked. So what is your advice in terms of spotting this stuff? Like, what do I look at? Because right now I spend a lot of time looking at the sugar part. Yeah, that's great. There's different ways we can do this, and obviously this is how I spend every clinic. That's, I'm in clinic yesterday. This is what I'm doing. I'm trying to help people understand. It's sometimes easier to talk about what, maybe, what you would eat rather than what you wouldn't eat. So I, for somebody with insulin resistance or type 2 diabetes, I would tend to say, well, why don't you base your meal on protein? So what have you got in the fridge? Could it be chicken? Could it be eggs? What would it be? So that's your protein. Have loads of it. Then I'm thinking, right, green veg. What green veg would you tolerate? What green veg could you buy? It might be frozen beans. Or it might be salad or whatever. And then I'm saying, how would you make that green veg tasty? Poor barbecue sauce on the top. Ah, no. Full fat mayo. Full fat mayo. Or butter. Or olive oil. Or whatever. So that I say barbecue sauce because when I looked at the back of mine, I had the shock horror of realizing that there's... It's a common one. 30 sugar cubes in a bottle, a standard bottle of barbecue sauce. It's just putting sugar on top. It is. You have to be so vigilant. And I think to do it successfully, I'm quite interested in the idea of, could you eat real food? That's not in a packet. It's Russian roulette food out of packets. And yet I understand my patients' north of Liverpool. Where are they going to buy the stuff? So I try and help them with... You could do it that way. If you're going to eat stuff out of packets, you have to wise up. And you have to log out the carbohydrate content. And bear in mind every four grams is broadly equivalent to sugar. So if there's... If something's got a hundred grams of carbs in it, I've already said carbohydrate varies in how sugary it is. But it gives you an idea. It's very sugary. So you see the area made with the cornflakes, is there's no sugar there, but it's all carbohydrate. And it's a very sugary carbohydrate. So we need to just explain that for people, which is... When I looked at those cornflakes, the question I asked you is they're not frosted, so there's no sugar on them. But what the body is doing is it's converting the carbs into glucose. Right. I've got a good way. So we have to think of starchy carbs as actually glucose molecules holding hands. Okay. And then digestion comes along and breaks down... They're not holding hands anymore and they become free sugar again. Because we think if it's not sweet, it's not glucose. Exactly. Exactly. So what I went to school was this thing where you chew bread for ages and then you could see if it became sweet or it turned into sugar. It's a schoolboy experiment that's done a lot to prove that the amylase, the enzyme in spit, turns starch into sugar. But that's the point. Starch is soon to be sugar. Glucose holding hands. Yeah. And when it holds hands, it's not sweet. But then when you digest it... Exactly. And that is broadly what... And you're not alone because didn't I make that error? Isn't that what the lady in 2012? That's what she was so furious that I was making. So here we are, senior partner of a large practice had forgotten that starch was sugar and we come full circle because and so many other people... They... patients say to me, Dr. Amin, I know not to have sugary things. I've given up sugar in my tea and coffee and I don't understand why my blood sugar is so high. People say that very often. And then, of course, we use the teaspoon of sugar equivalents or a continuous glucose monitor to really show them what's going on. Something that a lot of people have is bread. Yes. White bread. So I did some research and it said a single slice of white bread contains about 0.5 sugar cubes but a full life can pack up to 12 cubes of sugar in it. That's true. But it doesn't... it doesn't include the fact that the wheat that makes the bread will turn into sugar as well. Okay. So on my teaspoon of sugar equivalent, even a small slice of brown bread is about three teaspoons of sugar. Is there a healthy bread? That's a really great, great question. And of course, it depends how well your insulin's working. So if you're young and you take a lot of exercise and your insulin's really good, then maybe brown bread is okay. If you're like me, though, with insulin resistance, it would have to be a low carb bread. So I wouldn't normally bread under any circumstances but I might have low carb bread. I did some research that sprouted grain bread, never heard of that before. All 100% whole grain rye are the healthiest options because they contain 0.5 sugar and high fiber. Right. I mean, what I'd say to people, again, it depends. How much exercise do you take? How do you know have you had your fasting insulin measure? Do you know if you're insulin resistant or not? If you're healthy, take lots of exercise. Sounds good. Fair enough. If you're beginning to develop a tummy, well, maybe not so good. And if you don't know, I'm a great one for experimenting. And that's where I come back again to consider buying a continuous glucose monitor. The thing you wear on, I've got one on me now. And it tells my phone, how is my blood sugar? So I can experiment. Then I could try your bread. And within an hour, I would know. This has had probably the single biggest impact on my office. Of all the products that I've tried that have given me productivity gains or cognitive boosts, I would say that exogenous ketones are in the top three most pivotal things that have given me a massive productivity gain. It's some Stanford graduates that have been able to basically bottle up the effect you get from being in a ketogenic diet in a small shot that you can take. That makes you feel incredibly focused and gives your brain an incredible source of energy. And the clinical studies that have been done on exogenous ketones have absolutely blown my mind. I reached out to them. I became a coroner in the company. I became an investor in the company. And so it's with great pride that I can tell you that this exists. If you haven't tried these shots, go to ketone.com slash Stephen for 30% off your subscription order. And you'll also get a free gift with your second shipment. I still buy my ketone shots predominantly online. But thankfully, I can now grab the mitt target whenever I drive past them here in the United States as well, because we're now stocked in target. Where your first shot is completely free. Much of the reason most people haven't posted content or built their personal brand is because it's hard and it's time-consuming and we're all very, very busy. And if you've never posted something before, there's so many factors in your psychology that stop you wanting to post. What people will think of you. Am I doing this right? Is the thing I'm saying absolutely stupid? All of these result in paralysis, which means you don't post. And your feed goes better. I'm an investor in a company called StanStort. You've probably heard me talk about. And what they've been building is this new tool called Stanley that uses AI, looks at your feed, looks at your tone of voice, looks at your history, looks at your best performing posts, and tells you what you should post. Makes those posts for you. You can also use it for inspiration. And sometimes what we need when we're thinking about doing a post for our social media channels is inspiration. Building an audience has fundamentally changed my life. And I think it could change yours too. So, I'm inviting you to give this new tool a shot and let me know what you think. All you have to do is search coach.stan.store now to get started. Am I wise to be looking at the back of packets? I look at the back of everything I eat. Yes. And I'm building against a mental model of the different levels of carbohydrates and sugar content and fiber and all those other things and proteins, etc. But I always seem to zoom in on the sugar. Yes. The added sugar. Right. There is an error there. Okay. So, that's brilliant. And the fact you're interested and trying is great, because you'll learn so much more. Because, of course, the sugar is one thing, but you must also look at the carbohydrate. Okay. The carbohydrate content. Now, this is done differently in the United States from here. Confusingly. Here, we talk about carbohydrate separately from fiber so that in the UK, when it says carbohydrate, that turns into sugar. In the States, you've got the carbohydrate including fiber. So, it makes it more complicated for you. Because you need to know which, how much of that carbohydrate you're going to absorb. Well, let's go back to the three micronutrients. So, you should be interested in protein, how much you want. You want to be a muslim kind of guy so you want your protein. The carbohydrate will, why do you need that? I'm wondering. And then fats, well, you might need those for fat-soluble vitamins. So, those are the three things so that you become more sophisticated. And if things have a lot of preservatives, have an awful lot of ingredients, I'm immediately suspicious. I think one of the things that people that I've come to learn through interviewing people like yourself is that it's not just the direct consequence of having a big glucose spike or having high blood sugar. It's also the fact that when I eat things like Mars bars or the white rice here, I then get more hungry later. Exactly. Which means I eat even more sugar that same day. And the next day. And of course, that's what my patients right back in 2013. It was the absence of hunger they found fascinating. And I did, because I'd been hungry all my life. Because all my life, I'd been carb heavy. And I didn't realize that the more carbs you eat, the hunger you become. I don't know, have you ever tried fasting? I bet you have. Oh my gosh, yeah. Right. I've asked most days to be honest. I haven't eaten today. Yeah. One time a week. I don't know. One p.m. During the dragon's den filming, I don't eat often until the evening. Great. So isn't that interesting? So I used to have a model which was that if I didn't eat, I was hungry, right? So if I didn't eat for even twice as long, I'd be twice as hungry. And it would rise exponentially until I went mad. And what's surprising that you must have found is as you fast, you don't become more hungry, do you? Yeah. It's crazy. Well, it's not interesting that actually you get the more I eat the hunger you are, I become. I think that's... When I'm on keto. Pardon? When I'm on keto. Yeah. I can't believe. I can't. It's like a hunger just vanishes. It does. Actually, the thing that the remarkable thing. I love. What are those cinnamon roll things? I'd love those cinnamon rolls usually. I love them. And when I started doing the ketogenic diet, which is very, very, very low carb, I remember walking up to this cinnamon roll concession stand in keto and looking at them. And they were doing nothing to my brain. There was no temptation. Yeah, it's crazy. I've had that. It's like a super power. Yeah. Honestly, I've had that with Christmas cake. It was my kryptonite. It was the kind of thing I was sneaking down when they'd all gone to bed and having more. And then one day you can look at it. And you think it's not actually food. Your brain, that isn't food. Yeah, exactly. And I'm the same with buns as well. And all sorts of things. They're a lifetime of, and they're no longer food. And it feels like a super power because I can... I'm such a man. In fact, I throw this down as a challenge to men. Are you man enough to resist, you know, whatever it is? Let's do a challenge. Come back in a week and tell me you've not had any biscuits. It works. It works. What do you think of the ketogenic diet? Wow. That's a... Oh, that's a big question, isn't it? I don't think we need to begin with what you want. So I think we need to begin with your goals and hope. Why would... Is it... Are you wanting to lose weight? Are you wanting to sort out type to do diabetes? Or... I mean, George E. Dr. George E. is a close friend. And nutritional psychiatry is really growing. Ian Campbell in Edinburgh University is doing some amazing work with bipolar disorder and other things. So why are you doing it? That's... So that's my first thing because... I see it as there is a spectrum of carbohydrate that you're on. So I try and find out where are you now? And I, you know, approximately where are you now? And then I'd say, well, could you... Could you give up bread or reduce it? And then I'd say, let's measure whatever parameter we want, which might be blood work or weight or whatever, then we say, how are you doing? Are you happy now? Is this... is it? Or do you want... would you like to go a bit lower? And what I've discovered with my patients over 13 years is they tend to go lower over time, because when the experiment, when they go keto, what they like is the brain thing. Oh, gosh, yeah. And that's what I'm... that's right. So I would say to you now, because I'm interested. Yeah. Why would you go keto? What are you after? So I'm going to put the brain thing at the top of the list, which is just the clarity of thought. Obviously in my job, I have to sit here with very small people like you. Yes. And I have to talk sometimes for three, four hours, whatever it might be. But also I'm on television a lot now, and I'm speaking, you know, nine cameras rolling, BBC one. And I've got to think of something smart to say to this one, because I stood in front of me, and that's pitching to me. And then also I am in meetings, you know, I'll leave this conversation now, and I'll go straight downstairs, and I'll have two hours of straight meetings about very, very complicated things about buying companies. I'll be meeting founders interviewing people. And what I've noticed profoundly, because so much of my job centres on speaking and articulation, is there is this wild, wild, wild variants that I hate. And what I mean by that is some days I'm on it. Yeah. And some days I am almost embarrassed by my inability to string a sentence together. Today I'm almost testing myself now by trying to speak really, really fast and saying my brain is connected to my mouth. That's like, that's actually like what I do. I try and see if it flows out. Yeah. Today I'm okay. Yeah. But there are days where I'm stumbling over myself. Yeah. And I go, what's causing this? What's the causal factor? And how do I prevent this? That's one. Keto. When I'm in Keto, I always sound like Buster Rhymes. Yeah. It always, it's always working. And then I'd say the aesthetic stuff, because I want to look good as well, especially for my fiancee, so I want to be in shape, I want to be... And then I'd say the third is being strong. And then the fourth is, I want to live long. Exactly. I want to have a long health span, not just a long life span, but I want to be able to do things as I age. So you see, that's exactly what I began this meeting with. You've got a clear idea about your preferred future. And it's fairly specific to, and the more specific you are, the more likely you are to be successful, and then you're noticing. Then afterwards comes the feedback. Do you think most people even have thought about this? No. I was just thinking about my listeners, and I was thinking, they're listening right now. I wonder if they have written down their top four. Yeah. So what I'd love to do now is tell you something about my wife's work, because it relates to changing behavior fast. And that, she won't mind. So we're back to Jen now, we have a woman. She spent two years thinking about CBT, and what was, what, this is a type of therapy, and what were the necessary parts of it, and what was junk? And she reduced CBT down to something I'll teach you right now. All right, so we'll, off we go, off we go. So the first thing is to think about your health goals, so to think about what, in a year's time, if what you do is great, how does that look specifically? So I'll give you an example. You might think you'd like to lose weight, but that isn't specific enough. I want to know what difference would that make to you? So you will do it now. So if you said you wanted to be in shape, what, I don't know, what do you mean by that? Do you want to lose weight? What do you, tell me more? I want to be able to, hmm. What I'm really, I think, scared of, it's going to be completely honest, is I'm scared of, having the same health profile as my dad. Ah, right. Because I've seen, we have the same, you know, we have a lot of the same genetic profile. Yes. So I think a lot of us look at our parents and go, is that my future? Yes. Yeah. And to make it even more specific, I remember walking down some stairs, I've said this once before, but I remember walking down some stairs in Bali, along steep set of stairs, down to go whitewater, water rafting with my fiancee. And I remember as I walked down those stairs, recalling that my dad loses, can't walk up a single flight of stairs without problems. And I remember thinking, oh, my dad wouldn't have been able to come whitewater rafting, because we've got to walk back up these stairs. And so my dad would have lost out on one of the great joys of life, which is doing enjoyable things with friends and people you love, because his health is now, in that regard is gone. So I've always thought of that. And then generally, I remember when I was younger, my dad used to play football with us and all these things, and he's unable to do that now. And so, I know, because I've done this podcast in these times with health experts, I realize that the decisions I make at 30, which is where I am now, exist on this really interesting, quite predictable curve of inevitable decline. However, not like inevitable loss of lifestyle. What I mean by that is I just have this picture in my head of all these graphs I've seen, where your peak is around maybe 20, 30, and then you go in down, which we all accept. But how far you go down is determined by decisions you make right now. The decisions I make now will end me at 78 years old and either the inability to walk or the ability to run. Yeah. And it's all about what I do now. It is. So let's just refine that. So we've, we've, I've got your goal now. So let's, let's park your goal. Now the next thing we've got is in the past, what have you done that's worked towards those goals? So you probably tell me some stuff you've done that's worked. Um, things like going to the gym? Yeah, yeah, anything. Anything quickly that you did that worked, that was, is, is, is a first, you know, help that you did in the room of that work. So tell me anything. Well, I said to myself one year that I was going to go to gym every single day, terrible idea, because I got five months in and then I missed a day then it was over. I said to myself another year, I think it was 2017, that I'm going to get a six pack for summer, terrible idea, because when summer came or I got the six pack, my question was what did work in the past, not what didn't work. So what has worked for you in the past? So those two incidents helped me change my idea, and the idea that I came up with was I said, not a achievable thing as a goal, but consistency as the goal. I consistency became, for the last four years, this idea that the goal, my fitness goal is consistency, means that every day I wake up, I get a shot at it. And if I fuck up today, then I've got another shot tomorrow. Right, leave it there, that's good. So we did the goal, and then we did the next thing. What I just, the next thing is resources. So it's, what do you bring to the consultation that you've done in the past, intelligence, resources, friends that will help? You come already with expertise in yourself. So it's not, I'm not the expert to tell you what to do. You've already got some stuff. Then we go to the next thing. So if we had your goal at the beginning, which was the fitness and the song. So today, what might be a small step towards your goal, a realistic small step towards the goals we've already established? So I can think of two. Good. One of them is creating a social pact, which again was one of the things that helped. So we made a WhatsApp group. This is quite funny. The WhatsApp group, we put 10 friends in it. We made a simple rule. Whoever's the least consistent every month is evicted. And we invite any friend in. We've done that for four years. I've not been evicted in four years, which means that I'm doing enough. I'm consistent enough over those four years to not be evicted every day. When we work out, it puts our workouts into the group chat. And every week and every month, there's a winner. And there's this lead table. And you get these little emoji medals. And there's actually, I won one year, with this physical, massive gold belt on my bookshelf at home. It says fitness blockchain world champion. Brilliant. So I've done that for four years. So a social pact really helped me. The sort of accountability to others. Yes. And the other honestly was just, as I said a second ago, when I set the goal of going to the gym every single day, I set myself up for failure. Now, I set myself the goal of consistency, which means that I can do, have bad days, where I do 20 minutes or 15 minutes yesterday. Because I was finished, I can stand late, drove down to London, got home at 1am. I did 18 minutes. Yeah. And reducing the size of success really helped me to keep my feeling of momentum. Brilliant. We're nearly at the end of your degree in psychology. Okay. And then I'm going to pull it together. The final thing is, when things... What would you notice for you when things are going well? What would you notice? So you've done some of these things. What is it you actually notice? As in the benefit to me. Yes. What do you notice? So if you do, if tomorrow is a really good day, what might you notice at the end of it? Because you've much experience in this now. What would you notice? I mean, the first thing that comes to mind is just how I feel. Yes. I just feel... Do you mean emotionally or energetically? All of it. Great. All of it. Emotionally, I feel good about myself. Yeah. And energetically, I feel more energetic. And there is this element of identity in there where I have an opinion of myself in who I think I am. And I think I'm a healthy person and I think I'm someone that's in control. And when I'm not performing the consistent behaviors that I want to, I think I start to question that identity in a way that causes a lot of discomfort and say, well, you're not in control of your own life. That's crazy. So I think it links into self-esteem. Yeah. It really. So what we've just done, we had the goals. G. Yeah. Then we had your resources. R. Yeah. Then we had increments. What things had you done? Little things on the way. And then finally, I invited you to notice and reflect. And that spells grin. And that's Jen's published grin model. I just did it for you right there. And I could do it faster than that. I do it in nearly every surgery I do. Because what I'm trying to do is find out about you. And you didn't find out much about me in that process, did you? No. But I found out a lot of really useful stuff to you and it's motivational. And much better to do that than me tell you what to do. And I'm not a talking leaflet. But motivation, this is what Jen has taught me. It's key in everything we do. And the grin model isn't bad. Clever woman. So what do we do with the grin model? And so this is really helping me figure out how to change my behaviour. Yes. How does one apply it? Or are you saying that everyone listening now should answer those four questions themselves? Yes, I do. Because otherwise, it's possible to spend a lot of time blaming yourself. And particularly around if we're discussing weight problems and so on. You can spend a lot of time saying, I'm to blame or I wish or I shouldn't have. After Christmas everybody feels like this. But what is much better rather than focusing your wasting energy if you start thinking about guilt and negative stuff. And what Jen's trying to do is getting you to engage in thinking about a better future. And what the whole of that five minutes was engaging you in first of all the goal of a better future. Then some resources towards your better future. Then the first steps towards the better future. And then noticing what's good. Because I think in medicine what we've done. How do you get a doctor's attention? You get a doctor's attention by saying, oh, it's so bad. It's so, so bad. My pain is so, so bad. And I realised I had trained my patients to think that moaning was how, you know, they got my attention. And if you do that, the result is a very miserable to our surgery. But if you can talk, even people having a terrible time have got hope if you can find it. They have goals if you can discuss them. And you could have somebody with a drug addiction or what, you know, I see people dying people also every clinic I'm seeing sad stuff. But if you can also investigate hopes and good stuff as a doctor, I'm so much more energetic, so much more hopeful. I'm having a great time. And I wasn't when I was 55. And that's the process. I put there so many people listening now that maybe they, you know, because they listen to this show and they think of this sort of basics, they go, you know what? I understand this stuff and I'm making good progress. But I live with or love someone who, I am scared they're going down a slippery slope. Yes. And I don't know what to do. Do I intervene? Do I hide their sweets? Do I blame? What do I do? Why is it so hard, isn't it? That's so hard. I think you can. Why are you in that position to some degree? Yes. Yeah. So my first wife had a very severe addiction problem. So I lived with that for 12 years and she's unfortunately died now. So I lived with very, very serious addiction for 12 years. And what you're doing then is you're living with uncertainty. Serious uncertainty. You never, you cannot say what you'll come home to. You have no idea. No idea. It brings chaos into your life. It's very, very hard. Addiction. Yes. Are you able to say what kind of addiction? Was it a food addiction or a drug addiction? It was, nearly everybody concerned has died now. So I don't know whether I can say or not. But it was very serious, multiple addictions. I will say that. And she had, she died some years ago. And it doesn't, it actually wasn't food addiction. But it brings, I've so much sympathy with dealing, how hard it is to deal with uncertainty and not be able to, you love somebody and you can't do anything. It's very hard. There are things you can do. I think if you can engage people in that talking about goals, that can help. What we will do now is we'll change that conversation to the current Mrs Unwin, which is what we laughingly say. This is Jen. So we've been together for 30 years now. And Jen's story is that she actually is an ultra-processed food addict genuinely. And what that means is, I didn't understand, neither of us understood what that was. Even though she's a consultant psychologist, she didn't realize that she was an ultra-processed food addict. What she saw it as was a weight problem. And all her life, she's been boomerang dieting. So she'd be a big woman and then a little woman and a big woman. And I used to watch it all, what's going on? And then she would be tray-bakes, like she's trying to lose weight and making tray-bakes, saying it's for the children and then scoffing a lot herself. So then I, because I loved her, and I think blokes, we try and solve problems, don't we? We're like cavemen, I wanted to rescue her. So I'm either throwing the food away or I'm tackling her. And then we're having such arguments because she's defensive and cross. I couldn't understand with an intelligent woman what's going on. But then this is only a few years ago. She understood for the first time this is addiction. When you have intelligent people, highly, highly intelligent people, doing stuff that harms their health repeatedly, is this not like cigarettes? Is it not like alcohol? That is ultra-processed food addiction. And there's a patient I'd like to tell you about that is, explains it even more clearly. And this patient has consented for me to tell you because he wants to help the world. So this is a guy who's a very successful guy. He runs, he's a wealthy person with a successful business, he's not stupid. He has type 2 diabetes, he's 55, he has type 2 diabetes, he's very much overweight. Unfortunately, he needs really serious surgery because both his knees have been so destroyed by his weight that he can hardly walk because he's in real agony. But his type 2 diabetes is so bad, his blood sugar control is so bad the anesthetists won't touch him. So he's trapped, he can't get the hop because his blood sugar is high. He can't run his business easily because he can't hardly walk. So obviously what we do is we say you need to go low carb. And it works for a bit and he loses some weight, but then he gains the weight again. And this goes on for four years while I see him so regularly every month. What's going on, what's going on? Oh, excuse is the grandchildren? I've got a holiday, Christmas, it goes on. Anyway, then his wife came to see me and she said, Dramin, I need to level with you. You need to understand what's going on. I find that my husband is getting up before in the morning and eating bread out of the fridge. So what I do now, what I started doing was at the end of every day, I put all the bread in the bin if it hasn't been eaten that day. But then I discovered my husband was going in the bin to eat the bread. Then what she does, she's a very formidable woman. She started putting liquid detergent on any bread that goes in the bin. But he still eats it. He's getting up before in the morning rummaging through the bin to eat the bread with the detergent on. So then she tries something else and she says this is the only thing that will stop my husband from eating bread if it's there. I spray bleach on the bread and leave the can of bleach by the bin so he knows don't even look. What I've described to you is addiction. This is an intelligent person and imagine his self-esteem how it was to live like that, concealing what he was doing and not telling his doctor because I'm trying so hard for him for years. He's so sweet to me now and he often shakes my hand and gives me hope. He said, you tried, you really tried. My stories have a happy ending always. What I did for him in the end, he needed everything to low carb. Then I got him using a continuous glucose monitor so that he would get feedback immediately and see that spike. And also I could see the spikes as well because he had to come and show me his tracings. And on top of that I did something unusual. I gave him a low dose of the new GLP1 drugs. One of those. And the three together he managed to not, he couldn't moderate but he could abstain. And then he could do it. And then pick helped reduce the noise, the cravings in his head. The feedback from the CGM helped him know how he was doing. And the support he got from me and the low carb pulled together and all three and he's had his operation now. So it's a happy story. But he's got maintenance. All his life he's going to have to sort that out. And it's a wonderful example because I think we trivialize this. We call it carb creep like it doesn't matter. But there are many people listening to us right now and they know they know they're addicted to various foods. They know because when you ask them they often burst into tears. Often somebody will say I've never told anybody in my entire life about and bread is a common one. And if you're not addicted to bread you can't imagine it. But if you are addicted to bread they say this sounds so stupid. I'm so embarrassed to tell you I can't control how I eat bread. And so it's not great for your self-esteem is it? People might be addicted to many things and my wife's published many papers on this and written a book. And it's that and the other. And she would say about 14% of the population has some aspects of ultra-processed food addiction. And it kind of explained so much why are intelligent people eating foods they know? Do them. I've got another example. One of my patients with type 2 diabetes we got drug-free remission. I've done that now 157 times. So every one of them I'm cheering when it happens. So this guy we did it drug-free remission. Then he vanished for a while and came back with two dead toes. And he had to have them amputated. The toes? Yeah. They started rotting because diabetes takes the blood supply particularly from your toes. So we had to have surgery to have part of his foot removed. And so you call it carb-creep and he ended up with half his foot taken off. That's not carb-creep, something far more sinister. But I never give up. And fortunately the wounds took a long time to heal because he was sugary. So we do it all over again. I got him back into remission because this time he and his wife are really determined. But it's a struggle and he needs help and support to achieve that. He's not a foolish man. He's an intelligent man and yet various foods call to him. Eat me, eat me and it's very difficult for him to not. And that's a very extreme example. But many people with overweight and some who are not overweight are struggling with very, very significant carb cravings and they really, really struggle to control them. For those people and I assume there's a lot of people. And actually some people have seasons where they're in control. They're out of control. They're in control. I've been there. What is step one today? So they're listening to you. They're going, I don't want to lose my toes and all of these problems. What is step one now? Now are we talking about for somebody with type 2 diabetes or somebody who can't control what they're eating? For someone that can't control what they're eating. Right. So step one, we just did it. I think step one is acknowledging that is your problem. Because if you don't, if you're not honest about your problem, how are you ever going to sort it out? So the first thing is honesty and that's very hard for people. All of us have made excuses. Me and my biscuits. I believed that it was easier for me to think that that was stress and a reasonable reaction to the stress of running a practice than it was to say, I've got biscuits for me. It took me a year to give them up. A year. How pathetic is that? I was so driven. It took me a whole year. How did you give them up? I did it by weaning myself off a bit like methadone. So I went from, I like chocolate ginger biscuits and then I went to digestive plane and then I went to oat biscuits and then eventually I went to almonds. Why didn't you just do it all at once? I should have done. And Jen's a great believer in cold turkey like, what is the thing? Stop it. I wasn't man enough for that and it took me a whole year. So the first thing is be honest. Be honest with yourself even if you can't tell other people. Be honest with yourself. Is there an addictive potential there? Could that be? Does that fit? Number two. Specifically, which foods is your problem? And be honest. Because if you're not honest then number three is have a plan for abstinence. Because if you, if there isn't, if you have got an addictive potential, it won't be one biscuit. And we all, who, you know, how many of us have said I'm going to give up ice cream or biscuits or pizza or whatever it is? And then you have a shit day. You did, well, I have a drink or whatever you think tomorrow. Work stresses you out. Yeah, tomorrow, tomorrow, tomorrow, tomorrow. So it's very important to be specific about the food and then to have a plan for how you are going to do it. And another thing is sometimes it's helpful, you know, the people around you that love you. Maybe share with them that it's, that it's important and that I need, I might need some help. Please be tolerant with me. Like cigarettes. Please be tolerant if I'm short-tempered. I'm going to try and do this thing because it's important. The difficulty depends whether the person that loves you can be gentle or if they're heavy-handed. If you confess this and then they police you. Judgmental. Yeah, it doesn't help. Yeah, yeah. What you're asking for is gentle support and tolerance. I can think of a time of my life where I was with somebody. Yeah. And I was, they were so into their health that it made me start to hide when I was eating bad. Exactly. Yeah. Thank you for that. That's what happens. And you see that people become deceitful. Yeah. So if you police somebody you love, the result is deceit. I was hiding the wrappers of things I was eating. Yeah, yeah. Gendered that with me. She knew that I was monitoring. So she starts hiding the wrappers or then I'd find them in the car. But then we have a situation that we can no longer talk about it. Because so that if somebody, if you're forcing somebody to become deceitful, you have to back off a little bit. Yeah. Because that deceit then affects self-esteem and that can make them worse. And you didn't want to make them worse. And then they're lonely because they can't share the bad days. Yeah, it's really good. I wonder, please could we show Jen's book at this point? Of course. So can I just explain the book? So this, this is Jen's book. And the most important thing is Jen doesn't make a penny out of this book. So it's fork in the road with the idea in your journey which one you're going to pick. Do you see? So it's fork in the road. She doesn't make any money from this. Every penny goes to a charity that she's set up helping people with food addiction. It's available on Amazon and self-published on Amazon. How much does this book cost? It's not a lot, is it? It's about 15 pounds. Oh no, it's less. I think it might be 10. 10 quid. Okay, I'll tell you what I'll do. Yeah. I'll buy a thousand of them. Fabulous. And I'll put a link below in the comment section. And so all you've got to do is if you really enjoyed this conversation and you'd like to get Jen's book fork in the road. A fork in the road? Maybe we can even get some of them signed. Not all of them. Great to hand. Can we get a couple of them signed? Oh, that is brilliant. Click below and we'll send a thousand of them out. And that's just a thank you from me to both you and Jen. But also to the community who tune in for these conversations. And it's so great that people can get such simple information that's so accessible and so rigorous in its scientific credentials in a way like this that they can. That could change some people's lives. Great. Isn't that a wonderful thing, you know? Like a simple book like this, which isn't long either. So, you know, it's not a big read. It could change some people's lives. That's such a wonderful thing. What do you do? Just making myself a delicious coffee. From the freezer? From the freezer. You know, how do I come to you? No. Oh my gosh. This is going to change your life. I invested in this company called Commitier last year. And then I wanted the sponsors of this podcast because they've taken a pretty revolutionary approach to making coffee. Every coffee is precision brewed at 10 times the strength. And then they flash freezer with liquid nitrogen to lock in the flavor and freshness. And then it's delivered to you on dry ice in these recyclable aluminium capsules still frozen. Like a lice cube. All you have to do is pop the capsule out, add some hot water. And then you stir it and you are good to go. You can also make delicious ice coffee drinks as well. Just pour it in. Stir it up. And for anyone that hasn't tried it, you can get $30 off your first order of Commitier coffee if you go to comitier.com slash Stephen. I've done almost 700 interviews with some of the most interesting people in the world. And one of the things you learn, which is unexpected, is that vulnerability is the doorway to connection. And after sitting here for two, three hours with a guest, I feel a deep sense of connection to them. And as they leave, what I get them to do is to write a question in the diary of a CEO. We've taken all of the questions from the diary of a CEO. We have put the question here on this card with the name of the person that wrote it. So you can sit at home as I do with my fiance and my colleagues at work and other people in my life. Whenever we get a minute, we play the diary of a CEO conversation cards. And it is incredible what happens. These are great if you're in a romantic relationship and you want to connect your partner more. These are also great if you're in a team and you want to bond your team together. And I have to say they're also great for families that want to learn more about each other. And that need a good excuse to spend some time in a digital world in the analog environment connecting human to human. It is remarkable what the right question at the right time can do. Go to the diary.com and you can get these conversation cards right now. You said something earlier on about the link between sort of your dietary choices and cancer. I've actually got a friend of mine who used to work for me who is going through a cancer process at the moment. She's very, very young. She's actually younger than I am. And she was diagnosed with breast cancer. She's a really good friend of mine. And she was my, actually my manager for a couple years, she's called Katie. She's very public about this. So she's posting her journey online so I can say her name. And I've been following her and she's, you know, she's removing a lot of the foods we've talked about today from her diet. So she's very front of mine for me at the moment. And I was looking at some of the stats around the link between our dietary choices and cancer outcomes. And I'm going to read them. Now my team might cut some of them out. But I think they're worth hearing because hearing them, I think, is quite enlightening. A massive French study found that drinking just 100,000 of sugary drinks per day, which could be, you know, a third of a kind of soda is associated with a almost 20% increase risk of overall cancer. Women who consume two or more dietary drinks daily have over double the risk of early onset, chlorical cancer compared to those who drink less than one a week. High consumption of sugary sweetened beverages is linked to a 78% high risk of estrogen dependent endometrial cancer in women. Drinking 20 ounces of sugary soda daily is linked to shortening your telomeres, which are the protective caps on your DNA, equating to 4.6 years of extra biological aging, which is a major risk factor for cancer. High sugar intake causes chronic hyper saluminine, chronic hyper insulinemia. So that is what I'm saying when the insulin levels are high, which I explained at the beginning, which can inhibit apoptosis, the natural process where damaged or cancerous cells self-destruct. Yes. Wow. Fructose is processed in the liver and converted into lipids, which are fats, which is what we were talking about earlier, which recent studies show certain tumors directly consumed to build their cell membranes. And lastly, diets high in added sugars chronically elevate C-reactive proteins called CRPs, an inflammation marker that is heavily correlated with tumor progression and metastasis. Yeah. So what I'd like to, this is that is so interesting and it brings to mind a really important point. We talk so much around the world about treating cancer. But what about prevention? Because for your friend, that's a life sentence and she's living with uncertainty and fear. And when I tell patients they have cancer, you know, you feel it right here because you just took away so much. And it's interesting, do we try hard enough? If we know that, are we trying hard enough to prevent cancer? Because that's what we should be doing. Because we know a lot that I think after smoking, diet is the next commonest cause of cancer. And you know, how serious does it have to get when you just gave all those references then? And I know that junk food is linked to all cause mortality, it's linked to so many things. What do we prepare to sacrifice for enjoying, you know, treats and snacks? It's kind of, when you look at it like that, it's really bonkers, really bonkers. This sounds a bit crazy, but sometimes I imagine receiving the diagnosis. Yeah. And I do a bit of, I guess they might call it a pre-mortem, a pre-mortem or a post-mortem, where I imagine on that day the decisions I wish I would have made. And I'm not saying all cancer is linked to what we eat because that's not the case, but I'm imagining like the worst diagnosis I could ever be given and the doctor telling me that my lifestyle choices contributed to that over the last 5, 10, 15 years. And in that moment, is there any sugary drink that is worth it? There's just not, you would just wish with every bone in your body where you come home and tell your fiancee, your mom, your kids, that you've got this horrific diagnosis, you just wish that you had made a different decision. I also think that's a very good strategy for dealing with problems. You know, your life must be so complicated. It can't begin to imagine how many problems you're solving and the complications and the people you deal with. And yet all of them are as nothing against the cancer diagnosis, aren't they? So that you would look at the problems you have right now and you'd laugh. Yesterday, I was worried about the traffic or whatever. And I think it's a leveler, mortality is a leveler. All my life, I've been obsessed with death and it worries me. I can't sort out in my head what does death mean or, you know, it really scared me when I was a child, the idea of death. But what it's given me is a drive to not waste time and to think about what's the best use of today and you seem to have that kind of energy as well. Interesting thing about the side of wasting time as well is through everything you've talked about today, we can both waste less time but also have more time. And when I learned about the difference between like lifespan and health span that also added to this equation, you know, people still live to 80 years old but they're really healthy for like 30, 40 years. That's a very, the idea of health span is very important because we know in the UK it's going down. Oh, is it? Yes. They're looking at that. Now, life span is hanging out there as sort of stuttering along but health span is going down in the UK and it's worth thinking why that is. Well, I would hazard, I guess it's relates to all the things you've talked about today. I think it may do. In England, you're totally right. It says in England, the situation is particularly alarming. Health span is actively declining even as overall lifespan slowly creeps up. Recent 2024 to 2026 data from the Office of National Statistics, the ONS and the Health Foundation paints a stark picture of the UK's widening six years gap. Over the last decade, healthy life expectancy in the UK has fallen by roughly two years. As of the latest data, men in the UK can expect to spend about 60 years in good health and women about 60 years of good health as well because overall life expectancy in England is rising. People are now spending roughly up to 23 years at the end of their lives with poor health and insickness. This means the average person spends nearly a quarter of their life managing chronic illness and or disability. And that's exactly the point, isn't it? That's exactly the point. And it relates to another thing I'd like to tell you about as well. This is government figures. Every taxpayer in England pays an extra £7,000 tax per year for the consequences of ultra-processed food. Everybody's paying extra tax, £7,000 a year. And this is because it's not just the cost of the drugs. The bigger cost is the people not paying tax themselves and not able to work because they're ill. And that's two thirds of the cost is the lack of revenue because so much of our population isn't well enough to work and that's very... And a lot of its young people too, it's very serious. I know, I think about 30-40% of our listeners are in the United States. So I've got some bad news for everybody in the United States as well. How is it there? The US currently holds a rather grim record. It has the largest health span to lifespan gap on Earth. Despite the United States having lower overall life expectancy, then almost all of its peer nations and premature death rate that is nearly twice the average of comparable countries, it's health spans that as the worst in the world. So if you're in the United States as things stand, you will be sicker for longer. We're trying to catch up though, aren't we? We're doing our best in the UK. We're doing our best to catch up. I have this piece of string here, which is... I guess the mechanism you use to figure out if people's waste and I guess fat levels are too high on the belly? I think it's bigger than that. So I'm interested in low-cost ways for people to find out how are you doing? How are you doing? And so one recognized way looking at metabolic health is your waste should be less than half your height. So if we have a piece of string, which we have there, believe you're six foot one, and you've marked halfway. So half of that string should go around the fattest bit of your belly. People come up to me all the time and they go, oh my god, you're so much taller than I thought. Have any of you ever seen me sat down? Yeah. So that's right, cut it in half, and then let's see. Will it go around your belly, yes or no? Okay, so cut the string in half. Yes. Which part of my belly? Because the fattest part. Yeah, so be honest about the fat part. Okay. Can I look? Yeah. You did it. Is that... Are you squeezing it now? No, I'm not. Are you cheating? Let me see. I mean, it's not... Yes, it fits. Yeah. You're just on it. You've passed. Yeah, okay, passed. It's so interesting. That's so funny. Wow. But that is a very interesting thing for you. And as I say, insular resistance tends to put weight on your belly. But you may have a very muscular abdomen. Let's pretend it's that, you know? Yeah. But you're just about there. You're just about there. But it's a really simple test for everybody at home. A piece of string, as long as you are tall, cut it in half. Will it or will it not go around your middle? Okay. So everybody at home got by some string. Yeah. I mean, there's lots of other things you can do. But that's a simple way. Because you weigh to loan. As I said, it's where the fat is distributed. It's fat on your belly is more worrying than fat on your legs or on your arms, really. So one of the things people always ask me about is supplementation. It's kind of a good, bad and different. Yeah. What's your point of view? Right. So my point of view is, if you can, my gut reaction is to try and use diet to give you what you need if you can. Which diet? A real food, low-ish carbohydrate diet, is my preferred thing with plenty of protein in there. And healthy fats. I'm very interested in farming and regenerative agriculture and all that kind of thing. And what I know is that the nutrient profile of crops grown today is not nearly as good as it was a hundred years ago. So we have some problems in it. It's to do with the soil. If you keep just adding nitrogen and harvesting crops, those crops do not contain as much zinc or magnesium, particularly. And so the tragedy is that although my aim would be to have you healthy with a real food diet, there are some things you cannot get in the diet now that your grandparents could and one of them is magnesium. It's very, very difficult to get enough magnesium in your diet without supplementation. And as you get older, you absorb the magnesium less and less. Also, a lot of medication interferes with magnesium absorption, particularly drugs for acidity. So magnesium supplementation for most people. In myself, it was magic at getting rid of muscle cramps. I sleep a lot better. I think we also need to talk about magnesium, which magnesium? Because it varies a hell of a lot. And this bit's embarrassing. It depends on your bowels. Have you got fast or slow bows? You don't need to tell me. If you tend to be a bit constipated, magnesium citrate is very good. It helps. It's more laxative. And your absorbs some of it anyway. If your bowels are not a problem, and particularly if you're wanting better sleep or mood, magnesium glycinate or threonate is actually crosses the blood-brain barrier, but won't help with constipation. So that's a very quick thing on a magnesium. Have we got time for me to tell you about the first cow I ever bought? Go ahead. And it's relevant to magnesium. Go ahead. Right. So my wife and I, my wife Jen, we have this idea that if you love somebody, then gifts are you trying to think what would that person like? Don't buy somebody a present you would like. Yeah. And it was Jen trying to get me to grow up. Yeah. Right. And this is how she did it. So she said to me one day, right. Get a coat and a pair of Wellington's. I'm going to take you out. And she drove me into Lancashire. And there was a field of cows. And she said, I have bought you any one of those cows. Because I'd always wanted a cow. And we had a field. And she knew how, what a woman is this. She knew I wanted it. She went to the farmer in advance and prepaid for any cow and said, this field, I bought a cow. You just pick which one you like and he'll transport it home. How does this relate to magnesium you're wondering? Well, it does because the farmer said you can have whichever cow you like. But I've lost 15 cows to a thing called the staggers this year. And you cannot have the cow unless you promise me you'll buy magnesium supplements. Because the grass is now so short of magnesium that cows die fitting if you don't give them a magnesium supplementation. But it's better than that. At the same time, I had a patient that I couldn't work out why he was fitting. I was really fond of this guy and I kept being called out and admitting him to intensive care, fitting. And we couldn't work out. It wasn't a brain tumor. Why was he fitting? And I expect you've joined the dots. It was magnesium deficiency because of medication he was on. And that's the first time I ever seriously thought about magnesium. It's a most interesting subject, very important. And the modern diet is most people are magnesium deficient. And problem is you can't measure it. So your blood magnesium, serum magnesium, doesn't reflect what's going on because magnesium is mainly inside your cells. So you have to get the intracellular magnesium level. But do you know what? It's just easier to try magnesium supplements and see how you feel. So do you take magnesium? I do because the guests, the experts on my podcast have told me that magnesium is one of my five. For me, I've said to myself, I'll take five supplements a day. Five. Yeah, I'll take five. So vitamin D because I'm inside all the time. Vitamin D, so yes, definitely. And I'm black. So that, you know. Well, that combined, but everybody, and particularly in the... Most people just don't get enough sunshine. It'd be better if you could do it with sun. But yeah, vitamin D is very, very important. I take magnesium. Yeah. Because people that you've told me how important it is. Which magnesium do you take? That's a great question. I think it's citrate. Citrate. Right. Like anyone, what might you get me? Yes. Yeah. But that's good to know, because I'll think about my bowels. I take creatine. Yeah. There's this fiber supplement that I take because I did a couple of blood tests and they said that fiber would help, this particular fiber supplement would help reduce my LDL. Yeah. cholesterol. Yeah. And multivitamin. To cover everything. To cover everything. That's probably... I mean, that sounds okay, really? Yeah. I mean, one of the worries that... One of the clinical things I find is, honestly, if you ask people how many supplements they're taking, there's a carrier bag comes in and there's a blue one and a yellow one. And it is possible to over supplement quite easily, particularly maybe vitamin D. You can know various vitamins. You handed this as well. Oh, that's vitamin D. Yeah. Fine. Fine. I think that's... I would agree with you, basically. Mine's also going off my blood test results, so I've done two blood test results. Actually, I've done two blood test results in the last month, one with function health, who are a partner of ours, a sponsor of ours, and another one with Niko Health, which is actually a company that I've just invested a couple of million quid into, which is this health testing company. Have you had about Niko? No. Niko Health, you walk in, $299 whatever, you lay down, you get all of your blood tests done, you get all of these incredible tests done on your body. They show how good your circulation is from your neck to your toes. You stand in front of this scanner, it takes like 2,000, 3,000 photos of your body, tracks all of your muscles, tracks your heartbeat, does all of these incredible things. And then, instead of waiting two weeks for the results, you walk into a room, and your entire body is on this screen. Yes. When you look at all these different parts of your body, they do the blood tests at the very start, and then literally like, it felt like 20 minutes later, I'm in a room, I've got my blood test results back, I can see my entire body, they're going through my LDL, my this, my that, the other, they're showing my heartbeat, they're showing every single mole on my body, and it costs £299 and you get results then. And my alternative, this is me really plugging, the alternative that I used to do every year was this, honestly, I'll be honest, it was this £7,000 health screening, where I'd take it would take me six, seven hours, and I'd get the results back in two weeks, so what Nico have tried to do, it's actually a company started by the founder of Spotify, Daniel Eck. And yes, I did my blood test the other day, and both my function health test and my Nico health test said the same thing. And then I took those results and I processed them using some AI tools and said like, what am I deficient in? So I was deficient in was a mega three, that was the other one, a mega three, a vitamin D, I had high LDL, and so they said this fiber thing would be really good for you. And yeah, those are the main things, otherwise I was great, but yeah, high LDL. I think one that just, that makes me think of something, when you're screening, I think the important point is that you don't just scare people, that it has to be linked to what can you do about it? Yes. I've had a lot of experience of scared patients, so GPs, we worry about screening, because what happens is people do that, and then people get scared and use uploads of appointments in the health service, trying to sort out, so what's good is if you do screening that relates to actionable points, and then you help the people understand what they can do, and avoid leaving them as just worried, because for you, you know, if I can, I might be able to tell you accurately, you're going to die aged, whatever, or whatever, but if you can't do anything about it, you don't want to know what you do want to know is what can I, what can I take action on, what can I, you know, it's about optimizing, isn't it? The things that I hate about the health checking process before Nico was like, I hate how expensive it was, and that's quite, it's quite a privileged thing to get a health, a full body health scan, especially like, so now you can do it for 299, but then it was, I walked into a room straight away with a doctor, and the doctor sat me down, beautiful screen of my body, I was laying, do this, this, this, this is fine, this is fine, and she was so nice about it, but, yeah, I say that because I'm so passionate about it, because I realize there's a certain privilege that people that are able to access private healthcare have, that I think is really, really unfair. Well, obviously I, I think that's unfair, because I only work in the health service, yeah, the state itself, I don't do anything other, I won't take private patients or, because, I think it, it would be wrong, and because I don't think healthy inequality is getting really bad, yes exactly, really bad, and it kind of troubles me, and also if you, if you start in the UK and you go northwards, it just gets worse and worse, and the states is the same way, it's not like the same nation, you know, go to California, there's one kind of a thing, and then you go elsewhere, and it's not the same. Hopefully this is changing, this is, I, I think social media helps, because it didn't cost much, does it go on social media and find out things? Exactly, and people like you who've increasing, increasingly loud voice across lots of podcasts, and who are reaching millions and millions and millions and millions and millions of people. I think what's difficult, though, is not to become confused, you know, because you have the newspaper saying eggs are good, eggs are bad, and then you have this expert who's saying this, and another expert saying the other, I think what I've tried to do is base what I say on real world data, and that's different, so I'm, I'm very careful to take baseline data from my patients, and then update it all the time, so what are the publications I've done are based on real world, the health service in the north of the UK, I can't cherry pick my patients, I'm allocated my patients by the state, so I can't just pick wealthy people or people that will live longer, I'm allocated people and that's that, so part of what I do is proof of concept, because if you can achieve this in the north of England near Liverpool, and if other people can replicate it in Australia and New Zealand, North America, maybe it's true, perhaps. Dr David Unwin, we have a closing tradition on this podcast with the last one, this leaves a question for the next, not knowing who they're leaving it for, and the question left for you is, I'm sure the guest will figure out who left this one, if humanity organized to make contact with a more intelligent species, who should represent humanity and why? That's a brilliant question, who should... The first person, this is a person I'm going to nominate, what about David Attenborough? You know he's 100 years old and he spent so long thinking about the planet and wouldn't he be a wonderful ambassador, and because I am passionate about biodiversity, I'm passionate about sustainable agriculture and sustainable food, I pick David Attenborough. That's a wonderful choice, I think the aliens would really like him. They would. That's my answer. Thank you so much for what you do, you're really remarkable in a way that's quite rare, and listen, I would know. Give me feedback, I love feedback. You're really remarkable, you're really remarkable in a way that's very rare, and I don't say this to all of my guests, but you are for a variety of reasons. I'm going to give you all of the feedback. Thank you. The first, the most notable is you're a very kind human and the way that you speak is very nice to listen to, again, rare. The other thing that I noticed is you're very, very, very natural and good at telling stories, and listen, why does this matter? Because the human brain from what I've discovered from doing this podcast is really orientated towards stories. Now, you could sit here and say, no, I'm a bad, or you could say magnesium good, but I'll never forget the cow story. I'll never forget the cow story. I could have forgotten that magnesium good, magnesium bad, but the way that you tell these stories is so captivating that it enables me to learn in a way that is engaging, and that is rare, very, very rare. The other is just your depth of experience, your humility, your willingness to admit when you were wrong, which means that I trust you so much with what you're telling me, because you're saying, I'm an imperfect human too. I've made mistakes both in myself, with my patients, and this is what I've learned from it. The other thing is just your ability to simplify. It's remarkable. Listen, I sit here all day with super geniuses from this university in Harvard and Stanford and whatever else, and I'm struggling to understand what the hell they're talking about because they don't take a second to build the bridge between the science and the average person, and you do that so naturally. So I have no surprises. Coming from you, that means a great deal. No, but it's really just thank you. It's just what 40 years in general practice does to you, because if you wish to be effective, and if you notice, as in the grin model, I'm watching your face, I'm watching an audience, and I'm reading how I'm doing, or you're getting bored, or I need to move on, and that's why I do with patients. I watch very carefully. It's a recipe. Coming from you, because you really do know, because you've had all sorts of, that means it's such a lot. It's a really rare skill, and actually, because it's so rare, I would just implore you to do more. I don't know you're really doing so much, but it's so rare that you can have such a massive impact. You know, so I really wish. But we need to talk about how we, so I'm trying to get bigger on Twitter, so this will help me immensely. Well, how can the audience help? How can the audience help you with your mission? Well, at low carb GP on Twitter, please follow me on X, at low carb GP. The other thing that would help very much is to support the British charity die setup, the public health collaboration. It's held 10-year anniversary. We set up these were clinicians who got together, 16 clinicians said how we're doing rubbish. Can we do better? Can we give clear a public health advice? So it's called the public health collaboration. So please, please support our charity. Go online, find out about it, come to our conferences. I'd also say notice this. Each of us is on a journey. Be clear about your goals. Notice what works for you because that's what you're doing. And each of us see yourself as an experiment. Don't be frightened of experimenting, but if you're going to experiment, notice, measure something, measure something, and then you'll see how you're doing. One thing that gives me hope is continuous glucose monitors because you're getting, you know, individualising right there. How is my blood sugar? I can check mine in a minute, see how I'm doing. I think continuous glucose monitors. But by the way, are any 20, 30 dollars on Amazon or whatever? Yeah, I would think, you know what, if you loved your dad or you had somebody in his Christmas and you could buy useless ornament or something, they don't need it anyway, but would they be interested to find out about their blood sugar? You could maybe consider, you'd ask them first, but if they've, if they've got a mobile phone, they could try continuous glucose monitor and find out. Have you, have you tried what I have? What did you learn? I mean, so much. Well, did you? Yes, I learned that all these things I thought were, had no sugar in them, have loads of sugar in them. Exactly. I had no idea about ketchup. I thought it wasn't. And the point is, once you've seen it on your phone, you can't even see it. No. And I say them as the cavalry coming over the hill, because we can't be fooled much longer. Do mom just going to look at seeing what my blood sugar is right now. So can I just show you? Oh, well. So what that is, that's somebody with type 2 diabetes, but look, my blood sugar is absolutely level. Wow. And that's good, because you want it, but look how, how level it is. And that is because I don't eat stuff that puts my blood sugar. If I was to have some of those, you'd get a, you'd get a spike, but that's feedback. It also means if I get very stressed, it puts up my blood sugar, and you've been so kind, I haven't been stressed. So other podcasters are not as gentle and kind as you, and I get a horrible spike. So I was going to open here some feedback for you, Steven. So you and I have been together for a few hours, and my blood sugar, I felt safe. So you've done your job too, and there's some feedback for you. No spiking. I'll tell you a final story, a final story. So type 2 diabetes is brand new as a problem for pediatricians. What is a pediatrician? So a pediatrician is a doctor who specialises in the diseases of children, people under 16 years old. And the international problem is that children everywhere are now suffering from type 2 diabetes. Okay, but the pediatricians have had no training because it's a new disease. So a large group of pediatricians sent for me and said, please do a keynote, and teach us what to do because they, although they're specialists, they haven't experienced in type 2 diabetes. This is a new disease of children. What we're doing, what we're doing, live it at that. We didn't show the foie gras, but I'll eat some of that later. Dr David Almond, thank you. We're done. Fabulous. I enjoyed that. you