It was fantastic to talk today with Dr Jen Unwin @jen_unwin and Dr David Unwin (https://twitter.com/lowcarbGP) @lowcarbgp about their work to promote low-carb health. We talked about how they became advocates of low-carb living, and what they have learnt from their use of social media as a tool for communicating a positive message of personal and social change.
Jen has worked in the NHS for nearly 30 years and over this time has been interested in the way that people cope, and even thrive, with long-term health challenges. Jen believes that patients who are able to maintain their hopefulness and emotional well-being in the face of illness have better quality of life, experience fewer symptoms, take less medication, consult less and even live longer. Jen’s a solution focused practitioner and a former chair of the UK Association for Solution Focused Practice (https://ukasfp.org/) .
David Unwin is a GP based in Southport. David is the Royal College of General Practitioners (RCGP) National Champion for Collaborative Care and Support Planning in Obesity & Diabetes, as well as a Clinical Expert in diabetes. In 2016 he won the NHS ‘Innovator of the Year Award’ NW England. David has written and publish both in medical journals and the popular press, and in recent years has become a convert to social media.
Both Jen and David are directors of Public Health Collaboration UK (https://phcuk.org/) (PHCUK) which is a registered charity dedicated to informing and implementing healthy decisions for better public health.
So why does the widespread consumption of Carbohydrates matter?
In the UK 25% of adults are obese, the highest prevalence in Europe, and type 2 diabetes has risen by 65% in the past 10 years with no sign of slowing down, both cost the NHS £16 billion a year. PHCUK (https://twitter.com/PHCukorg) publish evidence-based reports on the most pressing public health issues alongside coordinated campaigns and implementing initiatives for improving public health.
Find out more by watching videos from the recent PHCUK conference that are available on YouTube (https://www.youtube.com/phcukorg) .
The question we discussed, is how we can go about changing this, and what might be the role of media and social media that can help to get the message about low-carb out into the public domain?
This is a decentered podcast from Rob Watson conversations about Community media look out for decentered media on Twitter and on iTunes or go to decentered Co.uk hello it’s Friday the 29th of May and this is a decentered media podcast with me uh with me Rob Watson uh today I’m joined over Zoom uh by Dr Jen Unwin and Dr David Unwin now Jen has worked in the NHS for nearly 30 years and over
This time she’s been interested in the way that people cope with and even Thrive with long-term health challenges Jen believes that patients who are able to maintain their hopefulness and emotional well-being in in the face of illness will have a often have a better quality of life they experience fewer
Symptoms take less medication consult less and even live longer and Jen’s a solution focused practitioner and current chair of the UK Association of solution focused practice uh David is a GP based in Southport David is the Royal College of general practitioners national champion for collaborative care and support Team Planning in obesity and
Diabetes as well as a clinical expert in diabetes David’s written and published in both medical journals and the popular press in recent years about the topic and experience of managing low carb diets uh particularly with a focus on diabetes and what we want to talk about
Today is the this kind of idea of um low carb what is it what’s it about what the experiences has been like the journey if you like of how you’ve kind of discovered this and and and and now are part of a really broad wide network of
People who have have got similar views and similar experiences and if you later on we’ll we’ll also talk about how you’ve established and are part of the P public health collaboration UK which is a registered charity dedicated to informing and implementing healthy decisions for better public health so I
Never normally do a long introduction but I thought you kind of get this one right and you you deserve that long introduction I think uh so I’m actually ex-chair of the UK SFP now not current not current chair just to clarify that all right okay it’s always good to give
Up a role isn’t it and focus on something else defitely yeah so so you know how how’s I suppose we’ve got to ask the inevitable question how’s lockdown been for you how social distancing manage it well of course I’m I’m not really because I’m a GP I’m not
That locked down so I still get to go to work and I still get to see other people which is quite nice apart from that the lockdown aspect of our life is very relaxing I think it’s actually better it’s actually very peaceful it’s peaceful because we don’t have the Mad
Pressure to fly places go places buy things and do things we we we live uh rurally so that’s that’s just been been so nice really I I live in uh what’s called the West End of Leicester So it’s 15 minutes walk from the city center and
To the to see the flourishing of nature in the city it’s completely transformed you know the the trees seem Fuller uh the birds are certainly louder um it’s and you know the flowers and the bees are out it’s remarkable whether I’m just noticing that and it always there or
Whether there is a measurable distance I I kind of don’t know I think it’s interesting that we’ve we’ve all had more time to notice some of the good things like the weather uh for me I’ve noticed a lot more birds and wildlife and I think maybe I’m too busy sometimes to even
Notice it yeah so I I we’ve had quite a good lockdown we’ve been ill we’ve both had covid but recovered from it yeah same here so early March so it’s and we are interacting differently with people aren’t we on the the topic of you know I think perhaps we’ve been
Using social media more and we’ve definitely been using Zoom for our patient meetings and um keeping in touch with family and uh I’ve been do some um private work so I’ve been doing that over zoom and also just with patients haven’t you’ve been you’ve been on the
Phone to people and a different way of interacting really but not not not necessarily worse in some ways interesting it’s had some some kind of benefits really so in the practice now oh 34s of the patients I’m ringing up and we’re doing it over the phone uh some of them we’re doing
Through open window we’re being very uh in ingenious really so sometimes they show me through a window or they turn up in a car and uh once or twice I’ve done injections where they just put their arm out of the car all sorts of things there is a great sense where we’ve been
Working together I’ve felt a lot of support for the Health Service and people are so kind and patient amazingly and flexible you know we’ve all just settled into a new normal haven’t we some some people who don’t want to go back to the old normal necessarily so
Let’s let’s let’s think about what that normal might be because um let’s put it bluntly we can’t go back to a high carb diet which is causing di we can’t afford now to to to have high rates of diabetes and people are sort of making that link and
That’s you know that’s the big message that we we’ try and get out that it does it does seem like when you look at the evidence that you know that has been a major factor in why people have got really ill I mean a lot of us have been
Have had it and been unwell but the people who’ve got really unwell there does seem a lot of explanatory power in the sort of obesity poor blood glucose control high blood pressure kind of that whole metabolic type type thing so that that how can we get that message out and also then how
Can how can we try and persuade the powers that be to take a different approach because because clearly the one we’ve been taking for the last 20 30 years I mean things are just getting worse in that respect they’re not getting better so to keep doing the same
Thing or insisting on the same message seems a little bit crazy so I think the uh the figures for the UK are pretty Stark aren’t they so and so in in in global global as as in UK terms I think 54% of meals produced Every Day in the
UK are convenience ready meals highest rate in Europe hence we have the highest rate of diabetes and obesity in Europe now is that if that’s a correlation or a cause I’ll let other people argue about that I know some people get very kind of specific about that but just tell us a
Bit about how you know what’s this journey been like how did you David you’ve talked about this I’ve seen you talk and there’s a lots of videos on YouTube so I’ll Point people in the direction of them as well uh but you know what was the the mo what was that
Transition from suddenly realizing that hang on a minute this is a problem in your practice and you need to change something about the way that you deal with it I think it’s one of those things that once you see it you can’t believe you didn’t see it earlier so for me A
Lot of it was a sense of Awakening and I couldn’t believe I’d been so stupid for the first 25 years of being a doctor where all I did was prescribe drugs for people and I never really thought about the true causes of illness um and then uh one day a patient
Came in who had reversed her diabetes spectacularly and come off medication made me look an idiot and she was quite right to do so because I’d never once thought about why that lady was ill and that for her with diabetes and obesity it boiled down to sugar and that
She said herself you know why did you never once mention that bread and breakfast cereal and potatoes and rice all turn into large amounts of sugar and when she gave up all of these things she lost stones in weight came off her medication and her blood glucose her
Blood sugar was normal at the same time I so a number of things came together all at once about years ago so at the same time so I’ve been a lifelong sugar addict and i’ picked up a book by Dr John briff called escape the diet trap
Um and I’ve been reading bits of that out to David and then and it was Bas basically you know explaining about low carbon and um it it’s only a little book but it it kind of uh really struck me and I thought right this is the next thing I’m
Going to try so I I tried it and felt better and kept reading bits out to David so was happening at the same time and then also um you know David was sub of a bit fed up with general practice really and thinking about retiring so we had a conversation a solution focused
Conversation about you know what what might make his work more exciting or maybe you know we’ always wondered about doing some work together we’d never worked together even though we both work in southp obviously David been doing his GP and I’ve been doing my psychology at the hospital so
Um we actually quite wanted to work on a project together so all of this things kind of came together to this Alchemy of why don’t we set up um a a group intervention for pre-diabetics to see if we can help them because I’d always run loads of groups doctors don’t tend to do
That but in my practice I I could see the power of that and I love working with people together um so so we thought right okay well have a go we did it in our own time our own cost in the evenings and um the first group went amazingly well people did incredibly
Well and some of those people are still now coming to the groups and helping other people they sort of turn into advocates for this approach themselves because they’ve lost seven Stone come off all their medication and we’ve had the most amazing Health Transformations and then of course people do become
Passionate because they feel again like we’ve just been saying that actually they’d had the wrong information they’d been trying knocking their heads against the Bri wall not getting just getting sicker and sicker and suddenly they had this simple it’s a really simple message the loward message and they got this they
Got it they did it and and and the rest is history and that’s why a lot of like ourselves and a lot of the patients become very passionate about it because you kind of feel that information has sort of been suppressed in some way or you know not not
Shared when or or even given as an option when it makes such a difference to people and I think for me what had happened for years you know you become a doctor not particularly to make money but you become a doctor because you want to make a difference and really I was
Giving myself a good hard look and really I wasn’t making much difference I was 55 years old and work was a I was a disappointment to myself because you know it isn’t happy to just prescribe drugs for people they watch them get worse they didn’t get better you see
They just got fatter and sicker and I’d add one drug and then another and another and that’s I was deeply disappointed in myself you have a dream as a doctor that patients will be grateful and look healthy and everything’s amazing and that hardly ever happened you never patients never
Thank you for the tenal or the you know the drugs you give foring because they don’t suddenly feel better but for the very first time and so late in my career I was seeing large numbers of patients looking amazing coming in the lightest they’d been for decades I’d never seen
This before so very rapidly I was wide awake and loving it it was so I couldn’t I was really looking forward to seeing patients wondering how they were doing when the blood tests started coming in day after day I used to keep opening the blood tests As a treat
To the end of the day so it turned normally opening blood tests is a chore because it’s full of oh dear she’s worse that one’s bad have to ring you up and tell them off these blood tests were full of amazing results I didn’t know
Was I thought people would think I was a fraud because the results uh of the sugar the blood test on sugar the blood test on liver was so amazing so ever so quickly I was very late in the day becoming the sort of doctor I’d always hoped to be like a magician and
Motivated again with people thanking me and and looking wonderful and we’ve got some amazing before and after photos and it it’s medicine as it could be for so many other people and medicine as it could be for doctors and medicine as it could be for patients where you’re
Working together that was the other thing it was truly collaborative because we were learning with the patients um and um I remember the book that Jen mentioned we actually bought a we bought I think 20 copies of that book and shared it with the patients to say
What do you make so that was a very different approach to say to patients read this book what do you think I think one of the early books I read was uh John yudkin uh I can’t remember the title but it’s about you know kind of
The the the sugar myth that’s the andad and you know just the the the message has been around for a long time um what what what is it that crowds out the simplicity then of that message you know what what what where does it come from that good question that’s such a good
Question I think I think there’s there’s sort of several levels of that I think at a personal level um at a sort of biological level so so my belief and plenty of evidence I think that actually carbohydrates and sugar particularly for some of us are ad are addictive so the
Thought of giving them up people don’t want to hear it it’s like a cognitive dissonance know that must must be another way yeah I I call myself a carboholic I literally just can’t go back to them I’ve got to stay clear from them got to stay clear and I think that’s um
Actually the case for much more people many more people than we think but actually the thought of that you know you have to get to quite a bad place before you think actually I I really need to give this stuff up just just the same as as smoking or drinking you know
It’s just the same principle I think so I think I think that’s one factor and then I think another Factor has obviously been um the low fat guidelines so so you know going going back um to when they were brought in in the 70s and that actually looking back now it does
Seem like the science they went the wrong way with the science they should have gone yudkin way which which put low sugar low carbohydrate and they went the low fat way um anel Keys wasn’t it and if you look at the work of Zoe harkham I
Don’t know if you might be able to link to her her website but if she did her PhD and was the evidence there in the 70s to bring in those low fat guidelines and and the short answer is no um but obviously if you take the fat out of
Everything um that allows food manufacturers to to do that you know somebody has to take the fat out of everything so you need a food manufacturer and then to actually make it taste half decent you have to add the sugar back in so we all went onto a much
Higher sort of sugar lowfat diet we all followed those guidelines you know Sam at the PHD will has the evidence um which shows that actually people are quite good at following the guidelines around eating low fat but actually it doesn’t lead and particularly when they’re endorsed and
You know uh uh the the typical story I’ve heard of you know your diabetes nurse gives you a leaflet and it says eat baked potatoes and bananas and you may as well be giving them a bag of sugar we had a friend who was told to have a
Slice of bake W tart at bedtime in case your sugar went too low two or two if it went even lower so there’s there’s I think there are other factors I’d like to I think the other factor is is the idea of a treat mentality that’s come in where go on treat
Yourself and advertising as to Children advertising generally basically the food manufacturers food you you know the idea that you deserve a treat and and we gone when we were when I was young a treat was on a Friday once a week and now people are living they they’ve normalized
Snacking well or like Chris if you look at Christmas Easter birthdays they’re all sort of it’s all about sugar it’s all about cakes and donuts and or particularly the way we reward children so you did you did well in your math test teachers give sweets in schools yeah uh grandparents who love their
Grandchildren give them bars of chocolate and this is a weird kind of love because we I’m dealing later on and Jenn’s that this is how how would you how would you uh form Addiction in somebody you would reward them yeah you know you want to train a dog you give it
Chocolate Drops we’re training our children that rewards are it’s the first drug that we get is sugar children get yeah and it’s well so I’m dealing with teenagers who cannot give up Sugar by then that’s another Factor another factor is I’ve got to hold my hand up his doctors
So it’s very odd as a as a medical student I was taught all about sugar and starch because really doctors have known about low carb for well over a hundred years and at Medical Stewart school we were taught that but then the Paradigm has changed since I was a medical
Student the Paradigm now is what’s wrong with you and what’s the drug to fix it and we now have a conspiracy in my opinion uh between doctors like me who feel pressure to prescribe and patients who expect an easy fix uh on the tablet rather than to have to do something that
A little bit more painful like change your lifestyle but the LIE is that that came to roost for me was that that didn’t work very well so yes I prescribed and yes you know uh the patients took the medication but they weren’t any healthier and I missed that
For 25 years and that’s I was so rapidly awake so I and then there there aspects of planning we’ve allowed uh fast food outlets near schools our streets are filling with this there’s a whole Machinery uh really to sell us junk food yeah uh for convenience but not to the extent that
We’re doing it in the UK so other countries have kind of they don’t have this this model I mean I was very disappointed cycling past a a nearby Drive-In chicken place and the queue of cars way depressing that shows how addictive it is I did a tweet actually because
Someone had posted a video of one of those cues and what are the characteristics of addiction they are you know um CRA craving something and willing willing to kind of go to extraordinary length to to get to to satisfy the you know and there it is in
Action you know people queuing for two hours in their cars to get a bucket of chicken there’s no other explanation than the addictive properties of that food because you could you could roast a chicken in that time yeah I mean that’s the that’s the con inconvenience isn’t
It you know the uh the the the convenience is quicker you know the microwave is it’s not it takes long longer most of the time and some basic so had steak I had a steak and broccoli for tea last night we both did it was it was ready in about five minutes flat
Because we have it medium rare and we pinged the the broccoli in the microwave well there’s nothing faster than that locally Sauced meat from the butcher locally produced vegetables and it feels odd doesn’t it when you go into The Butchers and you’re looking for the fatty cuz cuz I find in supermarkets you
Know kind of I can’t stand chicken breast it’s too lean it’s too dry I’m used now to the the the parts of the chicken that have the fat in it because that’s where the flavor is need to support The Butchers and our butcher always laughs because he has a special
Kind of bacon under the counter which is is it’s at least half fat isn’t it he makes it himself we call it the Contraband bacon and he only gets it out for for special people you can imagine how surprised there was when the blood test started coming in on the
Cholesterol and the lipids I was doing that because I I was scared about what the results would be because of all the fatty meats that we’re all having and to my utter amazement the the results were significantly better despite the cream the full fat milk and the eggs and I I
Keep thinking what’s going on uh because the results aren’t what I expect so what have you learned that is going on and The Smoking Gun is insulin um what is what what happened I read um it might have been Gary TBS had said it you know
Kind of if you went back to the 18th century uh you know kind of George Washington or something like that they might have maxed out their internal levels twice a year you know you know when when berries are available in the fields or whatever and then when you’ve
Pickled the you you you’ve you’ve made them into jams and then you have a feast at Christmas or something like that twice a we’re maxing out our insulin levels every day every day day after day day after day start the day with cereal uh and a glass of orange juice or
Some toast any of any of those things it’s just sugar digest into sugar have the meal deal at lunchtime the sandwich with the crisps and the and the and the bar it’s all sugar apart from whatever was in your sandwich which is probably a little sad piece of processed chicken go
Home and have pasta with sauce on it’s sugar all you’ve had all day is sugar you’ve not had any protein or or good fats which is what your body and your brain need to to be healthy and and yeah we’ve just all we’ve just all been conned both
I I think and again I I wasn’t asking intelligent questions and and and what does insulin do with sugar it why did I never ask that question what does insulin do with sugar and of course insulin pushes sugar into your muscles for energy but actually if day after day
You eat more sugar than you need for energy where does the rest of the sugar goes It goes into your belly fat middle-aged spread and into your liver fatty liver and and we’ve now got got a situation where 20% of the developed world has fatty liver and we just need
To ask why and everybody’s rushing around saying oh that’s you know where why why have we got all these people with diabetes and I think the answer is reasonably simple and as you say we are the fat man of Europe and the junk food and this idea that you need sugar for
Energy isn’t it like you know a miles a day and all of those sort of messages about you know you need carbohydrate for energy it’s just it’s just not true we have we don’t eat any um obviously in the early days you have to adapt and everything but actually your body makes
The sugar that you need for your brain to work and so on you do need a little bit but your body your liver will manufacture that for you from the proteins and the fats so um in your bloodstream at any one time all of us healthy people have one
Less than one teaspoon of of sugar well in a banana there’s six teaspoons of sugar so just just that simple fact you know I was amazed when I heard that because I’d always sort of you know like like yourself kind of thought oh I need
A banana in midm morning or and keep my energy up kind of thing it that was just a mistake another very important part of the jigsaw is the fact that insulin stops you from being able to burn fat so Jen and I have been uh keto now probably
For six to seven years so we’re fat burners and people love to be fat burners because that’s the best way to get rid of your belly but insulin prevents you from being able to burn fat so that’s why if you eat biscuits all day long you’re still hungry hungry because you cannot
Access the enormous amounts of energy locked up in your own belly and it’s one of the things the patients absolutely notice is lack of hunger I’m told that in every Clinic I ever Rong how surprised they are they say do I have to to eat breakfast because I’m not really
Hungry that’s because sometimes people are accessing fat as a fuel for the first time in years and they’re actually not hungry and that is to do with so insulin is Central to obesity Central to diabetes Central to hunger uh and those are some of the ideas that we’re trying
To promote through social media one of the things you’ve got on and it’s listed on your uh Twitter account David which is the the infographic that you’ve you you’ve done which really show that Stark relationship in terms of just just explain a little bit about that and I’ll
Put make sure there’s link to I will um so I became very interested in the glycemic index and the low GI diet and I was trying to explain to my patients about eating low glycemic index foods but I discovered that patients became confused because they’re not the answer
Comes out in GR of glucose so that um so much food is potato is equivalent to grams of glucose but my patients aren’t really familiar with glucose as a substance so that I they just glazed over nor do they understand grams very well so I got together with an expert on carbohydrates
And we we redid the calculations for 800 Foods in terms of teaspoons of sugar so that I can tell somebody that if you have a 150 grams of boiled rice that will affect your blood sugar to the same extent as consuming 10 teaspoons of sugar and that single fact has people
Understanding how starch is sugar and all of those infograms on my Twitter account are there to help people rapidly understand how to make better dietary choices because it’s it’s so simple to avoid sugar that people with diabetes know to do that but they don’t know about Corn Flakes and rice and bread and
That’s why I did it’s it’s a reworking of the glycemic load and actually the in terms of sort of communicating all of this the the real coup was that nice the National Institute for clinical experence have adopted those um infographics and attached them to their diabetes guidance their type two
Diabetes guidance so that has actually um been a major step forward in that actually getting getting the message out and accepted more widely in in health care so that that that one thing led to another and I think for people interested in other things not L carb it also illustrates some general principles
About communicating so that it’s you have to bear in mind uh you have to think like your audience so as I just explained my audience did not understand glucose and did not understand grams so you if if you can’t get that across you have to
Think of a new way to get it across and it’s no use thinking they’re stupid or not listening that’s the sort of way I operated for 25 years I had to find a way to get my message to people that would interest them the other thing is you visuals are so
Good because not all my patients want to read things and they they don’t want a long explanation but I I’m I’m dyslexic so I can’t spell so actually I don’t like to write long things anyway for me an infographic is so powerful and this is
The new world and I it’s I hated mobile phones and everything to do with media but at the end of the day I really did if if we wish to communicate we we have to coton onto these ideas of infographics who is the audience and my audience were were Ordinary People in
The north of England who you could misinterpret I used to think they didn’t care care about their health because they didn’t seem to listen to me it was actually my fault because my method of communication was poor people do care about health they do and the other thing
Which is Jen’s thing are what are the goals of your audience yeah my audience did care that that there is a kind of sense that you have to push through a lot of fog might be a good way of describing it before you can get some
Clarity uh about the choices and I saw a great phrase the other day about marginal decision I was reading I’ve said this a couple of times recently Jane Jacob’s book about the life and death of the American city um and what she talks about is the way
That we redesign our cities and again it’s timely at the moment with the interest in cycling and walking and creating space for people but when the planners widen the road and narrow the pavement even marginally you make a very uh marginal decision about whether you’ll carry on going through that route
It’s like I’m not into nudge Theory and behavioral uh uh psychology uh because I’m kind of more about empowerment and citizenship and being in control if you like and having the skills and the capacity to do things but we we suddenly are diverted off down a different route
Which has a massive effect later on but it was only a marginal decision that caused it and our food is is one of those things where well we could just stock up on convenient things pizza and frozen fries and all those kind of things and ice cream but and it’s a
Marginal Deion and the supermarkets are designed to make that an even narrower decision because they’re all plentiful and available um what what kind of uh Jen from a kind of psychological point of view and I don’t know what School of Psychology you you you you from say that again sorry yeah I yeah
Well this solution focused ideas really are the ones that I’ve most influence my my thinking and this this idea of Hope hope being so Central so what so when we do the group and when David talks to individual patients it all starts with you know genuinely what
What are their best hopes and it might not be about weight but it might be about they usually say things like you know I want to run around with the grandkids or I want to enjoy my retirement or you know um fashionable clothes is you know I want to yeah I
Want to you know look look good at your you know whatever that is for the person individually that’s actually going to motivate them and then once you know that you can you can tailor your conversation around that that person’s best hopes you you never get anywhere
Until you’re on the same page as as as somebody else you you you kind of pulling it pulling in different directions but then then then you’re on with it then and then you can sort of agree um a way forward and also I think doctors and the rest of us always forget
To ask about people’s um strengths and resilience and competencies and you know as as human beings we tend to focus on all the things we can’t do or you know should do better or you know um sort of self-critical really so encouraging people to think about you know how
They’ve met challenges in the past and um you know who might be helping them or what their character strengths are the organized person are they determined person and putting all of that together as well because that again helps people to see actually I can make a change you
Know I’ve I’ve done these other things in my life I’m a completely competent person you know I I I I have the confidence to sort of take these steps and make these changes and then it’s about small increments then and encouraging people and supporting people and David just did a tweet yesterday uh
We’re really big on the idea of of feedback um to help people keep on track and he did a brilliant tweet um yesterday which was just we he uses the graphs for people so they like in terms of taking measurements like maybe the blood sugars or um the liver function or
The weight is a common one um and the system in the practice you know will produce a graph and um in the groups we really noticed that when people were given their graphs feedback they AB love them and they would kind of hold on to them and they would tell us that they’d
Stuck them on the fridge and shown the family and and those were really motivating so even in lockdown he’s been printing out the graphs and sending them on but also that’s another powerful tool for social media because people love transformation photos don’t they they love they love to see they love story
We’re kind of story based aren’t we humans so people love a love a good story and the graphs sort of tell a story really you know I did this started on this date and after that look what happened and I think those are incredibly powerful motivating that
Individual but also other people who who might be struggling with the same absolutely because that that inspires hope in other people a bit like the idea of remission of type two diabetes which I’d never seen once in 25 years and now I’m seeing it every week because that
Becomes a hope for other people they’ve seen it and they they aspire to do the same and they say to me right how do we do this and they believe they believe in it which is like so so you know about the placebo effect um and obviously that’s that’s all about
Hope and belief that’s all it can be because um say in studies where they’re trying to control for the effects of a particular drug the placebo will just be um just a neutral substance um so and and the reason that they have to do those Placebo control
Trials is that we know the placebo effect is so powerful that if you give someone and they think it’s going to help them um you know up to 70% of symptoms can improve it’s absolutely stunning the placebo effect so you can actually use that in medicine as as a as
A sort of we should use that um effect that psychological effect to further help people so you know obviously they know about David’s work they’ve seen other people do it so just to interrupt you know in a way for some people hope is the placebo effect so if you hope a
Red tablet will help pain and it does well that was the placebo effect but we can you why don’t why aren’t why on Earth aren’t we using hope as part of um obesity diabetes so many other things and I want to add something as well contrast what Jen was saying to the
Established Paradigm of medicine so the estblished Paradigm is you come with pain or depression or whatever the problem we talk about your problem you become the problem and then I give you the drug for the problem at no point in that have we talked about your hopes at
No point is there any idea that you have personal strength resilience competence competence that you’ve faced things before so the the whole conversation is starts negative and and becomes more and more lessness isn’t it it’s about you need a tablet you can’t sort it yourself so this model is about well actually I
Believe that you can sort it yourself going to help you know going to help and sort of guide but actually you know we’re not in people’s homes closing the refrigerator door so they can’t get that kind of piece of cake out or whatever it
Is you know that they have to get to the point where they’re able to to to believe in themselves and to to experience that um that success and and to keep going with it in the face of this environment that we all live in that’s so obesogenic and crazy you have
To create this kind of new blindness to those aisles I find it almost impossible to walk around a city center to find I always have to travel with my own food um I’m not I’m not perfect I need to I’m nudging back to going back towards keto
Because I’ve put a bit a few pounds on but um but you know if I’m I’m terrified of going out to to just have a lunch you know if you go to an event or a conference and it’s a table full of pastries and bread and all of these
Things and you can’t you know you can’t get past that to eat one of the thing the the the the the dimensions of this I think it’s you’ve got the medical Dimension then you’ve got the psychological but I think you introduced something else which was if you like a
Social or Community Dimension so those having the groups meeting uh how important have you found that I think it’s really important because partly because of this um you almost have to help people into this new culture or this new way of seeing the world and it really helps if there’s
Other people who are also seeing the world in that way and talking in that way because otherwise um friends and family can easily undermine and kind of say you know that’s that’s going to kill you and this’s this wonderful idea about mirror neurons that hum humans
Um we’ survived because if we see other people or in the tribe so to speak acting in a certain way that’s a very very powerful um we almost kind of don’t have to think about it it becomes much easier to then act that way ourselves so this
Idea of if you can find a community to support you in this behav this new kind of behavior you’re much more likely to to stick with it so that’s the kind of groups that we run but also online groups and um people watching like you say YouTube videos of people speaking
About it and doing other things it’s I think it’s it’s an incredibly important PE piece of people being able to be successful long term another aspect of this I think is patients often tell me that they they’ve seen one of our patient experts who they identify
With so they think well you know if Eric can do it and he’s 72 and a bloke of it like me he lives around the corner you know I believe I can do it and that’s so seeing people like you who have done it is way different than an expert from on
High saying in my expert opinion and that’s the that’s the real uh benefit o of these patient experts um and also they it’s wonderful to see them answering each other’s problems in in in the group work it’s not tiring because I’ve learned so often you can let them answer somebody ask a
Question why don’t I let a patient ask answer so they’ll say things like what what should I take to work or oh go I’m going to a conference and I know it’s going to be pastries and and sandwiches what what do I do and then other people say well you know I
Take I got this from little and you know um it’s um it’s brilliant really there’s something about uh tacit knowledge between people uh which is it it doesn’t need you don’t need to consult a book about this because you kind of you know I don’t need to consult an expert about this
But they they’re the people who people have to then they’re part of that fog that you have to everybody’s got an opinion uh about what good nutrition is and you know if certainly if you’re using social media there’s there’s een numbers of people that you can follow I
Remember uh seeing a i i i when I when I was teaching about this and looking at social media and there was a there was a Nike uh advert I think it was or somebody had made like a it looked like a Nike advert and it was just said fat
Get the F out of my body and I thought know this willpower idea that you get you know kind of you know you you know all of that that kind of it just takes determination and grit to get through this it’s like that’s the fog that’s the
Nonsense and and a lot of it just is like yeah you know just just do this you know it’s it’s like lowering people’s expectations about what they can and need to do and and not making it anything special it’s just part of the common of community knowledge small sustainable steps it’s completely normal
To just give up bread in our group yeah that’s normalized yeah they and they they just say well that’s what we do my I always use my mom and I’ll give her a shout out on this because it’s uh she she got into low carb around the
Same time as I did and found it you know kind of transformational and uh mental healthwise it helps uh but she has arguments with you know people in cafes and restaurants that she doesn’t want the chips and she doesn’t want to baked potato you know she’s happy with the veg
And the meat that comes you know and and and pushing past that kind of peer pressure you know it’s like yeah yeah and you’ve got you’ve got to have seen the benefits of of of of doing it to allow you to sort of you know
Identify and and and and be a willing to have those conversations yeah so one of the things that we’ve we’ve kind of been able to do through this kind of process over the last couple of years is is yes you can have local groups that can meet at you know your community local
Community center or your your surgery um but actually we’ve got this other tool which is social media uh so what’s your experience been so David was a skeptic Jen was saying earlier about using social media what what’s changed I I really I used to T at anybody text thing
I was terrible I didn’t believe you know children mobile phones I was so against it all but the the principle here is find your tribe and I was alone yeah I was alone nut they call them don’t they apart from Jen of course but I was alone
And and social media allows you not to be alone and to find your tribe and you’re so much braver if you’ve got a group of people who say well I’m doing the same and that’s big how else would you contact with get with Prof Tim noes
In South Africa in the past it would have been really hard to do that so I I found lots of aspects of My Tribe so I’ve I now there’s hundreds and hundreds of doctors I think I’ve I probably got thousands of doctors follow me now so
That’s a big tribe and then there’s the tribe of of patients and people who are low carbs successfully and then it all begins to add up more and more because then as your tritter following gets larger then other people take ser seriously it’s a rolling sort of program of of extra
Influence because then politicians begin to look and I think at the moment I think I’ve got probably 47 or 48,000 followers now so politicians begin to be interested in what I have to say because they know my Twitter following is very large so it it grows and grows it’s
Really it’s very hard work in the beginning to build it up but when it once you get a a following going you you make friends it’s it’s it’s been a wonderful thing for me in most ways there are some drawbacks like dealing with trolls and one or two other things
That we might talk about but you you find your tribe you become more influential I’ve learned a great deal about why people use Twitter and because Twitter teaches you all the time because you get feedback so Jen would say feedback do more of what works and I
Know what works because I look at the number of people I know how many thousands of people have accessed any particular tweet and over years I’m refining what is it that people are interested and do more of what works which is absolutely Jen’s teaching Twitter’s a laboratory within that how
Do you remain because there’s an a really important thing about trust and accountability um in terms of this isn’t just a free-for-all of indignation uh although Twitter has that element to it which I I use at times I have two separate accounts one for my one one for
My indignation and one for my professional work um but you know it’s kind of how how how what what is it the core of this that then has that you know kind of the blue tick on Twitter isn’t it you know kind of what is who are you
Accountable to is a is an important question there were there were some early lessons I think for Health Care Professionals using social media and and the Royal College were very nervous of me using social media and generally I was told don’t go anywhere near it at the beginning but plain that can’t be
And we have to learn how to do it one of the things for Jen and I is General cheerfulness so we’re very disinclined to criticize anybody you’ll hardly ever find us saying something unpleasant about another person or another organization because that isn’t our ethos really so we’re we try and be an extra
Cheerful and optimistic and if you don’t criticize we just don’t talk just ignore what you don’t like so we we’re hardly ever outraged I’m a bit outraged can be food processed food and things like that so yeah another thing very important I never get into personal slagging off with
Trolls uh because what does I don’t think it establishes anything at all and then after a while they learn not to bother because I simply will never respond uh just always ignore and another most important thing for doctors is to bear in mind that uh what you’re doing is in the public
Arena and that people could take that as personal advice or it could be dangerous I always bear that in mind or you won’t sleep I don’t know in in kind of uh medical schools now that there is training about using media um you know how how have you found that because you
Know previously the model of engaging with media was been taught how to write a press release and and maybe ring up your local radio station or your local newspaper and try and get something in there and it has to be neatly packaged uh to to you know part of a
Campaign or uh you know the whole system had to be geared up you know the health authority had to be geared up to doing this and you were asked to pay aart and but you you’ve kind of got this independent identity and you can pursue your own interests with the the caveat
That you’re accountable and responsible to your colleagues and other professionals and your patients and and and and you’re not generally just flying off with some flaky wacky advice um this is this is valid this has been based on published guidance I’ve learn I’ve leared a lot over the years so say
Things like maybe are not always because you don’t know be try and be honest about what you do know and what you don’t know and and and if it’s based on my clinically experience well that’s valid so it’s fair to say that in my clinic I find this because that’s telling the
Truth so I think being truthful is is really important and not to Big it up beyond what you actually know otherwise you’ll get into difficulty because people will pull you to pieces and that’s what I’ve learn I made errors in the early days uh where I overclaimed or whatever
And so slightly understate what you do is is good and then people learn to trust you what do you think Jen yeah and also of course involving patients is is great but also potentially very difficult so a really important idea is first of all about anonymizing any data and secondly the idea of
Consent so that consent must be is not enough for my patients to say yes they must know what they’re saying yes to so that if I’m going to use your graph or talk about your case the patient concerned I asked them and in fact they never say no because
They they love being part of science but the point is you must you know you must get consent you must obtain consent and it must be informed consent but if it if you can work with patients it it comes across on social media so well this partnership between
Doctor and patient and and there is a kind of I think one of the things that’s to changed is an openness and transparency to the process is it gives people more confidence but we need to I mean there’s a you know a a discussion at the moment
About uh you know the the the lockdown response and the government saying we’re following the science what science you know you know people actually have the capacity to understand and to debate and deliberate and to to to co- uh um think through these things they don’t you
Can’t just be told it’s the side as if it’s some kind of Monolithic block yes exactly well and that brings me back to the the the old do onwi who I just used to tell people what they should do but what I’ve discovered is that people on the whole are
Intelligent and they do they’re intelligent they have judgment it’s up to us as communicators to find ways to give them the facts and let them decide what they eat I’m not telling you what to eat but I can demonstrate how much sugar there is in cornflakes and if you’re avoiding sugar
Well then you’ll avoid cornflakes but that will be your decision based on what I Supply you with and I think so often with mystified medicine um and if we can so nutrition it should be something that we can help people understand and if you can’t understand what I say then
Actually perhaps I’m a fault and I should find a way to help you understand it so then it becomes collaborative yeah and and and co-produced so the the the kind of solutions Focus I always like to finish the podcast because we’re really good at picking over the problems and
Actually spending a couple of minutes having an opportunity to celebrate the positive uh contribution the positive changes and the solutions what would you kind of identify uh uh as being the kind of key things that you want to you want to see change uh you know as we come out
Of this into this new normal what would be one or two headlines that you think would be simple um effective uh ways to change our thinking I think the real food message is a nice simple and communicable thing isn’t it that that people do do understand you know was it was it
Recently growing in a field uh walking in a field or swimming in the sea that kind of thing um and the idea of eating more real food and where does our food come from think those I’ve got a more basic one I’d like people to understand that of all the
People I see in every single surgery every single day I’d say two-thirds of them they’re there because of what they’ve eaten I can’t believe the difference that diet can make to Good Health mentally and physically mentally and physically and that um the various epidemics of poor health we are seeing
Doesn’t have to be and um I’m putting diabetes into remission on a daily basis I’m getting rid of high blood pressure obesity eczema psoriasis joint pain heart failure heart failure irritable bowel syndrome celiac disease psoriatic arthropathy the list goes on and on and on and that uh the message of Hope is
That eating real food can make a huge difference to your health and most people do care about their health and it’s a wonderful alter alternative to lifelong medication is it Robert luster who calls it processed food disease I think that the label of what we call these things is now really important and
Those kind of simple things are kind of quite effective that’s my message of Hope is is most people wish to be healthy and eating in a healthy way I have found after all these years so late in my career has made a big difference personally to our entire family and my
Mother and my sister and my grandchildren and the neighbors and the neighbors and and The Decorator and the plumber and the butcher up the road and thousands of patients and then we did the low car program which went out 440,000 people have done that around the
World now so those are messages of hope uh that we can make a difference and we shouldn’t don’t despair uh we can make a difference well it’s always fantastic listening to you both uh you’re always that optimism is just you know is infectious and and I
Think it’s needed at the moment as well what’s the best way for people to get in contact with you if they they want to follow up Twitter larb GP please follow me follow me and I’m at genore onwi I can’t promise from this podcast that you’ll get thousands of followers but new
Followers everyone counts everyone count it’s quality not quantity that’s what so thank you very much for your time uh it’s been been really fascinating a lot more that we could we we could talk about and discuss um if you want to get in touch with me uh I’m decentered media on Twitter and
Instagram um and if the website is des center.co uh if you want to pop over to patreon maybe make a donation for a cup of tea or some biscuits oh no we can’t have biscuits now I always say biscuits almonds yes or some cheese or something like that then uh then then
Look for decentered media on patreon as well uh but until next time thank you very much to Jen and David it’s been amazing thank you thank you Goodbye you’ve been listening to the decentered podcast I’m Rob Watson if you want to find out more information contact me on decentered media via Twitter or go to Des centered. Co.uk