Dr. David Unwin Reverses Type 2 Diabetes Through Low-Carbohydrate Diets

David Unwin 医生通过低碳水饮食逆转2型糖尿病 戒除淀粉类碳水化合物和超加工食品，无需药物干预即可逆转非酒精性脂肪性肝病并使2型糖尿病获得缓解。 David Unwin 医生分享了他从传统全科医疗转向通过低碳水饮食干预逆转2型糖尿病的历程。他阐释了日常碳水化合物和隐形糖如何在临床症状出现很久之前就引发高胰岛素血症、非酒精性脂肪性肝病及代谢功能障碍。内容涵盖了用于评估内脏脂肪的绳子测试和常见食物等糖测试等实用工具，同时探讨了食物成瘾机制以及 GRIN 模型等应对策略。Unwin 医生还指出了代谢健康恶化带来的更广泛影响，包括健康寿命缩短、儿童2型糖尿病发病率上升，以及高糖摄入与癌症风险增加之间的联系。 “绳子测试”（String Test）是一种简单有效的代谢健康检测方法：腰围应小于身高的一半，因为腹部内脏脂肪对健康的威胁显著高于四肢皮下脂肪。 (0:00) 全球约有三分之一的2型糖尿病患者未被确诊；在血糖控制不佳的情况下，每拖延未愈一年，患者的预期寿命就会缩短约100天。 (0:00) 过量摄入糖分和碳水化合物会导致脂肪异位堆积在肝脏和胰腺，过高的血糖仅需6小时即可损伤血管糖萼（glycocalyx），并逐步引发胰岛素抵抗与器官功能受损。 (6:30) 临床实践数据显示，低碳水饮食干预可使高达93%的糖尿病前期患者血糖恢复正常，并使73%的早期2型糖尿病患者实现无药物缓解。 (6:30) 米饭、土豆和面包等淀粉类碳水化合物在体内会直接分解为葡萄糖，例如150克熟白米饭的血糖负荷相当于10茶匙糖，其隐形含糖量常被大众严重低估。 (41:16)

Dr. David Unwin contends that widespread metabolic disease—notably non-alcoholic fatty liver disease and type 2 diabetes—is primarily driven by dietary carbohydrates and hidden sugars overloading insulin regulation. He argues that addressing root physiological mechanisms through carbohydrate restriction and behavioral change enables disease reversal where lifelong drug management fails. Visceral Fat, Insulin Resistance, and Liver Steatosis (6:30) Dr. Unwin explains that a healthy adult's five-liter blood supply contains only about 4 grams of dissolved glucose, or roughly one sugar cube. When refined carbohydrate intake exceeds metabolic requirements, elevated blood sugar damages the vascular glycocalyx lining within six hours. In response, the pancreas secretes insulin to clear circulating glucose, storing excess energy in abdominal adipose tissue and inside the liver. Citing Professor Roy Taylor's research, Unwin characterizes accumulating liver fat as a decade-long, asymptomatic "silent scream" that causes progressive insulin resistance. Non-alcoholic fatty liver disease now affects roughly one-third of adults in the developed world. Eventually, ectopic fat spills into the pancreas, impairing insulin secretion and triggering type 2 diabetes. Central visceral fat carries far greater metabolic risk than peripheral limb fat, which individuals can easily assess using a waist-to-height string test. Hidden Glycemic Loads in Everyday Carbohydrates (41:16) Nutritional guidelines often mislead patients by emphasizing glycemic index over glycemic load, which measures real-world serving sizes. Unwin points out that starchy carbohydrates are simply "glucose molecules holding hands," which digestive amylase rapidly dismantles into free sugar. According to Public Health Collaboration metrics, 150 grams of boiled white rice yields a glycemic load equivalent to 10 teaspoons of sugar, a baked potato equals 9 teaspoons, un-frosted cornflakes equal 8 teaspoons, and a banana equals 6 teaspoons. Consuming refined starches and fiber-depleted liquid sugars, such as orange juice, spikes blood glucose and triggers reactive insulin crashes, creating perpetual hunger. To stabilize metabolism, Unwin advises building meals around protein, non-starchy green vegetables, and natural fats like olive oil or butter, while avoiding ultra-processed foods carrying deceptive "natural fruit" health halos. Reversing Diabetes Against Standard Pharmaceutical Practice (18:12) For his first 25 years in NHS general practice, Dr. Unwin followed conventional guidance recommending low-fat diets and escalating medications like metformin, which aligned with practice financial targets. His approach shifted after a patient confronted him for never explaining that starchy staples convert directly into sugar, having reversed her own diabetes through an online low-carb community. Partnering with his wife, clinical psychologist Dr. Jen Unwin, he launched an off-hours low-carbohydrate clinic. Patient cohorts achieved 33% to 50% improvements in liver enzymes (ALT and AST) within weeks, alongside substantial drops in HbA1c, normalized blood pressure, and weight loss. Documenting 157 diabetes remissions, Unwin argues that conventional "eat less, move more" guidance fails because it misinterprets biological hunger crashes as patient willpower failure. Tackling Ultra-Processed Food Addiction and Compulsion (90:43) Referencing research by Dr. Jen Unwin indicating that roughly 14% of the population suffers from ultra-processed food addiction, Dr. Unwin stresses that chronic dietary relapse stems from neurochemical dependence rather than weak discipline. In severe clinical cases, Unwin pairs low-carb protocols with continuous glucose monitors (CGMs) for biofeedback and temporary low-dose GLP-1 receptor agonists to mute obsessive "food noise." To break food addiction, the Unwins recommend a four-step framework: practicing radical self-honesty, pinpointing specific dietary triggers, adopting total abstinence rather than moderation, and securing gentle family support with strict boundaries against policing. Sustainable transformation further requires replacing vague resolutions with vivid, measurable lifestyle targets that preserve long-term functional independence. Healthspan Decline and the Pediatric Diabetes Surge (105:05) Dr. Unwin highlights that while overall lifespan has crept upward, UK healthy life expectancy has dropped by roughly two years over the past decade. The average adult now faces 23 years burdened by chronic illness and disability, while ultra-processed foods cost English taxpayers an estimated £7,000 annually per person. Even more critical is the global surge of type 2 diabetes among children under 16—a condition once known strictly as maturity-onset diabetes. Because pediatricians historically received no training in managing adult metabolic disorders via dietary intervention, Unwin highlights an urgent clinical knowledge gap that leaves young patients vulnerable to lifelong vascular and metabolic injury unless medical guidance transforms. While Dr. Unwin demonstrates that dietary carbohydrate restriction can achieve drug-free diabetes remission and liver recovery, widespread implementation remains constrained by institutional clinical inertia, pervasive ultra-processed food marketing, and diagnostic approaches that generate patient anxiety rather than actionable behavioral solutions.

英国全科医生 David Unwin 博士指出，现代高碳水化合物与高糖饮食正在驱动全球性代谢危机，导致非酒精性脂肪肝、胰岛素抵抗与2型糖尿病的大规模隐蔽蔓延。通过建立直观的“茶匙糖等效量”打破对加工淀粉的认知误区，并辅以低碳饮食与成瘾行为干预，患者在临床上展现出逆转脂肪肝与改善多项代谢指标的显著成效。 胰岛素抵抗与脂肪肝的隐匿病理机制 (6:30) Unwin 博士指出，健康成年人全部 5 升循环血液中通常仅溶解着约 4 克葡萄糖（相当于一块方糖）。当高血糖发生时，血管内壁细腻的糖萼（glycocalyx）在短短 6 小时内就会受损；为保护血管，胰腺会分泌胰岛素将葡萄糖压入细胞供能。然而，当碳水化合物与糖分摄入持续超过身体消耗时，过剩能量将首先转化为腹部内脏脂肪，进而转变为肝脏内部的异位脂肪。在发达国家中，估计已有三分之一的成年人患有非酒精性脂肪肝。 Unwin 引用纽卡斯尔大学 Roy Taylor 教授的研究，将这种长达十余年的无症状脂肪蓄积过程称为“肝脏漫长的无声尖叫”。长期蓄积的肝脏脂肪会诱发胰岛素抵抗，迫使胰腺分泌更多胰岛素以维持血糖；当异位脂肪进一步扩散侵染胰腺本身时，胰岛素生成细胞遭到破坏，最终诱发显性 2 型糖尿病。目前全球约有三分之一的 2 型糖尿病患者未被确诊，而长期血糖控制不佳意味着患者每年将损失约 100 天的预期寿命。 淀粉本质与“茶匙糖”等效换算模型 (41:16) 针对公众营养常识的匮乏，Unwin 提出淀粉类碳水化合物在本质上就是“手拉手的葡萄糖分子”，摄入后经唾液淀粉酶等消化分解，会迅速转化为游离葡萄糖涌入血液。相比于容易产生误导的升糖指数（GI），综合考虑了实际分量、纤维与水分密度的升糖负荷（GL）更具指导意义。为帮助患者理解，Unwin 联合创办的英国公共健康协作组织开发了“4克茶匙糖等效量”图表，用日常方糖直观展示食物的可消化碳水负荷。 经换算测定，一份 150 克的熟白米饭消化后相当于 10 茶匙糖，一个大土豆相当于 9 茶匙糖，一碗未加糖的干玉米片相当于 8 茶匙糖，一块巧克力棒相当于 7.5 茶匙糖，一根熟香蕉则相当于 6 茶匙糖。这种糖分隐蔽性在诸多所谓的“健康食品”中更为严重：脱水水果由于水分蒸发，糖分浓度可达 60% 至 70%；鲜榨果汁或果昔在压榨过程中剔除了天然植物纤维，导致液态糖骤然冲入血液，引发强烈的胰岛素分泌与随后的血糖骤降，导致饮用者在上午极易陷入剧烈饥饿与恐慌感；部分市售烧烤酱整瓶含糖量甚至折合高达 30 块方糖。 低碳饮食临床逆转与代谢健康自测 (25:16) Unwin 反思了自身行医前 25 年开具“少吃多动”、脱脂牛奶与高纤麦麸的传统处方，直言热量限制引发的生理性饥饿必然导致方案失败，将责任推卸给患者意志力是医学指引的失误。在颠覆认知并开设低碳志愿门诊后，他发现患者在调整饮食数周内，原先归因于饮酒的肝功能指标（ALT/AST）普遍改善了 33% 至 50%，伴随体重持续下降、高血压恢复正常以及糖化血红蛋白（HbA1c）大幅降低，患者白天的精力与饱腹感也显著提升。 在日常饮食构建上，Unwin 建议以鸡肉或鸡蛋等优质蛋白质为餐食基础，加入大量西兰花或绿叶菜等非淀粉类蔬菜，并佐以黄油、橄榄油或全脂蛋黄酱等天然脂肪以提供美味与持久饱腹感。在自我监测方面，他推荐了低成本的“绳子测试”（String Test）：截取一段与自身身高相同的绳子并对折，若对折后的绳子无法轻松环绕腹部最宽处（即腰围超过身高的 50%），即标志着腹部内脏脂肪超标，存在较高的心血管和胰岛素抵抗风险。 超加工食品成瘾机制与四步戒断方案 (90:43) Unwin 指出，精制碳水化合物与超加工食品的复食不仅是习惯问题，而具有明确的神经生物学物质成瘾特征。根据其妻子、心理学专家 Jen Unwin 博士的研究，普通人群中约有 14% 的人存在超加工食品成瘾。在临床案例中，曾有严重关节受损且血糖失控的重症患者，因无法克制对面包的极度渴望，甚至在深夜从垃圾桶中刨出被家属喷洒了洗洁精甚至家用漂白水的面包食用。面对严重的食品成瘾，单纯依赖自制力往往无效，临床需结合持续葡萄糖监测仪（CGM）的即时生物反馈以及低剂量 GLP-1 受体激动剂来平息大脑中的“食物噪音”。 对此，Jen Unwin 提炼出四步行为戒断方案：第一步，进行彻底的自我坦诚，承认自身对特定食物失去控制，不再寻找借口；第二步，精准识别具体的诱发性食品；第三步，确立完全戒除而非“适度摄入”的目标，因为成瘾大脑对“仅吃一口”缺乏生物学制动机制；第四步，寻求伴侣或亲友的温和支持，同时设立明确边界，严防亲友演变成日常监控者。 农业退化、健康寿命缩水与儿科危机 (105:05) Unwin 解释称，受现代农业长期依赖合成氮肥且缺乏矿物质回补的影响，全球农田土壤严重退化，农产品中的锌和镁等关键元素相较百年前大幅缩减。日常饮食难以补充足够的镁，加之老龄化以及抑郁或胃食管反流药物对矿物质吸收的阻断，极易诱发严重的肌肉痉挛与睡眠障碍。英国国家统计局（ONS）与健康基金会的数据显示，过去十年英国人口的健康预期寿命下降了约 2 年，平均健康寿命仅剩 60 岁左右，个体在生命末期平均有长达 23 年的时间处于慢性病与残疾状态，超加工食品引发的代谢疾病每年让英国纳税人额外承受 7000 英镑的税负负担。 代谢危机正急剧向低龄群体渗透。Unwin 回顾自己在 1986 年刚执业时，2 型糖尿病曾被称为“成年发病型糖尿病”，在 55 岁以下人群中极为罕见；而如今全球 16 岁以下儿童及 25 岁以下青年的患病率正在激增。由于该病在儿科历史上从未出现过，全球儿科医生普遍缺乏利用饮食生活方式干预逆转该病的专业培训，反映出重构公共卫生指导的迫切性。 Unwin 博士强调，慢性代谢退行并非自然衰老的必然代价，而是被现代加工食品环境破坏的病理产物。尽管通过低碳饮食、纠正隐性糖认知与补充微量营养素能够在个体层面实现脂肪肝与糖尿病的临床逆转，但全社会在扭转土壤矿质贫瘠、遏制超加工食品成瘾及弥补儿科代谢诊疗空白等方面，仍面临巨大的结构性挑战。

## Background 本期内容由知名播客频道《The Diary Of A CEO》（主持人 Steven Bartlett）于 2026 年 5 月 18 日在 YouTube 平台发布。节目特邀行医逾 40 年的英国国民医疗服务体系（NHS）全科医生、2016 年度 NHS 创新奖得主 David Unwin 博士，深入探讨日常隐形糖分、非酒精性脂肪肝的隐匿形成、超加工食品成瘾机制，以及通过低碳饮食在无需药物干预下逆转 2 型糖尿病的临床实证。 ## TL;DR Unwin 医生结合自身行医经历与临床数据，揭露了米饭、面包等精制淀粉在体内转化为大量葡萄糖并诱发脂肪肝、胰岛素抵抗甚至多种恶性肿瘤的生理机制。他通过生动的“茶匙糖等效测试”和“毛线测腰围法”，打破了大众对健康食品的认知盲区，并指出单纯以开药为导向的医疗考核体系无法从根源解决慢病危机。此外，节目深入拆解了超加工食品成瘾的神经生物学真相，提出了结合动态血糖仪（CGM）、戒绝计划与心理学“GRIN 模型”的实用干预路径，呼吁大众主动夺回自身健康的主导权。 ## Atmosphere & style 整场对话在温和诚挚、发人深省且极具警示感的氛围中展开。Unwin 医生毫无名医的傲慢，以近乎自省的坦率讲述自己曾经的饼干成瘾、对患者的误解以及家庭中的成瘾伤痛，配合现场摆放方糖等具象道具，将晦涩的生化机制化为直击心灵的顿悟时刻；Steven Bartlett 则以敏锐且极具同理心的追问穿针引线，两者之间的互动真诚而深邃，让听众在感受到代谢危机沉重压力的同时，又能汲取到重获健康的切实希望与行动力量。 ## Bulletin - [07:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=428s) 大卫·安温医生（Dr. David Unwin）指出，发达国家已有三分之一的人患有脂肪肝，而正常成年人全血容量中仅溶解约4克葡萄糖（相当于一平茶匙），日常摄入的一碗米饭升糖效应等同于10茶匙白糖，正在将全社会推入代谢灾难。 - [05:30](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=330s) 2型糖尿病患者若长期血糖控制不良，平均每过一年将缩短约100天寿命；且该群体中增长最迅猛的死因并非传统的心血管病变，而是包括乳腺癌、子宫内膜癌在内的至少8种恶性肿瘤。 - [12:47](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=767s) 低碳饮食逆转2型糖尿病存在关键窗口期：在糖尿病前期干预成功率高达93%，确诊初期为73%，确诊5年后若未干预则降至约50%。 - [01:27:03](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5223s) 现代社会超加工食品成瘾率约为14%，其神经生物学机制与烟酒成瘾无异；对于真正的食物成瘾者，依赖“适度食用”几乎必然失败，必须采取彻底戒绝（abstinence）并配合CGM等手段协同干预。 - [01:50:19](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6619s) 现代集约化农业土壤退化导致锌、镁等微量元素严重流失，绝大多数人无法从膳食中摄入足量镁；安温医生建议根据肠道状态选用适合形态（如便秘选用柠檬酸镁，助眠选用甘氨酸镁或苏糖酸镁）。 ## Key takeaways - [00:00](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=0s) “毛线测试”（腰围身高比）：腰围应小于身高的一半。只需将等身高的绳子对折绕腹部最粗处，无法合拢即代表内脏脂肪与胰岛素抵抗超标，该测试比体重秤更能反映代谢健康风险。 - [02:20](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=140s) 疾病谱系与命名变迁反映代谢危机蔓延：2型糖尿病曾被称为“成人发病型糖尿病”，如今由于精制碳水和高糖饮食泛滥，儿童与25岁以下青少年代谢失控暴发，迫使儿科医生面对前所未有的慢病挑战。 - [10:32](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=632s) 脂肪肝与糖尿病形成的恶性循环：摄入过量葡萄糖促使胰岛素将其转化为脂肪塞入肝脏；长达十年的“无声呐喊”后，溢出的脂肪浸润胰腺，破坏胰岛素分泌细胞，最终导致血糖彻底失控。 - [15:57](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=957s) 现代医疗考核体系对生活方式干预的扭曲：传统全科医生受限于开药考核指标（如二甲双胍用药配额），系统性地将资源投入被动开药，忽视了从根源上通过低碳饮食逆转代谢综合征。 - [55:04](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3304s) 淀粉就是“手牵手”的葡萄糖：包装食品中的无糖淀粉（如玉米片、面包、土豆、白米饭）经唾液及胰腺淀粉酶分解后，会以极快速度转化为游离葡萄糖，每4克碳水化合物对血糖的冲击大致相当于1茶匙纯糖。 - [45:20](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2720s) 果汁与低脂高糖饮食的代谢陷阱：剥离膳食纤维的鲜榨果汁或果昔会造成血糖飙升并引发胰岛素过量分泌，随后的“反应性低血糖”会导致心悸、乏力及更强烈的饥饿恶性循环。 - [52:04](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3124s) 门诊实操餐盘构建原则：停止聚焦“绝对不能吃什么”，而是优先以优质蛋白质为核心，堆满低升糖绿叶蔬菜，并使用健康脂肪（黄油、橄榄油、全脂蛋黄酱）调味，避免含高糖的市售调味酱。 - [01:04:14](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3854s) 打破食物饥饿循环的生酮机制：在减少碳水化合物摄入并动用脂肪供能后，原本由胰岛素波动驱动的频繁饥饿感和对高糖面食的心理渴望会大幅消失，带来持续的大脑专注力与思维清晰度。 - [01:16:12](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4572s) 促成持久改变的心理学GRIN模型：由珍·安温（Dr. Jen Unwin）博士提出的四步法——确立深层目标（Goals）、调动既有资源（Resources）、拆解微小步进（Increments）与觉察积极反馈（Notice），用希望取代自责与内疚。 - [01:33:38](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5618s) 面对亲友食物成瘾切忌充当“饮食警察”：强行监控、说教或藏匿食物只会迫使成瘾者产生羞耻感、秘密进食与欺瞒，反噬当事人自尊；唯有基于尊重的坦诚沟通与专业戒绝方案才能破局。 - [01:39:03](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5943s) 糖、高胰岛素血症与恶性肿瘤的紧密联系：长期高糖摄入导致慢性高胰岛素血症，抑制受损细胞的正常凋亡（Apoptosis），果糖代谢生成的游离脂质还会直接被肿瘤细胞用于构建细胞膜。 - [01:45:04](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6304s) 寿命（Lifespan）与健康寿命（Healthspan）的脱节：现代人虽然预期寿命延长，但带病生存期平均长达23年；通过“事前检视”（pre-mortem）正视生命终点，有助于在当下建立严格的主动健康管理。 - [01:57:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7028s) 可行动的健康筛查与CGM的普及意义：单纯恐吓患者的体检缺乏临床价值，筛查必须绑定可立即落地的干预手段；低成本的连续血糖监测仪（CGM）让隐形糖分无处遁形，是促成生活方式转变的利器。 ## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=0s) 隐藏的糖分陷阱与一根绳子的体检测试 节目在一组极具冲击力的视觉演示与警告中拉开序幕。大卫·安温医生（Dr. David Unwin）首先提出了一个极为简单却切中要害的自测方法——“毛线测试”（string test）：人的腰围应当小于身高的一半。只需截取一段与自己身高相同的绳子，对折之后尝试绕过腹部最粗的位置，如果绳子无法合拢，就意味着内脏脂肪已经超标。安温医生强调，长在肚子上的脂肪远比长在手臂或腿部的皮下脂肪危险得多；然而现代社会却开始将“老爹肚”（dad bod）视作常态，完全忽视了这种体型绝非人体应有的健康状态。全球约有三分之一的2型糖尿病患者根本不知道自己患病，而数据表明，2型糖尿病患者每处于血糖失控状态一年，就会白白损失整整100天的寿命。 在节目的前瞻片段中，主持人史蒂文·巴特利特（Steven Bartlett）与安温医生在桌面上用茶匙量化了常见食物中暗藏的糖分。面对麦片、土豆、白米饭、香蕉和巧克力棒，真实数据彻底颠覆了大众的常识认知： - **玉米片（Cornflakes）**：一碗所产生的葡萄糖效应相当于整整 8 茶匙糖。 - **巧克力棒**：相当于 7.5 茶匙糖。 - **香蕉**：相当于 6 茶匙糖。 - **土豆与150克熟米饭**：其引发的血糖飙升同样令人震惊，甚至超过普通甜食。 史蒂文忍不住惊呼：“我一直以为米饭是非常健康的食物！”安温医生指出，食品包装与营销广告长期误导了大众，而他作为全科医生的核心使命就是推动行为改变，帮助人们在充满冲突的养生信息中，看清饮食的真相并选择自己真正想要的生活与健康未来。随后，史蒂文真诚地呼吁观众顺手点击订阅频道，支持团队继续带来高质量且颠覆认知的对话。 --- ### [02:20](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=140s) 年轻人正步入代谢灾难：从“成人发病型”到“2型糖尿病” 访谈正式开始，史蒂文隆重介绍了安温医生——他不仅在2018年被评为全英国十大最具影响力的医生之一，更以 diet-first（饮食优先）逆转2型糖尿病的卓越临床成果享誉国际。当被问及当前最挂心、最困扰的问题时，安温医生严肃地指出，每个人未来都面临着截然不同的“健康走向”——可能走向癌症、多发性硬化症，或是拥有长寿健康的体魄。他最为关切的是：如何让大众真正认清何种生活方式能通往健康的未来。 在安温医生眼中，这场危机在年轻人身上尤为紧迫，因为年轻人拥有最充裕的时间去扭转命运，但他们身处的大环境却让健康饮食的选择变得空前艰难。安温医生直言，当今世界正笼罩在一场“代谢健康的全球大流行病”（a pandemic of poor metabolic health）中。就在节目录制的前一天，他在门诊接诊了两名不满25岁、血糖严重失控的严重糖尿病患者，其中一人的体重甚至超出了诊所体重秤的测量上限。 ```mermaid flowchart TD accTitle: 代谢疾病命名与流行病学变迁 accDescr: 展示从1986年到现代，糖尿病患者年龄分布与疾病命名的转变历程。 subgraph S1["1986年：传统认知"] A["罕见肥胖症"] --> B["55岁以下无一例发病"] B --> C["成人发病型糖尿病<br/>(Maturity-Onset Diabetes)"] end subgraph S2["现代：代谢恶化"] D["年轻群体暴发"] --> E["不满25岁严重失控"] E --> F["更名为：2型糖尿病<br/>(Type 2 Diabetes)"] end C -.->|"流行病迫使医学界更名"| F ``` 这种景象在过去是完全无法想象的。安温医生回忆道，当他于1986年在利物浦北部刚刚开启行医生涯时，诊所辖区内的肥胖病例极为罕见，55岁以下的人群中找不出哪怕一例类似病患。当时该疾病甚至被称为“成人发病型糖尿病”（maturity-onset diabetes），顾名思义是老年人的专属疾病。而如今，医学界被迫将其改名为“2型糖尿病”，正是为了涵盖数量庞大、发病年龄极骤降的青少年与年轻人。安温医生愤怒地指出，全社会正在梦游般地走向一场代谢大灾难，把腹部隆起的大肚腩轻描淡写地调侃为“幸福肥”或“老爹肚”，而付出最沉重健康代价的正是懵然无知的年轻一代。 --- ### [05:30](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=330s) 糖尿病的真正杀手：不只是血管病变，更有癌症阴影 安温医生进一步澄清，饮食与代谢改善的建议不仅针对年轻人，对50岁以上的人群同样生死攸关。来自英国政府的权威官方统计数据表明： - 2型糖尿病患者的血糖若长期处于控制不佳的状态，**每度过一年，预期寿命就会缩减约100天**（相当于生命缩短了近三分之一年）。 - 全球范围内约有 **三分之一的2型糖尿病患者** 处于未确诊状态，由于缺乏筛查测试，他们对体内潜伏的危险浑然不觉。 当安温医生提问“究竟是什么夺走了2型糖尿病患者的生命”时，史蒂文猜测是心血管疾病。安温医生对史蒂文的敏锐表示赞赏，指出绝大多数临床医生的第一反应也是心血管损伤，因为长年累月的高血糖会直接破坏全身动脉血管，产生不可逆的累积性损害。 然而，安温医生揭示了一个鲜为人知的残酷趋势：在糖尿病患者群体中，**增长最迅猛的死亡原因其实是癌症**。现代医学研究已经证实，至少有 **8种不同类型的恶性肿瘤** 与糖尿病及高血糖状态存在极强的直接关联。 --- ### [07:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=428s) 胰岛素的防御机制：血糖如何悄悄转化为脂肪肝 史蒂文坦言，很多人曾误以为糖尿病是某些人先天自带的疾病，只要自己没得上就无需多虑。安温医生借此厘清了1型与2型糖尿病的区别，并强调要真正理解代谢疾病，首先必须读懂人体内至关重要的荷尔蒙——**胰岛素（Insulin）**。 高血糖对机体的破坏极其迅速。安温医生指出，已有前沿研究证实，极高的血糖水平会在短短 **6小时内** 摧毁动脉内壁一层名为**糖萼（glycocalyx）**的“防粘附保护涂层”（nonstick lining），使血管迅速暴露在炎症和损伤风险之下。这里所说的“高血糖”指的是血液中的**葡萄糖（glucose）**，而这些葡萄糖绝大部分来自于日常摄入的大量碳水化合物食物。 为了保护血管免遭葡萄糖的高毒性侵蚀，胰腺分泌的胰岛素承担起了防卫职责： ```mermaid flowchart LR accTitle: 胰岛素处理葡萄糖与脂肪储存机制 accDescr: 解释胰岛素如何将血液中的葡萄糖转移至细胞供能，并在摄入过量时代谢转化为脂肪储存于内脏与肝脏。 A["摄入高碳水化合物食物"] --> B["血液葡萄糖飙升"] B --> C["胰腺分泌胰岛素"] C --> D{"身体是否需要立刻供能？"} D -- "运动消耗" --> E["进入肌肉与细胞<br/>转化为活动能量"] D -- "超出机体能量需求" --> F["安全机制启动：<br/>在细胞内合成为脂肪"] F --> G["腹部内脏脂肪堆积<br/>(啤酒肚 / 老爹肚)"] F --> H["脂肪渗入并填满肝脏<br/>(非酒精性脂肪肝)"] ``` 安温医生现身说法，坦白自己也曾是一名2型糖尿病患者。当年作为诊所的资深合伙人，面对繁重的工作压力，他养成了严重的“饼干瘾”——抽屉里塞满了感激他的病患送来的各色饼干。在长期久坐且超量摄入精制碳水的情况下，他的胰岛素拼命工作以压低有害的血糖，将其转化为脂肪封存： 1. **外在表现**：腰围持续增大，被他自我安慰为普通的“中年发福”。 2. **内在危机**：脂肪在沉默中大量渗透并充斥肝脏，演变成严重的脂肪肝。 安温医生在桌上展示了真实的肝脏模型作为直观对比：健康的肝脏呈现深红润泽的健康肉色；而严重病变的脂肪肝则因过度充斥脂肪而彻底发黄变色、体积肿胀。安温医生严肃指出，如今在整个发达国家中，已有整整**三分之一的普通人身患脂肪肝**，其根本原因在于肝脏长期超负荷运转，被现代饮食中过量的碳水化合物与糖分彻底压垮。 ### [10:32](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=632s) 脂肪肝的形成与恶性循环：胰岛素抵抗与胰腺崩溃 过剩的葡萄糖在胰岛素的作用下被强制推入细胞，除了腹部脂肪，最直接的受害器官就是肝脏。戴维·昂温医生（Dr. David Unwin）展示了正常人类肝脏与病变脂肪肝的直观对比：浸泡在过量脂肪中的肝脏不仅体积明显肿大，而且呈现出发黄的病态外观。这种脂肪堆积直接破坏了胰岛素的正常运作，引发“胰岛素抵抗”（Insulin Resistance）。当胰岛素的效力大打折扣，人体处理碳水化合物与糖分的能力便开始恶化，而身体唯一的应对机制就是迫使胰腺开足马力，合成并分泌更多胰岛素，从而形成恶性循环。 纽卡斯尔大学的罗伊·泰勒教授（Professor Roy Taylor）将这一隐匿的发展过程称为“来自肝脏漫长而无声的呐喊”（the long silent scream from the liver）。在长达大约十年的时间里，患者对体内正在发黄、变胖的肝脏浑然不知，体检指标甚至看似正常。然而不幸的转折在于，过剩的脂肪最终会溢出并沉积到胰腺——这个关乎生命机能、负责制造胰岛素的腺体中。一旦胰腺被脂肪侵蚀，其生产胰岛素的能力便会骤然崩溃，人体彻底失去调节血糖的防线，最终确诊为2型糖尿病。 ```mermaid flowchart TD accTitle: 脂肪肝发展与胰岛素崩溃恶性循环 accDescr: 展示从摄入过多糖分到脂肪肝、胰岛素抵抗，再到胰腺脂肪浸润并导致控糖崩溃的恶性循环路径。 subgraph LiverCycle ["肝脏病变阶段"] A["过量葡萄糖摄入"] --> B["胰岛素将脂肪推入肝脏"] B --> C["形成脂肪肝"] C --> D["引发胰岛素抵抗"] end subgraph PancreasCycle ["胰腺衰竭阶段"] D --> E["胰腺代偿性分泌更多胰岛素"] E --> C E --> F["脂肪沉积浸润至胰腺"] F --> G["胰岛素分泌功能彻底崩溃"] G --> H["血糖失控（2型糖尿病确诊）"] end ``` ### [12:47](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=767s) 逆转疾病的黄金窗口：防患于未然的时间账本 昂温医生反思道，现代医疗最大的盲区就是一直被动等待，直到患者真正出现2型糖尿病的所有并发症才开始干预。自2013年起，他在位于利物浦北部的全科诊所中追踪并监测了数百名患者的基线数据与长期随访结果，建立起庞大的数据库，用以回答不同阶段干预的真实效果。 数据显示，早期的生活方式干预具有立竿见影的逆转力量。如果在“无声的呐喊”阶段（即糖尿病前期）采取低碳水饮食，有高达93%的患者能够完全恢复正常血糖，且随访证明该效果能稳定维持数年。然而，一旦拖延十年直到正式确诊2型糖尿病才开始行动，早期逆转的概率便降至73%；如果患者继续舍不得放弃面包、薯条和披萨，再拖延五年，不靠药物实现血糖正常的成功率将暴跌至50%。正如谚语所言“一针不缝，九针难补”，干预的时间节点越往后推，摆脱药物依赖的希望就越渺茫。 - **糖尿病前期干预**：低碳水饮食下，93% 的患者可恢复完全正常的血糖，且长期维持。 - **确诊早期干预**：逆转并恢复正常血糖的几率为 73%。 - **确诊5年后干预**：成功逆转的几率降至 50% 左右。 ### [14:36](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=876s) 食物里的隐形糖：升糖指数（GI）与血糖负荷（GL）的真相 大众对日常食物的成分认知极其匮乏。许多人虽然知道饼干等精制碳水具有高升糖指数（Glycemic Index, GI），但升糖指数仅仅衡量了某种碳水化合物转化为纯葡萄糖的速度（以纯葡萄糖为基准值100）。它无法真实反映日常实际摄入一份食物后对血糖的全面冲击。 昂温医生指出，真正更科学、更具预测价值的指标是“血糖负荷”（Glycemic Load, GL）。血糖负荷将食物的分量及其所含的营养密度（如蛋白质、纤维和水分）全面纳入考量。以西瓜为例，尽管西瓜的升糖指数较高，但其绝大部分成分是水，糖分密度较低，因此需要吃下体积极其庞大的西瓜，才会产生相当于一块巧克力棒的升糖负担。理解食物中的糖分密度和血糖负荷，是看穿日常健康陷阱的关键。 ### [15:57](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=957s) 医生的职业困惑：当开药沦为考核指标 行医前25年里，昂温医生始终恪守临床指南，努力当一名受人尊敬的优秀医生，渴望在扎根的小社区里为居民带来健康。然而随着时间推移，现实却让他深感沮丧：他所照护的群体整体健康状况不仅没有改善，反而持续恶化。他不禁拷问自己：“如果我是负责这片社区的医生，而大家的身体却每况愈下，难道我没有责任吗？我当初想做出的改变究竟在哪里？”在内心深处，他一直觉得不断给病人加药是一种隐秘的失败——“如果一个人每天要吃六种药，他怎么能算真正健康？” 更荒谬的矛盾在于医疗体制背后的利益绑定与考核机制。在当时的国民医疗服务体系（NHS）规则下，医生的收入与用药依从性考核直接挂钩。官方指南将二甲双胍（Metformin）等降糖药的使用率视为“良好行医规范”，诊所必须达到特定比例的用药配额才能获得相应报酬；反之，若病人擅自停药，不仅被视为不合格的医疗实践，甚至会直接导致医生被扣减绩效收入。在这种机制下，系统性地鼓励了开药，却忽视了从根源上治愈疾病。 ### [18:39](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1119s) 诊室里的当头棒喝：一位愤怒女病人的当面质问 打破昂温医生二十余年思维定势的转折点，源于一位他照料了十余年的女性老病人（他化名称其为琼斯太太，Mrs. Jones）。琼斯太太和丈夫都严重超重且患有控制不佳的2型糖尿病。诊所系统监测到她擅自停用了二甲双胍，为了维持考核指标，昂温医生用极其礼貌的英国绅士口吻给她寄信，催促她尽快回诊讨论用药。 然而，推开诊室大门的琼斯太太怒气冲冲，一进门就先发制人：“昂温医生，你以为你要教训我一顿，是吧？我告诉你，今天是我要教训你！”她斩钉截铁地宣告，即便自己停掉了二甲双胍，验血结果也绝对完全正常。随后，她发出了让昂温医生终生难忘的质问： > “我真怀疑你到底有没有行医执照！过去这十年里，你哪怕有一次告诉过我面包就是糖、早餐麦片就是糖吗？我不得不自己在网上查资料才搞明白：面包是糖，米饭是糖，早餐麦片全都是糖！当我把这些东西戒掉后，我根本不需要你的二甲双胍！” 琼斯太太甚至毫不留情地补了一刀：“这是16岁中学生物课就该学的常识，你当年到底是怎么学的？”面对患者的当头棒喝，昂温医生感到前所未有的震动与惶恐。但他选择压下防卫本能，虚心接受并为她安排了复查。化验结果证实，她确实在完全停药的情况下实现了血糖正常——这是昂温医生行医25年来亲眼见证的第一例不用药物逆转2型糖尿病的奇迹。 进一步探寻后，昂温医生发现琼斯太太只是互联网上一个4万人互助社群的冰山一角，普通患者们正在通过彼此分享低碳饮食自救。而令人羞愧的是，正统医疗界的专业人士当时却普遍对这一群体冷嘲热讽，斥责他们“这是在找死”、“极度危险”。巨大的职业羞耻感促使昂温医生彻底反思既有的医学教条。与此同时，同在一个月内，他的妻子——被他赞誉为“世界上最聪明女性”的心理学专家 Jen，也作为关键人物走进了这场健康认知变革的序幕。 ### [22:09](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1329s) 一本折价书与周一晚上的免费诊所 大卫·安温（Dr. David Unwin）医生的妻子珍（Jen Unwin）是一名临床健康心理学博士，长年致力于研究“希望”（hope）在疾病康复与临床结局中所起的作用。就在安温医生被那位自行靠低碳饮食治愈糖尿病的女患者震撼之际，珍偶然在超市的打折区看到了一本降价健康书籍——约翰·布里法博士（Dr. John Briffa）撰写的《摆脱节食陷阱》（*Escape the Diet Trap*）。珍买下这本书并催促丈夫赶紧阅读，安温医生翻开后震惊地发现，那位女患者告诉他的每一句话，都在书中得到了严谨、透彻的现代医学原理解释。 看着深陷职业无力感、觉得自己行医失败的丈夫，珍鼓励他说：“大卫，在退休之前，你为什么不放手做一件自己真正坚信、能让人振作起来的事呢？我们为什么不亲自尝试低碳饮食，并邀请一些患者自愿加入我们？”作为诊所的高级合伙人（Senior Partner），安温医生兴冲冲地向其他合伙医生提出了开展低碳饮食项目的设想，却立刻遭到了同行们的一致反对。在当时的医疗界，低碳水饮食根本不被视为正统医学，合伙人们甚至认为这是一种“自我放纵”（self-indulgent），并质疑道：“如果在上班时间做这种非主流的尝试，耽误了治疗胸部感染等常规疾病，岂不是滥用有限的医疗资源？” 面对同行们的冷水，珍提出了一个毫不妥协的方案：“既然他们担心资源，那我们就免费干。我们在诊所下班后的周一晚上，用自己的业余时间来做。”于是，他们招募了18位愿意尝试的患者，加上安温医生和珍，一共20个人组成了一个先锋小组。诊所的一位护士海瑟（Heather）也被深深打动，主动提出无偿加班协助他们：“我也免费来干，我渴望能真正坚信自己每天所从事的工作。” ```mermaid flowchart TD accTitle: 低碳饮食逆转试验启动流程 accDescr: 展示从偶遇科普书籍到诊所合伙人反对，再到组建周一晚间自愿小组的流程。 subgraph S1["观念启蒙与受阻"] A["阅读书籍《Escape the Diet Trap》<br/>理解低碳与胰岛素抵抗"] --> B["向诊所合伙人提议试验"] B --> C["同行反对：非正统医学、<br/>占用NHS常规医疗资源"] end subgraph S2["破局与实施"] C --> D["夫妻二人决定业余时间免费坐诊"] D --> E["护士Heather主动志愿加入"] E --> F["招募18位患者 + 夫妻2人<br/>（共20人，每周一晚聚会）"] end subgraph S3["实践内容"] F --> G["学习低碳烹饪与饮食技巧"] F --> H["定期测量体重、肝功、血压、HbA1c"] end ``` ### [25:16](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1516s) 无法解释的奇迹：脂肪肝逆转与自动消失的饥饿感 2013年，这个20人的低碳小组在每周一晚上聚会，大家一起学习如何低碳烹调、分享日常体验并称量体重。由于深知低碳饮食在当时饱受主流医学界质疑，安温医生怀着战战兢兢的心态密集监测患者的各项生化指标与血脂谱，生怕这种“怪异的方法”会对患者造成伤害。然而，实验室反馈回来的血液报告却带来了他从医数十年未曾见过的奇迹。 最先发生惊人改变的是肝功能。安温医生手头曾有许多肝功能异常长达十余年的患者，由于指标居高不下，他过去一直武断地认定这些人是在背地里酗酒；然而仅仅采取低碳饮食数周之后，这些患者的肝酶指标突然大幅改善，往往直接下降了三分之一甚至50%。随后是体重，在周一晚上的体重计前，患者们的体重开始飞速往下掉。 更令人困惑的生理变化接踵而至。患者们开始频繁向医生汇报：“大卫，你觉得饿吗？我一点都不饿。”甚至有人好奇地问：“人真的必须吃早餐吗？”安温医生自己亲身践行低碳，也体验到了完全一样的状态——曾经困扰他的腹部赘肉不知不觉消失了，他也自然而然地省去了早餐。随后的一天，当安温医生从办公桌前站起身时，突然感到一阵头晕。他多年来一直患有中度高血压，但作为一名不愿当病人的医生，他过去总是采取“鸵鸟政策”逃避就医；当他给自己量血压时，惊讶地发现血压已经恢复到了低正常水平。紧接着，其他患者的血压监测数据也全面下降。几个月后，代表过去三个月平均血糖水平的糖化血红蛋白（HbA1c）报告出炉，所有人的指标都出现了极其亮眼的断崖式改善。 - **肝功能逆转**：原先被误判为酒精性脂肪肝的严重异常，在低碳数周内指标下降 30%–50%。 - **食欲自发调控**：胰岛素水平下降后，饱腹感显著提升，成员自发省去早餐。 - **血压自然平稳**：安温医生隐瞒多年的中度高血压不药而愈，患者整体血压明显回落。 - **血糖核心指标**：3个月后的糖化血红蛋白（HbA1c）呈现出颠覆常规药物治疗的显著好转。 ### [28:46](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1726s) 行医25年的认知颠覆与盲目归咎患者的内疚 这场发生在13年前的诊所试验彻底改变了安温医生的健康轨迹。低碳饮食不仅重塑了他的体型，更赋予了他前所未有的精力与精神韧性。在实行低碳之前，作为高级合伙人的他每天午休时必须在诊室挂上“请勿打扰”的牌子、拉严窗帘，在检查床上雷打不动地小睡20分钟，否则根本无法熬过高强度的工作；而低碳之后，这种白天嗜睡的状态荡然无存，他每天的睡眠需求减少了整整一个小时，精力充沛、专注度大幅提高，不再心浮气躁，“就像拥有了更充沛的大脑马力（mental horsepower），重获年轻活力一样”。 在与斯蒂芬·巴特利特（Steven Bartlett）探讨日常决策如何决定个人健康未来时，安温医生痛苦地反思了自己从医前25年向患者灌输的荒谬建议。在传统认知中，他认为饮食和生活方式只是医学治疗边缘的微弱附属品，药物才是拯救病人的核心武器。面对肥胖患者，他曾机械地重复“少吃多动”（eat less and move more）的陈词滥调，甚至曾刻薄地用二战集中营来举例：“贝尔森（Belsen）集中营里可没有胖子走出来”——这种潜台词无异于直接将肥胖归咎于患者缺乏意志力和道德自律。 过去，安温医生最常给出的减脂处方极其刻板：“每天吃两汤匙全麦全麦麸麦片（All-Bran）、喝几品脱脱脂牛奶、补充几种复合维生素片”。然而，当这套违背代谢机制的方案毫无效果时，他过去总是毫不犹豫地指责是患者执行不力、偷吃作弊。直到这场低碳革命发生，他才恍然大悟：持续失败的并不是无辜的患者，而是医生给出的错误医学建议。如果社会上的整体代谢健康已经沦为一场灾难，继续重复无效的教条就是医学界的失职。这种关于食物认知的极度匮乏甚至蔓延在社会的精英阶层——斯蒂芬在结尾感叹，他一位极其成功的商界领袖好友，竟然会在午餐吃下一个12英寸大披萨的同时，一脸认真地发问：“披萨算不算健康食品？” ### [33:36](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2016s) 普遍的营养认知盲区与“命运注定”的误解 史蒂文·巴特利特（Steven Bartlett）分享了两个令他极其震惊的真实生活案例。一位大约四十到六十岁的朋友曾无比认真地向他请教：“史蒂文，你觉得南多斯（Nando's）烤鸡胸肉和一张12英寸的大披萨相比，哪个更健康？”史蒂文当时难以置信地看着对方，以为对方在开玩笑，但对方神情完全是严肃的——一个人生过半的成年人，竟然分不清一块天然鸡胸肉和一张精制面粉加工披萨的营养优劣。另一个例子则发生在节目录制前，一位家喻户晓的英超传奇球星也问过史蒂文：“一大盘奶油培根意大利面（Spaghetti Carbonara）到底算不算健康食品？”这位运动员在青训营和职业联赛摸爬滚打了一二十年，职业生涯中一直被灌输“多吃碳水、糖原储备（Carb loading）”的观念，却依然不知道哪些食物其实是披着主食外衣的糖。 这些交流让史蒂文产生了一种强烈的同理心与警惕感：尽管互联网如此发达、健康类播客层出不穷，但最基础的营养常识依然无法触达大众。绝大多数普通人甚至抱有一种悲观的“宿命论”，认为健康只是一种装饰品——自己的寿命和疾病早由基因命运决定，如果为了追求体型上的美观而放弃美味的软糖（如著名的 Percy Pigs 糖果），不仅麻烦而且毫无意义，反正生老病死天注定。 戴维·昂温医生（Dr. David Unwin）深有感触地指出，现代社会在营养教育上存在着彻底的溃败。人体所需的宏量营养素本质上只有三种：蛋白质、脂肪和碳水化合物。然而，即便像英超球星和商业精英这样聪明且成功的人，甚至连这三大宏量营养素的概念都从未真正弄清楚过，这足以证明整个社会的公共健康教育正在严重失序。 - **健康认知的巨大断层**：连拥有专业队医指导的顶尖职业运动员和年过半百的成功人士，都无法辨别精制碳水面食、披萨与优质蛋白质的健康差异。 - **健康宿命论心态**：大众普遍误以为慢性病全由遗传基因决定，饮食调控只关乎外貌体态，从而低估了日常饮食对代谢寿命的根本影响。 - **三大宏量营养素常识普及率极低**：人体所需的能量与结构基石仅包含蛋白质、脂肪与碳水化合物，但基础教育几乎未教会公众如何识别它们。 --- ### [35:19](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2119s) “水果”光环下的糖分陷阱与全天的“糖叠糖”循环 史蒂文回忆起在商业投资节目中遇到的一位创业者，对方带着一款水果干零食前来路演，宣称是将芒果等热带水果切片脱水后制成的天然健康脆片。史蒂文翻到配料与营养成分表一看，发现其中的含糖量竟高达 60% 至 70%。商人们利用公众对“水果（Fruit）”这个词的天然好感，给高糖零食披上健康光环——只要包装上印有水果或果汁，哪怕实质上就是浓缩糖果，消费者依然会趋之若鹜，商家也能借此大发横财。如果患有2型糖尿病的人或发育中的儿童把这种脱水干果当成健康加餐，身体将承受毁灭性的代谢冲击。 昂温医生随即指出，代谢不良早已不是局部的“流行病”，而是一场席卷全球的“全球大流行”（Pandemic）。无论走到世界的哪个角落，肥胖、2型糖尿病和糟糕的代谢健康指标都无处不在。造成这一局面的核心原因之一，正是现代人全天候不间断的“糖叠糖（Sugar with your sugar with your sugar）”进食模式。 ```mermaid flowchart TD accTitle: 现代人一整天的糖叠糖饮食循环 accDescr: 展示了从早到晚不断摄入高碳水与高糖零食，导致缺乏蛋白质的恶性循环结构。 subgraph Morning["早晨至上午：血糖激升"] A["高糖早餐谷物 + 鲜榨橙汁"] --> B["通勤小吃：能量棒 / 薯片"] B --> C["课间/茶歇：松饼 + 苹果"] end subgraph Afternoon["下午至晚间：持续高负荷"] C --> D["午餐：三明治 + 蛋糕/冰淇淋"] D --> E["晚餐：披萨 / 炸薯条"] end subgraph Impact["代谢后果"] E --> F["整日缺乏构建身体的优质蛋白质"] F --> G["全天候胰岛素高位，驱动脂肪肝与胰岛素抵抗"] end ``` 在典型的现代日常作息中，一个人早晨醒来吃一碗精制谷物麦片，顺便喝一大杯“健康”的鲜榨橙汁；在上班或上学的路上，随手买一根能量棒或一包薯片当零食；上午课间可能再吃一个松饼和一个苹果；午餐吃夹着精制面包的三明治，餐后搭配蛋糕或冰淇淋；到了晚上下班回家，晚餐又是炸薯条或披萨。昂温医生激动地强调，现代人一整天的进食逻辑就是用糖配糖，几乎没有任何可用于生长修复身体的优质蛋白质。大量父母向昂温医生抱怨自己的孩子“整天吃零食，一口正经饭都不吃”，而很多吃这类高糖超加工零食长大的青少年，甚至外表看起来并不胖，内部的代谢系统却早已千疮百孔。 --- ### [38:21](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2301s) 桌面实测：“一茶匙糖”等效测试与主食的惊人真相 为了打破大众的认知误区，昂温医生在访谈演播室的桌面上摆出了一组实物道具，并为史蒂文设计了一场震撼的“猜糖量”测试。桌上放有五种常见食物：一碗普通玉米片（Corn Flakes，无糖霜、无添加牛奶）、一个未烤制的大土豆（用于代表烤土豆）、150克煮熟的白米饭、一根熟透的大香蕉，以及一根看起来令人垂涎的巧克力棒。此外，昂温医生准备了若干块代表每块含4克白砂糖（相当于一茶匙糖）的方糖，要求史蒂文为每种食物摆上对应的等效糖量。 史蒂文表示，如果按照自己两年前采访各路专家前的常识来判断： - **玉米片**：因为没有糖霜涂层，平时完全不觉得它是糖，勉强摆上 1 茶匙。 - **土豆**：史蒂文直言觉得土豆完全不可能有糖，摆 1 茶匙都像是在撒谎。 - **白米饭**：同样认为米饭里根本没有糖，给 0 茶匙。 - **熟香蕉**：吃起来口感清甜，给出 1 茶匙。 - **巧克力棒**：作为公认的高糖甜食，史蒂文给出了 2 到 3 茶匙的预估。 昂温医生随后揭开了背后的临床转化逻辑。在全科诊所的日常工作中，医生通常只有10分钟的时间向病人解释“为什么必须改变饮食”以及“该如何吃”。如果直接跟老人、儿童或普通工薪族谈论复杂的“升糖负荷（Glycemic Load）”或“血液中葡萄糖的克数”，普通人根本无法理解。因此，昂温医生开创了一套“等效茶匙糖（Teaspoon of Sugar Equivalent）”评估体系，将各种食物经过消化分解后释放到血液中的葡萄糖总量，重新换算成大众能够具象感知的 4 克一茶匙标准白砂糖。 随后，昂温医生公布了令人大跌眼镜的真实数据并逐一码放方糖： - **无糖霜的纯玉米片**：等效糖量高达 **8 茶匙糖**（32克纯糖等效）。 - **烤土豆（个头偏大）**：等效糖量高达 **9 茶匙糖**（36克纯糖等效），远超绝大多数人的想象。 - **巧克力棒**：实际等效糖量为 **7.5 茶匙糖**（折合摆放 7 块方糖）。 - **熟透的大香蕉**：随着成熟度增加，淀粉转化为单糖，一根大香蕉的等效糖量达到 **6 茶匙糖**。 当揭晓一直被大众视为“绝对健康清淡主食”的白米饭时，昂温医生拿起方糖一边计数一边码放，仅 150 克煮熟的白米饭，方糖数量就迅速数过了 1、2、3、4、5、6 块，彻底颠覆了史蒂文对淀粉类食物的全部认知。看似不甜、无脂的谷物主食，在进入消化道后会以惊人的速度全数水解成游离葡萄糖，直接对胰岛素分泌与肝脏代谢形成猛烈冲击。 ### [44:12](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2652s) 一碗白米饭等于10茶匙糖：风靡全球的血糖信息图 大卫·安温医生（Dr. David Unwin）展示着他的“茶匙糖”换算图表，数到第七、第八、第九乃至第十茶匙——一碗米饭转化为血糖的效果竟然相当于整整十茶匙白糖。他感慨道，正是这个直观而令人震惊的事实，在全世界范围内引发了巨大轰动，也让他本人广为人知。在这份图表上，清晰列出了食物种类、升糖指数（GI）、单次摄入份量以及折算出的等效茶匙糖量。 这项视觉化科普源自安温医生与兰根·查特吉医生（Dr. Rangan Chatterjee）在十年前共同创立的英国慈善机构“公共健康协作组织”（Public Health Collaboration，PHC）。目前，这套信息图不仅拥有多种食物延伸版本，更被世界各地的志愿者自发翻译成了35种语言。安温医生明确表示，这些图表不设任何版权保护，他甚至鼓励所有人去“盗用”、复制并广泛传播，因为揭示主食背后隐藏的巨大糖分，是帮助大众理解代谢真相最关键的一步。 - **公共健康协作组织（PHC）**：安温医生与查特吉医生联合创立十周年，致力于通过普及饮食与代谢知识改善公众健康。 - **信息图传播规模**：完全开源无版权，全球志愿者已译为35种语言，帮助患者直观建立“淀粉即是糖”的概念。 ### [45:20](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2720s) 果汁的健康陷阱与恶性循环的血糖过山车 主持人史蒂芬·巴特利特（Steven Bartlett）顺着糖分话题提到了橙汁。他坦言自己和许多人一样，从小在父母的引导下将橙汁视为绝佳的健康饮品，甚至曾把“SunnyD”等果汁饮料当作能让自己变得高大强壮的补品开怀畅饮。安温医生随即指出了果汁光鲜外表下的健康陷阱：水果一旦被榨成果汁，天然的膳食纤维便被彻底剥离，果糖与葡萄糖不再受纤维基质的缓慢释放限制，会以极其凶猛的速度直接冲击血液。 这种凶猛的糖分冲击随即拉开了一场代谢恶性循环的序幕。大量糖分涌入引发血糖急剧飙升，迫使胰腺过量分泌胰岛素进行紧急扑救；然而胰岛素的作用往往过于剧烈且反应迟滞，不仅将血糖迅速按倒，还会导致血糖过度暴跌。安温医生回忆起自己过去吃饼干的经历——血糖骤降时浑身发慌、心悸出汗，一度让他误以为自己突发惊恐发作（Panic Attack），而当时的本能应对方式竟是吃更多饼干来缓解，从而陷入停不下来的死循环。他强调，很多人早餐习惯喝果汁、吃高糖食物却缺乏蛋白质，结果往往在上午十点钟就饥肠辘辘、食欲失控，根源正是这趟血糖过山车。 ```mermaid flowchart TD accTitle: 果汁与高糖早餐导致的血糖过山车机制 accDescr: 展示饮用果汁导致血糖飙升、过量胰岛素分泌、血糖骤降并诱发低血糖饥饿感的循环过程 A["摄入高糖/果汁（缺乏纤维与蛋白质）"] --> B["血糖短时间内急剧飙升"] B --> C["胰岛素超量过激分泌"] C --> D["血糖崩塌式骤降（反应性低血糖）"] D --> E["出现心悸慌乱感与剧烈饥饿"] E --> A ``` ### [46:51](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2811s) 秘鲁巧克力工坊的震撼：白巧克力竟有近八成是糖 史蒂芬分享了自己在秘鲁旅行时的一段生动经历。秘鲁以出产优质可可豆闻名，在当地的一堂手工巧克力制作课上，导师指导大家分别制作黑巧克力、牛奶巧克力和白巧克力。当轮到制作白巧克力时，导师递给史蒂芬一个巨大的玻璃量筒，并让他把白糖往里倒。史蒂芬倒了一些停下来，导师却摇手催促：“不，不，朋友，继续倒！”史蒂芬不停地倒，直到那个大量筒里几乎80%的容积全被白糖填满，接着导师又让他往里添加糖浆和油脂。看着眼前堆成小山般的白砂糖，史蒂芬被深深震撼了——原来市面上香甜丝滑的白巧克力，本质上竟有大约70%到80%纯粹就是糖。自那次亲身体验之后，他再也没有碰过哪怕一口白巧克力。 安温医生对史蒂芬的观察深表赞同，并借此揭穿了许多所谓“巧克力成瘾者”（Chocoholics）的真相。门诊中经常有患者向他倾诉自己对巧克力严重上瘾、无法自拔；然而当安温医生建议他们换成纯度更高的90%黑巧克力以获取更纯粹的可可风味与满足感时，患者往往连连摆手拒绝，抱怨那“太苦了”。这恰恰说明，绝大多数人迷恋的根本不是可可本身，而是包裹在可可脂里的糖。在安温医生的糖分信息图中，也专门有一张揭示各种巧克力的含糖量： - **白巧克力**：含糖量高达70%~80%，配料以纯白砂糖、糖浆和油脂为主。 - **牛奶巧克力**：含有大量添加糖，一块常规市售包装中暗藏数茶匙糖。 - **90%黑巧克力**：整块巧克力仅含约2茶匙糖，糖分极低且保留了天然可可的抗氧化成分。 ### [49:22](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=2962s) 全身5升血液里究竟有多少糖？颠覆认知的“一块方糖”实验 话题转向同样被包装成健康食品的果昔（Smoothies），安温医生直言这类高糖饮品经常让他在社交平台X（前Twitter）上出离愤怒，不得不拍照发帖警示公众。为了让史蒂芬直观感受人体对糖分的敏感度，安温医生现场提出了一个极具戏剧性的思考实验：“如果现在把我体内所有的血液抽干，装在一个桶里，大约有5升血。在正常血糖状态下，这5升血里总共融化了多少糖？”史蒂芬猜测大约有一杯的量，但安温医生拿出的答案彻底惊呆了全场——仅仅只有一块小小的方糖（约4克，相当于一茶匙）。 安温医生严肃地指出，这正是最关键但几乎无人知晓的生理学事实：葡萄糖对生命而言一方面不可或缺，另一方面若在血液中过量便极具毒性。人体通过复杂的内分泌系统将全身体液的血糖精密调控在仅仅一块方糖的极窄范围内。对于像安温医生这样佩戴动态血糖仪（CGM）监测的糖尿病患者来说，由于胰岛素调节机制已经受损，随便吃下一整根香蕉，身体无法及时处理其中的果糖和葡萄糖，血液中的糖量就会瞬间翻倍，甚至直接引发身体不适。当普通人明白全身血容量仅能容纳一块方糖的糖分时，就会瞬间明白日常饮食中的高糖炸弹对机体带来了多么恐怖的代谢过载。 - **健康人体总血量**：成年人约为5升。 - **正常全血含糖总量**：仅约4克葡萄糖，视觉上只有一块标准方糖或一平茶匙的量。 - **糖尿病患者的耐受极限**：吃下一根完整香蕉所释放的糖分，就足以使体内游离血糖直接翻倍。 ### [52:04](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3124s) 避开食品营销陷阱：门诊医生给出的实操饮食法则 史蒂芬指出，普通公众在日常生活中极易被食品工业的营销包装所蒙蔽。例如许多软糖正面醒目地印着“由纯正果汁制成”的宣传语，若非专业人士，连他自己都险些受骗；而那些平时搭乘出租车时遇到的普通司机或听众，更没有时间深入研读复杂的配料表。面对货架上琳琅满目的商品，大众究竟该如何鉴别并制定切实的饮食选择？ 安温医生分享了自己在诊室里每天都在践行的实操法则：与其花大量精力告诉患者“什么绝对不能吃”从而引发排斥心理，不如从“你应该吃什么”来积极构建食谱。对于存在胰岛素抵抗或2型糖尿病的人群，他建议直接围绕高品质蛋白质来搭建核心餐盘，辅以足量绿色蔬菜和健康的天然脂肪： - **第一步：确立蛋白质核心**：打开冰箱，优先选择鸡蛋、鸡肉等优质蛋白质，并且确保份量充足。 - **第二步：堆满绿色蔬菜**：选择自己能接受并容易买到的绿叶蔬菜，如冷冻四季豆、新鲜沙拉菜等。 - **第三步：用优质脂肪调味替代酱料**：蔬菜可能寡淡无味，但切忌使用市售酱汁。史蒂芬脱口而出想加烧烤酱（BBQ Sauce），安温医生立刻制止并指出，一瓶普通的市售烧烤酱里往往浓缩了整整30块方糖，浇酱无异于直接往蔬菜上倒糖；正确的调味应选用全脂蛋黄酱（Full-fat Mayo）、优质黄油或纯橄榄油，既美味饱腹，又不会刺激胰岛素分泌。 ### [54:20](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3260s) 包装食品的“俄罗斯轮盘赌”与碳水化合物的糖分换算 包装食品给现代人的饮食带来了极大的隐患。David Unwin 医生指出，吃包装食品就像在玩“俄罗斯轮盘赌”，你永远不知道里面藏了什么；最理想的方式是吃不装在包装袋里的天然真实食物（real food）。然而，对于他在利物浦北部的很多普通患者而言，新鲜真实的天然食材并不容易买到。Unwin 医生强调，如果不得不购买包装食品，就必须保持警惕并学会看懂标签。 大众最容易掉入的陷阱是将“糖”和“碳水化合物”割裂开来。许多包装食品（如玉米片 cornflakes）表面虽然没有像糖霜玉米片那样裹上一层可见的白糖，但配料表里几乎全都是高淀粉碳水化合物。Unwin 医生提出了一个极为实用的换算基准：在包装食品中，**每 4 克碳水化合物，在体内对血糖的影响大致相当于 1 茶匙糖**。因此，一份含有 100 克碳水化合物的食品，即使标签上写着“无添加糖”，其转化为血糖的负荷也极其惊人。 ```mermaid flowchart LR accTitle: 碳水化合物到糖的消化转化 accDescr: 展示淀粉在唾液淀粉酶作用下分解为葡萄糖分子并进入血液的过程 subgraph Starch ["淀粉结构"] A["葡萄糖分子 (手牵手，无甜味)"] end subgraph Digestion ["消化水解"] B["唾液与胰腺淀粉酶 (Amylase)"] end subgraph Glucose ["游离糖"] C["自由葡萄糖分子 (进入血液，血糖飙升)"] end A --> B B --> C ``` --- ### [55:04](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3304s) 淀粉就是“手牵着手”的葡萄糖 人们普遍误以为“只有尝起来甜的才含有葡萄糖”。Steven Bartlett 疑惑道，既然普通玉米片上没有糖霜，身体到底是如何将它们变成糖的？Unwin 医生用了一个生动的比喻来阐释生物化学过程：**淀粉类碳水化合物本质上就是一串“手拉着手”的葡萄糖分子**。当它们紧紧相扣时，舌头尝不到甜味；但一旦进入消化道，人体分泌的淀粉酶（例如唾液中的 amylase）就会将这些手切断，使它们重新变回自由游离的糖分子。这正是学校课堂上“长时间咀嚼无味面包会尝到甜味”的经典实验原理——淀粉从一开始就是“未来的糖”。 Unwin 医生坦言，即使作为资深全科医生，自己过去也曾犯过同样的认知错误。2012 年，一位患有糖尿病的女患者在查阅资料后愤怒地质问他，为什么身为大型诊所的合伙人兼资深医生，却从未告诉过她“淀粉吃下去就是糖”。正是这次经历促使他彻底反思。现实中有大量患者困惑地向他诉苦：“我已经戒掉了茶和咖啡里的糖，为什么血糖还是居高不下？”这就是因为他们戒了表面的糖，却依然摄入了大量面包、米饭和玉米片等高淀粉食物。 --- ### [56:58](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3418s) 面包对健康的隐秘冲击与连续血糖监测仪（CGM） 很多人视面包为主食，Steven 提到自己查阅的数据：单片白面包可能只含约 0.5 块方糖，但整条面包却含有相当于 12 块方糖的添加糖。Unwin 医生指出，这个数据其实远远低估了面包的实际血糖冲击，因为它完全忽略了小麦淀粉本身在体内转化成的糖分。根据他的“茶匙糖等效模型”（teaspoon of sugar equivalent），**即便是小小的一片全麦面包（brown bread），其在体内的升糖效应也相当于吞下大约 3 茶匙白糖**。 关于“是否存在绝对健康的面包”（如发芽谷物面包 sprouted grain bread 或 100% 全麦黑麦面包 whole grain rye），Unwin 医生认为答案取决于个体的代谢与胰岛素敏感性： - **代谢健康人群**：年轻、运动量充足且胰岛素敏感度极高的人，可能可以耐受适量的高纤维或全麦面包。 - **胰岛素抵抗人群**：对于像 Unwin 医生自己这样存在胰岛素抵抗、或者腹部已经开始堆积脂肪（"developing a tummy"）的人群，普通面包或全麦面包都会引发血糖激增，只有特制的低碳水面包（low-carb bread）才相对安全，日常应尽量不碰常规面包。 Unwin 医生建议，与其争论哪种食物绝对健康，不如成为自己身体的“实验者”。他极为推崇连续血糖监测仪（CGM）：将传感器佩戴在手臂上，实时连接手机，吃下一片面包后 1 小时内就能清楚看到自己真实的血糖波动曲线，用数据代替盲目猜测。 --- ### [59:17](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3557s) 节目赞助商：外源性酮体（Ketone）与内容创作工具 Stan Store 在访谈间歇，Steven 分享了本期节目的赞助品牌与他的亲身体验： - **外源性酮体（Ketone Shots）**：Steven 提到在所有尝试过的生产力和认知提升产品中，外源性酮体稳居前三。它由斯坦福大学毕业生团队研发，能够将生酮饮食（Ketogenic diet）带来的专注力与大脑能量浓缩进一小瓶即饮 Shot 中。临床研究打动了 Steven，使他成为了该公司的联合创始人与投资人。观众可通过专属链接 `ketone.com/steven` 享受首单订阅 7 折优惠并附赠二期礼品，美国线下 Target 超市亦可免费领取首支体验。 - **内容创作者工具 Stan Store**：针对多数人因自我怀疑、时间匮乏而产生的“社交媒体发布瘫痪”（paralysis），Stan Store 推出了名为 Stanley 的 AI 工具。该工具能分析创作者的历史风格与最佳表现帖文，自动生成贴合语气的灵感建议与发帖草稿，助力个人品牌的搭建。用户可访问 `coach.stan.store` 免费试用。 --- ### [01:01:06](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3666s) 读懂营养标签的隐蔽陷阱与饥饿循环 回归正题，Steven 提到自己每次看食品背面的营养标签时，往往只会紧盯“添加糖”（added sugar）。Unwin 医生纠正道，仅关注糖分是不够的，必须将目光放在**总碳水化合物（total carbohydrate）**上。同时，不同国家的营养标签规则存在显著差异： - **英国标签**：通常将总碳水化合物与膳食纤维（fiber）分开单列。 - **美国标签**：总碳水化合物栏目中包含了膳食纤维，消费者需要自行用总碳水减去膳食纤维来计算“净碳水”（net carbs），以评估身体真正吸收的糖分负荷。 Unwin 医生强调，在三大宏量营养素（蛋白质、脂肪、碳水化合物）中，追求肌肉力量需要蛋白质，吸收脂溶性维生素需要健康脂肪，而精制碳水化合物并非必需。更重要的是，过量碳水化合物的危害绝不仅仅是一次性的血糖峰值（glucose spike）。Steven 谈到，当他吃下士力架（Mars bar）或一大碗精制白米饭后，血糖剧烈升降反而会引发后续更强烈的饥饿感，导致接下来几天持续摄入更多糖分。 Unwin 医生回忆道，早在 2013 年他指导患者转向低碳水饮食时，患者们最惊喜的共同反馈就是**“饥饿感的彻底消失”**。Unwin 医生自己过去也长期处于“饥饿循环”中，误以为多吃碳水才扛饿，殊不知正是摄入过多碳水化合物导致胰岛素频繁波动，才让人时刻处于饥饿状态。他与 Steven 探讨了断食（fasting）的体验——Steven 在录制节目当天直到下午 1 点都未进食，甚至在录制《龙穴之创业投资》（Dragon's Den）时常常一天不吃直到傍晚也不觉得饥饿。这彻底颠覆了“不吃就会更饿、两倍时间不吃就会两倍饥饿”的传统直觉认知。 ### [01:04:14](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3854s) 饥饿感消失与食物渴望的截断：从肉桂卷到圣诞蛋糕 当一个人进入断食或生酮状态时，最令人意外的生理变化并非忍饥挨饿的痛苦，而是食欲的彻底消失。相反，吃得越多，饥饿感反而越容易呈指数级上升。Steven 分享了自己在生酮饮食（极低碳水化合物）期间的一段神奇经历：他以往极度迷恋肉桂卷，但在开普敦的一家肉桂卷专柜前，他突然发现大脑对眼前喷香的甜点毫无波澜，既没有生理冲动，也没有情绪渴望，仿佛食欲被凭空切断了一般。 Unwin 医生对此感同身受，并用自己的“软肋”圣诞蛋糕作比喻。过去他常常在家人熟睡后偷偷溜下楼切蛋糕吃，但在适应了低碳水生活后，某一天他看着蛋糕，脑海中浮现的念头竟然是：“这根本不是食物。”面包、甜甜圈等曾让人欲罢不能的加工面食，在摆脱糖瘾后都不再被大脑视作维持生命的真正食物。Unwin 医生笑称，这种克制力就像赋予了自己一种“超能力”，他甚至常以此向诊所里的男性患者下战书：“你够不够硬汉？敢不敢接受挑战，下周来见我时告诉我你一块饼干都没吃过？” ### [01:05:47](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3947s) 审视生酮饮食：从个人目标与碳水摄入谱系出发 面对 Steven 提出对生酮饮食的整体看法，Unwin 医生并没有直接给出非黑即白的评判，而是强调一切必须从个人的初衷与具体诉求出发。每个人的目标截然不同：有人为了减肥，有人为了逆转 2 型糖尿病，而像乔治亚·埃德（Georgia Ede）医生以及爱丁堡大学的伊恩·坎贝尔（Ian Campbell）等人，正在营养精神病学领域开拓生酮饮食对双相情感障碍等精神疾病的惊人干预效果。 在 Unwin 医生的临床理念中，碳水化合物的摄入量是一个连续的谱系，而非一蹴而就的极端选择。面对患者，他通常首先评估对方当前的碳水基线，再提议从微小的改变切入，例如尝试戒掉或减少面包的摄入。随后通过定期的血液指标与体重监测，询问患者的主观感受：“现在的状态你满意吗？还是希望尝试更低的碳水区间？”他发现，在过去十三年的临床观察中，患者往往会在体验到思维敏捷和精力提升后，主动自愿地进一步降低碳水摄入。 ```mermaid flowchart TD accTitle: 碳水谱系循序渐进法 accDescr: 评估现状后设定微小减碳目标，经指标与体验反馈后由患者自主决定是否进一步降低碳水 subgraph Phase1["第一阶段：现状评估与微调"] A["评估当前碳水基线与核心诉求"] --> B["尝试微小调整<br/>（如停食或减半面包）"] end subgraph Phase2["第二阶段：客观指标与主观体验"] B --> C["追踪健康参数<br/>（血液指标、体重、精神状态）"] C --> D{"患者是否满意？<br/>脑雾改善与活力提升"} end subgraph Phase3["第三阶段：自主深入"] D -- "维持现状" --> E["稳态维持"] D -- "体验良好并希望更进一步" --> F["自主逐步下调碳水<br/>（迈向深度生酮）"] end ``` ### [01:07:17](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4037s) 追求极致的思维清晰：主持人的核心驱动力与健康寿命 当被问及践行生酮的核心目的时，Steven 将“大脑极致的思维清晰度”排在首位。他的日常工作对语言表达和临场反应有着极高的要求——不仅要与顶尖专家进行数小时的高强度深度对谈，还要在英国广播公司第一台（BBC One）九台摄像机环绕的聚光灯下，即时剖析创业者的商业计划书；离开演播室后，他又必须立刻下楼主持两小时极其复杂的并购谈判与高管面试。这种职业压力让他最痛恨思维状态的剧烈波动：有的日子他口齿伶俐，思维宛如连接了高速输出端口，语速极快且逻辑严密；而在某些“脑雾”笼罩的日子里，他甚至连连结完整的句子都感到磕磕绊绊。 Steven 坦言，生酮状态能让他稳定保持如说唱歌手“Busta Rhymes”般行云流水的敏捷语速。在此基础上，他总结了支撑自己健康自律的四大核心支柱： - **思维极致清晰**：消除脑雾，确保高强度访谈、电视录制及商业并购决策中的敏锐度。 - **体态与美感**：为了未婚妻与自我认同，保持精干健美的形体。 - **身体机能与力量**：具备强健的肌肉力量，维持身体的充沛活力。 - **健康寿命（Healthspan）**：不仅延长生命年限，更要确保老龄阶段依然拥有高度自主的行动能力。 ### [01:09:16](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4156s) Jen Unwin 精简版认知行为疗法：将模糊愿景化为深层恐惧与具体目标 Unwin 医生指出，设定具体而精准的愿景是促成持久改变的前提。为了帮助人们快速重塑行为，他介绍了妻子 Jen Unwin（临床心理学家）的研究成果。Jen 耗费两年时间提炼认知行为疗法（CBT），剔除繁琐无用的理论框架，将其精简为一套直击痛点的行动工具。其核心第一步是追问：如果一年后你达成了绝佳的转变，那个画面具体是怎样的？仅仅说“想减肥”是无效的，必须挖掘这个数字背后的生命意义。 在 Unwin 医生的引导下，Steven 剖析了自己最深层的心理恐惧：害怕步父亲晚年病痛的后尘。两人拥有相似的基因画像，他在三十岁时清醒地意识到，若不采取干预，自己很可能会重蹈覆辙。Steven 分享了一个刻骨铭心的瞬间：他在巴厘岛与未婚妻沿着一段漫长而陡峭的台阶走向峡谷去玩白水漂流，走着走着，他突然意识到自己的父亲如今连上一层楼梯都极其艰难，根本无法走下这段台阶，更别提再爬上来了。这意味着父亲彻底丧失了与挚爱之人共享户外冒险的生命乐趣。 Steven 意识到，人在二三十岁达到生理巅峰后，机能衰退的曲线是客观规律；然而衰退的斜率与下限，完全取决于当下所做的每一个微小抉择——是让七八十岁的自己卧床不起、寸步难行，还是依然能够自由奔跑。这种对丧失生活品质的敬畏与恐惧，成为了驱动他自我克制的最强动力。 ### [01:12:46](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4366s) 寻找过往成功的支点：健康习惯的建立与复盘 在明确了核心目标与内在情感纽带后，Jen 的干预模型迅速推进到第二步：复盘过往经验中真正奏效的行为。Unwin 医生要求 Steven 迅速列举出过去曾成功帮助他朝健康目标迈进的具体做法。 Steven 回顾起自己以往的健身尝试，并坦言了极端目标带来的教训：有一年他发誓必须“每天都去健身房”，结果前五个月执行得非常完美，却因为偶然漏掉了一天而全盘崩溃；而在另一年，他调整了策略，采取了更为可持续的节奏，才逐渐找到了让身体保持力量与规律运动的有效平衡点。这一反思为进一步制定抗衰与控糖的行为干预奠定了现实基础。 ### [01:13:22](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4402s) 斯蒂芬的健身契约：从执着结果到“一致性”与社交问责 在回顾过去的改变经历时，斯蒂芬·巴特利特分享了自己在 2017 年立下的一个教训惨痛的目标——“为了夏天练出六块腹肌”。大卫·安温医生随即纠正并打断了他，指出核心问题不是去反思“什么行不通”，而是挖掘“过去究竟什么在起作用”。斯蒂芬坦言，正是两次失败的教训彻底改变了他的思路：他不再将某个具体达成的外在形体（如六块腹肌）作为目标，而是将“一致性”（Consistency）本身确立为终极目标。在过去四年里，这一理念让他每天清晨醒来都拥有一次重新投入的机会；即使某天搞砸了，明天太阳升起时依然可以重振旗鼓。 安温医生赞许地指出，这正是挖掘个体自身“内在资源”（Resources）的过程——来访者本身就带着过去的经验、智慧、朋友和解决问题的能力走进咨询室，医生绝不是高高在上的权威指挥官。斯蒂芬进一步分享了促使他保持一致性的两个关键微小步骤（Increments）：首先是建立“社交契约”（Social pact）机制。他与 10 位朋友建了一个名为健身群的 WhatsApp 小组，制定了严苛而有趣的规则——每个月运动一致性排名垫底的人会被直接踢出群聊，由新朋友补位。在整整四年中，斯蒂芬从未被踢出群过。群里每天会自动同步每个人的训练动态，每周和每月更新积分榜、发放 emoji 奖章，甚至还有一条印有“健身区块链世界冠军”（fitness blockchain world champion）字样的巨型实体金腰带，就摆在他家里的书架上。 另一个关键步骤是重新定义成功。以往设定“每天必须去健身房”往往导致彻底崩溃，而现在他允许自己在状态极差时只练 15 到 20 分钟。例如前一天斯蒂芬录制《龙穴》（Dragon's Den）节目直到深夜，开车赶回伦敦到家已是凌晨 1 点，但他依然坚持完成了 18 分钟的锻炼。这种对成功标准的弹性调整，维系住了珍贵的心理惯性与前进势头。 ### [01:16:12](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4572s) 揭秘心理学利器：赋能改变的“GRIN”行为转变模型 安温医生随后引导斯蒂芬关注最后一步：“当一切进展顺利时，你会注意到自己身上发生什么变化？”斯蒂芬思考后表示，最直接的反馈是身心感受——情绪上对自己感觉良好，精力上也变得格外充沛；更重要的是触及了“自我认同”（Identity）。他将自己定义为一个健康、能够掌控生活的人，一旦未能践行持续的自律行为，这种自我怀疑会带来极大的心理不适，直接冲击自尊心。 ```mermaid flowchart LR accTitle: GRIN 行为转变模型 accDescr: 由 Jen Unwin 提出的四步行为改变心理学框架 subgraph GRIN["GRIN 行为改变模型"] direction LR G["G - 目标 (Goals)<br/>聚焦渴望的未来"] --> R["R - 资源 (Resources)<br/>调动内在优势与支持"] R --> I["I - 微步 (Increments)<br/>拆解切实可行的小步骤"] I --> N["N - 觉察 (Notice/Reflect)<br/>反思并感受积极变化"] end ``` 此时，安温医生揭晓了刚才对话的玄机：这短短几分钟的互动完整演示了他妻子简·安温（Dr. Jen Unwin，顾问临床心理学家）发表的 **GRIN 模型**： - **G（Goals，目标）**：明确想要达到的健康未来与状态； - **R（Resources，资源）**：挖掘当事人自身已具备的智慧、人际网络与成功经验； - **I（Increments，微小步进）**：寻找通往目标的现实小步骤（如社交问责群、缩短单次运动时长）； - **N（Notice and reflect，觉察与反思）**：觉察并反思正面进展带来的内在感受与自尊提升。 安温医生强调，自己在诊室里几乎每次看诊都会运用这套模型。医生不应该充当“会说话的宣传单”（talking leaflet）向患者单向灌输指令；通过短短几分钟提问，不仅能挖掘出专属于患者的个性化动力，更能真正激发他们从内在做出改变。 ### [01:18:19](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4699s) 告别内疚与呻吟：用希望重塑医患对话与未来 对于这套模型是否适用于所有受困于生活习惯的人，安温医生的回答是肯定的。他解释道，大多数人在面对体重或健康问题时，往往将大把心理能量浪费在自责、内疚与负面情绪上——“都怪我”、“我真希望当初没那样”、“我不该吃那个的”，尤其是在节假日（如圣诞节）过后，这种懊悔情绪最为普遍。然而，沉溺于愧疚是对心力的极大浪费，GRIN 模型的核心正在于将当事人从负面情绪中拉出来，全身心投入到构建更美好的未来之中。 安温医生反思了传统医疗模式的弊端：在过去的行医过程中，病人体会到只有不断向医生倾诉“情况太糟糕了、我的疼痛太严重了”，才能获得医生的关注与重视。无形之中，医生实际上“训练”了患者依靠抱怨和呻吟（moaning）来互动，导致整个门诊长达两小时的看诊过程变得极其压抑和痛苦。 然而，哪怕是深陷药物成瘾或身患绝症、正走向生命终点的患者，只要医生去用心探寻，每个人心中依然怀揣着希望与目标。当医生学会去探寻患者的内在希望与美好闪光点时，医患关系会发生质的转变，医者自身也能重新汲取充沛的能量与快乐。安温医生坦言，自己在 55 岁之前常常感到职业倦怠，而正是这种思维方式的转变，让他如今的行医生活充满了前所未有的激情。 ### [01:20:31](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4831s) 面对深陷成瘾的挚爱：痛苦的个人经历与超加工食品成瘾真相 斯蒂芬将话题引向现实中最棘手的困境：许多听众自身掌握了健康知识并取得了进展，但眼睁睁看着自己深爱的伴侣或家人正滑向不健康的危险深渊，常常陷入不知所措——究竟是该强行干预、藏起他们的甜食，还是大加指责？ 面对这个痛点，安温医生罕见地敞开了极其沉重的个人往事。在与现任妻子相遇之前，他的第一任妻子患有极为严重的成瘾症。安温医生与她共同生活了 12 年，最终她不幸离世。安温医生回忆道，与严重成瘾者生活在一起，意味着每天都要承受巨大的“不确定性”与生活的全面失控——你永远无法预料推开家门时会面对怎样的混乱场景。那种深爱着一个人却完全无能为力的痛苦与煎熬，让他对身处类似境地的家属怀有极深的同理心。尽管多位当事人均已离世，安温医生并未透露具体的成瘾物质细节，但他明确表示那是非常严重的多重成瘾，且并非食品成瘾。 安温医生指出，面对深陷泥潭的家人，强行指责往往适得其反，试着引导他们谈论内心的目标与希望才是可行之路。随后他将话题转向与他携手走过 30 年的现任妻子简（Jen）。出人意料的是，身为资深顾问心理学家的简，自身其实是一位货真价实的“超加工食品成瘾者”（Ultra-processed food addict）。在长达数十年的时间里，无论是简还是安温医生，都未曾意识到这属于成瘾范畴，而仅仅将其归咎为“体重问题”。简一辈子都在经历残酷的“溜溜球式节食”（boomerang dieting）——体重在肥胖与消瘦之间剧烈反复循环，而当时的安温医生只能在一旁困惑地看着这一切不断重演。 - **斯蒂芬的 10 人运动监督群**：采用末位淘汰制（每月运动一致性最差者被踢出），每日自动同步运动记录，设有实体冠军金腰带奖励，斯蒂芬已连续 4 年未被淘汰。 - **重新定义运动底线**：在深夜 1 点到家的极端忙碌情况下，将原先苛刻的全程训练压缩为 18 分钟，以保持心理惯性。 - **GRIN 模型四要素**：Goals（目标）、Resources（资源）、Increments（微小步进）、Notice and reflect（觉察与反思）。 - **安温医生的家庭成瘾印记**：第一任妻子患严重多重成瘾症，两人共同生活 12 年直至其病逝；现任妻子简·安温长期受超加工食品成瘾困扰，此前一直误认为是单纯的溜溜球节食减肥问题。 ### [01:23:11](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4991s) 聪明人的隐秘困境：超加工食品成瘾的真相 大卫·安温医生（Dr. David Unwin）回忆起自己的妻子珍（Dr. Jen Unwin）过去的一段经历：当时她一直努力减肥，却总是烤一盘又一盘的托盘点心（tray bakes），嘴上坚称这些甜点是“做给孩子们吃的”，背地里自己却风卷残云般吃掉大半。安温医生出于对妻子的爱，骨子里男性的“洞穴人（caveman）”拯救本能被激发出来，试图通过强硬手段去解决问题——要么直接把食物扔进垃圾桶，要么当面阻拦质问。然而这种干预引发了激烈的争吵，妻子变得极度戒备且愤怒。安温医生百思不得其解：一个受过高等教育、极具智慧的职业女性，怎么会在食物面前完全失控？直到数年前妻子才幡然醒悟，承认这本质上就是成瘾。当智商极高的人一次又一次做出明知会严重摧毁自身健康的行为时，这与烟瘾、酒瘾没有任何分别，正是典型的超加工食品成瘾。 为了更透彻地阐明这种成瘾机制，安温医生在征得患者知情同意的前提下，分享了一个极其震撼的真实病例。一名 55 岁、极其成功的富商，不仅智力超群且经营着庞大的企业，却饱受严重肥胖与 2 型糖尿病的折磨。由于体重过重，他的双膝关节已被彻底破坏，每走一步都痛苦万分，急需接受重度膝关节置换手术；然而由于其血糖控制极差，麻醉医师明确拒绝为其施术，他陷入了既无法手术又因寸步难行而难以打理生意的双重死局。安温医生指导他践行低碳水饮食，初期虽然见效，但随后便陷入了反复反弹的恶性循环。整整四年间，这位商人在每月随访中找尽了各种借口——诸如孙辈来访、度假出游或圣诞假期。 直到某天，该患者雷厉风行、令人敬畏的妻子私下来见安温医生，坦白了残酷的真相：“我必须跟您坦白，我的丈夫每天凌晨四点爬起来，从冰箱里偷面包吃。”为了阻止他，妻子开始在每晚睡觉前把吃剩的面包丢进垃圾桶，却惊恐地发现丈夫凌晨会在垃圾桶里翻面包吃。妻子随后加大惩罚力度，往垃圾桶的面包上倒洗洁精，然而丈夫竟然依然把沾着洗洁精的面包捡出来吞下肚。逼入绝境的妻子只能使出终极绝招：用漂白剂直接喷洒在废弃面包上，并将漂白剂罐直接留在垃圾桶旁作为醒目的警示，丈夫才彻底放弃翻找。安温医生指出，这就是毫无掩饰的成瘾——一个平日里体面成功的智者，在食物诱惑下自尊被粉碎殆尽，活在隐瞒、羞耻与欺骗之中。 - **超加工食品成瘾的本质**：高智商群体反复实施自我伤害式的饮食行为，其神经生物学机制与尼古丁、酒精成瘾如出一辙。 - **极端面包成瘾案例**：一名身价丰厚、急需膝关节手术的企业家，在长达四年的时间里瞒着医生，甚至不惜从垃圾桶翻找沾有洗洁精的面包食用，直到妻子喷洒漂白剂才被迫收手。 ```mermaid flowchart TD accTitle: 极端食物成瘾与综合干预突破路径 accDescr: 展示严重面包成瘾患者从失控恶性循环到三联疗法实现缓解的过程 subgraph Cycle ["成瘾失控的恶性循环"] A["严重肥胖与高血糖\n双膝损毁需手术"] --> B["麻醉风险拒签\n困于身体与生意"] B --> C["凌晨失控暴食面包\n翻垃圾桶/无视洗洁精"] C --> D["羞耻掩饰与心理借口\n低碳反复失败"] D --> A end subgraph Intervention ["安温医生的三联破解方案"] E["连续血糖监测 (CGM)\n实时数据反馈直观显现糖尖峰"] F["低剂量 GLP-1 药物\n平息大脑中的食物渴求噪音"] G["严格低碳饮食与戒绝\n医生全程高密度随访支持"] end Cycle -->|寻求彻底干预| Intervention Intervention --> H["成功戒绝精制面包\n血糖达标并顺利完成膝关节置换"] ``` ### [01:27:00](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5220s) 破局之道：CGM、GLP-1 与彻底戒绝的协同治疗 这个原本令人绝望的病例最终迎来了转机。面对这种顽固且失控的成瘾，安温医生采取了全方位的综合干预策略：在严格低碳饮食的基础上，他首先为患者佩戴了动态血糖仪（Continuous Glucose Monitor, CGM），使患者和医生都能实时看到进食后飙升的血糖尖峰轨迹，用冰冷客观的数字击碎任何侥幸心理；其次，安温医生罕见地为他开具了低剂量的 GLP-1 受体激动剂（如 Ozempic 类药物）。这三项措施产生了决定性的协同效应——药物抚平了大脑中整日盘旋的“食物噪音（food noise）”和强烈的生理渴求，CGM 提供了瞬时反馈，而医患之间的支持网络构筑了底线防护。 安温医生强调，对于真正的食物成瘾者而言，“适度享用（moderation）”完全是天方夜谭，他们唯一能做到的就是“彻底戒绝（abstain）”。如今这位企业家已成功控制血糖并完成了膝关节置换手术，重获新生，但这将是一场终身必须持续维护的战役。公众往往轻描淡写地将这种失控称为“碳水蠕变（carb creep，碳水摄入不知不觉增多）”，仿佛那只是无伤大雅的微小松懈，但现实中无数人深陷其中。当被问及特定食物时，许多患者常常当场痛哭流涕，坦言一辈子从未向任何人透露过自己无法控制吃面包的事实。在世俗观念中，“戒不掉面包”听起来愚蠢且令人尴尬，这极大侵蚀了患者的自我认同。据安温医生的妻子珍博士（发表过多篇相关学术论文并著有《Fork in the Road》）的研究估算，全人口中约有 14% 的人存在不同程度的超加工食品成瘾。 为了说明这种所谓“碳水蠕变”绝非儿戏，安温医生又列举了另一个令人心碎的案例：在他成功帮助实现无药缓解（drug-free remission）的 157 名 2 型糖尿病患者中，有一位患者在病情完全缓解后失联了一段时间。当他再次走进诊室时，脚上的两根脚趾已经发黑坏死（gangrenous），不得不接受局部截肢手术切除了半只脚。糖尿病悄无声息地剥夺了肢体末端的血液供应，而导致这一切的根本原因，正是那被轻描淡写掩盖的食物成瘾。所幸在安温医生与患者妻子的全力支持下，他们重新发起攻坚，最终再次实现了糖尿病的彻底缓解。 - **三联挽救方案**：低碳水饮食基石 + 连续血糖监测（CGM）瞬时警示 + 低剂量 GLP-1 药物阻断中枢渴求噪音。 - **适度 vs 戒绝**：成瘾患者无法做到中途刹车（无法“适度吃一点”），必须像戒毒一样实施“彻底戒绝”。 - **普遍性与严重后果**：约 14% 的人群存在超加工食品成瘾；所谓“碳水蠕变”若不加以干预，最终代价可能是溃烂截肢、丧失行动能力。 ### [01:31:15](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5475s) 终结失控的第一步：从坦白自欺到建立戒绝计划 针对那些处于食物失控边缘、陷入“失控—挣扎控制—再次失控”恶性循环的人群，史蒂文·巴特利特（Steven Bartlett）提出了核心疑问：对于那些深感恐惧、急于摆脱泥潭的人来说，当下迈出的第一步究竟是什么？安温医生直截了当地指出，第一步就是“诚实（Honesty）”——彻底承认自己存在进食失控的问题。人性的弱点在于极度擅长合理化自身的恶习，安温医生拿自己当年戒除饼干成瘾的亲身经历现身说法：在整整一年的时间里，他一直自欺欺人地认为吃饼干只是应对繁重门诊压力的“合理宣泄”，而非成瘾。 安温医生自嘲当年甚至“不够男人”，无法像妻子珍所倡导的那样采取干脆利落的“完全断绝（cold turkey）”疗法，而是像戒毒人员服用美沙酮替代维持治疗一样，经历了一条极其漫长而滑稽的渐进脱敏路线：从最初酷爱的巧克力姜汁饼干，降级到消化饼干，再退守到燕麦饼干，最后才艰难替换成生杏仁，耗费了整整一年光阴才彻底摆脱。因此，面对成瘾，首先必须对自己绝对诚实，哪怕不敢告诉别人，也必须在内心审视自己是否存在成瘾潜能。 紧随其后的第二步，是精准且诚实地排查出“究竟哪一种特定食物是引发失控的罪魁祸首（trigger foods）”；第三步则是针对该食物制定绝不妥协的“戒绝计划（plan for abstinence）”。安温医生警告，对于具有成瘾体质的大脑而言，永远不可能存在“就吃一块饼干”的奇迹，任何试图与诱惑妥协的微小试探，最终都会演变成不可收拾的全面溃堤。 - **戒除食物成瘾的三步行动法则**： 1. **坦承成瘾现实（Honesty）**：击碎借口，承认自己对某些食物丧失控制力，正视自身的成瘾特质。 2. **锁定触发食物（Identify specific trigger foods）**：精确查明让自己失控的具体食物品类（如面包、饼干、糕点）。 3. **制定戒绝方案（Plan for abstinence）**：彻底放弃“适度尝试”的幻想，确立零容忍的绝对戒绝红线。 - **安温医生的“美沙酮式”饼干戒断史**：巧克力姜汁饼干 $\rightarrow$ 原味消化饼干 $\rightarrow$ 纯燕麦饼干 $\rightarrow$ 坚果（杏仁），历时整整一年才斩断心瘾。 ### [01:33:38](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5618s) 戒除食物成瘾：为何严苛说教只会导致隐瞒与欺骗 在谈到戒除某些诱人食物时，大卫·昂温博士（Dr David Unwin）与史蒂文·巴特利特（Steven Bartlett）指出，几乎每个人都曾信誓旦旦地对自己说过：“我要戒掉冰淇淋、饼干或披萨。”然而现实中，往往只要经历了一整天的工作压力，或者喝了杯酒，大脑里的声音就会立刻妥协并推脱道：“算了，明天再说吧。”这种“明天、明天、又一个明天”的拖延循环无处不在。因此，想要打破恶性循环，必须对目标食物做到绝对明确，并制定出具体的应对方案。与此同时，向身边关爱自己的家人和朋友坦诚相告也非常关键——就像戒烟一样，坦白告知对方：“这对我至关重要，但我可能会需要帮助，如果这期间我脾气暴躁，请多包容我。” 然而，亲友的支持是一把双刃剑，关键在于他们究竟能给予温柔的理解，还是会采取专断粗暴的干涉。如果求助者刚坦白自己的困境，伴侣便化身为居高临下的“饮食警察”，对其百般审判和监督，局面往往会彻底恶化。史蒂文坦承，自己过去曾交往过一位极其注重健康的伴侣，对方那种严苛的健康狂热反而逼得他开始偷偷吃垃圾食品并四处藏匿食物包装袋。昂温博士对此深有共鸣，笑着透露自己的妻子珍（Dr Jen Unwin）当年对他也是如此——因为知道昂温在暗中监视她的饮食，珍便开始把零食包装纸藏在车里。 昂温博士严肃地分析道，如果你在亲密关系中去强行“管制”你所爱的人，最终必然催生欺骗。当一个人被迫变得隐秘与不诚实时，双方之间便彻底丧失了坦诚沟通的空间；更严重的是，这种偷偷摸摸的欺骗行为会反噬当事人的自尊心，让他们在遇到低谷时倍感孤独与羞耻，最终导致饮食失控更加严重。因此，陪伴者必须学会适度放手退后，给予宽容与温柔的支持，而不是把对方逼入孤立无援的死角。 ```mermaid flowchart TD accTitle: 强行监管与食物成瘾恶性循环 accDescr: 伴侣的严苛监管如何导致欺瞒并最终摧毁戒瘾计划 subgraph PolicingCycle ["严苛监管带来的反向循环"] A["向亲友坦白食物成瘾困境"] --> B["伴侣化身'饮食警察'过度监控与评判"] B --> C["产生恐惧与羞耻，开始藏匿零食与包装袋"] C --> D["出现欺骗行为，亲密关系丧失坦诚对话空间"] D --> E["当事人自尊受损、孤独感加剧，导致成瘾变本加厉"] end ``` ### [01:35:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5708s) 《Fork in the Road》：千本赠书与用知识改变命运 昂温博士借此机会向观众展示了妻子珍·昂温博士所著的书籍《分水岭》（*Fork in the Road*）。书名的寓意非常直观：在通往健康的漫长旅途中，摆在每个人面前的都是一条岔路，你究竟要选择哪一条？昂温博士特别强调，珍写这本书完全不是为了商业利益，她个人不从中赚取一分钱，该书的所有收益都全额捐赠给她为帮助食物成瘾人群而创立的慈善机构。 在得知这本在亚马逊上自主出版的书售价仅需大约十英镑左右时，史蒂文毫不犹豫地当场决定，由他个人出资自费购买 1,000 本，并在视频下方附上申领链接免费赠送给听众与观众。史蒂文表示，甚至可以争取让珍签名一部分，以此作为对昂温夫妇倾囊相授的由衷感谢，同时也是回馈长期支持节目的广大社群。昂温博士深受感动，由衷感叹道，这样一本篇幅短小、通俗易懂却有着严谨科学依据支撑的小册子，如果能够切实改变某些人的人生轨迹，那将是一件无比美好的善举。 ### [01:37:24](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5844s) 赞助商插播：Cometeer 冷冻咖啡与促进深层沟通的对话卡 史蒂文在中场休息时冲泡了一杯咖啡，并向观众介绍了播客赞助商之一的 Cometeer 冷冻浓缩咖啡。史蒂文透露自己早在前一年就投资了这家咖啡品牌，其颠覆性的生产工艺在于先以常规浓度 10 倍的超高规格进行精准萃取，随后立即采用液氮进行极速闪冻，以此将咖啡最原始的香气与新鲜风味瞬间锁住。这些浓缩液被装在可回收的铝制胶囊中，通过干冰冷冻运送至消费者家中，形态宛如小巧的冰块；饮用时只需将冷冻胶囊脱模倒入杯中，加入热水或冷水牛奶搅拌，几秒钟内便能还原出一杯高品质的冷热黑咖啡或拿铁。 随后，史蒂文分享了自己采访近 700 位全球顶尖嘉宾后得出的核心感悟：“展现脆弱是通往深度联结的唯一大门。”每次长达两三个小时的对谈结束后，他都会邀请嘉宾在日记本中亲笔留下一个深刻的问题。节目团队如今将这些极具穿透力的问题整理成了实体的《CEO 日记对话卡》（DOAC Conversation Cards）。史蒂文提到，在快节奏的数字化时代，无论是伴侣之间渴望加深情感理解、职场团队想要强化信任凝聚力，还是家庭聚会需要放下手机回归面对面的人性交流，一张恰逢其时、直击心灵的问题卡片，往往能带来超乎想象的深层共鸣。 ### [01:39:03](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5943s) 糖、高胰岛素血症与癌症：触目惊心的科学数据与预防缺位 话题重新切回健康与代谢，史蒂文提到了昂温博士早些时候谈到的饮食选择与癌症之间的潜在关联。史蒂文神情严肃地讲述了自己身边的一位挚友兼前团队主管凯蒂（Katie），她甚至比史蒂文还要年轻，却在近期不幸确诊了乳腺癌。凯蒂目前公开在社交媒体上记录自己的抗癌历程，并且正在坚决剔除日常饮食中所有高糖与超加工食品。这件事让史蒂文深受触动，促使他系统查阅了饮食与癌症预后之间的一系列触目惊心的科研数据： - **含糖饮料与全因癌症**：一项大型法国流行病学研究发现，每天仅摄入 100 毫升含糖饮料（仅相当于大约三分之一罐常规苏打汽水），便与全因癌症整体患病风险上升近 20% 显著相关。 - **代糖/无糖饮料与早发性结直肠癌**：每天饮用两杯或以上代糖/无糖饮品的女性，罹患早发性结直肠癌的风险比每周饮用少于一杯的女性高出两倍以上。 - **子宫内膜癌风险**：大量摄入加糖饮料会导致女性罹患雌激素依赖型子宫内膜癌的风险激增 78%。 - **端粒缩短与生物学衰老**：每天饮用 20 盎司（约 590 毫升）含糖苏打水，与人体保护性 DNA 结构——端粒的过早缩短直接相关，相当于在生物学年龄上平白衰老了 4.6 岁，而细胞老化正是诱发癌症的重大隐患。 - **高胰岛素血症抑制细胞凋亡**：长期高糖饮食会导致体内慢性“高胰岛素血症”（Chronic Hyperinsulinemia），居高不下的胰岛素水平会抑制细胞的正常凋亡（Apoptosis），即阻止受损细胞或潜在癌变细胞启动自然的自我毁灭程序。 - **果糖代谢滋养肿瘤细胞膜**：果糖在肝脏中完全被代谢转化为脂质（脂肪），最新前沿研究证实，某些肿瘤细胞能够直接摄取并吞噬这些游离脂质，用来构建并扩增其自身的细胞膜。 - **C 反应蛋白与癌症转移**：高添加糖饮食会诱发体内 C 反应蛋白（CRP）长期慢性升高，这一系统性炎症标志物与肿瘤的快速恶化演变及远端转移（Metastasis）高度正相关。 听完这串沉重的学术数据，昂温博士深有感触地指出，现代医学体系和全社会花费了数以千亿计的资金去讨论如何“治疗”癌症，却悲哀地几乎完全忽视了癌症的“预防”。对于史蒂文的朋友凯蒂以及无数被确诊的病患而言，这无异于一场伴随着巨大未知与恐惧的漫长宣判；每当昂温在全科诊室里不得不当面向患者宣布癌症确诊时，那种瞬间剥夺对方生活的沉痛感始终重重压在心头。昂温博士质问道，医学界目前公认，在吸烟之后，饮食不当就是导致癌症的第二大诱因；既然背后的病理机制与流行病学证据已经如此清晰确凿，整个社会究竟还要付出多大代价，才肯真正严肃地直面防癌问题？ ### [01:43:02](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6182s) “事前检视”与直面死亡的力量：为了口腹之欲我们究竟牺牲了什么？ 垃圾食品与全因死亡率及众多严重慢性疾病紧密相关。Steven Bartlett 与 David Unwin 医生反思道，当退一步审视时，人们为了短暂享受那些零食甜点所付出的代价，简直“疯狂至极（really bonkers）”。Steven 分享了他经常采用的一种心理策略——“事前检视（pre-mortem）”：在脑海中预演自己未来某一天坐在诊室里收到最坏确诊通知的场景。医生指着化验单告诉他，过去 5 年、10 年、15 年不良的生活方式是致病的罪魁祸首。Steven 坦言，在那个瞬间，当你必须回家面对未婚妻、伴侣和孩子，告知自己患上绝症时，没有任何一瓶含糖饮料或垃圾食品是值得的，“你的每一根骨头都会在那一刻无比渴望自己当初做出了不同的选择”。 Unwin 医生对这种直面生死的思维策略深表赞同，认为面对绝症确诊这一终极现实，生活中所有错综复杂的矛盾和困扰瞬间都会化为乌有，“昨天你可能还在为堵车焦虑，但比起重病诊断，那些烦恼显得无比可笑”。Unwin 医生坦承自己从小就对死亡深感恐惧与执念，但这种敬畏感转变成了一种积极的动力——绝不虚度光阴，每天清晨都认真思考“今天怎样度过才最有价值”。死亡成为了人生最公平的尺度，它提醒人们珍惜当下，并在健康管理上掌握主动权。 ### [01:45:04](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6304s) 寿命与健康寿命的脱节：日益扩大的“患病余生”鸿沟 双方进一步探讨了“寿命（Lifespan）”与“健康寿命（Healthspan）”之间的危险鸿沟。现代人虽然普遍能活到 80 岁左右，但往往在四五十岁之后就深陷各种慢性病的折磨，真正健康生活的时间在急剧缩短。根据英国国家统计署（ONS）与健康基金会（The Health Foundation）的最新数据，英国面临着令人担忧的“带病生存年限”激增现象： - **健康预期寿命下滑**：过去十年间，英国人口的健康预期寿命下降了约 2 年，目前男女健康生活的时间平均仅为 60 年左右。 - **长达 23 年的病痛期**：随着总体预期寿命的小幅攀升，平均每个人在生命最后阶段需要忍受长达 23 年的慢性病或残疾，相当于整个人生的近四分之一都在疾病管理中度过。 - **超加工食品的沉重社会代价**：英国政府数据显示，由于超加工食品引发的健康后果，英国每位纳税人每年要额外承担约 7,000 英镑的税负。这一经济损失中，药物和医疗支出仅占一小部分，高达三分之二的损失来自于大量劳动力（甚至包括很多年轻人）因病丧失劳动能力、无法工作及由此导致的税收锐减。 - **美国的严峻现状**：美国拥有全球同类发达国家中最悬殊的“寿命与健康寿命差距”，不仅整体预期寿命普遍低于同类国家，过早死亡率接近发达国家平均值的两倍，其健康寿命数据更是位列全球最糟糕水平，意味着美国人在更长的时间里处于患病状态。 ```mermaid flowchart TD accTitle: 寿命与健康寿命之间的病痛差距 accDescr: 展示现代人总体预期寿命与健康预期寿命的差距，说明生命后期有长达数十年的慢病困扰。 subgraph Timeline["人均寿命阶段划分"] A["健康生活期：约 60 年<br/>（高生活质量、无严重慢性病）"] B["慢性病与残疾困扰期：长达 23 年<br/>（约占人生的 1/4）"] A --> B end subgraph Impacts["社会与经济代价"] B --> C["沉重医疗与财政负担"] C --> D["英格兰纳税人额外支出：<br/>每年约 £7,000 /人"] C --> E["2/3 损失源自劳动力病休<br/>造成的税收与生产力流失"] end ``` ### [01:48:18](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6498s) 简单的“一根绳子”测试：评估代谢健康与腹部脂肪 为了让大众无需昂贵仪器就能自测代谢状况，Unwin 医生推荐了一种极其实用且低成本的筛查手段——腰围身高比（Waist-to-Height Ratio）。医学界公认的代谢健康指标要求：**腰围应当小于身高的一半**。过多的腹部脂肪往往是胰岛素抵抗（Insulin Resistance）的直接外在表现，相较于手臂或腿部积聚的皮下脂肪，腹部内脏脂肪对身体健康的威胁要严重得多。 Unwin 医生现场用一根棉绳为 Steven Bartlett 进行演示： 1. 取一根长度与本人身高完全一致的绳子（Steven 身高为 6 英尺 1 英寸，约 185 厘米）。 2. 将这根绳子对折，取其一半长度。 3. 将对折后半长的绳子绕在肚子最粗的部位测量，看是否能合拢围上一圈。 现场测试中，Steven 将绳子绕过腰部最粗处，绳头勉强能够重合。Unwin 医生幽默地调侃他“有没有偷偷吸肚子作弊”，随后确认他顺利过关，并指出无论是肌肉健硕还是腹部稍有脂肪，这都是一个每个人在家里只要花几分钱买根绳子就能快速了解自身胰岛素抵抗与内脏脂肪隐患的简易金标准。 ### [01:50:19](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6619s) 现代土壤退化与镁元素补充的必要性 针对观众高度关注的营养补充剂（Supplements）问题，Unwin 医生阐述了他的核心观点：理想状态下，人体应尽可能通过以天然未加工全食物（Real Food）为主、蛋白质充足、富含健康脂肪且低碳水化合物的健康饮食来获取所需全部营养。然而，受现代集约化农业与种植方式的影响，如今的作物营养成分已大不如前： - **现代农业的矿物质流失**：土壤在长期施用单一氮肥、过度耕作与机械化采收的模式下，微量元素被严重消耗，导致今日农作物中所含的锌（Zinc）和镁（Magnesium）等关键矿物质远低于 100 年前祖辈所食用的水平。 - **老年与药物干扰吸收**：人体随着年龄增长，对镁的肠道吸收率本身就在逐步下滑；加之常见药物（尤其是治疗胃酸过多的抗酸剂/抑酸药）的干扰，使得绝大多数人极难单纯依靠现代膳食摄入足量的镁。 - **补充镁的切身体验**：Unwin 医生分享道，自己服用镁补充剂后效果立竿见影，“神奇地彻底解决了肌肉痉挛问题”，并且显著改善了睡眠质量。 - **按肠道状况挑选适宜剂型**：选用镁补充剂时必须因人而异，关键取决于肠道蠕动速度。如果平素有便秘倾向或排便较慢，**柠檬酸镁（Magnesium Citrate）** 是绝佳选择，因为该形式自带温和的轻泻通便效果；而对于肠道通畅正常的人群，则应选择其他更具针对性的吸收形式。 ### [01:52:45](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6765s) 镁的不同形态与买牛的奇遇：草痉挛与致命抽搐 关于镁的补充形式，不同形态有着截然不同的生理作用。甘氨酸镁（Magnesium Glycinate）或苏糖酸镁（Magnesium Threonate）能够有效穿透血脑屏障，对改善睡眠质量和调节情绪非常有效，但它们并不能缓解便秘；如果想要促进肠道蠕动，则需要选择柠檬酸镁等其他形式。为了阐述镁对生命机制到底有多关键，David Unwin 医生分享了一段看似离奇却深刻影响他医学生涯的往事——他人生中第一次“买牛”的经历。 Unwin 医生与妻子 Jen Unwin 之间有一个共同的送礼信条：“如果你真爱一个人，送礼物时就应该站在对方的角度思考他真正喜欢什么，而不是买你自己想要的东西。”当时 Jen 觉得丈夫需要学会真正长大，于是有一天对他说：“穿上大衣和威灵顿长筒雨靴，我带你出门。”她开车将 Unwin 带到了兰开夏郡（Lancashire）的一片牧场前，指着满地的牛群说：“这里面的牛，你随便挑一头，我已经买下来送给你了。”Unwin 一直渴望拥有一头属于自己的牛，而家里正好有一块草地，妻子提前找到农场主付了全款，只要他挑中哪一头，农场主就会负责运送到家。 这段经历之所以与镁密切相关，是因为农场主在交牛前提出了一个不容妥协的前提条件：“你可以挑走这里的任何一头牛，但我今年已经因为一种叫‘草痉挛’（the staggers）的病损失了整整 15 头牛。除非你向我发誓一定会给它买镁补充剂，否则绝不能把牛带走。”农场主解释道，如今牧场土壤和青草中的镁含量极度匮乏，如果牛得不到外源性的镁补充，就会因为低镁血症引发剧烈痉挛甚至死亡。巧合的是，当时 Unwin 的诊所里正好有一位让他十分牵挂的男性患者，长期反复出现不明原因的严重抽搐，屡次被急救车送进重症监护室抢救，医生们排除了脑肿瘤等所有可能，始终找不出病因。农场主的一番话瞬间让他将两件事串联了起来——那名患者正是因为所服用的某种药物导致了体内严重的镁流失。这是 Unwin 医生从医以来第一次意识到镁的重要性，而现代饮食结构导致了绝大多数普通人群都处于普遍缺镁的隐性状态。 ```mermaid flowchart TD accTitle: 缺镁引发痉挛的病理关联 accDescr: 展示牧场奶牛草痉挛与人类药物致缺镁抽搐之间的诊断联想过程 subgraph Farm["兰开夏郡牧场"] A["土壤与牧草严重贫镁"] --> B["奶牛患草痉挛 (The Staggers)"] B --> C["剧烈抽搐甚至死亡"] C --> D["农场主强制补充镁制剂"] end subgraph Clinic["诊所临床疑案"] E["患者反复剧烈抽搐进 ICU"] --> F["排查脑肿瘤无果，病因不明"] D -. "顿悟并串联线索".-> G["药物副作用诱发人体极度缺镁"] G --> H["确诊低镁血症，通过补镁逆转"] end ``` ### [01:55:06](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6906s) 细胞内的隐形缺乏：日常补充与盲目过量的误区 在临床检测中，人体内的镁极难被常规化验准确捕捉。普通的血清镁（Serum Magnesium）检查无法真实反映机体的实际储备，因为体内绝大部分的镁都储存在细胞内部，唯有检测细胞内镁水平（Intracellular Magnesium）才具有参考价值。由于这类细胞检测流程繁琐昂贵，Unwin 医生认为最实用的方法往往是直接尝试摄入适量的镁补充剂，并观察自身的睡眠、情绪或身体状态是否出现改善。 谈到日常补剂的摄入，主持人 Steven Bartlett 透露自己根据多位专家的建议，给自己制定了每天固定摄入五种基础营养素的原则： - **维生素 D**：由于长期处于室内工作环境缺乏日晒，加之自身肤色较深导致皮肤合成维生素 D 的效率显著降低，因此这是他的必备项。 - **镁（Magnesium）**：通常摄入柠檬酸镁或根据团队准备的配方轮换，用于支持神经与身体机能。 - **肌酸（Creatine）**：用于支持肌肉与代谢机能。 - **特定纤维膳食补充剂**：在近期多次血液化验中显示低密度脂蛋白（LDL）胆固醇偏高，检测机构建议使用特定水溶性纤维来辅助降低 LDL。 - **复合维生素（Multivitamin）**：用于覆盖潜在的微量营养素缺口。 Unwin 医生对 Steven 这种克制且具有针对性的补充方案表示认可，但他也指出了临床上极其普遍的“过度补充”乱象。在门诊中，很多健康焦虑的患者甚至会拎着满满一塑料袋的保健品走进诊室，里面堆满了红黄蓝绿各种胶囊和药片。他警示盲目过量补充存在切实的毒性风险，特别是像维生素 D 这类脂溶性维生素，过量摄入会在体内组织蓄积，引发高钙血症等严重后果。补剂应当基于真实生理短板进行理性调配，而非盲目堆叠。 --- ### [01:57:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7028s) 从七千英镑到平价筛查：Neko Health 与可行动的医疗检测 Steven 分享了自己过去一个月内所做的两次全面血液与身体检测，分别来自 Function Health 以及他近期斥巨资入股的健康筛查公司 Neko Health（由 Spotify 联合创始人 Daniel Ek 创立）。过去，Steven 每年都会自费做一次极其昂贵的传统全面体检，单次花费高达 7,000 英镑，耗时六七个小时，并且需要煎熬等待两周才能拿到化验报告；而 Neko Health 将这一流程彻底重塑为平价与高效。 只需花费 299 英镑，受检者即可完成抽血与全身多维扫描：受检者站在高科技扫描舱前，设备在极短时间内拍摄两三千张高精度身体图像，追踪全身每一颗痣的变化、测量从颈部到脚趾的血液循环状态，并实时记录心脏跳动节奏。在抽血完成仅约 20 分钟后，受检者便被带入诊室，眼前巨大的屏幕上完整投射出自己的三维身体影像，现场常驻医生会逐项拆解血液数据中的各项指标（如 LDL 水平），并与身体扫描画面进行直观比对。Steven 随后通过 AI 工具梳理这两份化验报告的交集，精准诊断出自己存在 Omega-3 匮乏、维生素 D 不足以及 LDL 偏高的问题，从而锁定了纤维与脂肪酸补充的具体方案。 针对这种新兴的全身体检模式，Unwin 医生提出了临床医生的审慎见解。他指出，全科医生（GP）通常对无差别的商业化大筛查保持警惕，其核心顾虑在于“很多体检纯粹是在恐吓受检者”。如果筛查只是抛出一堆晦涩异常的数据，告诉患者未来患某种致命疾病的风险有多高，却不能提供明确的干预手段，患者就会陷入巨大的恐慌之中，继而涌入公共医疗系统挂号求医，挤占宝贵的急需资源。Unwin 强调："筛查的真正价值，在于它必须与切实可行的应对措施（actionable points）直接绑定。" 医生有责任帮助患者理解数据背后的含义以及能够立即落地的生活干预方式，否则单纯的告知风险不仅毫无意义，反而是对患者心理的一种伤害。 ```mermaid flowchart TD accTitle: 医疗健康筛查的良性与恶性循环对比 accDescr: 对比传统恐吓型筛查与提供行动方案的高效筛查对患者和公共医疗系统的不同影响 subgraph BadScreening["盲目/恐吓型筛查"] B1["高危风险数据轰炸"] --> B2["受检者陷入未知恐慌"] B2 --> B3["缺乏可操作干预方案"] B3 --> B4["挤兑公共医疗门诊资源"] end subgraph GoodScreening["可行动赋能型筛查"] G1["精准检测生理指标异常"] --> G2["医生/系统现场解读机制"] G2 --> G3["提供切实行动方案 (饮食/补剂/作息)"] G3 --> G4["生活方式主动干预与健康逆转"] end ``` --- ### [02:00:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7208s) 医疗不平等与信息时代的健康普及 对于 Neko Health 提供的 299 英镑筛查，Steven 感慨虽然这已远低于以往 7,000 英镑的门槛，但能够自费享受私立高端体检和专属医生解读的人群终究享有某种阶层特权，这种医疗资源的不对等在现实中极为残酷。 这番话深深触动了 Unwin 医生。他坦言自己行医数十年来，始终严格恪守一条底线——只在英国国家医疗服务体系（NHS）体制内行医，坚决不接诊任何私立自费病人。在 Unwin 看来，医疗资源的阶级断层正在愈演愈烈： - **地域健康断层**：在英国，从南部向北部走，居民的代谢健康和预期寿命一路呈现断崖式恶化；在美国同样如此，加利福尼亚州的整体健康与医疗环境与其他贫困地区相比，几乎像是两个截然不同的国家。 - **底层民众的困境**：承受最糟糕饮食诱惑和慢性病折磨的人群，往往最缺乏获取优质私立医疗与精准检测的财力保障。 面对这种系统性的健康不平等，Unwin 认为社交媒体与网络播客正在成为扭转局势的重要力量。公众无需支付高昂的诊疗费，通过一部手机就能免费听到顶级专家的健康见解，正是像 Steven 这样拥有广泛影响力的播客主，将代谢健康与营养科学传播给了成百上千万普通受众。然而 Steven 在最后也道出了信息普及背后的新痛点：网络上铺天盖地、彼此矛盾的健康说法层出不穷，公众当前最大的挑战已经变成了“如何在海量信息轰炸中保持清醒，不被各种极端言论彻底搞糊涂”。 ### [02:01:45](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7305s) 真实世界数据的力量与概念验证 Dr. David Unwin 谈到了公众目前面临的信息混乱：各大报纸今天宣称“吃鸡蛋有益健康”，明天又宣称“吃鸡蛋有害健康”；不同的专家各执一词，互相矛盾。面对这种无所适从的局面，Unwin 强调自己始终坚持立足于“真实世界的数据”（Real-world data）。他解释称，自己在英国国民医疗服务体系（NHS）北部的诊所中，非常细致地记录患者的基线数据，并随着时间的推移不断追踪更新，所有发表的研究论文都直接源自一线门诊的真实临床结果。 这种来自英国北部的真实数据具有不可替代的说服力，因为在全民医疗体系下，全科医生无法“挑选”患者。他无法筛选富有阶层，也无法专挑预期寿命较长、健康素养较高的人群，而是全盘接纳国家系统分配的各类普通大众。正因如此，他的研究成果具备强大的“概念验证”（Proof of concept）价值——如果这一低碳饮食方案能在利物浦附近的普通工人阶层中取得糖尿病缓解的惊人成效，并且随后在澳大利亚、新西兰和北美等多国同行手中被成功复现，那么这就证明该方案在现实世界中是切实可行的。 - **患者分配机制**：通过英国 NHS 分配患者，无任何“挑选样本”（cherry-picking）或偏向富裕人群的可能。 - **国际复现性**：低碳逆转 2 型糖尿病的临床成果已在英国、澳大利亚、新西兰、北美等全球多地独立复现。 --- ### [02:02:52](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7372s) 播客传统提问：谁应代表人类会见外星文明？ Steven Bartlett 提出了《The Diary Of A CEO》播客的压轴传统：由上一位未曾谋面的嘉宾为下一位嘉宾留下一个未知问题。这次的问题颇具科幻色彩与哲学深意：“如果人类必须组织代表团与更高智慧的地外文明进行首次接触，谁应该代表全人类出面？为什么？” Unwin 听到问题后连连赞叹其精妙，稍作沉思后毫不犹豫地给出了答案：大卫·爱登堡爵士（Sir David Attenborough）。Unwin 解释道，爱登堡即将迎来百岁高龄，他将毕生心血都奉献给了对这颗星球的观察、记录与沉思。作为一名对生物多样性、可持续农业以及健康可持续食品体系怀有极高热情的人，Unwin 坚信爱登堡会是代表地球文明最完美的大使。Steven 也笑着附和道，外星人一定会非常喜欢这位温和而智慧的老爷爷。 --- ### [02:04:00](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7440s) 深度反馈：讲故事的艺术与医学沟通的桥梁 Steven Bartlett 向 Unwin 表达了由衷的敬意，并给出了极高的个人反馈。Steven 强调，自己每周接触各路来自哈佛、斯坦福等顶尖学府的天才学者，但很多人完全不具备将艰深医学科学转化为普通人通俗易懂语言的能力，经常让人听得一头雾水。而 Unwin 却具备一种极为罕见的特质：极其温和善良的人格魅力、真诚谦逊的品格，以及炉火纯青的“讲故事”能力。 Steven 坦言，人脑天生对抽象的概念不敏感，如果只是干瘪地讲“香蕉不好”或者“镁元素有益”，听众转头就会遗忘；但 Unwin 讲述的“奶牛缺镁导致抽搐与草痉挛”的故事，生动到令人终生难忘。更重要的是，Unwin 拥有 40 年的一线临床积淀，敢于直面过去的认知盲区，坦承自己和患者共同经历的失误，这种“不完美的真实”极大地建立了患者与听众的信任。Unwin 则回应，这正是全科医生数十年的本能反应——在应用沟通模型（如 GRIN 模型）时，他会全程高度敏锐地注视对方的微表情，感知对方何时感到困惑或厌倦，并随时调整节奏，这构成了医患与人际沟通的真正桥梁。 ```mermaid flowchart TD accTitle: 复杂医学知识向大众传播的信任转化模型 accDescr: 展示学术专家与 Unwin 医生在向公众传达健康认知时的不同路径与结果对比 subgraph Trap["传统学院派沟通困境"] A["高深前沿研究"] --> B["术语堆砌 / 理论说教"] B --> C["大众困惑与信息过载"] end subgraph Bridge["Unwin 的临床沟通模型"] D["真实临床数据"] --> E["生动故事化叙事\n（如奶牛与镁的故事）"] E --> F["实时表情与反馈观察\n（GRIN 模型与微表情）"] F --> G["真诚谦逊与承认局限"] G --> H["通俗可落地的行为转变"] end ``` --- ### [02:06:27](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7587s) 公益呼吁与健康建议：成为自己的“实验对象” 在探讨如何支持 Unwin 的理念传播时，Unwin 呼吁观众关注他在社交平台 X（原 Twitter）上的账号 `@lowcarbgp`，并全力支持他发起创立的英国注册慈善机构——公共健康协作组织（Public Health Collaboration, PHC）。该组织正值成立十周年，最初由 16 位一线临床医生发起，初衷是反思目前糟糕的公共健康状况，力求向大众普及更清晰、更真实的代谢与营养健康指导。 面向正在探索自身健康的普通人，Unwin 给出了核心指导原则： 1. **明确健康目标**：清楚自己究竟想要什么样的身体状态与未来生活。 2. **把自己视作“实验对象”**：不要害怕尝试新的饮食调整，但必须做到“有测量、有追踪”（Measure something），用客观生理指标来评估某种饮食方式是否真正对自己有效。 3. **拥抱连续血糖监测（CGM）技术**：Unwin 将 CGM 形容为“冲下山头支援的骑兵”（the cavalry coming over the hill），这项技术的普及彻底打破了食品工业的欺瞒。Steven 也分享了自己的亲身经历：戴上监测仪后才震惊地发现番茄酱等看似无害的调味品竟含有惊人的糖分，而一旦在手机上亲眼看见这种血糖飙升曲线，就再也无法自欺欺人。 - **社交媒体**：X（Twitter）账号 `@lowcarbgp`。 - **慈善组织**：英国公共健康协作组织（Public Health Collaboration, PHC），专注改善公共健康指导。 - **监测工具**：持续葡萄糖监测仪（CGM，价格约在 20–30 美元/英镑左右），是极具性价比的自身健康追踪工具及赠予长辈的务实礼物。 --- ### [02:08:54](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7734s) 现场实测平稳血糖与儿科领域的沉重警钟 为了直观展示身体状态，Unwin 现场查看了自己手臂上佩戴的连续血糖监测仪数据。令人惊叹的是，作为一名曾经被诊断为 2 型糖尿病的患者，他的实时血糖曲线呈现出一条近乎完美的平直水平线。Unwin 指出，平稳的血糖一方面归功于他长期杜绝引起血糖剧烈波动的碳水化合物，另一方面也源于心理压力管理——当人体处于高压状态时皮质醇等激素会导致血糖飙升，而 Steven 营造的温和、安全的对谈环境让他的身体全程保持在平静放松的状态。 在访谈尾声，Unwin 留下了一个发人深省、甚至令人心碎的真实故事作为警示：如今，儿科医生（专门诊治 16 岁以下儿童疾病的专家）正面临一场前所未有的全球危机——原本专属成人的 2 型糖尿病正大规模蔓延至儿童群体。由于这在医学史上是一个全新的疾病谱系演变，全球的儿科专家此前根本未接受过针对儿童 2 型糖尿病的专门培训。一个大型儿科医师协会甚至特意邀请 Unwin 开展主旨演讲，请他为儿科医生传授应对方案。Unwin 沉重地抛出反问：“我们究竟在对下一代做什么？”这为全社会敲响了关注高糖精制饮食毒害代谢健康的最高警钟。 ## Notable quotes > [18:39](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1119s) 昂温医生，你以为你要教训我一顿，是吧？我告诉你，今天是我要教训你！ — 琼斯太太 > [18:39](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1119s) 我真怀疑你到底有没有行医执照！过去这十年里，你哪怕有一次告诉过我面包就是糖、早餐麦片就是糖吗？我不得不自己在网上查资料才搞明白：面包是糖，米饭是糖，早餐麦片全都是糖！当我把这些东西戒掉后，我根本不需要你的二甲双胍！ — 琼斯太太 > [22:09](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1329s) 大卫，在退休之前，你为什么不放手做一件自己真正坚信、能让人振作起来的事呢？我们为什么不亲自尝试低碳饮食，并邀请一些患者自愿加入我们？ — 珍·安温 > [22:09](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1329s) 我也免费来干，我渴望能真正坚信自己每天所从事的工作。 — 护士海瑟 > [28:46](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=1726s) 贝尔森集中营里可没有胖子走出来。 — 大卫·安温 > [01:04:14](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=3854s) 你够不够硬汉？敢不敢接受挑战，下周来见我时告诉我你一块饼干都没吃过？ — 大卫·安温 > [01:23:11](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=4991s) 我必须跟您坦白，我的丈夫每天凌晨四点爬起来，从冰箱里偷面包吃。 — 患者妻子 > [01:37:24](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=5844s) 展现脆弱是通往深度联结的唯一大门。 — 史蒂文·巴特利特 > [01:43:02](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6182s) 你的每一根骨头都会在那一刻无比渴望自己当初做出了不同的选择。 — 史蒂文·巴特利特 > [01:52:45](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=6765s) 你可以挑走这里的任何一头牛，但我今年已经因为一种叫‘草痉挛’的病损失了整整 15 头牛。除非你向我发誓一定会给它买镁补充剂，否则绝不能把牛带走。 — 农场主 > [01:57:08](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7028s) 筛查的真正价值，在于它必须与切实可行的应对措施直接绑定。 — 大卫·安温 > [02:08:54](https://www.youtube.com/watch?v=zc8Nh4TMB1s&t=7734s) 我们究竟在对下一代做什么？ — 大卫·安温 ## Mentioned 大卫·安温（Dr. David Unwin）, 史蒂文·巴特利特（Steven Bartlett）, 珍·安温（Dr. Jen Unwin）, 罗伊·泰勒（Professor Roy Taylor）, 约翰·布里法（Dr. John Briffa）, 兰根·查特吉（Dr. Rangan Chatterjee）, 乔治亚·埃德（Dr. Georgia Ede）, 伊恩·坎贝尔（Ian Campbell）, 丹尼尔·埃克（Daniel Ek）, 大卫·爱登堡爵士（Sir David Attenborough）, 《摆脱节食陷阱》（Escape the Diet Trap）, 《分水岭》（Fork in the Road）, 《CEO日记》（The Diary Of A CEO）, DOAC 对话卡（Conversation Cards）, 英国国民医疗服务体系（NHS）, 纽卡斯尔大学（Newcastle University）, 爱丁堡大学（University of Edinburgh）, 公共健康协作组织（Public Health Collaboration, PHC）, 英国国家统计署（ONS）, 健康基金会（The Health Foundation）, Neko Health, Function Health, Cometeer, Stan Store, Ketone Shots, 二甲双胍（Metformin）, 司美格鲁肽（Ozempic）, 连续血糖监测仪（CGM）, GRIN 心理行为转变模型 ## Video description Insulin Expert Dr. David Unwin has put 157 patients into drug-free Type 2 diabetes remission using diet alone. He reveals the hidden teaspoon of sugar in your everyday food, the link between sugar and cancer, and why the average person will spend 23 years of their life in poor health. Dr. David Unwin is an NHS GP with over 40 years in general practice, known for his expertise in reversing Type 2 diabetes through dietary changes. He was named NHS Innovator of the Year in 2016 and is the co-author of the most-read paper in BMJ Open, on reversing Type 2 diabetes through a low-carbohydrate diet. He explains: ◼ The "teaspoon of sugar" test that exposes the hidden glucose in your food ◼ Why your liver silently fills with fat for years before anything shows up ◼ Why you can't stop eating certain foods and what food addiction really is ◼ How sugar feeds cancer cells faster and the diet that slows them ◼How Ozempic quiets food cravings and why it's only part of the answer 00:00:00 Intro 00:02:00 Why Your Future Health Depends On This One Question 00:02:24 What It Really Takes To Create The Future You Want 00:06:30 What Actually Happens Inside Your Body With Diabetes 00:14:16 The Hidden Truth About What’s Really In Your Food 00:15:36 The Moment That Completely Changed How He Saw Medicine 00:16:49 The Real Reason Doctors Are Incentivized The Wrong Way 00:21:40 How Food Becomes Medicine—Or Makes You Sicker 00:28:39 What Happens When You Truly Transform Your Health 00:29:44 The Everyday Habits Quietly Destroying Your Health 00:32:45 Why Most People’s Idea Of “Healthy” Is Completely Wrong 00:35:00 Is Dried Fruit Healthy—Or A Sugar Trap In Disguise? 00:38:06 These “Healthy” Foods Have More Sugar Than You Think 00:45:05 Is Orange Juice Actually Good For You? 00:46:36 The Truth About White, Milk, And Dark Chocolate 00:49:08 Why Smoothies Aren’t As Healthy As You Think 00:51:51 How To Tell If Your Food Is Actually Healthy 00:55:04 How Your Body Secretly Turns Carbs Into Sugar 00:56:58 Is Bread Ruining Your Health? 00:59:02 Ads 01:01:06 What Nutrition Labels Aren’t Telling You 01:05:29 Keto Diet: Solution Or Hidden Risk? 01:10:06 How To Set Health Goals That Actually Work 01:20:16 How To Help Loved Ones Change Before It’s Too Late 01:30:43 The 4-Step Plan To Break Addiction For Good 01:34:12 Why Addiction Leads To Deception 01:35:08 Book Giveaway 01:36:49 Ads 01:39:03 The Link Between Diet And Cancer—What This Means 01:44:31 Why Our Healthspan Is Quietly Declining 01:47:42 The Simple String Test That Reveals Your Metabolic Health 01:49:46 Are Supplements Helping—Or Hurting You? 01:52:26 The Magnesium Story That Will Change How You Think 02:02:18 Guest’s Last Question 02:09:18 A Final Story You Won’t Forget Enter here for the chance to win one of 1000 copies of Dr. Jen Unwin’s Book, “Fork in the Road”: https://link.thediaryofaceo.com/6OxWpCa You can follow David, here: X - https://link.thediaryofaceo.com/5ZMguOY Support his charity, Public Health Collaboration: https://link.thediaryofaceo.com/APtcZJH Independent Fact Check: https://stevenbartlett.com/wp-content/uploads/2026/05/DOAC-Dr-David-Unwin-Independent-Research-Further-Reading.pdf The Diary Of A CEO: ◼ Join DOAC circle here - https://doaccircle.com/ ◼ Buy The Diary Of A CEO book here - https://smarturl.it/DOACbook ◼ The 1% Diary is back - limited time only: https://bit.ly/3YFbJbt ◼ The Diary Of A CEO Conversation Cards: https://linkly.link/2io2A ◼ Get email updates - https://bit.ly/diary-of-a-ceo-yt ◼ Follow Steven - https://g2ul0.app.link/gnGqL4IsKKb Sponsors: Ketone - https://ketone.com/STEVEN for 30% off your subscription order Stan - Visit https://coach.stan.store/?ref=stevenbartlett&utm_source=youtube&utm_medium=podcast&utm_campaign=episode6 Cometeer - https://cometeer.com/steven for $30 off your first order Conversation Cards: https://linkly.link/2io2A [Source](https://www.youtube.com/watch?v=zc8Nh4TMB1s)

[18:39] 琼斯太太: 昂温医生，你以为你要教训我一顿，是吧？我告诉你，今天是我要教训你！ [18:39] 琼斯太太: 我真怀疑你到底有没有行医执照！过去这十年里，你哪怕有一次告诉过我面包就是糖、早餐麦片就是糖吗？我不得不自己在网上查资料才搞明白：面包是糖，米饭是糖，早餐麦片全都是糖！当我把这些东西戒掉后，我根本不需要你的二甲双胍！ [22:09] 珍·安温: 大卫，在退休之前，你为什么不放手做一件自己真正坚信、能让人振作起来的事呢？我们为什么不亲自尝试低碳饮食，并邀请一些患者自愿加入我们？ [22:09] 护士海瑟: 我也免费来干，我渴望能真正坚信自己每天所从事的工作。 [28:46] 大卫·安温: 贝尔森集中营里可没有胖子走出来。 [64:14] 大卫·安温: 你够不够硬汉？敢不敢接受挑战，下周来见我时告诉我你一块饼干都没吃过？ [83:11] 患者妻子: 我必须跟您坦白，我的丈夫每天凌晨四点爬起来，从冰箱里偷面包吃。 [97:24] 史蒂文·巴特利特: 展现脆弱是通往深度联结的唯一大门。 [103:02] 史蒂文·巴特利特: 你的每一根骨头都会在那一刻无比渴望自己当初做出了不同的选择。 [112:45] 农场主: 你可以挑走这里的任何一头牛，但我今年已经因为一种叫‘草痉挛’的病损失了整整 15 头牛。除非你向我发誓一定会给它买镁补充剂，否则绝不能把牛带走。 [117:08] 大卫·安温: 筛查的真正价值，在于它必须与切实可行的应对措施直接绑定。 [128:54] 大卫·安温: 我们究竟在对下一代做什么？

[2:00] Dr. David Unwin: We're all sleepwalking into a metabolic disaster, and the people paying the greatest price, in my opinion, are young people... and I'm hopping mad, really. [18:12] Mrs. Jones: In the last 10 years, did you ever once tell me that bread was sugar or breakfast cereals were sugar? I had to learn online that bread is sugar, that rice is sugar, that breakfast cereals are sugar. [25:16] Dr. David Unwin: The first thing I saw was the liver function improving... they'd had abnormal liver function for 10 years, and suddenly within weeks the liver function was improving, often by a third or 50%. [30:05] Dr. David Unwin: Imagine 25 years of blaming patients for their failure to lose weight, and it was my failure because I didn't give them advice that worked. [35:00] Dr. David Unwin: Because it uses the word fruit, people have this sort of halo assumption that if the word fruit is on it... it will sell. [60:00] Dr. David Unwin: And then one day you can look at it and you think it's not actually food. [70:10] Dr. David Unwin: I realized I had trained my patients to think that moaning was how they got my attention. And if you do that, the result is a very miserable two-hour surgery... [99:03] Steven Bartlett: High sugar intake causes chronic hyperinsulinemia... which can inhibit apoptosis, the natural process where damaged or cancerous cells self-destruct. [107:42] Dr. David Unwin: Your waist should be less than half your height... Fat on your belly is more worrying than fat on your legs or on your arms. [122:18] Dr. David Unwin: He's spent so long thinking about the planet. And wouldn't he be a wonderful ambassador? Because I am passionate about biodiversity, I'm passionate about sustainable agriculture and sustainable food, I pick David Attenborough. [129:51] Dr. David Unwin: Type 2 diabetes is brand new as a problem for pediatricians... The international problem is that children everywhere are now suffering from Type 2 diabetes. But the pediatricians have had no training because it's a new disease.

[0:00] Your waist should [music] be less than [0:02] half your height. So, half of that [0:04] string should go around the fattest bit [0:06] of your [music] belly. And this is a [0:07] really simple test for everybody at [0:09] home. I mean, it's not loose. [0:11] >> you [laughter] just done it. You passed. [0:13] But fat on your belly is more worrying [0:15] than fat on your legs or on your arms. [0:17] And unfortunately, we've started to [0:18] normalize things like the dad bod [0:20] without realizing that isn't how you're [0:22] supposed to be. And maybe a third of all [0:24] the people in the world with type 2 [0:25] diabetes don't even know they have it. [0:27] But every year that you have poorly [0:29] controlled type 2 diabetes, you're [0:30] losing 100 days of life. And it's [0:33] because people don't know. The truth [0:34] being fooled with the packaging and [0:36] advertising. [0:37] >> So, let's talk about the food we have on [0:39] this table. Because this is how much [0:40] sugar I would have thought was in all of [0:42] these things here: cereal, potato, white [0:44] rice, a banana, and a chocolate bar. [0:46] >> So, now I'm going to give you the [0:48] correct figure. The cornflakes is 1 2 3 [0:52] 4 5 [music] 6 7 8. That chocolate bar is [0:56] 7 and a half. The banana, that's 6. And [0:59] then the potato is actually Oh my gosh. [1:02] And then 150 g [music] of boiled rice is [1:06] Oh. [1:07] I thought rice was healthy. [1:09] But each of us has a number of different [1:12] health futures. And what I'm interested [1:14] in is how do I get you to pick a [1:15] lifestyle that will get you the future [1:17] you want. Because my job is about [1:19] behavior change. [1:21] >> The floor is yours. All right. So, off [1:23] we go. [1:26] This is super interesting to me. My team [1:27] give me this report to show me how many [1:29] of you that watch this show subscribe. [1:30] And some of you have told us, according [1:32] to this, that you are unsubscribed from [1:34] the channel randomly. So, if I were to [1:35] ask all of you, please could you check [1:37] right now if you've hit the subscribe [1:38] button. If you are a regular viewer of [1:40] the show and you like what we do here. [1:41] We're approaching quite a significant [1:42] landmark on this show in terms of a [1:44] subscriber number. So, if there was one [1:46] simple, free thing that you could do to [1:48] help us, my team, everyone here, to keep [1:51] this show free, to keep it improving [1:53] year over year and week over week, it is [1:54] just to hit that subscribe button and to [1:56] double-check if you've hit it. Only [1:57] thing I'll ever ask of you. [1:59] Do we have a deal? [2:00] If you do it, I'll tell you what I'll [2:01] do. I'll make sure [2:03] every single week, every single month, [2:04] we fight harder and harder and harder [2:05] and harder to bring you the guests and [2:06] conversations that you want to hear. I [2:08] stayed true to that promise since the [2:09] very beginning of The Diary Of A CEO, [2:11] and I will not let you down. Please help [2:14] us. Really appreciate it. Let's get on [2:15] with the show. [2:17] >> [music] [2:20] >> Dr. David Unwin. [2:22] You were named in 2018 among the top 10 [2:25] most influential doctors in the United [2:28] Kingdom. Um, you've got an incredible [2:30] list of accomplishments, and you're held [2:33] in the highest regard, maybe of all the [2:34] doctors I've ever had the chance to [2:35] speak to, by many people that I've [2:36] spoken to. [2:38] We were talking before we started [2:39] recording about what's on your mind. [2:41] And what's been bothering you. [2:43] And so, the floor is yours. What is [2:45] front of mind for you, Dr. David? What's [2:46] front of mind for me is the the idea [2:49] that each of us has a number of [2:52] different health futures. So, you have [2:55] So, in your future, uh, I don't know, [2:57] there could be cancer. There could, [3:00] uh, be multiple sclerosis, or there [3:02] there could be many futures. What I'm [3:04] interested in is how do I get you to [3:08] pick a lifestyle that will get you [3:10] the future you want. And I think that's [3:13] very difficult in the world now to know [3:16] what is the best lifestyle cuz you're [3:18] given so much conflicting advice. [3:21] And the particular focus for me in terms [3:23] of [3:24] picking health futures is around young [3:26] people because they've got the longest [3:29] time [3:31] to make a difference. [3:33] And it's getting harder and harder and [3:36] harder to make good [3:38] health choices in your lifestyle. It's [3:40] really hard. [3:41] I'd say it's a pandemic [3:44] of poor metabolic health. Yesterday in [3:47] clinic, I saw two people under the age [3:49] of 25 who had poorly controlled [3:53] diabetes, and one of them was too heavy [3:55] for me actually to weigh. [3:57] And this situation is completely new. [4:01] So, when I when I was a young doctor [4:04] uh and just starting off in practice, [4:06] that was in 1986. [4:09] Wow. And that's a long time ago. Just [4:11] north of Liverpool in the practice, I'm [4:13] still there now. Obesity was rare, and [4:17] we didn't have a single case of type 2 [4:20] diabetes in anybody under 55. Not a [4:24] single case, it was quite unknown. [4:26] And in fact, type 2 diabetes had a [4:28] different name. We've had to change the [4:30] name because of the epidemic. Used to be [4:32] called maturity-onset diabetes. That [4:34] meant old people. Right? Now we call it [4:37] type 2 diabetes because we have to [4:39] include so many young people. It's [4:42] really, really serious [4:45] uh because people are losing their life [4:48] expectancy. [4:49] I don't I'm witnessing this. We're all [4:52] sleepwalking into a metabolic disaster, [4:54] and the people paying the greatest [4:56] price, in my opinion, are young people, [4:59] and it's a scandal, and [5:01] I'm [snorts] hopping mad, really. I [5:03] think we've started to normalize [5:06] the dad bod. [5:08] You know, the big tummy and haha without [5:11] realizing that maybe that isn't how [5:13] you're supposed to be. [5:15] So, that that's what's on my mind. Young [5:17] people [5:18] and their future. And they don't even [5:21] know. [5:22] You say young people there Yeah. [5:24] >> because they've got the biggest [5:25] opportunity to change the trajectory of [5:27] their health future. [5:29] >> Yes. But for the audience that's [5:30] listening that might be in their 50s [5:32] now, is this advice also applicable? [5:34] Absolutely. So, we know from get [5:36] government figures, UK government [5:38] figures, [5:40] that for every year that you have poorly [5:43] controlled type 2 diabetes, you're [5:45] losing 100 days of life. That's about a [5:48] third of a year, isn't it? [5:50] So, [5:51] whatever age you are, if you uh have [5:54] poorly controlled diabetes, you're [5:57] losing life expectancy, and and maybe a [5:59] third of all the people in the world [6:00] with type 2 diabetes don't even know [6:02] they have it. [6:03] Because they haven't taken a test, so [6:05] they don't know. [6:07] What do you think kills people with type [6:09] 2 diabetes? [6:11] >> [snorts] [6:11] >> Um is it some [6:13] cardiovascular issue? [6:15] Yeah, well done. Well done. You don't [6:17] receive You've not been to medical [6:18] school. You're doing all right. [6:19] That most doctors, that's what they'd [6:21] say, because we know [6:24] uh that a high blood sugar over time [6:27] damages your arteries. [6:29] So, it's a cumulative thing over time. [6:32] But what you may not know [6:34] is that actually [6:37] a rising cause of mortality for people [6:40] with diabetes is cancer. Oh, really? [6:43] >> Yeah. So, eight forms of cancer [6:46] uh are strongly associated uh with [6:49] diabetes. I want to just define that [6:51] term diabetes, because I think I went [6:53] through a lot of my life assuming that [6:54] diabetes was a disease that some people [6:56] are born with, and because I didn't have [6:58] it, I thought I don't need to worry [6:59] about that. [7:00] >> really important. Yeah. So, first of [7:02] all, there's type 1 diabetes and type 2. [7:05] But before I can explain [7:08] about diabetes, I need to explain about [7:11] insulin. This is absolutely key to our [7:14] whole discussion. [7:16] >> [sighs] [7:16] >> So, I've already said that a high blood [7:19] sugar [7:21] damages your arteries. And in fact, [7:23] there's work to show that a very high [7:25] blood sugar [7:26] damages the nonstick lining of your [7:29] arteries within 6 hours. Oh, wow. Really [7:31] quick. It's called the glycocalyx, the [7:33] nonstick lining. [7:35] And uh damage is occurring very quickly. [7:37] So, I'm going to ask you a really stupid [7:39] question. Yeah. When you say high blood [7:41] sugar, I get high blood sugar when I eat [7:43] lots of sugar. [7:45] Okay. So, first of all, we're actually [7:47] talking about glucose. Yeah. And sugar [7:51] can mean table sugar or it could mean [7:53] many different things, but we're [7:54] actually talking about blood glucose. [7:57] >> Which comes from lots of foods. [7:58] >> Which comes from many foods. [8:00] Carbohydrate heavy foods. [8:02] Yes. Yes, it does. It does. So, that [8:04] that's right. [8:05] >> Okay. But [8:07] you have the hormone insulin to defend [8:09] you from poor dietary choices. So, the [8:12] question is what does insulin do with [8:15] the sugar you just ate? And here's the [8:18] answer. [8:19] Insulin, the hormone insulin produced by [8:21] your pancreas gland, [8:24] it pushes [8:26] the sugar [8:28] and it pushes it out of the bloodstream [8:30] inside cells where it can be used for [8:33] energy for you to run around. [8:36] But what if you take in uh more [8:39] carbohydrate than you need to run [8:41] around? Well, then that sugar is turned [8:45] to fat inside cells [8:48] because it's safer for you to turn that [8:50] sugar into fat than it is is to have it [8:53] damaging your arteries. [8:55] So, I am somebody with type 2 diabetes, [8:58] so we can talk about me. [9:00] So, I had a really heavy biscuit habit. [9:04] Uh I was senior partner of the practice [9:06] and it's stressful and I had patients [9:09] used to bring me biscuits all the time [9:11] as a gift cuz they you know, they want [9:12] the doctor to be happy. So, in the [9:14] drawer in the top of my desk was packets [9:17] and packets of biscuits. So, I'm taking [9:20] in more sugar and I didn't run around. [9:23] And gradually my waist got bigger. [9:26] And [9:28] what was actually happening was [9:30] as I took in [9:32] more sugar than I needed to run around, [9:35] my insulin was working to get rid of [9:37] that sugar. [9:38] And it was giving me two things. One, [9:42] a belly. Mhm. [9:44] >> [clears throat] [9:44] >> So my, you know, and I thought it's just [9:45] middle-age spread, you know? And the [9:48] other was I didn't know, [9:50] but my liver was filling with fat. [9:53] And that's [9:54] that is very common now. So we have [9:59] well, it's a third of everybody in the [10:01] developed world has fatty liver now. [10:03] Here we got the wonderful props. Let's [10:05] talk about these. Great. [10:07] So fatty liver, [10:09] this is the healthy liver here. [10:12] And you see the color. [10:14] Look at this one. [10:15] It's yellow. [10:17] It's the wrong color. [10:19] And it's because of fat. [10:21] So in that case, like has happened to me [10:24] over years, [10:26] my liver began to fill with fat. Because [10:30] it was essentially overworked and the [10:32] glucose was being stored there. Yes. So [10:35] I was taking in too much glucose. [10:38] Insulin was doing its good job of taking [10:41] it out of my bloodstream and forcing it [10:43] inside cells in my belly, but [10:45] unfortunately in my liver. Okay. And so [10:48] there's a progressive laying down of fat [10:51] in the liver. So if we look at actually [10:53] some proper liver, so this is the put on [10:56] your seat belts now cuz this is [10:58] >> somebody's somebody's actual liver. [11:01] So then that's the normal liver. But [11:03] look at this is larger. That's a real [11:06] human liver. [11:06] >> Yes, these are human livers and that's [11:08] as it should be. But this look at this [11:10] liver, it's larger. And it's larger [11:13] because of so much fat in it. Now the [11:15] twist in the story is fatty liver [11:19] interferes with the good work of [11:21] insulin. [11:23] So you develop a thing called insulin [11:25] resistance, which means your insulin is [11:27] no longer as powerful as it was. It's [11:30] beginning to become difficult for you to [11:32] deal with carbohydrate and sugar because [11:34] your insulin isn't working as well. [11:37] And the only way to deal with that [11:40] is the next twist in the story. [11:42] You have to start producing more [11:44] insulin. [11:46] Mhm. Do you see? Because it doesn't work [11:47] as well. [11:48] >> Yeah. So, your pancreas has to [11:51] crank up the supply. We need more [11:53] insulin. So, now you have two things. [11:56] You have [11:57] insulin resistance. Your insulin isn't [12:00] working as well. [12:02] But at the same time, you're trying to [12:05] produce more insulin in the pancreas. [12:08] This bit's called the long silent scream [12:10] from the liver. This is work by [12:12] Professor Roy Taylor, a friend of mine [12:15] at Newcastle University. And he pointed [12:17] out that [12:19] you've you've got fatty liver for about [12:21] 10 years. You don't even know. You [12:23] wouldn't know that your liver's gone [12:26] fatty and yellow like that. [12:28] But unfortunately, this is another [12:30] twist. Fat is being laid down in the [12:33] pancreas gland, the very gland that your [12:36] life depends upon producing insulin. And [12:39] your ability to produce enough insulin [12:42] collapses. [12:43] And at that point, you can't regulate [12:46] blood sugar anymore. [12:47] But upstream of that, you have a [12:50] problem. You've got that. [12:52] But you don't even know. You're talking [12:54] about what's in my mind. Why are we [12:57] waiting [12:58] until you actually have all the problems [13:00] of type 2 diabetes? So, since 2013, [13:05] I've got hundreds of patients, and I'm [13:07] monitoring [13:08] the baseline and latest follow-up. So, I [13:11] what happens to them? It's really [13:13] important. [13:14] And now I have a a huge data set that I [13:17] can interrogate and answer questions. [13:20] So, number one question, [13:23] let's think about prediabetes. So, this [13:25] is in the long silent screen. [13:28] Well, I can tell you [13:30] that the people with pre-diabetes in my [13:32] practice north of Liverpool, [13:35] 93% of them will get [13:38] a completely normal blood sugar if they [13:41] go low carb. 93% [13:43] resolution and that will last for years [13:46] because I've checked. [13:48] Okay. [13:49] How about we wait for the 10 years and [13:51] Steven until Steven you've got type 2 [13:53] diabetes and then you go low carb. [13:57] At that point, if I can get you early, [13:59] I've got a 73% chance of you having a [14:02] normal blood sugar. [14:04] Let's wait another few years because you [14:06] don't want to give up bread and you [14:07] don't want to give up chips and pizza. [14:09] Fair enough, I'll wait. [14:12] But, [snorts] you know, if we wait 5 [14:14] years, you only stand a 50% chance. [14:17] So, do you see? It goes 93 over 70% 50%. [14:22] So, the chances of me not needing drugs [14:25] and be able to do a good job for you are [14:27] diminishing. So, [14:29] really it's a stitch in time. Mhm. [14:32] And so much of this you don't even know. [14:34] You don't even know it's going on. [14:36] One of the things that shocks me is [14:39] is how little we know about what's in [14:40] our food. Yes. You know, cuz I think we [14:43] all know that like biscuits are a food [14:46] that has a high glycemic index. Well [14:48] done. Which is a term that I've learned [14:49] from this podcast which means Some [14:51] carbohydrates are more sugary than [14:53] others. [14:54] And then So, that's the glycemic index. [14:56] What that is doing [14:58] is comparing different carbohydrates [15:00] with pure glucose. All right. So, you [15:03] see pure glucose is 100 and then other [15:05] sugars come further down. [15:09] But, there is there's something better [15:11] than the glycemic index and that's [15:13] called the glycemic load. [15:16] The glycemic load takes portions of food [15:20] and predicts [15:23] how will that portion of food [15:27] actually affect your blood sugar? And am [15:30] I right in thinking the glycemic load [15:31] would factor in the amount of nutrients [15:33] in the food? Exactly. So like protein, [15:35] fiber. Yeah, because if you took [15:37] watermelon, well, it's mainly water, [15:39] isn't it? Mhm. So you have to factor in [15:42] you can have quite a lot of watermelon [15:45] uh to equal a chocolate bar. Mhm. [15:48] So the density you what you're looking [15:50] at the density of sugar in it as well. [15:52] >> Okay. So that's why the glycemic load [15:55] is better. [15:57] Was there was there a moment in your [15:58] career where [16:00] you started to question what you had [16:02] been told? [16:03] Yeah. [16:04] You know, [16:05] so you start as a young doctor. I wanted [16:08] to be part of a small community and stay [16:10] there and make a difference. And then [16:13] comes the sad bit, really. So I [16:16] for the first 25 years, I was trying to [16:19] do what's in the guidelines. I was [16:21] trying to be a good doctor. [16:23] But what I noticed I noticed [16:26] two things. [16:28] Number one, I noticed what I've already [16:30] said to you, that the health of the [16:32] population I cared for [16:35] was deteriorating. It wasn't getting [16:37] better. So if I'm the doctor in charge [16:39] of the practice looking after these [16:41] people, [16:42] and health is deteriorating, [16:45] am I not responsible? [16:47] And where's where is all this difference [16:50] I was hoping to make? [16:52] It just wasn't panning out. At the same [16:54] time, I I'd always in my heart [16:57] felt that prescribing lots of drugs felt [17:00] a bit [17:01] wrong. [17:02] It felt like a mini failure because how [17:05] is somebody well [17:07] if they're taking six tablets a day? Was [17:09] there one particular patient that you [17:11] met? There were two. [17:13] Two things happened, both to do with [17:15] very powerful women. [17:18] The first powerful woman was a lady I'd [17:20] known for over 10 years. [17:22] She and her husband I'd cared for them [17:24] both. [17:25] They both had poorly controlled diabetes [17:28] and they were both very heavy. [17:30] At the time I could monitor how my [17:35] how compliant my patients were with [17:37] their medication. [17:39] And if I'm to be truthful, in part that [17:42] was how I was paid. [17:44] So, the part of my payment was to do [17:46] with all the patients having in this [17:49] case metformin, the most commonly used [17:51] drug [17:52] for type 2 diabetes. [17:53] >> Part of your payment? Yep. Yeah, how [17:55] would you mean? [17:55] >> Well, because there's a you're supposed [17:57] to that the government approve of the [18:00] fact that we give drugs that are needed [18:03] for type 2 diabetes. So, that you're [18:05] given a sort of quota where it's expe- [18:08] it's regarded as good practice that such [18:10] a a certain percentage of your patients [18:12] will be on metformin. What? Yeah. [18:15] It's true. So, is it fair to say that [18:17] you were somewhat incentivized to give [18:19] people metformin? Yes, that would be [18:21] true. But, I think we should also be [18:23] fair to say that the body of evidence at [18:25] the time would say [18:27] uh that it's good practice to give [18:29] metformin to people with type 2 diabetes [18:32] and [18:34] conversely poor practice not to use [18:37] metformin, but we'll develop that. [18:39] So, the the backdrop is we're we're [18:42] monitoring the patients who stopped [18:44] taking their metformin because that uh [18:46] is number one poor practice and number [18:49] two actually cost me. [18:51] So, I wrote to the person. [18:53] Dear Mrs. So-and-so, I'm concerned that [18:56] uh you're not you don't seem to be [18:57] taking your metformin. Please make an [19:00] appointment with me at your earliest [19:02] convenience. Very British, very polite. [19:05] Anyway, nothing prepared me for what was [19:08] going to happen that morning and it's [19:09] changed my entire life [19:12] on that point. So, [19:16] the lady with let's call her Mrs. Jones. [19:19] That wasn't her name. She marches in and [19:23] uh she said to me, "You think you're [19:25] going to tell me off, don't you, Dr. [19:26] Unwin? [19:27] Well, I've got news for you. I'm going [19:30] to tell you off." [19:31] I was scared. Like, what's going on? [19:34] She's never been like this before. She's [19:35] a [19:36] a polite person. [19:38] Anyway, she went on to explain and she [19:40] said, [19:42] "When you do my blood tests, you will [19:44] find that my blood glucose is completely [19:46] normal [19:47] despite not taking your metformin." [19:52] And she said, [19:55] "I'm wondering if you're actually [19:56] qualified as a doctor [19:59] because [20:00] >> [snorts] [20:00] >> in the last 10 years, did you ever once [20:03] tell me that bread was sugar or [20:05] breakfast cereals were sugar? I had to [20:07] learn online [20:10] uh that bread is sugar, [20:12] that rice is sugar, [20:15] that breakfast cereals are sugar. [20:17] And when I cut those foods, I don't need [20:19] your metformin now." [20:21] And she She made it worse. She said, [20:24] "This is schoolboy biology. You should [20:27] have learned that when you were 16." [20:31] I was dead scared because, you know, [20:34] complaints as a GP is really bad. They [20:36] go on for years and years. [20:38] But mainly I was scared because every [20:40] word she said was true. [20:43] And one thing I had learned about when [20:45] you're an older doctor is you've got to [20:46] listen to people properly. If they're [20:48] complaining, [20:50] don't deny it. Don't defend yourself. [20:54] Take it. [20:55] So, I said, "Okay. [20:58] I've got I want to learn what you've you [21:00] know, if this is true, will you meet me [21:02] again? Let's do the blood test." So, we [21:04] did the blood test. It was true. [21:06] It was the first case of drug-free type [21:09] 2 diabetes I'd ever seen. [21:12] I'd never seen a single case in 25 years [21:15] where people came off medication. [21:18] I was fascinated [21:20] because she'd done it, like a miracle. [21:23] But there was another detail I'd just [21:24] share with you. [21:26] She was one of 40,000 people online [21:30] learning from each other how to do it. [21:34] And when I looked [21:36] they were being rubbished by the health [21:38] care professionals. So people like me [21:41] were telling them you'll die. [21:43] What you're doing is dangerous. And [21:47] I was ashamed, really ashamed. [21:50] >> [snorts] [21:51] >> And it's complete coincidence, but [21:54] in the same month [21:57] uh we have to introduce my wife, Jen. [22:00] Is there a photo? Come on, let's see [22:02] Jen. [22:02] >> This is Jen. Oh. [22:05] She's probably the cleverest woman in [22:06] the world. She's so clever, I love that [22:09] woman. So Jen [22:11] uh so her back she is a um a clinical [22:16] health psychologist and she specializes [22:19] she's fascinated by the role of hope [22:22] in disease and the difference it can [22:24] make. And she spent her life researching [22:27] the difference that hope makes to [22:28] clinical outcomes. So [22:31] it just so happened that she was in a [22:33] supermarket and she saw some a [22:36] discounted diet book. That one. That's [22:38] the book. Escape the diet trap by Dr. [22:41] John Briffa. [22:42] >> Dr. John Briffa. What a lovely guy. [22:45] So Jen bought that book just around the [22:48] time I'm telling her about this patient. [22:51] So she said you have to read this book [22:53] about the low a low carbohydrate [22:55] approach [22:56] to um [22:58] insulin resistance to type 2 diabetes. [23:02] And in the book [23:05] everything that my patient had told me [23:07] was there. [23:09] And but it was done in a medical way [23:12] from and I understood. [23:14] She said, "David, why [23:16] why are you [23:19] sort of failing? Why don't you [23:22] do one thing [23:24] before you retired? Why can't you do a [23:26] cheerful, something you really believe [23:28] in? [23:29] Why don't you have a go with this low [23:30] carb? Yourself? Yeah. She said, "Why [23:33] don't you and me [23:36] go on this diet [23:38] for see if some patients would volunteer [23:40] and do it with us?" [23:43] And I mentioned it to the partners. [23:46] And they said no. These are other [23:48] doctors? Yeah, so I'm senior partner. [23:50] I'm supposedly the boss. [23:53] Uh but [23:54] at the time low carb was not [23:56] respectable. [23:57] And they didn't like it. And they said, [23:59] "We don't want you to do this." [24:01] And partly cuz they said, "Well, how [24:05] it you know, is that a good use of the [24:07] the resources of the practice?" [24:10] Because if you're doing this, David, [24:11] maybe you're not treating chest [24:13] infections or other things. And there's [24:14] pressure on the health service. So this [24:16] felt a bit they felt it was a bit [24:18] self-indulgent. So go back to my wife [24:21] and said, "The partners say no." [24:23] And she said, "I I I'll tell you what [24:25] we're going to do. [24:27] We're both going to work for free. And [24:29] we'll do it. Why don't we do this [24:32] in our own time in on in an evening [24:36] when the practice has no resources." [24:39] So that's exactly what we did. We found [24:42] 18 volunteers [24:44] who were interested amongst the [24:46] patients. And then Jen and I So that was [24:49] 20 of us. We started meeting every [24:51] Monday night [24:53] talking about low carb, learning [24:56] how do you cook stuff? How do you do it? [24:59] We did it together. And one of the [25:00] nurses [25:02] was so excited, Heather is her name, [25:04] let's give her a, you know, [25:06] thumbs up to Heather. [25:08] Heather said, "I'll work for free. I'll [25:10] help you. I'd love to do this. I want to [25:13] I want to believe in what I do." [25:16] And then the magic begins. The results, [25:19] I couldn't believe it. I could not, you [25:22] know, I'd never seen anything like it. [25:23] And the first thing [25:25] the first thing I saw [25:28] was the liver function improving. [25:31] You see, cuz I'm doing blood tests, cuz [25:32] I know I'm doing something weird. I'm [25:35] doing something that I would be [25:37] criticized for. [25:40] So, if you're going to do a weird thing, [25:41] you need to measure stuff. [25:43] You [clears throat] can't, you know, [25:44] it's these are [25:45] patients, so you can't just experiment [25:47] and not be am I doing harm? [25:50] What's happening What's happening to the [25:51] cholesterol and the lipid profiles? So, [25:54] I was monitoring stuff really closely. [25:57] The liver function though, Steven. [26:00] I got people who I thought they were [26:02] drinking alcohol, [26:05] and I thought their liver problem was [26:06] due to alcohol. [26:08] >> [snorts] [26:09] >> And they'd had abnormal liver function [26:11] for 10 years, and suddenly within weeks [26:15] the liver function was improving, often [26:17] by a third or 50%. [26:20] I was so excited. Can you imagine? I'm [26:22] sitting there, and the laboratory [26:24] results are coming in, [26:26] and they're like, "Wow." [26:29] And then another [26:30] and another. [26:33] So, that was the first thing, then the [26:34] weight. We all meet every Monday night, [26:37] and we got the scales, and everybody [26:38] gets weighed every Monday night, and the [26:41] weight started falling off people. It [26:43] really did. [26:45] And then the all sorts of other weird [26:47] stuff started happening, [26:49] some of which I couldn't make sense of [26:51] for years. [26:53] The first one was [26:55] people said, "Are you hungry cuz I'm [26:57] not?" And they started saying things [26:59] like, [27:00] "Do you have to eat breakfast?" [27:03] Where and I also I wasn't hungry. [27:06] I wasn't hungry. They were telling me [27:08] the truth cuz I was experiencing this [27:10] with them. [27:12] "Why are we not hungry?" [27:15] That's so odd. And I was starting I not [27:17] bothering with breakfast, so I didn't [27:20] didn't eat it. You don't have to have [27:22] it. And my and my belly [27:24] went away. Next thing was I noticed when [27:27] I stood up from my desk, [27:30] I felt dizzy. [27:32] Weird. [27:34] Now, I hadn't told anybody but I had [27:37] moderate high blood pressure for years. [27:40] But I didn't like to be a patient. So I [27:43] never went to a doctor. [27:45] I just put my head in the sand. So I had [27:47] high blood pressure for years. [27:49] When they took my blood pressure, it was [27:50] low normal. [27:52] Why? [27:53] I didn't know. [27:55] But on the patients as well, I'm doing [27:57] that as well. I'm measuring all the [27:58] blood pressure. [27:59] And it's improving. [28:02] So it's getting weirder and weirder. [28:03] Liver function improving. [28:06] Weight going down. [28:09] Blood pressure improving. [28:11] In those days, we were [28:14] the blood test that we we did was a [28:16] thing called a hemoglobin A1C. [28:18] The A1C in America. [28:21] This is the average sugariness of your [28:23] blood for the preceding 3 months. So the [28:25] results take a while. [28:27] But then when the [28:30] hemoglobin A1C came in, there it was. [28:33] We were getting really spectacular [28:35] improvements in in average blood sugar. [28:39] And that's so that's kind of how it [28:41] began. So that's 2013. So that's 13 [28:44] years ago. [28:46] And uh [28:48] the rest is history, but that I was [28:50] completely blown away and I was full of [28:53] curiosity about all these other things [28:56] and how was it? Why were these things [28:58] improving? So, in this 13 years, how has [29:01] your fitness, your health changed? My [29:03] mental powers were much greater. I could [29:06] concentrate better. I wasn't fretty. [29:09] So, I noticed that. [29:11] I The next thing I noticed was [29:14] I needed a lot less sleep. [29:17] So, yeah, in the beginning [29:20] I used to have to have a little sleep on [29:22] my doctor's couch every lunchtime. [29:25] So, I was senior partner, so you press [29:27] do not disturb and you put the curtains [29:30] round and have a little nap on my own [29:32] couch for 20 minutes. It was the only [29:34] way I could get through the day. [29:36] I didn't need that nap anymore. [29:39] I was less sleepy. [29:40] I needed an hour's less sleep a day. [29:43] I could [29:45] think better. I was I could cope with [29:48] the same problems. [29:50] And this is so weird. [29:53] Mentally, I was stronger. It was like [29:56] being a younger man. [29:58] Um the way [30:00] I don't know. You I think you have a [30:02] sense of mental horsepower. [30:05] Going back to the top of this [30:05] conversation, we talked about how [30:07] everybody listening right now has a [30:08] variety of different health futures. [30:11] >> And which which health future they end [30:13] up in is going to be determined by the [30:15] everyday decisions they make. [30:17] >> Yes. Yes. So, I want to really zoom in [30:18] on some of those everyday decisions. We [30:20] talked about you and your biscuits. And [30:22] at the time you said you were you were [30:23] probably quite sedentary as a doctor. [30:25] Yeah. Sitting in a chair, patients [30:27] coming in. [30:27] >> yeah. [clears throat] You weren't doing [30:28] exercise. [30:30] No. Um I didn't fundamentally believe it [30:34] would make that much difference. [30:36] Hm. And this is such a great point. [30:39] You've You've really great point. So, [30:41] let's think about weight loss. [30:43] So, I would give advice on weight loss [30:46] to my patients and I would say eat less [30:49] and move more. And I'd even sometimes [30:51] say that Belsen thing, you know, the no [30:53] fat people came out of Belsen. I've [30:56] never heard that before. But it's a [30:57] horrible thing to say to a patient, [30:59] isn't it? [30:59] >> What's Belsen? Well, that that's in [31:01] World War II where they all starved to [31:03] death. [31:03] >> Oh, okay. So, the the point is you're [31:05] saying to somebody with an obesity [31:07] problem It's their fault. [31:09] >> Yes, you're blaming them. That's exactly [31:12] the point and that's what I did. [31:15] And it's worse than that because [31:18] I give them that advice and it just [31:19] about never works. [31:22] I did a horrible thing. I used to say to [31:24] them, "Right. [31:25] So, why don't you just have 2 Tbsp of [31:29] All-Bran a day? [31:30] Oh, breakfast cereal? [31:31] >> Yeah. [31:32] Uh with skim milk and I would advise a [31:35] few multivitamins [31:38] and uh a couple of pints of skimmed milk [31:41] a day." [31:42] That was my advice. And then when it [31:45] didn't work, who do you think I blamed? [31:47] Them. Yeah. [31:49] And [snorts] this was all part of my [31:50] epiphany. [31:52] I never joined the dots [31:54] that the failure was not theirs, it was [31:57] mine. [31:59] And that's horrible, isn't it? Imagine [32:01] 25 years of I was blaming patients for [32:04] their failure to lose weight. [32:06] And it was my failure [32:09] because I didn't give them advice that [32:12] worked. And if you keep giving the same [32:14] advice to people and it doesn't work, [32:16] shouldn't I have questioned [32:19] But isn't that happening in society [32:21] overall? How are we doing? How are we [32:23] doing [32:25] with health? How's it going? [32:26] It's a disaster, isn't it? [32:28] So, we need to do something different. [32:31] But for me, for 25 years, I did not [32:35] believe that lifestyle was key and now I [32:38] do. [32:39] And that's why I didn't I didn't [32:43] think that the biscuits made that much [32:44] difference. [32:46] Obviously, I knew basic nutrition. So, I [32:48] made sure there's protein and there's [32:50] iron and stuff. [32:52] I fundamentally [32:54] believed that [32:56] drugs is what I should be using, [32:58] medication, and that lifestyle was a [33:01] sort of [33:03] add-on. [33:04] Is that terrible? I I think this is so [33:06] important because it really gets to [33:08] what I believe the average person thinks [33:11] as well. [33:11] >> Yeah. Yeah. [33:12] >> Um we were talking before we started [33:14] recording about some of my friends. They [33:16] are There's There's two friends I [33:17] mentioned. One of them is a very very [33:18] successful businessman. [33:20] Um everybody knows who this person is [33:23] and they asked me this weekend, "Is [33:24] pizza healthy?" [33:26] And I just couldn't believe I It shook [33:28] >> It's gobsmacking. It's like, "Oh, what? [33:30] Pizza? What?" Cuz they were choose [33:31] trying to choose between They usually [33:33] have a big 12-in pizza Yeah. for lunch. [33:36] And And he was asking me, "What's [33:38] healthier, Stephen? Nando's chicken or [33:40] this 12-in pizza he was going to get?" [33:43] And I literally looked at him like I was [33:44] looking at a ghost. I was like, "Are you [33:45] winding me up?" And he was genuinely [33:47] serious. He's what 4 or 60 years old now [33:50] and he doesn't know if a chicken breast [33:54] is healthier than a 12-in pizza. And the [33:56] other example that I mentioned to you [33:58] before we started recording is a very [33:59] famous Premier League football superstar [34:02] legend who you would assume had gone [34:04] through those sort of 15-20 years of [34:06] being an academy player and then a a pro [34:08] athlete knows [34:11] what has sugar in and what doesn't. And [34:12] he was asking me, "Is Is a big spaghetti [34:14] carbonara, is that healthy? Is that [34:16] health food?" Because he said to me [34:17] during his football years, they were [34:19] told always to carb load. And again, [34:21] this [34:23] It It gave me a huge amount of empathy [34:24] because it made me realize how even [34:26] though there's podcasts like this where [34:27] we talk so much about health and even [34:28] though there's the internet now, the [34:30] have this information is not getting [34:31] through to the average person for some [34:33] reason and they too I believe think [34:36] exactly what you just said that health [34:37] is you know it's this sort of accessory [34:39] where [34:41] my fate is determined anyway. [34:43] And if I do this health stuff which is a [34:45] bit of an inconvenience because these [34:46] Percy Pigs taste great. [34:48] >> Yeah. Um all these these these candies [34:50] taste great then I might be able to look [34:53] a little bit better a little bit more [34:54] aesthetically pleasing but my fate is [34:56] determined. The simple point. [35:00] Yeah nutrition we're not teaching it. So [35:01] there's only three macronutrients. [35:03] There's only protein, fats, and [35:06] carbohydrate. And yet your friends there [35:09] haven't even got the three [35:11] macronutrients [35:13] and they are successful intelligent [35:15] people. So somewhere we're going badly [35:19] wrong aren't we? [35:19] >> Someone came in and pitched a fruit [35:22] snack business [35:24] and it's basically dried out fruit [35:26] pieces. [35:27] Now I looked at the back I'm loving this [35:29] already. [35:31] I looked at the back and it said in the [35:33] range of 60 to 70% sugar because what [35:37] they've done is they've taken exotic [35:39] fruits like mangoes, dried them out, and [35:42] now you have this little chip which is [35:43] this piece of mango. 60-70% [snorts] [35:46] sugar. So I'm looking at the back of [35:47] this thing thinking [35:48] this is candy. This is basically candy. [35:51] >> Thank you. But I'm looking at around and [35:53] every because it because it uses the [35:54] word fruit [35:55] >> Yes. people have this sort of halo [35:57] assumption that if the word fruit is on [35:59] it fruit juice fruit will sell. Yeah. [36:02] And who and also it's a sort of a cares [36:04] about the consequence but will make a [36:05] pile of money Yeah. selling dried up [36:07] fruit and they miss [36:10] what you read on the back. Yeah. And [36:12] it's 60-70% [clears throat] [36:13] sugar. I was like this is not healthy. [36:15] >> How's that? You know what if somebody [36:16] had type two that what for kids this [36:18] we'll just give them [36:20] Yeah. And I [36:23] you've touched on another thing about [36:26] what's going wrong. So [36:29] when we look at my practice and this [36:31] epidemic [36:33] and really, as I've said already, it's [36:34] not an epidemic, it's a pandemic. It's [36:37] everywhere. I go all over the world and [36:39] obesity, type 2 diabetes, [36:42] uh poor metabolic health is in it's [36:45] everywhere. It's everywhere. [36:48] And I think one of the things [36:50] touching on what you just said [36:52] is so you you wake up and you have your [36:55] cereals for breakfast. Which you've got [36:57] some here. [36:58] >> Which we have some cereals there. [37:00] And then uh you'll have Why don't Why [37:03] don't you have a big glass of fresh [37:05] orange juice as well? [37:07] Great idea. [37:09] And then uh [37:11] you Okay, that's your breakfast. But [37:12] then on the way in, you have a little [37:14] snack and people do. They buy a bar or [37:17] some crisps or something like that. [37:20] And then even at school, they might get [37:21] a muffin [37:23] mid-morning. [37:24] It's fine enough. They might then have [37:25] an apple. [37:27] At lunchtime, you're going to have some [37:28] sandwiches [37:30] and then you've eaten your sandwich, so [37:32] you'll I don't know, you might have [37:35] might have a cake or something or some [37:36] ice cream. Then you'll go home and then [37:39] it's time for you, you know, maybe your [37:41] chips or your pizza. [37:43] What you've actually done is have sugar [37:45] with your sugar with your sugar. Sugar, [37:47] sugar, sugar, sugar all day long. [37:50] There's hardly any protein. Going back [37:51] then to those macro Where was the [37:53] protein to grow you? [37:56] You know, and that That's the thing that [37:58] [snorts] that's changed over time that [38:00] we are [38:02] the snacking. So, I've I come across a [38:04] lot of young people [38:08] and their mother is saying, "I can't get [38:09] him to eat any proper food. He just eats [38:12] snacks all day long and it it won't I [38:15] can't They can't get protein in them." [38:17] And some of them are actually thin kids. [38:19] They're not all fat. Let's talk about [38:21] what you just said there and we can walk [38:23] through the day using Yes. the food we [38:25] have on this table. Now, I just want to [38:26] caution that we do have some people that [38:28] are probably out walking their dog [38:29] listening and can't see. So, we're going [38:30] to have to do a bit of a voice over as [38:32] to what's going on. But, you said wake [38:34] up in the morning, you have your cereal. [38:35] Yeah. Now, cereal growing up I thought [38:38] was a health food. Me, too. Yeah. Me, [38:41] too. How much sugar is in the average [38:43] standard bowl of, let's say, frosted [38:45] cereal? [38:46] Well, we can do this different ways, [38:48] Steven. [38:48] >> Mhm. [38:49] >> [clears throat] [38:49] >> This is actually like a test for you [38:51] laid out here. [38:52] >> is that for Okay. Yeah, that This is a [38:54] test for you and I'll describe it. So, [38:56] what you've got, you've got um [39:00] a bowl of we'll call them They're corn [39:02] flakes. Mhm. [39:04] Then you've got a potato a baked potato. [39:07] It isn't baked yet, but you could bake [39:09] it if you want. [39:10] You've got 150 g and this is boiled [39:13] rice. So, it's not dry, it's boiled [39:15] rice. [39:16] You've got a very ripe banana. [39:19] And at the end there, you've got a [39:21] delicious looking chocolate bar. Yeah. [39:24] So, you've got there [39:27] uh some cubes of sugar and this is the [39:29] test bit, you see, as to how I'm going [39:32] to give you We'll score you in the end. [39:34] Okay. So, what I'd like you to do is [39:35] consider these relatively [39:39] and each of those cubes of sugar [39:41] represents a 4 g teaspoon of sugar. [39:44] Yeah. So, if you could now just go along [39:46] these and put beside each food what you [39:49] believe to be the equivalent in terms of [39:52] teaspoons of sugar and then I'll give [39:54] you a score and see how you do. Okay. [39:56] >> And And those are the answers, so I'm [39:57] going to turn it down so you don't [39:59] cheat. Okay, so I'm going to score them [40:01] as I would have thought 2 years ago. [40:05] Thank you. Yes. Because 2 years I've [40:07] interviewed a lot of experts, so I'm I'm [40:08] generally quite shocked by all these [40:10] things, but I'm going to score them as I [40:11] would have thought when I was 31 years [40:13] old 2 years ago. Yes, that's great. [40:15] >> Cereal, Yes. [40:17] Yeah. um I And there's no sugar on it. [40:19] It's not a sugared cereal. It's just the [40:21] dry flakes. I honestly didn't think [40:23] there was sugar in that. Yeah. So, [40:26] if you would have pushed me, I would [40:28] have [40:29] Well, give it one, eh? I'll give it one. [40:31] >> Thank you. [40:31] >> didn't think there was sugar in that. [40:32] >> One. Again, a potato, I didn't think [40:35] there was any sugar in a potato. So, [40:38] even giving it one feels like I'm lying [40:39] because I didn't think there was sugar [40:40] in a potato. And I'll be honest, rice, I [40:43] didn't think there was any sugar in [40:44] rice. [40:45] Okay. A banana. Ah. It tastes sweet. [40:47] >> Yes. [40:48] >> brain would have said one. Yeah. But [40:50] this [40:51] this chocolate bar that's in front of [40:52] me, [40:54] I would have said [40:55] I'm going to say two. [40:57] Okay. Two or [41:00] I'm going to say three. Right. I'm going [41:01] to say three. I actually think it was [41:02] two, but Right. That's how much sugar I [41:04] would have thought was in all of these [41:06] things here. Cereal, a potato, white [41:07] rice, a banana, and a chocolate bar. [41:10] Right. Well, To be fair, I still kind of [41:11] do, but I know better. [41:12] >> [clears throat] [41:12] >> So, now I'm going to give you the [41:14] correct [41:15] figure. [41:16] Now, uh this is worked out from the [41:19] glycemic load that we already discussed. [41:23] So, I explained about the glycemic load. [41:26] And then, [41:28] so, in clinical practice, I had a [41:29] problem. [41:30] My problem was in 10 minutes trying to [41:33] explain to you how you could eat [41:35] differently and why you should eat [41:37] differently. [41:38] And so, I needed a way of quickly [41:41] communicating with children, with old [41:44] people, with a teacher, [41:46] the consequences of dietary choices. [41:49] Mhm. So, I came up with a new idea, [41:52] which was why don't we represent the [41:55] glycemic load, [41:58] and instead of using [42:00] grams of glucose, which nobody [42:02] understands, and what's glucose anyway, [42:05] instead of doing that, we redid the [42:07] calculations, [42:09] redoing it for tea four-gram teaspoons [42:12] of sugar. And that's my teaspoon of [42:15] sugar equivalent system and I'm using [42:18] that now to give you the correct answer. [42:20] Okay. Right. So, the the cornflakes is [42:23] one, two, [42:27] four, [snorts] [42:28] five, [42:30] six, seven, and eight. [42:32] One, two, three, four, five, six, seven, [42:37] eight. [42:38] And with no frosting? No frosting. I [42:41] know. No milk, nothing. [42:44] The potato, obviously it depends on its [42:46] size. That's quite a big one. [42:49] So, that one is one, two, three, four, [42:52] and there's more. [42:54] Five, six. [42:58] Is nine. [43:00] There they go. Nine. [43:02] >> Equivalent of nine sugar cubes. Is that [43:03] nine? Yeah. Right. [43:09] And we're going to leave the rice till [43:10] last. [43:11] That chocolate bar [43:14] is actually You could do it for me. [43:16] Yeah. Is seven [43:19] and a half. So, you [43:21] you can give it seven. Seven. [43:25] Seven. [43:27] Now, the banana depends on the size and [43:30] how ripe it is. [43:32] A ripe banana has more sugar in it as [43:34] you probably know when you eat it. But [43:35] that Let's say that banana is quite a [43:38] ripe one. It looks quite ripe. Let's say [43:39] that's six cuz it's a big banana. Oh my [43:42] gosh. [43:47] Okay. [43:48] Then, the final one [43:50] obviously is going to be the killer, [43:52] isn't it? [43:54] I thought rice was healthy. [43:57] Well, I I thought rice was [43:58] >> really healthy. [44:00] >> Depends. So, [44:01] one. This is 150 grams of boiled rice. [44:06] three, [44:07] four, [44:08] five, [44:10] six, [44:12] seven, [44:14] eight, [44:15] nine, and [44:17] 10. So, that's the winner. [44:19] And I would say that's the single fact [44:22] around the world. So, my my teaspoon of [44:24] sugar, [44:26] there we are. [44:27] That's one of my teaspoon of sugar [44:28] charts. So, what you've got there is the [44:31] food, [44:33] the glycemic index, [44:36] the the serving size, and then the [44:38] teaspoons of sugar there. So, this is [44:41] available. The Public Health [44:42] Collaboration is a charity I helped set [44:45] up with Dr. Rangan Chatterjee [44:47] 10 years ago. It's our 10th anniversary [44:49] tomorrow. [44:51] These infographics, [44:54] there are actually [snorts] far more [44:55] than this. This is the seven more. [44:57] They're available in 35 languages. [45:00] Volunteers have translated this to go [45:02] all over the world. [45:04] It's not copyrighted. I want people to [45:06] steal it, take it, use it. So, the [45:10] >> [snorts] [45:10] >> the white rice fact, [45:13] I would say [45:15] has astonished people all over the world [45:17] and led to me becoming far better known. [45:20] What what about orange juice? A lot of [45:23] parents, including my parents, give me [45:25] gave me orange juice. And I used to [45:26] think orange juice was a health food. [45:28] So, I would literally I'd go to the [45:30] fridge, I'd get open the SunnyD or [45:31] whatever it was. SunnyD. And I would [45:33] drink that and I'm going to be strong [45:36] and big and my body's going to love me. [45:38] Well, let's [45:39] So, that there's a lot of sugar in [45:41] orange juice. It's a lot of sugar in [45:43] orange juice. And you've taken away all [45:46] the Once you take it from the fruit [45:49] as it was meant to be and you juice it, [45:52] the sugar hit is fast. Mhm. So, what [45:55] that does [45:56] is [45:58] if you think if we go back to insulin [45:59] again, [46:01] >> [snorts] [46:01] >> um [46:03] So, you you you drink the orange juice, [46:05] your blood sugar goes up rapidly. [46:08] So, your body responds rapidly with [46:10] insulin. [46:11] Then, you What happens? Your blood sugar [46:13] falls. [46:15] But then you kind of hungry again. [46:17] And that's what happened to me with the [46:18] biscuits, wasn't it? I ate biscuits. [46:22] My blood sugar is up. Then insulin comes [46:25] in heavy and slow, but too much. Then I [46:28] thought I was having a panic attack cuz [46:30] I had low blood sugar. And what's the [46:32] answer to that? More biscuits. And round [46:34] you go. Round. And that's how without [46:36] thinking, you'd start the day starting [46:39] the day with a sugary breakfast [46:42] without enough protein in it is driving [46:45] hunger. And then you wonder why you're [46:48] ravenously hungry at 10:00. [46:51] There was a few others that shocked me. [46:52] One of them was I was in Peru. And [46:55] obviously Peru's quite famous for [46:56] chocolate cuz of the cacao and all that [46:57] stuff. And so we went to a chocolate [46:59] making class. [47:00] And he told us to make dark chocolate, [47:03] normal chocolate, and then white [47:05] chocolate. Yeah. And when I made the [47:07] white chocolate, this guy got me this [47:08] big glass cylinder. [47:11] And he goes, "Here's some white sugar." [47:13] He goes, "Pour it in." So, I you know, I [47:14] get it and I pour some in and I And he [47:16] goes, "No, no, no, no, my friend. Pour [47:18] it in." [47:19] >> Yeah. And I pour it and pour it and pour [47:21] it and pour it and pour it and pour it [47:22] and pour it. And I'm not kidding you. I [47:24] feel like And I have to check the facts [47:26] here. So, community note me on the [47:28] screen, divers your team. I feel like I [47:30] poured into this huge glass cylinder [47:33] Yeah. [47:33] it 80% of white sugar. Yes, you would. [47:37] And then It's true. Yeah. And then he [47:39] And then he said, "Put put some syrup [47:40] in." I was like, "What?" I said, "This [47:42] is This is white sugar." It was like [47:43] some syrupy stuff, some oil stuff. And I [47:45] was like, "So, white sugar um So, white [47:47] chocolate is like 80% white sugar?" [47:50] Yeah. [47:51] I've never eaten white chocolate since. [47:54] Ever. [47:55] You That's so important. So, very often [47:57] people think they're a chocoholic. [48:00] That's really common [clears throat] [48:01] that people say to me, "I'm I'm addicted [48:03] to chocolate." [48:05] If you look at If you actually look at [48:06] how much sugar there is in milk [48:08] chocolate, [48:09] uh [48:10] you know, there's many teaspoons of [48:12] sugar in milk chocolate. [48:15] If you eat [48:16] 90% dark chocolate, there's only about [48:19] two teaspoons of sugar in a bar. [48:22] And what you find with the chocoholics [48:23] is I say, [48:25] "Oh, if you're addicted to chocolate, [48:27] why don't you get a bigger hit and have [48:29] the dark chocolate?" And they say, "Oh, [48:30] I couldn't eat that. It's too bitter." [48:32] What they're actually addicted to is the [48:34] sugar. [48:35] What they're So, I've done that There is [48:37] for the the folks at home, there is one [48:40] of these sugar infographics on [48:43] chocolate on that subject of chocolate [48:45] because I want people to understand [48:48] the consequences of what they do. [48:50] So, just to illustrate this cuz I've [48:53] just [48:54] I've just looked up the stats, right? [48:56] >> Yeah. So, I think this is this is this [48:58] is what I saw, right? I've just looked [48:59] up the facts to make sure one thing is [49:01] true. [49:03] When I made that bar of white chocolate [49:05] in Peru, [49:05] >> Yeah. this [49:07] was the total ingredients, and this is [49:09] how much sugar I they asked me to put [49:11] into it. Blinding. [49:12] >> I I looked at it and thought, "Okay, so [49:14] white chocolate is basically like 70-odd [49:16] percent just pure white sugar." [49:19] >> Yeah. And nobody knows. Yes, exactly. [49:22] >> Exactly. [49:22] >> The other one I've got a bee in my [49:23] bonnet about is smoothies. Yes, I [49:25] >> I had one, too. I thought smoothies were [49:27] healthy. Yeah. No. [49:29] They're the [49:30] You know, I'm on X or Twitter quite a [49:32] lot, and that's the kind of thing fills [49:34] me with rage, and I have to take a photo [49:37] with like my Look at the sugar. Uh [49:40] there was Yeah, it fills me with rage. [49:42] I've got another thing. This is fun. [49:44] I've got another I've got a question. [49:45] Right, [clears throat] Stephen. [49:47] >> [sighs and gasps] [49:48] >> Why don't we We could take all the blood [49:50] out of me, right? There'd be 5 L. We [49:53] could bleed me out right now, there [49:55] would be 5 L of blood in me. [49:58] Let's get it in a bucket, all right? 5 L [50:01] of blood. [50:02] How much sugar would be in that 5 L of [50:06] blood? [50:08] I've no idea. I don't Well, it's an [50:09] interesting question, isn't it? Because [50:11] it relates to [50:13] the consequences of eating some of these [50:15] things. [50:16] So, [snorts] I would just like you to [50:18] estimate So, let's say my blood sugar is [50:21] normal. Yeah. Um [50:24] if you have a normal blood sugar, I [50:26] would like you to guess how much sugar [50:28] is there in my entire blood system. [50:31] >> At one one cup like this. [50:34] Thank you. [50:35] No. [50:36] The answer is this. Let me show you. [50:40] That is all there is. [50:42] You're joking. [50:43] >> I am not. And you see immediately One [50:45] sugar cube. [50:46] >> That's all. And I'll do it on Twitter [50:48] for you, X. I can show you the [50:50] calculations. [50:52] So, you see, if I have a banana [50:55] and I have diabetes, that there's too [50:57] much sugar for me. [50:59] See, because glucose is number one [51:01] vital, but number two toxic if you have [51:04] too much of it. [51:06] The level of it in my blood is [51:07] controlled minutely. Wow. It's [51:10] controlled to this extent. [51:13] And I think that single fact You didn't [51:15] know that, did you? [51:15] >> No, I did not at all. And it it [51:16] immediately shows you how it's so easy [51:19] to have more sugar than you actually [51:20] need. [51:22] Given that And if your insulin stops [51:24] working. [51:24] >> So, [51:25] for me, [51:27] I've done an awful lot of this. So, I [51:28] monitor my blood sugar with a continuous [51:31] glucose monitor. [51:33] And I get my blood sugar up on my phone. [51:35] So, I can check at any time what my [51:37] blood sugar is, and we'll do it in a [51:39] minute and see. [51:40] But you see, if I if I eat a banana, [51:44] it doubles my blood sugar because I [51:46] can't regulate my blood sugar. Because [51:48] of the diabetes. Yeah. So, So, a whole [51:50] banana [51:52] is far too much for me [51:54] and will double [51:56] my blood sugar. Because you see if I'm [51:58] only supposed to have this much and I [52:00] have that much [52:02] it's too much for me and I feel ill. [52:04] Giving you know, I go out into the world [52:06] and I speak to the people that listen to [52:08] the show and they're like taxi cab [52:09] drivers. There's a lot of taxi Do you [52:11] know I wonder I I've got this bias [52:12] towards thinking everybody that listens [52:14] is a taxi cab [52:15] I've got this bias towards thinking [52:16] everybody that listens is a taxi cab [52:18] driver because I really only spend my [52:20] time in the office or in a taxi. So, I [52:22] get lots of feedback from these cab [52:24] drivers. And the average person out [52:26] there listening now [52:28] they don't know how to check if the food [52:31] they are eating is good or not because [52:33] the labels on these foods I I've got so [52:35] obsessed by the marketing. Yes. And you [52:38] know, I I I was looking at this bag of [52:40] sweets the other day and it said made [52:42] with real fruit juice and they put [52:44] [snorts] it front and center. And I I I [52:46] was almost tricked. [52:48] So, I can't imagine someone who like me [52:49] who doesn't spend I can't imagine [52:51] someone who doesn't spend their time [52:52] interviewing health experts [52:54] how easily the general public is being [52:56] tricked. So, what is your advice in [52:57] terms of [52:59] spotting this stuff? Like what do I look [53:01] at? Cuz right now I spend a lot of time [53:02] looking at the sugar part. [53:03] >> Yeah, that's great. [53:05] There's different ways we can do this [53:06] and obviously this is how I spend every [53:08] clinic. That's I'm in clinic yesterday. [53:10] This is what I'm doing. I'm trying to [53:11] help people understand. [53:14] It's sometimes easier to talk about what [53:17] maybe what you would eat rather than [53:19] what you wouldn't eat. [53:21] So, I for somebody [53:23] with insulin resistance or type 2 [53:25] diabetes, I would tend to say well, why [53:28] don't you base your meal on protein? So, [53:31] what have you got in the fridge? [53:33] Could it be chicken? Could it be eggs? [53:36] What would it be? [53:38] >> [snorts] [53:38] >> So, that's your protein. Have loads of [53:40] it. Yeah. Then I'm thinking, right, [53:43] green veg. [53:45] Will you What green veg is would you [53:46] tolerate? What green veg could you buy? [53:48] It might be frozen beans, or it might be [53:51] salad, or whatever. [53:53] And then I'm saying, how would you make [53:54] that green veg [53:56] tasty? Put barbecue sauce on the top. [53:58] Ah, no, full-fat mayo. Full-fat mayo, or [54:02] butter, or olive oil, or whatever. So, [54:05] that I say barbecue sauce because when I [54:07] looked at the back of mine, I had the [54:08] shock horror of realizing It's a It's a [54:10] It's a common one. 30 sugar cubes in a [54:14] bottle a standard bottle of barbecue [54:16] sauce. [54:16] >> Table. [54:17] It's just pouring sugar on top. [54:18] >> is. It is. You have to be so vigilant, [54:20] and I I think to do it successfully, [54:23] I'm quite interested in the idea of [54:25] could you eat real food that's not in a [54:27] packet? [54:29] It's It's It's Russian roulette, food [54:31] out of packets. And yet, I understand my [54:35] patients north of Liverpool, [54:37] you know, where are they going to buy [54:38] the stuff? So, I try and help them with [54:41] You could do it that way. [54:43] If you're not If you're going to eat [54:44] stuff out of packets, you have to wise [54:46] up, and you have to look at the [54:49] carbohydrate content, [54:51] and bear in mind every 4 g [54:55] is [54:56] broadly equivalent to sugar. So, if if [54:58] if there's a If there's If something's [55:01] got 100 g of carbs in it, [55:04] I've already said carbohydrate varies in [55:06] how sugary it is, but it gives you an [55:09] idea it's very sugary. So, you see the [55:11] the area you made with the cornflakes [55:13] Mhm. is there's no sugar there, but it's [55:15] all carbohydrate. Mhm. And it It's a [55:17] very sugary carbohydrate. I think So, we [55:20] need to just explain that for for [55:21] people, which is [55:22] >> Yes. When I looked at those cornflakes, [55:24] the question I asked you, is they're not [55:25] frosted, so there's no sugar on them. [55:27] But, what the body is doing is it's [55:29] converting the carbs into glucose. [55:32] Right, I've got a good way. [55:34] So, we have to think of starchy carbs [55:37] as [55:38] actually glucose molecules holding [55:40] hands. Okay. And then digestion comes [55:43] along and breaks down [55:47] they're they're not holding hands [55:48] anymore and they become free sugar [55:50] again. Cuz we think if it's not sweet, [55:52] it's not glucose. [55:53] >> Exactly. Exactly. I don't know whether [55:55] when you went to school, was there this [55:56] thing where you chewed bread for ages [55:59] and then you could see if it became [56:00] sweet or it turned into sugar. I didn't [56:03] know. [56:03] >> schoolboy experiment that's done a lot [56:05] to prove that uh the amylase, the enzyme [56:09] in spit [56:11] uh turns starch into sugar. But that's [56:14] the point. Starch is soon to be sugar. [56:17] It's glucose holding hands. Yeah. [56:19] >> And when it holds hands, it's not sweet, [56:21] but then when you digest it [56:22] >> Exactly. it's no longer holding hands. [56:24] >> Perfect. And that was is broadly what [56:27] and you're not alone because didn't I [56:28] make that error? [56:30] Isn't that what the lady in 2012 [56:34] that's what she was so furious that I [56:36] was made So here here we are, senior [56:38] partner of a large practice [56:41] had forgotten [56:43] uh that starch was sugar and we've come [56:46] full circle because and so many other [56:48] people [56:50] they they [56:51] patients say to me, "Dr. Unwin, [56:54] I know [56:55] uh not to have sugary things. I've given [56:57] up sugar in my tea and coffee and I [57:01] don't understand why my blood sugar is [57:03] so high." [57:05] People say that very often and then of [57:06] course we use the teaspoon of sugar [57:07] equivalents or a continuous glucose [57:09] monitor to really show them what's going [57:12] on. [57:13] Something that a lot of people have is [57:15] bread. Yes. Um white bread. So I I did [57:18] some research and it said a single slice [57:19] of white bread contains about 0.5 sugar [57:22] cubes, but a full loaf can pack up to 12 [57:25] cubes of sugar in it. [57:27] That's true. [57:29] But it doesn't [57:31] it doesn't include the fact that the [57:34] wheat that makes the bread will turn [57:36] into sugar as well. Okay. So, on my [57:38] teaspoon of sugar equivalent [57:41] even a small slice of brown bread is [57:44] about three teaspoons of sugar. Is there [57:47] a healthy bread? [57:49] Now, that's a really great great [57:51] question. [57:52] And of course, it depends [57:54] how well your insulin's working. [57:57] So, if you're young and you take a lot [57:59] of exercise and your insulin's really [58:01] good [58:03] then [58:04] maybe brown bread is is okay. If you're [58:07] like me though with insulin resistance, [58:09] there it it would have to be a low-carb [58:12] bread. [58:13] So, I wouldn't normally eat bread under [58:15] any circumstances, but I might have [58:17] low-carb bread. I did some research that [58:21] sprouted grain bread, never heard of [58:23] that before, or 100% whole grain rye are [58:26] the healthiest options because they [58:27] contain zero added sugar and high fiber. [58:29] So Right. I mean, what I'd say to people [58:34] again, it depends [58:36] how much exercise do you take? How do [58:38] you know? [58:39] Have you had your fasting insulin [58:41] measured? Do you know if you're insulin [58:43] resistant or not? Mhm. [58:45] Um [58:47] if you're healthy, take lots of [58:49] exercise, sounds good. Fair enough. If [58:51] you if you're beginning to develop a [58:53] tummy, well, maybe not so good. And if [58:55] you don't know [58:58] I'm a great one for experimenting. [59:00] And that's where I come back again [59:03] to consider [59:04] uh buying a continuous glucose monitor. [59:08] The thing you wear on I've got one on me [59:09] now, and it tells my phone how is my [59:11] blood sugar, so I can experiment. Then I [59:13] could try your bread, and within an hour [59:16] I would know. [59:17] This has had probably the single biggest [59:20] impact on my office. Of all the products [59:22] that I've tried that have given me [59:24] productivity gains or cognitive boosts, [59:26] I would say that exogenous ketones are [59:30] in the top three most pivotal things [59:33] that have given me a massive [59:34] productivity gain. It's some Stanford [59:35] graduates that have been able to [59:36] basically bottle up the effect you get [59:40] from being in a ketogenic diet in a [59:42] small shot that you can take that makes [59:45] you feel incredibly focused and gives [59:46] your brain an incredible source of [59:48] energy. And the clinical studies that [59:49] have been done on exogenous ketones have [59:51] absolutely blown my mind. I reached out [59:53] to them. I became a co-owner in the [59:54] company. I became an investor in the [59:56] company. And so it's with great pride [59:57] that I can tell you that this exists. If [59:59] you haven't tried these shots, go to [60:01] ketone.com/steven [60:03] for 30% off your subscription order. And [60:05] you'll also get a free gift with your [60:07] second shipment. I still buy my ketone [60:09] shots predominantly online, but [60:11] thankfully, I can now grab them at [60:13] Target whenever I drive past them here [60:14] in the United States as well because [60:15] we're now stocked in Target where your [60:17] first shot is completely free. [60:20] Much of the reason most people haven't [60:21] posted content or built their personal [60:23] brand is because it's hard and it's [60:25] time-consuming. And we're all very, very [60:26] busy. And if you've never posted [60:28] something before, [60:30] there's so many factors in your [60:32] psychology that stop you wanting to [60:34] post. What people will think of you? Am [60:36] I doing this right? Is the thing I'm [60:37] saying absolutely stupid? All of these [60:40] result in paralysis, which means you [60:42] don't post and your feed goes bare. [60:45] I'm an investor in a company called Stan [60:47] Store, which you've probably heard me [60:48] talk about. And what they've been [60:49] building is this new tool called Stanley [60:51] that uses AI, looks at your feed, looks [60:53] at your tone of voice, looks at your [60:54] history, looks at your best-performing [60:56] posts, and tells you what you should [60:58] post, makes those posts for you. You can [61:00] also you just use it for inspiration. [61:02] And sometimes what we need when we're [61:04] thinking about doing a post for our [61:05] social media channels is inspiration. [61:07] Building an audience has fundamentally [61:09] changed my life. And I think it could [61:10] change yours, too. So, I'm inviting you [61:13] to give this new tool a shot and let me [61:15] know what you think. All you have to do [61:16] is search coach.stan.store [61:19] now to get started. [61:21] Am I wise to be looking at the back of [61:23] packets? I look at the back of [61:25] everything I eat. Yes. And I'm building [61:27] I guess a mental model of the different [61:29] levels of carbohydrate and sugar content [61:31] and fiber and all these other things and [61:32] proteins etc. But I always seem to zoom [61:35] in on the sugar. [61:36] Yes. The added sugar. [61:38] Ah, right. There is an error there. [61:40] Okay. So you that's brilliant and you [61:42] the fact you're interested and trying [61:45] is great because you'll learn so much [61:47] more. Because of course [61:51] the sugar is one thing but you must also [61:53] look at the carbohydrate. [61:55] The carbohydrate content. Now [61:58] um this is done differently in the [62:00] United States from here. [62:03] Confusingly, here we talk about [62:06] carbohydrate [62:07] separately from fiber. [62:10] So that in the [62:13] UK when it says sugar. [62:16] In the States you've got uh the [62:19] carbohydrate including fiber. So it [62:22] makes it more complicated for you. [62:24] Because you need to know which [62:27] how much of that carbohydrate are you [62:28] going to absorb? Well, let's go back to [62:31] the three macronutrients. So [62:34] you should be interested in [62:36] protein. How much you want you want you [62:38] want to be a muscly kind of guy so you [62:41] need want your protein. [62:43] Uh the carbohydrate Well, why do you [62:45] need that? I'm wondering. [62:47] And then fats. Well, you might need [62:49] those for fat soluble vitamins. So those [62:51] are the [62:52] uh the three things so that you become [62:55] more sophisticated. And if things have a [62:57] lot of preservatives, if they have an [62:59] awful lot of ingredients, I'm [63:01] immediately suspicious. I think one of [63:03] the things that people that I've come to [63:05] learn through interviewing people like [63:06] yourself is that it's not just a direct [63:08] consequence of [63:09] having a big glucose spike or [63:13] you know, having high blood sugar. It's [63:15] also the fact that when I eat things [63:17] like Mars bars or the white rice here, [63:20] I then get more hungry later. Exactly. [63:22] >> I eat even more sugar that same day, and [63:24] the next day, and the next day. [63:25] >> course, that's what my patients, right [63:29] back in 2013, it was the absence of [63:31] hunger they found fascinating. And I did [63:33] cuz I'd been hungry all my life. Because [63:36] all my life I'd been uh [63:39] carb heavy. And I didn't realize that [63:42] the more carbs you eat the hungrier you [63:43] become. I don't know, have you ever [63:45] tried fasting? I bet you have. [63:47] >> gosh, yeah. Right. [63:48] >> I fast most days to be honest. I'm I [63:50] haven't eaten today. And it What What [63:51] time are we in? We're What I don't know. [63:52] Uh [63:53] 1:00 1:00 p.m. And during the Dragon's [63:55] Den filming, I I don't eat often until [63:58] the evening. So Great. So, isn't that [64:01] interesting? [64:02] So, I used to I used to have a model [64:04] which was [64:05] um that if I didn't eat, I was hungry, [64:08] right? [64:09] >> Mhm. So, if I didn't eat for even [64:12] twice as long, I'd be twice as hungry, [64:14] and it would rise exponentially until I [64:16] went mad. [64:17] >> Yeah. [64:18] And what's surprising that you must have [64:20] found is as you fast, you don't become [64:22] more hungry, do you? [64:23] >> Yeah, it's crazy. [64:24] >> Well, isn't that interesting? [64:25] >> Mhm. That actually get the more I eat, [64:27] the hungrier I become. It's the same [64:29] when I'm on keto. Pardon? When I'm on [64:31] keto. [64:32] >> Yeah. I I can't believe I can't It's [64:34] like [64:35] hunger just vanishes. And you know the [64:36] thing that the remarkable thing I love [64:38] What are those cinnamon roll things? I [64:39] love those cinnamon rolls usually. I [64:41] love them. And when I started doing the [64:43] ketogenic diet, which is very, very very [64:45] low carb, I remember walking up to this [64:47] cinnamon roll concession stand in Cape [64:49] Town, and looking at them, and they were [64:51] doing nothing to my brain. There was no [64:54] temptation, no craving. [64:55] >> had that. [64:56] >> I said, "Where's the craving?" [64:58] >> Yeah. I honestly I've had that with [65:00] Christmas cake. It was my kryptonite. It [65:02] was the kind of thing [65:04] I was sneaking down when they'd all gone [65:07] to bed and having more. [65:09] And then one day you can look at it and [65:10] it and you think it's not actually food. [65:13] Mhm. Your brain know [65:14] that isn't food. Yeah, exactly. [65:16] >> And and I'm the same with buns as well. [65:18] And all sorts of things that a lifetime [65:21] of and they're no longer food. And it [65:23] feels like a superpower cuz I can I'm [65:26] such a man. In fact, I I throw this down [65:28] as a challenge to men. [65:30] Are you man enough to resist, you know, [65:33] what whatever it is? Mhm. Let's do a [65:36] challenge. Come back in a week and tell [65:38] me you've not had any biscuits. [65:40] Mhm. It it it it works. It works. What [65:43] do you think of the ketogenic diet? [65:47] Wow, that's a Oh, that's a big question, [65:49] isn't it? [65:52] And don't you think we need to begin [65:53] with what you want? [65:55] So, I think we need to begin with your [65:57] goals and hope. So, why would Is it Are [66:01] you wanting [66:02] to lose weight? Are you wanting to sort [66:05] out type 2 diabetes or I'm I mean, [66:09] Georgia Ede to Georgia Ede is a close [66:11] friend. Mhm. And nutritional psychiatry [66:13] is really growing in the is Ian Campbell [66:16] in Edinburgh University is doing some [66:18] amazing work with bipolar disorder and [66:20] other things. [66:21] So, [66:22] why you doing it? That's So, that's my [66:24] first thing because [66:26] this is I see it as there is a spectrum [66:29] of carbohydrate that you're on. [66:31] So, I try and find out where are you [66:32] now? [66:34] And I, you know, approximately where are [66:35] you now? [66:37] And then I'd say, "Well, could you Could [66:39] you [66:40] give up bread or reduce it?" [66:43] And then I'd say, [66:44] "Let's Let's measure whatever parameter [66:46] we want, which might be blood work or [66:48] weight or whatever. Then we say, 'How [66:50] are you doing? [66:52] Are you happy now? Is this Is it? [66:55] Or do you want Would you like to go a [66:56] bit lower?' And what I've discovered [66:58] with my patients over 13 years is they [67:01] tend to go lower over time because when [67:03] they experiment [67:05] when they go keto, what they like the [67:07] brain thing. Oh, gosh, yeah. And that's [67:10] what I'm That's Right. So, I would say [67:12] to you now, cuz I'm interested, why [67:14] would you go keto? What are you after? [67:17] Um so, I'm going to put the brain thing [67:18] at the top of the list, which is just [67:19] the clarity of thought. Obviously, in my [67:21] job, I have to sit here with very smart [67:22] people like you, and I have to talk [67:24] sometimes for 3 4 hours, whatever it [67:25] might be. But also, I'm on television a [67:27] lot now, and I'm speaking, and you know, [67:29] cameras nine cameras rolling, BBC One, [67:32] and I've got to think of something smart [67:33] to say to this entrepreneur sitting in [67:34] front of me on That's pitching to me. [67:36] And then also, I'm in meetings, you [67:38] know, I'll leave this conversation now, [67:39] and I'll go straight downstairs, and [67:41] I'll have 2 hours of straight meetings [67:42] about very very complicated things about [67:44] buying companies. I'll be meeting [67:45] founders, interviewing people. And what [67:47] I've noticed profoundly, because so much [67:49] of my job centers on speaking and [67:50] articulation, is there is this wild wild [67:53] wild variance that I hate. [67:55] And what I mean by that is some days I'm [67:57] on it, Yeah. and some days I'm almost [68:00] embarrassed by my inability to string a [68:01] sentence together. Yeah. Today, I'm I'm [68:03] almost testing myself now by trying to [68:05] speak really really fast and think my [68:06] brain's connected to my mouth. That's [68:07] That's actually like what I do. I try [68:08] and see if I if it flows out. Today, I'm [68:10] okay. Yeah. Um but there are days where [68:13] I'm stumbling over myself. Yeah. And I [68:17] go, "What's What's causing this? What's [68:18] the causal factor, and how do I prevent [68:20] this?" That's one. Keto, when I mean [68:22] keto, [68:23] I always sound like Busta Rhymes. It [68:24] always just [68:26] Yeah. It always It's always It's always [68:27] working. [68:28] And then I'd say [68:30] the aesthetic stuff, cuz I want to look [68:31] good as well, especially for, you know, [68:32] my fiance. So, I want to be in shape. I [68:34] want to be Uh and then I'd say the third [68:36] is being strong. And then the fourth is [68:39] I want to live long. Exactly. I want to [68:41] have a long health span, not just a long [68:43] life span, but I want to be able to do [68:45] things as I age. So, you see, you're [68:47] That's exactly what I began this meeting [68:50] with. [68:51] You've got a clear idea about your [68:53] preferred future. Mhm. And it's it's [68:55] it's it's fairly specific, too. And the [68:57] more specific you are, the more likely [69:00] you are to be successful. And then [69:02] you're noticing. Then afterwards comes [69:04] the feedback. Do you think most people [69:05] even have thought about this? [69:07] No. I was just thinking about my [69:08] listeners, and I was thinking, they're [69:10] listening right now. I wonder if they [69:11] have written down their top four. Yeah. [69:14] So, I Do you know what I'd love to do [69:16] now is tell you something about my [69:17] wife's work because it relates to [69:20] changing behavior fast. [69:22] And that She won't mind. So, that we're [69:25] back to Jen now, clever woman. She spent [69:27] 2 years [69:29] um thinking about CBT. [69:32] And what was what This is a type of [69:34] therapy, and what were the necessary [69:37] parts of it, and what was junk. [69:39] And she reduced CBT down to something [69:41] I'll teach you right now. [69:43] All right? So, we'll Off we go. Off we [69:45] go. [69:46] So, the first thing is to think about [69:50] your health goals. [69:52] So, to think about what in a year's [69:55] time, if what you do is great, how does [69:58] that look specifically? [70:01] So, I'll give you an example. You might [70:04] think you'd like to lose weight. [70:06] But that isn't specific enough. I want [70:08] to know [70:10] what difference would that make to you? [70:12] So, you we'll do it now. So, if you you [70:14] said you wanted to be in shape, what I [70:17] don't know what do you mean by that? Do [70:18] you want to lose weight? What do you [70:19] Tell me more. [70:21] >> [snorts] [70:21] >> Um I want to be [70:25] able to [70:29] Hmm. [70:30] >> [clears throat] [70:35] >> What I'm really, I think, scared of, [70:39] I'm going to be completely honest, Yeah. [70:40] is I'm scared of [70:49] having the same health profile as my [70:51] dad. [70:52] Ah, right. Yes. [70:53] >> Because I've seen We have the same, you [70:55] know, we have a lot of the same [70:57] genetic profile. Yes. [70:59] >> So, [71:00] I think a lot of us look at our parents [71:02] and go, "Is that my future?" [71:04] >> Yes. [71:05] Yeah. And to make it even more specific, [71:08] I remember walking down some stairs. [71:10] I've said this once before, but I [71:11] remember walking down some stairs in [71:13] Bali, long steep set of stairs, down to [71:16] go white water rafting with my fiance. [71:19] Yeah. And I remember as I walked down [71:20] the stairs recalling that my dad loses [71:23] can't walk up a single flight of stairs [71:25] without problems. And I remember [71:27] thinking, "Oh, my dad wouldn't have been [71:29] able to come white water rafting because [71:30] we've got to walk back up these stairs." [71:32] And so, my dad would have lost out on [71:33] one of the great joys of life, which is [71:34] doing enjoyable things with friends and [71:36] people you love because his health is [71:38] now in that regard is gone. [71:41] Um so, I I've always thought of that. [71:43] And then generally, like I I remember [71:45] when I was younger, my dad used to play [71:46] like football with us and and all these [71:48] things and he's unable to do that now. [71:51] Um [71:52] and [clears throat] so, I'm And all [71:54] because I've done this podcast so many [71:55] times with health experts, I realized [71:57] that the decisions I make at 30, which [72:00] is where I am now, [72:01] exist on this really interesting, quite [72:03] predictable curve of inevitable decline. [72:08] However, not like inevitable [72:14] uh loss of lifestyle. What I mean by [72:16] that is I just have this picture in my [72:17] head of all these graphs I've seen where [72:19] like your peak is around maybe 2030, and [72:22] then you going down, which we all [72:23] accept. [72:25] But how far you go down is determined by [72:27] decisions you make right now. [72:28] >> Absolutely. The decisions I make now [72:30] will end me at 70, 80 years old in [72:32] either the inability to walk [72:35] or the ability to run. Yeah. And it's [72:38] all about what I do now. It is. So, that [72:41] Let's just refine that so we we we we we [72:44] I've got your goal Yeah. [72:45] >> now. [72:46] So, let let's park your goal. [72:49] Now, Now next thing we've got is in the [72:52] past [72:53] what have you done that's worked [72:56] towards those goals? So you probably [72:57] tell me some stuff you've done that's [72:58] worked. [73:00] Um [73:03] little things like going to the gym. [73:04] >> Yeah, yeah, anything. Anything quickly [73:06] that you did that worked that that was [73:09] is is a is a first, you know, helped [73:12] that you did and you remember that [73:13] worked. So tell me anything. I said to [73:15] myself one year that I was going to go [73:16] to the gym every single day. Terrible [73:17] idea. Because I got 5 months in and then [73:19] I missed today then it was over. I said [73:21] to myself another year, I think it was [73:22] 2017, that I'm going to get a six-pack [73:24] for summer. Terrible idea. Because when [73:27] summer came or I got the six-pack [73:28] >> My question was what did work in the [73:30] past, not what didn't work. So what has [73:32] worked for you in the past? [73:34] >> So those two incidents um helped me [73:36] change my idea and the idea that I came [73:39] up with was I set not a [73:41] achievable thing as a goal, but [73:43] consistency is the goal. Correct. [73:45] >> became for the last 4 years this idea [73:48] that the goal my fitness goal is [73:50] consistency means that every day I wake [73:52] up I get a shot at it and if I up [73:54] today then I've got another shot [73:55] tomorrow. [73:56] >> Right. Right. Leave it there. That's [73:57] good. So we we did the goal and then we [74:00] did the next thing. What What I just The [74:02] next thing is is resources. Mhm. So it's [74:05] it's [74:06] what do you bring to the consultation [74:09] that you've done in the past? [74:11] Intelligence, resources, friends that [74:13] will help. [74:14] >> Yeah. You come already with expertise in [74:17] yourself. So it's not I'm not the expert [74:19] to tell you what to do. You've already [74:21] got some stuff. And then we go to the [74:23] next thing. [74:24] So if we had your goal at the beginning [74:27] which was the fitness and the so on so [74:31] today [74:32] what might be a small step towards your [74:35] goal, a realistic small step towards the [74:38] goals we've already established? [74:45] So I can think of two. Good. of them is [74:48] uh [74:48] creating a social pact, which again was [74:51] one of the things that helped. So, we [74:52] made a WhatsApp group. This is quite [74:53] funny. We made a WhatsApp group. We put [74:55] 10 friends in it. We made a simple rule. [74:57] Whoever's the least consistent every [74:58] month is evicted, and we invite a new [75:00] friend in. Wow. [75:01] >> We've done that for 4 years. I've not [75:03] been evicted in 4 years, which means [75:04] that I'm doing enough I'm consistent [75:06] enough over those 4 years to not be [75:08] evicted. Every day when we work out, it [75:10] puts our workouts into the group chat. [75:12] >> Yeah. And um every every week and every [75:15] month um there's a winner, and there's [75:17] this league table, and you get these [75:19] little emoji medals, and there's [75:21] actually I what one one year so I've got [75:22] this physical massive gold belt on my [75:24] bookshelf at home that says fitness [75:25] blockchain world champion. [75:26] >> Brilliant. So, I've done that for 4 [75:28] years. Um so, social pact really helped [75:30] me. The the sort of accountability to [75:32] others. [75:32] >> Yes. Yeah. [75:33] And [75:34] the other [75:36] the other honestly was just [75:39] >> [clears throat] [75:40] >> as I said a second ago, when I set the [75:42] the goal of going to the gym every [75:43] single day, I set myself up for failure. [75:45] Now, [75:46] I set myself the goal of consistency, [75:48] which means that I can do have bad days [75:50] where I do 20 minutes or 15 minutes. [75:52] Yesterday, cuz I was finished Dragon's [75:54] Den late, drove down to London, got home [75:55] at 1:00 a.m., I did 18 minutes. [75:58] >> of success really helped me to [76:04] keep my feeling of momentum. Brilliant. [76:07] We're nearly at the end of your degree [76:09] in psychology. [76:10] >> Okay. [76:10] >> And then [clears throat] I'm going to [76:11] pull it together. [76:12] The final thing is [76:14] um when things [76:17] if you What would you notice [76:19] for you when things are going well? What [76:22] would you notice? [76:25] So, you've done some of these things. [76:27] What is it you actually notice? I mean, [76:29] the benefit to me [76:30] >> Yes. Yeah. Yeah. What you What do you [76:32] notice? So, if you do If tomorrow is a [76:34] really good day, what might you notice [76:36] at the end of it cuz you've much [76:38] experience in this now? What would you [76:39] notice? [76:41] I mean, the first thing that comes to [76:42] mind is just how I feel. Yes. I just [76:44] feel [76:45] Do you mean emotionally or [76:46] energetically? [76:47] >> [clears throat] [76:48] >> Great. [76:48] >> All of it. Emotionally, I feel good [76:49] about myself. [76:50] >> Yeah. Um energetically, I feel more [76:52] energetic. [76:54] Um and there is this um [76:58] there is this element of identity in [77:00] there where I have a an opinion of [77:02] myself and who I think I am, and I think [77:04] I'm a healthy person, and I think I'm [77:05] someone that's in control. And when I'm [77:07] when I'm not going when I'm not [77:09] performing the consistent behaviors that [77:11] I want to, [77:12] I think I start to question that [77:14] identity in a way that's that causes a [77:15] lot of discomfort and say, "Well, you're [77:16] not in control of your own life. Like, [77:18] how does that's that's crazy." [77:19] >> So, I think it it links into [77:20] self-esteem. Yeah. It really. So, what [77:23] we've just did, we had the goals. [77:25] G Yeah. Then we had your resources. R [77:30] Yeah. Then we had increments. What [77:33] things had you done, little things on [77:36] the way. And then finally, I invited you [77:38] to notice and reflect. And that spells [77:40] grin. And that's Jen's published grin [77:43] model. I just did it for you right [77:45] there. And I could do it faster than [77:47] that. I do it in nearly every surgery I [77:49] do because what I'm trying to do is find [77:52] out about you. Mhm. And you didn't find [77:54] out much about me in that process, did [77:56] you? No. But I found out a lot of really [77:59] useful stuff to you, and it's [78:00] motivational. And much better to do that [78:03] than me tell you what to do. And I'm not [78:06] a talking leaflet. [78:08] But motivation, this is what Jen has [78:10] taught me, is key in everything we do. [78:13] And the grin model isn't bad. [78:16] Clever woman. So, what do we do with the [78:18] grin model? And so, this is really [78:20] helping me figure out how to change my [78:22] behavior? Yes. How do How does one apply [78:24] it? Or Are you saying that everyone [78:26] listening now should should answer those [78:28] four questions themselves? [78:29] >> do because otherwise, it's possible to [78:33] spend a lot of time blaming yourself. [78:35] Mhm. You know, and particularly around [78:37] if we're discussing weight problems and [78:39] so on, you can spend a lot of time [78:41] saying, "I'm to blame." or "I wish." or [78:46] "I shouldn't have." That you know, [78:48] after Christmas everybody feels like [78:50] this. [78:51] But what is much better rather than [78:54] focusing [78:55] you're wasting energy if you start [78:58] thinking about guilt and negative stuff. [79:01] And what Jen's trying to do is getting [79:04] you to engage [79:06] by in in thinking about a better future. [79:09] And what the whole of that 5 minutes was [79:12] engaging you [79:14] in in [79:16] first of all the goal of a better [79:17] future, then some resources towards your [79:21] better future, then the first steps [79:23] towards the better future, and then [79:25] noticing what's good. [79:27] >> Mhm. [79:28] Because I think in medicine what we've [79:30] done, [79:32] how do you get a doctor's attention? You [79:33] get a doctor's attention by saying, [79:36] "Oh, it's so bad. It's so so bad. My [79:39] pain is so so bad." [79:42] And I realized I had trained my patients [79:46] to think that moaning was how, [79:49] you know, they got my attention. And if [79:51] you do that, the result is a very [79:53] miserable 2-hour surgery. [79:56] But if you can talk even people having a [79:59] a terrible time have got hope if you can [80:02] find it. They have goals if you can [80:05] discuss them. [80:06] And you could have somebody with a drug [80:08] addiction or what you know, I see people [80:09] dying people all sort every clinic I'm [80:11] seeing [80:13] sad stuff. [80:14] But if you can [80:17] also investigate [80:19] hopes and good stuff, as a doctor I'm so [80:22] much more energetic, so much more [80:24] hopeful. I'm having a great time. [80:27] And I wasn't when I was 55. And that's [80:30] the process. I bet there's so many [80:31] people listening now that that maybe [80:33] they, you know, cuz they listen to this [80:34] show and they've got the sort of basics, [80:36] they go, "Do you know what? [80:37] I understand this stuff and I'm making [80:39] good progress, but I live with or love [80:41] someone Yes. who I I'm I'm scared [80:45] they're going down a slippery slope. [80:46] Yes. And I don't know what to do. Do I [80:49] intervene? Do I hide their sweets? Do I [80:51] blame What do I do? [80:52] >> That's so hard, isn't it? That's so [80:54] hard. I think you can Weren't you in [80:57] that position to some degree? [80:59] Yes. Uh yeah. So, uh my first wife [81:04] had a very severe addiction problem. So, [81:07] I lived with her for 12 years and she's [81:09] unfortunately died now. Um [81:12] so, I lived with [81:14] very, very serious addiction for 12 [81:17] years. And what you're doing then is [81:19] you're living with uncertainty. [81:21] Serious uncertainty. [81:23] Uh you never You cannot say what you'll [81:26] come home to. You have no idea. No idea. [81:30] It brings chaos into your life. It's [81:31] very, very hard. [81:33] Addiction? [81:35] Yes. Are you able to say what kind of it [81:37] Was it a food addiction or a drug [81:38] addiction or It was a It was [81:41] Nearly everybody concerned has died now, [81:43] so I don't know whether I can say or [81:45] not, but it was very serious multiple [81:48] addictions. I will say that. And she had [81:50] She died some years ago. [81:53] And it doesn't It It It actually wasn't [81:56] food addiction. Mhm. [81:57] >> [clears throat] [81:58] >> But it brings I have so much sympathy [82:01] with [82:02] dealing how how hard it is to deal with [82:05] uncertainty [82:06] and not be able to You love somebody and [82:08] you can't do anything. It's very hard. [82:11] There are things you can do, I think. [82:14] Um [82:16] if you can engage people in in that [82:19] talking about goals, that can help. [82:23] Uh what we will do now is we'll change [82:25] that conversation to to the current Mrs. [82:29] Unwin, which is what we laughingly say. [82:30] This is Jen. So, we we've been together [82:33] for 30 years now. [82:36] And Jen's story is that she actually is [82:39] an ultra-processed food addict, [82:41] genuinely. [82:42] And what that means is [82:45] I didn't under- Neither of us understood [82:47] what that was, even though she's a [82:49] consultant psychologist, she didn't [82:51] realize [82:53] that she was an ultra-processed food [82:54] addict. [82:56] What she saw it as was a weight problem. [82:59] And [83:00] all her life, she's she's been boomerang [83:04] dieting. So, she'd be a big woman and [83:06] then a little woman and a big woman. And [83:08] I used to watch it all. What's going on? [83:11] And then she would there'd be tray [83:13] bakes. Like she's trying to lose weight [83:16] and making tray bakes, saying it's for [83:18] the children and then scoffing a lot [83:20] herself. [83:22] So, then I'd [83:24] because I loved her and I think blokes [83:26] we try and solve problems, don't we? [83:28] We're like caveman. Yeah, wanted to [83:30] rescue her. So, [83:32] I'm I'm [83:33] either throwing the food away [83:36] or I'm tackling her. And then she's [83:39] we're having such arguments cuz she's [83:40] defensive and cross. [83:43] I I couldn't understand with an [83:44] intelligent woman what's going on. [83:47] But then [83:48] uh this is only a few years ago, she [83:50] understood for the first time [83:53] this is addiction. When you have [83:55] intelligent people [83:58] highly highly intelligent people doing [84:01] stuff that harms their health [84:02] repeatedly, [84:04] is this not [84:06] like cigarettes? Is it not [84:09] like alcohol? That is ultra-processed [84:12] food addiction. And there's a patient [84:14] I'd like to tell you about that is [84:17] explains it even more clearly. And this [84:19] patient has consented for me to tell you [84:22] because he wants to help the world. [84:24] So, this is a guy is a very successful [84:27] guy. He runs He's a wealthy person with [84:29] a successful business. He's not stupid. [84:33] He has type 2 diabetes. He's 55. He has [84:35] type 2 diabetes. He's very much [84:37] overweight. [84:39] Unfortunately, he needs really serious [84:42] surgery [84:44] because both his knees have been so [84:46] destroyed by his weight that he can [84:48] hardly walk because he's in real agony. [84:51] But, his type 2 diabetes is so [84:55] bad. [84:56] His blood sugar control is so bad, the [84:58] anesthetist won't touch him. [85:00] So, he's trapped. He can't get the op [85:03] because his blood sugar is high. [85:06] He can't run his business easily cuz he [85:08] can't hardly walk. [85:10] So, [85:11] obviously, what we do is we say you need [85:13] to go low-carb. [85:16] And it works for a bit, and he loses [85:18] some weight, but then he gains the [85:19] weight again. [85:21] And this goes on for 4 years while I see [85:24] him so regularly every month. What's [85:26] going on? What's going on? Oh, excuses, [85:29] the grandchildren. [85:31] Um I've got a holiday, Christmas. It [85:33] goes on. Anyway, then his wife came to [85:34] see me, and she said, "Dr. Unwin, [85:36] I need to level with you. You need to [85:38] understand what's going on. [85:40] I find that my husband is getting up at [85:42] 4:00 in the morning and eating [85:44] bread out of the fridge." [85:47] So, [85:49] what I do now what I started doing was [85:51] at the end of every day, I put all the [85:54] bread in the bin if it hasn't been eaten [85:55] that day. But then I discovered my [85:57] husband was going in the bin to eat the [85:59] bread. [86:01] Then what she does, she's a [86:03] a very formidable woman, she started [86:06] putting detergent, liquid detergent, on [86:08] any bread that goes in the bin. [86:10] But he still eats it. [86:13] He's getting up at 4:00 in the morning [86:14] rummaging through the bin to eat the [86:16] bread with the detergent on. [86:19] So then, [86:20] she tried something else and she says [86:22] this is the only thing that will stop my [86:23] husband from eating bread if he's there. [86:26] I spray bleach on the bread and leave [86:29] the can of bleach by the bin so he knows [86:32] don't even look. [86:34] Okay? [86:35] What I've described to you [86:37] is addiction. [86:39] This is an intelligent person and [86:41] imagine his self-esteem how it was to [86:44] live like that, concealing what he was [86:46] doing. [86:48] And not telling his doctor cuz I'm [86:50] trying so hard for him for years and [86:52] he's so sweet to me now and he often [86:55] shakes my hand and gives me a hug. He [86:57] said, "You tried. You really tried." [87:00] Anyway, my stories have a happy ending [87:02] always. [87:04] What I did for him in the end, he needed [87:06] everything. So low carb. [87:08] Then I got him using a continuous [87:11] glucose monitor. Mhm. So that he would [87:13] get feedback immediately and see that [87:15] spike. And also I could see the spikes [87:18] as well cuz he had to come and show me [87:20] his tracings. [87:22] And on top of that, [87:24] I did something unusual. I gave him a [87:26] low dose of the new GLP-1 drugs. [87:29] Ozempic? One of those. Yeah. Um [87:32] and [87:33] the three together, [87:37] he managed to not He couldn't moderate [87:39] but he could abstain. [87:41] And then he could do it. The Ozempic [87:44] helped reduce the noise, the cravings in [87:48] his head. The feedback from the CGM [87:51] helped him know how he was doing. [87:54] And [snorts] the support he got from me [87:56] and the low carb pulled together and all [87:58] three and he's had his operation now. [88:01] And so it's a happy story but he's got [88:03] maintenance. All his life he's going to [88:06] have to sort that out. [88:08] Um and it's a wonderful example because [88:11] I think we trivialize this. We call it [88:13] carb creep, like it doesn't matter. But [88:16] there are many people listening to us [88:18] right now, and they know [88:21] they know they're addicted to various [88:23] foods. They know because when you ask [88:25] them, they often burst into tears. [88:27] Often I somebody will say I've never [88:29] told anybody in my entire life [88:32] about and bread is a common one. [88:34] And if you're not addicted to bread, you [88:36] can't imagine it. [88:38] But if you are addicted to bread, they [88:39] say this sounds so stupid. I'm so [88:41] embarrassed to tell you I can't control [88:44] how I eat bread. Mhm. And [88:47] so it's not great for your self-esteem, [88:49] is it? Mhm. [88:50] >> But people might be addicted to many [88:52] things and [88:53] my wife's published many papers on this [88:56] and written a book and this that and the [88:58] other. [88:59] And she would say about 14% of the [89:01] population [89:04] has some aspects of ultra-processed food [89:06] addiction. [89:08] And [89:10] >> [snorts] [89:11] >> it kind of explains so much [89:13] why are intelligent people eating foods [89:17] they know [89:18] do them harm. I've got another example. [89:21] One of my patients with type 2 diabetes, [89:24] we got drug-free remission. [89:26] Hooray! I've done that now 157 times. So [89:30] every one of them I'm cheering when it [89:32] happens. So this guy, we did it. [89:34] Drug-free remission. [89:36] Then he vanished for a while [89:38] and [89:40] um [89:40] and came back with two dead toes. [89:44] And he had to have them amputated. Now [89:46] what [89:47] >> Yeah. [89:47] They started rotting [89:49] because diabetes takes the blood supply, [89:52] particularly from your toes. So we had [89:55] to have surgery to have part of his foot [89:56] removed. [89:58] And so you call it carb creep, and he [90:01] ended up with half his foot taken off. [90:03] That's not carb creep. Something far [90:05] more sinister. [90:07] But I never give up. And unfortunately, [90:10] the wounds took a long time to heal [90:11] because he was sugary, so we do it all [90:13] over again. [90:15] I got him back into remission. [90:17] Because this time he and his wife are [90:19] really determined, but it's a struggle [90:21] and he needs help and support [90:26] to achieve that. He's not a foolish man. [90:29] He's an intelligent man and yet various [90:32] foods call to him. [90:34] Eat me, eat me and it's very difficult [90:36] for him to not and that [90:40] I mean, that's a very extreme example. [90:42] But many people [90:45] with overweight and some who are not [90:47] overweight are struggling [90:49] with very, very significant carb [90:52] cravings and they really, really [90:55] struggle to control them. [90:58] There should be a button just down below [91:00] here and if it says subscribe, you're [91:01] already subscribed. If it says subscribe [91:03] bar, that means you're not yet. If [91:06] you're not not subscribed, please could [91:07] you do us a favor and hit that button. [91:08] It helps to show more than you know and [91:10] according to the algorithm, you're [91:11] someone that watches our show, but you [91:13] haven't yet hit that button. Thank you [91:14] so much. [91:15] For those people and I assume there's a [91:17] lot of people and actually some people [91:19] have seasons where they're in control, [91:21] they're out of control, they're in [91:22] control. [91:23] You know, I've been there. [91:25] Um [91:25] What is step one today? [91:29] So they're listening to you, they're [91:29] going hell, I don't want to lose [91:30] my toes and all of these problems. What [91:33] is step one now? [91:35] Now, are we talking about for somebody [91:37] with type two diabetes or somebody who [91:38] can't control what they're eating? [91:40] >> Someone that can't control what they're [91:41] eating. [91:42] >> Great. Right. So, [91:44] step one, [91:45] we just did it. I think step one is [91:49] acknowledging that is your problem. [91:51] Because if you don't if you're not [91:53] honest about your problem, how are you [91:54] ever going to sort it out? Honesty. So [91:57] the first thing is honesty and that's [91:59] very hard for people. [92:02] All of us have made excuses. You know, [92:04] me and my biscuits. I believed that that [92:07] it was easier for me to think that that [92:09] was stress and a reasonable reaction to [92:12] the stress of running a practice than it [92:14] was to say, "I've got a [92:17] You know, biscuits for me, it took me a [92:18] year to give them up. A year. [92:22] How pathetic is that? I was so driven [92:25] that it took me a whole year. How did [92:26] you give them up? [92:27] Um I did it by weaning myself off a bit [92:30] like methadone. So, I went from um I [92:33] like chocolate ginger biscuits and then [92:35] I went to digestive plain and then I [92:38] went to oat biscuits and then eventually [92:41] I went to almonds. [92:42] >> Why didn't you just do it all at once? I [92:44] should have done. [92:45] And uh Jen Jen's a great believer in [92:47] cold turkey. Like, what is the thing? [92:49] Stop it. [92:51] I wasn't man enough for that and it took [92:53] me a whole year. So, the first The first [92:55] thing is be honest. [92:58] Truth Be honest with yourself even if [93:00] you can't tell other people. Be honest [93:02] with yourself. [93:05] Uh [93:05] Is there an addictive potential? Like, [93:07] could that be Does that fit? [93:10] Number two, [93:12] specifically, which foods is your [93:14] problem? [93:16] And be honest. [93:18] Um because if you If you're not honest, [93:21] then it you Number three [93:23] is have a plan for abstinence. [93:27] Because if you if if there is an If you [93:30] have got an addictive potential, [93:33] um [93:35] it won't be one biscuit. And we all who, [93:38] you know, how many of us have said, "I'm [93:41] going to give up ice cream or biscuits [93:44] or pizza or whatever it is?" [93:46] >> And then you have a day and [93:47] >> You did. Well, or you have a drink or [93:48] whatever. You think, "Tomorrow." Work [93:50] stresses you out. [93:51] >> Yeah, tomorrow. Tomorrow. Tomorrow. [93:52] Tomorrow. So, that it's very important [93:55] to be specific about the food and then [93:58] to have a plan [94:00] for how you are going to do it. And [94:03] another thing is sometimes [94:06] it's helpful, you know the people around [94:08] you that love you [94:10] >> [clears throat] [94:10] >> maybe share with them [94:13] that it's it's [94:15] that it's important and that I need I [94:17] might need some help. Please be tolerant [94:19] with me. Like cigarettes. Please be [94:21] tolerant if I'm short-tempered. I'm [94:24] going to try and do this thing cuz it's [94:25] important. [94:27] The difficulty depends whether the [94:29] person that loves you can be gentle or [94:32] if they're heavy-handed. If you confess [94:35] this and then they police you [94:37] Judgmental. Yeah, it doesn't help. [94:39] >> yeah. What you're asking for is gentle [94:42] support and tolerance. I can think of a [94:45] time in my life where I was with [94:47] somebody [94:47] >> Yeah. and [clears throat] I was they [94:49] were so into their health Yeah. that it [94:52] made me start to hide when I was eating [94:54] bad Exactly. Thank you for that. That's [94:57] That's what happens. And you see that [94:59] people become [95:01] deceitful. Yeah. So the if you police [95:04] somebody you love, the result is deceit. [95:07] >> hiding the wrappers of the things I was [95:08] eating. Jen did that with me. She would [95:11] she [95:12] >> [snorts] [95:13] >> she knew that I was monitoring, so she [95:15] starts hiding the wrappers or then I'd [95:17] find them in the car. Mhm. And and and [95:19] but then we have a situation that we can [95:21] no longer talk about it because [95:24] so that if if somebody if you're forcing [95:26] somebody to become deceitful, you have [95:29] to back off a little bit. Yeah. Because [95:31] that deceit [95:33] then affects self-esteem and that can [95:35] make them worse and you didn't want to [95:37] make them worse. [95:38] >> they're lonely cuz they they can't share [95:40] the bad days. Yeah, it's really good. I [95:42] wonder, please could we show Jen's book [95:44] at this point? [95:45] >> Of course. [95:46] So can I just explain the book? [95:48] So this [95:50] this is Jen's book. [95:52] And the most important thing is Jen [95:54] doesn't make a penny out of this book. [95:56] So, it's Fork in the Road with the idea [95:59] that in your journey, which one are you [96:02] going to pick? Do you see? [96:04] So, it's Fork in the Road. [96:06] She doesn't make any money from this. [96:08] Every penny goes to a charity that she's [96:10] set up helping people with food [96:12] addiction. It's available on Amazon and [96:15] self-published on Amazon. [96:17] >> How much How much does this book cost? [96:19] It's not a lot, is it? [96:20] It's about 15 pounds. Oh, no, it's less. [96:23] I think it might be 10. [96:25] 10 quid. [96:26] Okay, I'll tell you what I'll do. [96:27] >> Yeah. [96:28] >> [clears throat] [96:28] >> I'll buy a thousand of them. Fabulous. [96:31] >> And I'll put a link below in the comment [96:33] section. And so, I All you've got to do [96:36] is if you really enjoyed this [96:38] conversation and you'd like to get Jen's [96:41] book, um [96:43] Fork in the Road. [96:44] >> A Fork in the Road. Maybe we can even [96:46] get some of them signed, not all of them [96:47] cuz that'll break your hand, but [96:49] maybe get a couple of them [96:50] >> Oh, that That is brilliant. Click below [96:52] and um we'll send a thousand of them [96:54] out. And that's just a thank you from [96:55] from me to both you and Jen, but also to [96:58] the community who tune in for these [96:59] conversations. And it's so great that [97:01] people can get such simple information [97:03] that's so accessible and so um rigorous [97:05] in its scientific credentials [97:08] um in a way like this that they can that [97:09] could change some people's lives. Great. [97:12] Isn't that a wonderful thing, you know, [97:13] that [97:14] a simple book like this, which isn't [97:16] long, either? [97:17] So, it's not It's not a big read. [97:20] Could change some people's lives. That's [97:21] such a wonderful thing. [97:24] Hey, what day? [97:25] Uh just making myself a delicious [97:27] coffee. From the freezer? From the [97:29] freezer? You've not heard about [97:30] Cometeer? No. Oh, my gosh. This is going [97:33] to change your life. I invested in this [97:35] company called Cometeer last year, and [97:37] they're now one of the sponsors of this [97:38] podcast because they've taken a pretty [97:39] revolutionary approach to making coffee. [97:42] Every coffee is precision brewed at 10 [97:45] times the strength, and then they flash [97:47] freeze it with liquid nitrogen to lock [97:51] in the flavor and freshness. And then [97:53] it's delivered to you on dry ice in [97:55] these recyclable aluminum capsules still [97:58] frozen, like a little ice cube. All you [98:00] have to do is pop the capsule out, add [98:04] some hot water, [98:06] and then you stir it and you are good to [98:08] go. You can also make delicious iced [98:10] coffee drinks as well. Just pour it in, [98:14] stir it up. [98:17] And for anyone that hasn't tried it, you [98:18] can get $30 off your first order of [98:21] Cometeer Coffee if you go to [98:23] cometeer.com/steven. [98:26] I've done almost 700 interviews with [98:29] some of the most interesting people in [98:30] the world. And one of the things you [98:31] learn, which is unexpected, is that [98:33] vulnerability is the doorway to [98:35] connection. And after sitting here for 2 [98:37] 3 hours with a guest, I feel a deep [98:39] sense of connection to them. And as they [98:41] leave, what I get them to do is to write [98:44] a question in the Diary of a CEO. We've [98:47] taken all of the questions from the [98:49] Diary of a CEO. We have put the question [98:52] here on this card with the name of the [98:55] person that wrote it. So, you can sit at [98:56] home as I do with my fiance and my [98:58] colleagues at work and other people in [99:00] my life. Whenever we get a minute, we [99:02] play the Diary of a CEO conversation [99:04] cards. And it is incredible what [99:07] happens. These are great if you're in a [99:08] romantic relationship and you want to [99:10] connect your partner more. These are [99:11] also great if you're in a team and you [99:13] want to bond your team together. And I [99:15] have to say they're also great for [99:16] families that want to learn more about [99:17] each other and that need a good excuse [99:19] to spend some time in a digital world in [99:22] the analog environment connecting human [99:25] to human. It is remarkable what the [99:27] right question at the right time can do. [99:29] Go to the diary.com [99:32] and you can get these conversation cards [99:34] right now. [99:36] You said something earlier on about the [99:38] link between [99:39] sort of your dietary choices and cancer. [99:42] I've actually got a friend of mine who [99:44] used to work for me who is going through [99:46] a a cancer process at the moment. She's [99:48] very very young. She's actually younger [99:49] than I am and she was diagnosed with [99:51] breast cancer. She's a really good [99:52] friend of mine [99:54] and she was my actually my manager for a [99:55] couple of years. She's called Katie. [99:57] She's very public about this so she's [99:59] posting her journey online so I can I [100:00] can say her name and [100:03] I've been following her and she's she's [100:05] you know she's removing a lot of the the [100:06] foods we've talked about today from her [100:08] diet. So she's very front of mind to me [100:10] at the moment and I was looking at some [100:11] of the stats around the link between our [100:13] dietary choices and cancer outcomes and [100:15] I'm going to read them. Now my team [100:17] might cut some of them out but I think [100:18] they're worth hearing [100:19] because hearing them I think is quite [100:22] enlightening. [100:23] A massive French study found that [100:25] drinking just 100 mil of sugary drinks [100:28] per day which could be you know a third [100:29] of a can of soda is associated with a [100:33] almost 20% increased risk of overall [100:36] cancer. [100:37] Women who consume two or more dietary [100:39] drinks daily have over double the risk [100:42] of early onset colorectal cancer [100:45] compared to those who drink less than [100:47] one a week. High consumption of sugary [100:50] sweetened beverages is linked to a 78% [100:53] higher risk of estrogen-dependent [100:56] endometrial cancer in women. [100:58] Drinking 20 oz of sugar [101:00] of sugary soda daily is linked to [101:02] shortening your telomeres which are the [101:04] protective caps on your DNA equating to [101:07] 4.6 years of extra biological aging [101:09] which is a major risk factor for cancer. [101:11] High sugar intake causes chronic [101:14] hyperinsulinemia. [101:18] Chronic hyperinsulinemia. [101:21] Can I So that is what I'm saying when [101:23] the insulin levels are high High insulin [101:25] >> explained at the beginning. Which can [101:26] inhibit [101:28] apoptosis, the natural process where [101:30] damaged or cancerous cells [101:31] self-destruct. [101:32] >> Yes. Wow. [101:34] Two more. Fructose is processed in the [101:36] liver and converted into lipids which [101:38] are fats, which is what we were talking [101:39] about earlier, which recent studies show [101:42] certain tumors directly consume to build [101:45] their cell membranes. [101:46] >> Yeah. And lastly, diets high in added [101:49] sugars chronically elevate C-reactive [101:51] proteins called CRPS, an inflammation [101:54] marker that is heavily correlated with [101:55] tumor progression and metastasis. [101:59] Yeah. [102:01] So what I'd like to This is That is so [102:03] interesting and it brings to mind a [102:05] really important point. [102:08] We talk so much around the world about [102:11] treating cancer. [102:14] But [102:15] what about prevention? Because for your [102:17] friend, [102:19] that's a life sentence and she's living [102:21] with uncertainty and fear. And when I [102:23] tell patients [102:25] they have cancer, [102:26] you know, you feel it right here because [102:29] you just took away so much. [102:32] And it's interesting, do we try hard [102:34] enough? If we know that, [102:37] are we trying hard enough to prevent [102:39] cancer? Because that's what we should be [102:41] doing cuz we know a lot that [102:45] I think after smoking, Mhm. [102:47] >> [clears throat] [102:48] >> diet is the next commonest cause of [102:50] cancer. [102:51] And [102:53] you know, how serious does it have to [102:55] get? [102:56] When when you [snorts] you just gave all [102:57] those references then [102:59] and [103:00] I know that [103:02] uh junk food is linked to all cause [103:05] mortality. It's linked to so many [103:07] things. [103:09] Uh what what are we prepared to [103:10] sacrifice [103:12] for enjoying, you know, treats and [103:14] snacks? It's kind of When you look at it [103:16] like that, it's really bonkers. Really [103:19] bonkers. This sounds a bit crazy, but [103:21] sometimes I imagine receiving a [103:23] diagnosis. Yeah. And I do a bit of, I [103:25] guess a they might call it a pre-mortem, [103:27] um a pre-mortem not a post-mortem, where [103:30] I imagine on that day [103:32] the decisions I wish I would have made. [103:34] And I'm not saying all cancer is linked [103:36] to what we eat because that's not the [103:37] case, but I'm I'm imagining like the [103:39] worst diagnosis I could ever be given [103:42] and the doctor telling me that my [103:43] lifestyle choices contributed to that [103:45] over the last 5, 10, 15 years. And in [103:48] that moment is there any [103:51] sugary drink that is worth it? [103:53] There's just not You would just wish [103:56] with every bone in your body where you [103:57] come home and tell your fiance, your [103:59] partner, your kids that you've got this [104:01] horrific diagnosis. You would just wish [104:03] that you had made a different decision. [104:06] I also think that's a very good strategy [104:08] for dealing with problems. [104:10] >> Mhm. You know, your life must be so [104:12] complicated. I can't begin to imagine [104:14] how many problems you're solving, the [104:16] complications, and the people you deal [104:18] with. [104:19] And yet all of them are as nothing [104:22] against the cancer diagnosis, aren't [104:23] they? So, that you would look at the [104:25] problems you have right now and you'd [104:28] laugh. Yesterday, I was worried about [104:31] the traffic or whatever. [104:33] And I think it's a leveler. Mortality is [104:37] a leveler. All my life, I've been [104:39] obsessed with death. And it worries me. [104:42] I can't sort out in my head [104:45] what does death mean or, you know, [104:47] it really scared me when I was a child, [104:49] the idea of death. But what it's given [104:52] me [104:52] is a drive to not waste time. [104:56] And and to think about what's the best [104:58] use [104:59] of today. And and you seem to have that [105:02] kind of energy as well. [105:04] Interesting thing about the side of [105:05] wasting time as well is through [105:07] everything you've talked about today, we [105:08] we can both waste less time, but also [105:11] have more time. [105:13] And when I learned about the difference [105:14] between like lifespan and healthspan, [105:16] that also added to this equation. People [105:18] still live to 80 years old, but they're [105:20] only healthy for like 30, 40 years. And [105:24] that's a very imp- The idea of [105:27] healthspan is very important because we [105:29] know in the UK it's going down. Oh, is [105:31] it? Yes. [105:33] Um uh [105:35] it's it they're looking at that. Now, [105:36] life span is hanging out there as sort [105:39] of stuttering along, but health span is [105:42] going down in the UK, and it's worth [105:44] thinking why that is. [105:46] Well, I I would hazard a guess it's uh [105:49] relates to all the things you've talked [105:50] about today. [105:50] >> it may do. In England, you're totally [105:53] right. It says, "In England, the [105:54] situation is particularly alarming. [105:57] Health span is actively declining even [105:59] as overall life span slowly creeps up." [106:03] Recent 2024 to 2026 data from the Office [106:06] of National Statistics, the ONS, and the [106:08] Health Foundation paints a stark picture [106:10] of the UK's widening sick years gap. [106:12] Over the last decade, healthy life [106:14] expectancy in the UK has fallen by [106:16] roughly 2 years. As of the latest data, [106:18] men in the UK can expect to spend about [106:20] 60 years in good health, and women about [106:22] 60 years of good health as well. Because [106:25] overall life expectancy in in England is [106:27] rising, [106:29] um people are now spending roughly up to [106:32] 23 years at the end of their lives with [106:34] poor health and in sickness. This means [106:36] the average person spends nearly a [106:38] quarter of their life managing chronic [106:40] illness and or disability. [106:44] And that's exactly the point, isn't it? [106:46] That's exactly the point. [106:49] And it relates to another thing I'd like [106:50] to tell you about as well. This is um [106:54] government figures. [106:56] Every taxpayer in England pays an extra [106:59] £7,000 tax per year for the consequences [107:03] of ultra-processed food. Hm. [107:06] Everybody's paying [107:08] tax extra tax, £7,000 a year. And this [107:12] is because it's not just the cost of the [107:14] drugs. [107:16] The bigger bigger cost is the is the [107:19] people not paying tax themselves and not [107:21] able to work because they're ill. [107:24] And that is that's two-thirds of the [107:26] cost is the lack of revenue because so [107:29] much of our population isn't well enough [107:31] to work and that's very and a lot of [107:33] it's young people too. It's very [107:34] serious. I know I think about 30-40% of [107:36] our listeners are in the United States. [107:38] So I've got some bad news for everybody [107:39] in the United States as well. The US How [107:40] is it there? [107:41] >> [clears throat] [107:42] >> The US currently holds a rather grim [107:44] record. It has the largest health span [107:46] to lifespan gap on earth. [107:50] Despite the United States having lower [107:52] overall life expectancy than almost all [107:54] of its peer nations and premature death [107:56] rate that is nearly twice the average of [107:59] comparable countries. [108:01] It's health span stats sit as the worst [108:03] in the world. So if you're in the United [108:05] States as things stand, you will be [108:06] sicker for longer. Um or have less of a [108:09] health [108:10] >> we're trying to keep catch up there, [108:11] aren't we? [108:12] We're doing you know, we're doing our [108:13] best in the [108:14] >> our best in the UK. We're doing our best [108:16] to catch up. Um [108:18] I have this piece of string here. Yes. [108:20] And which is I I I I I I I I I I I I I I [108:21] I I I I I I I I I I I I I I I I I I I I [108:22] I I I I I I I I I I I I I I I I I I I I [108:22] I I I I I I I I I I I I I I I I I I I I [108:23] I [108:24] >> waist and I guess fat levels are too [108:27] high on the on the belly? I think it's [108:28] bigger than that. So I'm interested in [108:31] low-cost ways for people to find out [108:34] well, how are you how are you doing? How [108:36] are you doing? And so one recognized way [108:39] looking at metabolic health is [108:42] your waist should be less than half your [108:46] height. So if we have a piece of string [108:47] which we have there, I believe you're [108:49] 6'1". Yes. And you've you've marked [108:52] halfway. So half of that string [108:55] should go around the fattest bit of your [108:57] belly. [108:58] >> People come up to me all the time, you [108:59] know, and they go, "Oh my god, you're so [109:00] much taller than I thought." Yeah, cuz [109:01] they've only ever seen me sat down. My [109:03] entire career is people watching me on [109:05] >> right. Cut it in half and then let's [109:06] [clears throat] see will it go around [109:08] your belly yes or no? Okay, so I've cut [109:10] the the string in half. [109:11] Which part of my belly? The fattest [109:13] part. The fattest part, okay. Yeah, so [109:15] be honest about the fat part. Okay. Can [109:18] I look? Yeah. [109:19] You did it. Yeah. [109:20] >> Is that I tell you what, it's not No, [109:22] I'm not. Are you squee- Are you [109:24] cheating? Let me see. [109:28] I mean, it's it's not Yeah, [109:30] >> [laughter] [109:30] >> yeah. [109:32] You You've just done it. You passed it. [109:33] You passed it. [109:34] >> It's so interesting and so funny. And [109:37] And but that is a very interesting thing [109:39] for you. [109:40] And as I say, it's insulin resistance [109:42] tends to put weight on your belly. But [109:46] you may have a very muscular abdomen. [109:47] Let's pretend it's that, you know. You [109:49] could just about get there. You're just [109:50] about there. But it's a really simple [109:52] test for everybody at home. Piece of [109:54] string [109:55] as long as you are tall. Cut it in half. [109:58] Will it or will it not go around your [109:59] middle? Okay, so everybody at home go [110:01] buy some string. Yeah. And I mean, [110:03] there's lots of other things you can do. [110:05] But that that's as as [110:07] a simple way because your weight alone [110:10] as I said, it it's where the fat is [110:12] distributed. It [110:14] It's fat on your belly is more worrying [110:16] than fat on your legs or on your arms, [110:18] really. So [110:19] So one of the things people always ask [110:21] me about is supplementation. Um [110:23] How good, bad, and indifferent. What's [110:25] your What's your point of view? [110:27] Right. So my point of view is if you can [110:32] My My gut reaction is to try and use [110:35] diet [110:37] to give you what you need. If you can. [110:40] >> Which diet? [110:41] A lower a real food [110:44] lowish carbohydrate [110:46] is my preferred thing with plenty of [110:48] protein in there. [110:50] And healthy fats. [110:52] >> [sighs] [110:54] >> I'm very interested in farming and [110:56] regenerative agriculture and all that [110:58] kind of thing. And what I know [111:01] is that the nutrient profile of crops [111:03] grown today is not nearly as good as it [111:07] was 100 years ago. So we have some [111:09] problems and it it's to do with the [111:11] soil. [111:12] If you keep just adding nitrogen and [111:14] harvesting crops, [111:16] those crops do not contain as much zinc [111:18] or magnesium particularly. [111:22] And so, [111:24] the tragedy is that although my aim [111:26] would be to have you healthy with a real [111:28] food diet, [111:29] there are some things you cannot get in [111:31] the diet now that your grandparents [111:33] could and one of them is magnesium. [111:36] It's very, very difficult [111:38] to get enough magnesium [111:43] in your diet without supplementation. [111:45] And as you get older, you absorb the [111:48] magnesium [111:50] less and less. Also, lot of medication [111:52] interferes with magnesium absorption, [111:54] particularly drugs for um acidity. So, [111:59] magnesium supplementation for most [112:01] people Okay. In myself, it was magic at [112:04] getting rid of muscle cramps. [112:08] I sleep a lot better. [112:11] I think we also need to talk about [112:13] magnesium, which magnesium, cuz it [112:15] varies a hell of a lot. [112:17] And uh this bit's embarrassing. Depends [112:20] on your bowels. Okay. Right. Have you [112:22] got fast or slow bowels? You don't need [112:24] to tell tell me. [112:26] >> [snorts] [112:26] >> If If you If you tend to be a bit [112:28] constipated, magnesium citrate is [112:32] very good. It helps It's more laxative. [112:37] And it You're a You absorb some of it [112:39] anyway. [112:40] If your bowels are not a problem, [112:44] >> [snorts] [112:44] >> and particularly if you're wanting [112:45] better sleep or mood, magnesium [112:48] glycinate or threonate is actually [112:51] crosses the blood-brain barrier, but [112:53] won't help with constipation. So, that's [112:56] a very quick thing on magnesium. [112:59] Have you Have we got time for me to tell [113:01] you about the first cow I ever bought? [113:04] Go ahead. [113:04] >> relevant to magnesium. [113:06] >> Right. [113:07] So, my wife and I, my wife Jen, [113:10] we have this idea [113:12] that if you love somebody, [113:15] then gifts are you should try and think [113:18] what would that person like. Don't buy [113:21] somebody a present you would like. Yeah. [113:23] And it was Jen trying to get me to grow [113:25] up. Yeah. Right? [113:27] And this is how she did it. [113:30] So, she said to me one day, [113:33] "Right, get a coat and a pair of [113:35] wellingtons. I'm going to take you out." [113:37] And she drove me into Lancashire [113:40] and there was a field of cows and she [113:42] said, "I have bought you [113:44] any one of those cows." Cuz I'd always [113:46] wanted a cow [113:47] and we had a field [113:49] and she how [113:51] what a woman is this? [113:53] She knew I wanted She went to the farmer [113:55] in advance and prepaid for any cow and [113:58] said, "This field, I've I've I bought a [114:01] cow. You just pick which one you like [114:03] and he'll transport it home." How does [114:05] this relate to magnesium, you're [114:07] wondering? Well, [114:09] it does because the farmer said, "You [114:11] can have whichever cow you like, but [114:13] I've lost 15 cows [114:15] uh to a thing called the staggers this [114:18] year and you cannot have the cow unless [114:20] you [114:21] promise me you'll buy magnesium [114:22] supplements [114:24] because the grass is now so short of [114:26] magnesium [114:28] that uh cows die fitting if you don't [114:31] give them a magnesium supplementation. [114:34] But it's better [114:36] At the same time, I had a patient that I [114:38] couldn't work out why he was fitting. [114:41] I was really fond of this guy and I kept [114:43] being called out and admitting him to [114:45] intensive care fitting. [114:48] And we couldn't work out. It wasn't a [114:50] brain tumor. Why was he fitting? And I [114:52] expect you've joined the dots. It was [114:54] magnesium deficiency because of [114:56] medication he was on. Mhm. And that's [114:58] the first time I ever a [115:00] thought about magnesium. It's a most [115:02] interesting subject, very important. [115:06] And the modern diet is most people are [115:08] magnesium deficient. [115:10] >> [snorts] [115:10] >> And uh problem is you can't measure it. [115:14] So, your blood magnesium, serum [115:15] magnesium, [115:17] um doesn't reflect what's going on [115:20] because magnesium is mainly inside your [115:22] cells. So, in the you have to get the [115:26] intracellular magnesium level. But, do [115:29] you know what? It's just easier to try a [115:30] magnesium supplement and see how you [115:32] feel. So, do you take magnesium? I do [115:35] because the guests, the experts on my [115:36] podcast have told me that magnesium is [115:38] one of my five. I For me, I've said to [115:40] myself, I'll take five supplements a [115:41] day. [115:42] Um Five? Yeah, I'll take five. So, [115:45] vitamin D because I'm inside all the [115:46] time. Vitamin D, so yes, definitely. And [115:50] I'm black, so that, you know. Well, that [115:53] combined, but everybody, and [115:54] particularly in the [115:55] we most people just don't get enough [115:57] sunshine. It'd be better if you could do [115:59] it with sun, but yeah, vitamin D's very, [116:01] very important. I take magnesium. Yeah. [116:05] Cuz people like you've told me how [116:06] important it is. [116:06] >> Which magnesium do you take? That's a [116:08] great question. I think it's citrate. [116:09] Citrate. [116:10] >> Right. But, I actually think it varies [116:11] depending on what my team get me. [116:13] >> Yeah, yes, yeah. Um but, that's good to [116:15] know cuz I'll think about my bowels. I [116:17] take creatine. [116:18] Yeah. Um there's this fiber supplement [116:21] that I take because I did a couple of [116:24] blood tests and um they said that fiber [116:26] would help this particular fiber [116:28] supplement would help reduce my LDL Yep. [116:31] >> cholesterol. Yeah. [116:32] And [116:35] multivitamin. [116:36] To cover everything. [116:37] >> To cover everything. That's probably I [116:39] mean, [116:40] that sounds okay, really. Yeah. I mean, [116:43] one of the worries that or one of the [116:45] clinical things I find [116:47] is honestly, if you ask people how many [116:48] supplements they're taking, there's a [116:50] carrier bag comes in and there's a blue [116:52] one and a yellow one and a [116:53] And it's possible to over supplement [116:56] quite easily. [116:57] >> Mhm. [116:57] Particularly maybe vitamin D, you can [116:59] know various [117:01] vitamins. You handed this as well. Oh, [117:03] that's vitamin D. Fine. Fine. [117:06] So, I think that that's I would agree [117:08] with you basically. Mine's Mine's also [117:10] going off my blood test results. I've [117:13] done two blood test results Actually, [117:14] I've done two blood test results in the [117:16] last month. Yeah. One with Function [117:18] Health, who are a partner of ours, a [117:20] sponsor of ours, and another one with um [117:22] with Neko Health, which is a actually [117:25] company that I've just invested a couple [117:27] million quid into, which is this health [117:29] testing company. Have you heard about [117:31] Neko? No. Neko Health, you walk in, [117:34] $299, whatever, you lay down, you get [117:37] all of your your sort of blood tests [117:39] done, you get all of these incredible [117:40] tests done on your body. [117:42] Um they show like how you know how how [117:44] good your circulation is from your like [117:45] neck to your toes. You stand in front of [117:48] this scanner, it takes like 2,000, 3,000 [117:50] photos of your body, tracks all of your [117:52] moles, tracks your heartbeat, does all [117:53] of these incredible things. And then, [117:55] instead of [117:56] waiting 2 weeks for the results, you [117:58] walk into a room and your entire body is [118:00] on this screen. Yes. And you can look [118:02] at, you know, all these different parts [118:04] of your body. They do the blood tests at [118:06] the very start, and then literally like [118:08] it felt like 20 minutes later, I'm in a [118:10] room, I've got my blood test results [118:11] back, I can see my entire body, they're [118:14] going through my LDL, my this, my that, [118:16] the other. They're showing my heartbeat, [118:17] they're showing every single mole on my [118:18] body, [118:19] and it cost 299 pounds, and you get the [118:21] results then. [118:23] And I My alternative, and this is me [118:25] really plugging, the alternative that I [118:27] used to do every year was this Honestly, [118:28] I'll be honest, it was this 7,000-pound [118:31] health screening [118:33] where I'd take it would take me [118:35] 6, 7 hours, and I'd get the results back [118:37] in 2 weeks. So, what Neko have tried to [118:39] do, it's actually a company started by [118:40] the founder of Spotify, [118:43] Daniel Ek. [118:44] And yes, so I did my blood test the [118:45] other day, and both my Function Health [118:47] test and my my Neko Health test said the [118:49] same thing. [118:50] And then I took those results, and I I [118:52] processed them using some AI tools and [118:53] said like, "What am I deficient in?" And [118:55] one of the things I was deficient in was [118:56] omega-3. That was the other one. Uh [118:58] omega-3, vitamin D, I had high LDL. [119:03] And so they said, "This fiber thing [119:04] would be really good for you." [119:06] And yeah, those are the main things. [119:08] Otherwise, I was great, but yeah, high [119:10] LDL. [119:11] >> I think one of just [119:13] That makes [snorts] me think of [119:13] something. When you're screening, I [119:15] think the important point is that you [119:17] don't just scare people. Yeah. It has to [119:20] be linked to what can you do about it. [119:22] I've had a lot of experience [119:25] of scared patients. [119:27] So, GPs, we we're we worry about [119:29] screening cuz what happens is people do [119:31] that [119:33] and then people get scared and use up [119:35] loads of appointments in the health [119:37] service trying to sort out. So, what [119:39] what's good is if you do screening that [119:42] relates to actionable points and then [119:45] you help the people understand what they [119:46] can do. Yeah. And [119:48] avoid leaving them [119:50] just worried. Exactly. [119:52] >> is for you, [119:54] you know, if if I can I might be able to [119:55] tell you accurately you're going to die [119:57] aged whatever of whatever, but if you [119:59] can't do anything about it, you don't [120:00] want to know. Yeah. What you do want to [120:02] know is what can I [120:03] What can I take action on? What can I [120:05] You know, it's about optimizing, isn't [120:07] it? The things that I hate about the [120:09] health checking process before Nico was [120:11] like I hated how expensive it was and [120:13] that's quite It's quite a privileged [120:14] thing to go to get health a full body [120:15] health scan. [120:16] >> Yes. Especially like So, but now you can [120:18] do it for 299, but then it was I walked [120:20] into a room straight away with a doctor. [120:22] Yeah. [120:22] >> And the doctor sat me down. Beautiful [120:24] screen of my body and was like, "Do [120:26] this, this, this. This is fine, this is [120:27] fine." And she was so nice about it, but [120:30] yeah, I say that cuz I'm so passionate [120:32] about it cuz I realized there's a [120:33] certain privilege that people that are [120:34] able to access private health care have [120:36] that I think is really, really unfair. [120:39] Well, obviously I [120:41] I think that's unfair cuz I only work in [120:43] the health service. Yeah. The state's [120:45] health I don't do anything other, I [120:47] won't take private patients or because [120:52] I think it it would be wrong. [120:55] And because don't you think health [120:57] inequalities is getting really bad? Yes, [120:59] exactly. [120:59] >> Really really bad. [121:01] And it kind of troubles me. [121:03] And it also if you [121:05] you start in the UK and you go [121:06] northwards, it just gets worse and [121:08] worse. And And the states is the same [121:10] way. It's not like the same nation. Oh [121:12] my gosh, it's unbelievable. [121:13] >> go to California is one kind of a thing [121:15] and then you go elsewhere [music] and it [121:17] it's not the same. [121:19] But hopefully this is changing. Um this [121:21] is I I I've Well, I think social media [121:23] helps because [121:25] it didn't cost much, does it, to go on [121:28] social media and find out things? [121:29] Exactly. [121:31] And people like you [121:32] who've um increasing increasingly loud [121:35] voice across lots of podcasts and who [121:36] are reaching millions and millions and [121:38] millions and millions and millions of [121:39] people. [121:40] Um and teaching them the [121:41] >> What's difficult though is not to become [121:43] confused. [121:45] >> [snorts] [121:45] >> You know, because you have the newspaper [121:47] saying eggs are good, eggs are bad. [121:50] And then you have this expert who's [121:52] saying this and another expert saying [121:54] the other. [121:55] I think what I've tried to do [121:58] is base what I say on real world data. [122:02] And that's different. So I'm [122:05] I'm very careful to take baseline data [122:08] from my patients and then update it all [122:11] the time. So what I'm The publications [122:14] I've done are based [122:16] on the real world, the health service in [122:19] the north of the UK. I can't cherry-pick [122:22] my patients. I'm allocated my patients [122:25] by the state. [122:26] So I I can't just pick wealthy people or [122:29] people that will live longer. I'm [122:31] allocated people and that's that. [122:34] So [122:35] part of what I do is proof of concept [122:38] because if you can achieve this [122:41] in the north of England near Liverpool. [122:43] And if other people can replicate it in [122:45] Australia, New Zealand, North America, [122:48] maybe it's true. [122:50] Perhaps. [122:52] Dr. David Unwin. [122:54] We have a closing tradition on this [122:56] podcast where the last guest leaves a [122:57] question for the next, not knowing who [122:58] they're leaving it for. And the question [122:59] left to you Yeah. is [123:02] I'm sure the guest will figure out who [123:03] left this one. Um if humanity organized [123:05] to make contact with a more intelligent [123:07] species, Yes. who should represent [123:11] humanity and and why? [123:14] Funny. [123:14] >> [sighs] [123:14] >> god. [123:15] That's a brilliant question. Who should [123:23] The first person to This is a person I'm [123:25] going to nominate. [123:27] What's about David Attenborough? [123:30] You [laughter] know, he's a hundred [123:30] years old and he's spent so long [123:34] um [123:35] thinking about the planet. [123:37] And wouldn't he be a wonderful [123:38] ambassador and because I am passionate [123:41] about biodiversity, I'm passionate about [123:46] sustainable [123:47] agriculture and sustainable food. I pick [123:51] David Attenborough. [123:52] >> that's a wonderful choice. I think the [123:54] aliens would really like him. I think [123:55] they would. [123:56] They would. [laughter] [123:57] That's my answer. [124:00] Thank you so much for what you do. Um [124:01] you're really remarkable in a way that's [124:03] quite rare. And listen, I would know [124:05] because [124:05] >> give me the feedback. I love feedback. [124:07] >> No, you really are remarkable. You're [124:08] really remarkable in a way that's very [124:10] rare. And I don't say this to all of my [124:11] guests, but you are for for a variety of [124:14] reasons. Okay, I'm going to give you all [124:15] of the feedback. [124:16] >> Thank you. [124:16] >> The first The first The most notable is [124:18] you're a very kind human. And the way [124:20] that you speak is very nice to listen [124:23] to. And again, rare. The other thing [124:25] that I noticed is you're very very very [124:27] natural and good at telling stories. [124:30] And listen, why does this matter? [124:31] Because the human brain, from what I've [124:33] discovered from doing this podcast, is [124:34] really orientated towards stories. Now, [124:37] you could sit here and say, "Banana [124:38] bad." Or you could say, "Magnesium [124:40] good." But I'll never forget the cow [124:41] story. Yeah. [124:43] You know, I'll never forget the cow [124:45] story. I could have I could have [124:46] forgotten that magnesium good, magnesium [124:47] bad. But you the way that you tell these [124:49] stories is so captivating that [124:51] it enables me to learn in a way that is [124:54] engaging, and that is rare, very, very [124:56] rare. And the other is just um your your [124:58] depth of experience, your humility, your [125:00] willingness to admit when you were [125:01] wrong, which means that I trust you so [125:04] much with what you're telling me because [125:05] you're you're saying, "Listen, I'm I'm [125:06] an imperfect human, too. I've made [125:08] mistakes both in myself, with my [125:10] patients, and this is what I've learned [125:11] from it." And um the other thing is just [125:14] your ability to simplify. It's [125:15] remarkable. Listen, I sit here all day [125:17] with super geniuses from this university [125:19] and Harvard and Stanford and whatever [125:20] else, and I'm struggling to understand [125:22] what the hell they're talking about [125:23] because they don't take a second to [125:25] build the bridge between [125:27] the science [125:28] and the average person, and you do that [125:30] so naturally. So, I I have no I have no [125:32] surprise [125:33] >> Coming from you, that means a great [125:34] deal. It really does. Thank you. [125:37] >> It's just what 40 years in general [125:39] practice does to you because if you wish [125:40] to be effective, and if you notice, as [125:43] in the grin model, [125:45] I'm I'm watching your face. [125:48] I'm watching an audience, [125:50] and I'm reading how I'm doing, or you're [125:52] getting bored, or I need to move on, or [125:54] whatever. And that's what I do with [125:55] patients. I watch very carefully. So, [125:59] but the coming from you, cuz you really [126:01] do know, cuz you've had all sorts, that [126:03] means such a lot. It's a really rare and [126:05] actually, cuz it's so rare, I would just [126:07] implore you [126:09] to do more. And I know you're already [126:10] doing so much, but it's like it's so [126:12] rare [126:13] that you can have such a massive impact. [126:16] Yeah. You know, so I really I really [126:18] wish [126:18] >> we need to talk about how the how we So, [126:21] I'm trying to get bigger on Twitter, so [126:23] this will help me um [126:25] immensely. [126:27] Um Well, how can the audience help? How [126:29] can the audience help you [126:31] with your mission. [126:32] Well, [126:34] @lowcarbgp on Twitter, please follow me [126:36] on X @lowcarbgp. [126:39] Yeah. The other thing that would help [126:40] very much is to support the British [126:43] charity that I set up, the Public Health [126:45] Collaboration. Um it's our 10-year [126:48] anniversary. We set up these were [126:50] clinicians who got together, 16 [126:53] clinicians said, "How we doing? Rubbish. [126:56] Can we do better? Can we give clearer [126:58] public health advice?" [127:01] So, it's called the Public Health [127:02] Collaboration. So, please, please [127:04] support our charity. [127:06] Go online, find out about it, come to [127:08] our conferences. I'd also say notice [127:14] each of us [127:15] is on a journey. [127:18] Be clear about your goals. [127:21] Notice what works for you because that's [127:23] what you're doing. Mhm. [127:24] And each of us see yourself as an [127:27] experiment. [127:28] Don't be frightened of experimenting, [127:30] but if you're going to experiment, [127:32] notice, measure something. [127:34] Measure something, and then you'll see [127:36] how you're doing. [127:38] Um and I I've One thing I think that [127:41] gives me hope is continuous glucose [127:43] monitors because [127:45] you're getting you know individualizing [127:48] right there. How is my [127:50] blood sugar? I can check mine in a [127:51] minute and see how I'm doing. [127:53] I think continuous glucose monitors [127:56] Which, by the way, are only 20 30 [127:58] dollars on on Amazon Yeah. Yeah. Yeah, I [128:01] I would think, "You know what? If you [128:03] loved your dad [128:05] or you had somebody and it's Christmas [128:07] and you could buy a useless [128:09] ornament or something, and they don't [128:11] need it anyway, [128:13] but would they be interested to find out [128:15] about their blood sugar? Yeah. You could [128:17] maybe consider You'd ask them first, but [128:19] if they've if they've got a mobile [128:22] phone, [128:23] they could try a continuous glucose [128:25] monitor and find out. Have you Have you [128:27] tried one? [128:28] >> I have. [128:29] >> did you learn? I mean, so much. Ah, [128:31] well, did you? What did you learn? [128:33] >> I learned that all these things I [128:34] thought were were had no sugar in them [128:36] have loads of sugar in them. I had no [128:37] idea about ketchup. I thought it was a [128:39] >> [laughter] [128:39] >> And the point is, once you've seen it on [128:42] your phone [128:42] >> You can't unsee it. No. And [128:45] I see them as the the cavalry coming [128:48] over the hill [128:49] because [128:51] we can't be fooled much longer. [128:54] Do you mind if I just going to look Can [128:55] I see what my blood sugar is right now? [128:57] >> this with my wife. [128:57] >> So, can I just show you? Oh, wow. So, [128:59] what that is, that's somebody with type [129:01] 2 diabetes, but look, their blood sugar [129:03] is absolutely level. [129:06] Wow. And that's good. [129:09] Uh because [129:11] you want it But look how how level it [129:13] is. And that is because I don't eat [129:16] stuff that puts up my blood sugar. If I [129:18] was to have some of those, you'd get a [129:20] um [129:20] you'd get a spike. But that's feedback. [129:23] It also means if I get very stressed, it [129:25] puts up my blood sugar. You've been so [129:27] kind, I haven't been stressed. [129:30] >> Thank god for So, other podcasters [129:33] are not as gentle and kind as you, and I [129:35] get a horrible spike. So, it's going to [129:37] Here's some feedback for you, Stephen. [129:40] So, you and I have been together for a [129:42] few hours, and my blood sugar [129:45] I felt safe. [129:46] So, you've done your job, too, and [129:48] there's some feedback for you. No [129:49] spiking. [129:51] I'll tell you a final story. A final [129:53] story. [129:55] Um [129:57] So, type 2 diabetes is is brand new as a [130:00] problem for pediatricians. [130:02] What is a pediatrician? So, a [130:03] pediatrician is a doctor who specializes [130:06] in the diseases of children. [130:08] People under 16 years old. [130:11] And the the The international problem is [130:14] that children everywhere are now [130:16] suffering from type 2 diabetes. [130:20] Okay? [130:21] But [130:22] the pediatricians have had no training [130:25] because it's a new disease. [130:27] So, [130:29] um a large group of pediatricians [130:31] sent for me and said, "Please do a [130:34] keynote [130:36] and teach us what to do because they, [130:38] although they're specialists, they [130:40] haven't experienced in type 2 diabetes. [130:43] This is a new disease of children." [130:45] >> [clears throat] [130:46] >> What we doing? [130:47] What we doing? [130:49] Leave it at that. We didn't show the [130:51] foie gras, but [130:54] I'll eat some of that later. [130:57] Dr. David Unwin, thank you. We're done. [130:59] Fabulous. [snorts] [131:00] I enjoyed that. YouTube have this new [131:02] crazy algorithm where they know exactly [131:05] what video you would like to watch next [131:07] based on AI and all of your viewing [131:08] behavior. And the algorithm says that [131:11] this video is the perfect video for you. [131:14] It's different for everybody looking [131:15] right now. Check this video out. I bet [131:17] you you might love it.