The low carb GP taking a stand against type 2 diabetes Adapted from Optimum Nutrition Autumn 2018 Feature Type 2 diabetes is crippling our health service. We speak to Dr David Unwin, an NHS staff member who is fighting back By Louise Wates Dr David Unwin, a softly-spoken GP based in Southport, Merseyside, has become a formidable voice on the treatment of type 2 diabetes. His surgery spends an average of £38,000 less each year on diabetes medication compared with other surgeries in his area, and many of his patients are now symptom free and off medication. The secret of Unwin’s success is quite simple: a low carbohydrate diet — less sugar and fewer starchy carbs such as bread or potatoes that break down into sugar. In 2016, when Unwin received the National NHS Innovator of the Year Award for his “outstanding” work, he described diabetes as a “national emergency”. Now, following NHS approval of a low-carbohydrate plan from diabetes.co.uk — one that Unwin played a leading role in developing — it is hoped that the rise of type 2 diabetes might not just be halted, but reversed. Historically, type 2 diabetes has been treated as an irreversible, life-long condition. Unwin says that until 2012, in 25 years of practice, he had never seen a patient reverse their diabetes. But eight years ago, one of his patients did. “I wondered how she had done it,” he says. “It turned out she’d been part of an online society and to my utter amazement there were 40,000 people online, helping each other.” The patient had been following a low-carbohydrate diet and told Unwin he ought to know that starch — found in carbohydrates such as bread, pasta, potatoes and rice, and which are recommended by Public Health England as the basis of a healthy diet — break down into sugar, which then has an impact on blood sugar and insulin production. Unwin says that from that first patient, he was determined to learn more and began to question whether starchy carbohydrates were good foods for people with type 2 diabetes. “It could be said they have almost a carbohydrate intolerance, so their bodies can’t deal with it,” he says. Eventually, he asked some patients with pre-diabetes if they would like to try a low-carbohydrate diet, going on the diet himself, even though he did not have the condition. “Personally, I was surprised that I wasn’t hungry,” he says. “At the same time, the results that were coming in for the patients were really good.” Unwin also signed up to diabetes.co.uk — the online community his patient had been using — to find out more. The site, he says, “was being rubbished by the medical profession”. So when he offered his help in his professional capacity, he was immediately suspended as a troll. “I didn’t know what a troll was,” he laughs. Until then he had no experience of social media, and his children had to explain what it meant. Since then, Unwin has joined Twitter as @lowcarbGP and can be found on YouTube. He was welcomed back by diabetes.co.uk some time ago and is now the community’s senior medical advisor. Low-carbohydrate diets have long been controversial, however, and some doctors have faced criticism for recommending them while the carbs versus fat debate rumbles on. However, Unwin explains that his recommendations were, in fact, in line with guidelines then and now. “I’m very clear that the NICE guidelines for type 2 diabetes specifically mentions that we should recommend low-glycaemic index sources of carbohydrate,” he says. “And for me that really describes a low-carb diet because there are no low-glycaemic breads that I’m aware of, no low-glycaemic index breakfast cereals, and no low-glycaemic potatoes.” Yet Unwin’s patients do have a choice. “What I would say is really important, another thing that NICE guidelines enshrine is individual choice. It’s essential that people enjoy the food that they eat; I don’t force patients. “It’s an option, and it’s an exciting option if you want to come off medication. I’ve discovered that patients are very interested — and are prepared to make dietary changes to avoid going on lifelong medication. That really surprised and pleased me. “Patients are far more sophisticated than they are given credit for in terms of their wish to be well and ability to make positive lifestyle choices.” It’s possible some GPs may remain reluctant to support lifestyle changes over medication. In such a situation, Unwin advises polite compromise. “The NICE guidelines are helpful here because they enshrine individual choice,” he says. He suggests if a person finds their GP is reluctant to put off medication, that patients propose trying lifestyle changes just for a couple of months, perhaps with the agreement to go on medication afterwards, should it fail to make a difference to diabetic control. But, says Unwin, there is a growing interest among British doctors in lifestyle medicine — particularly young ones coming into the profession. Conferences on the subject are selling out with long waiting lists. And if the NHS is to be with us for another 70 years and beyond, he thinks that lifestyle medicine is the way forward. “Surely this is a more cheerful, patient centred and yet cost-effective way to go,” he says.