You May Never Eat Sugar Again! – How To Reverse Diabetes & Prevent Early Death | Dr. David Unwin

In this podcast episode, Dr. David Unwin shares his personal journey and professional insights into type 2 diabetes, metabolic health, and lifestyle medicine. He discusses the early signs of metabolic dysfunction, the role of diet—particularly low carbohydrate and ketogenic approaches—in reversing diabetes, and the challenges within the healthcare system regarding prevention and patient engagement. The conversation also touches upon food addiction, the importance of informed consent in prescribing medication, and the broader societal factors that contribute to the growing epidemic of chronic illness.

The Continuum of Metabolic Health and Early Signs

Dr. Unwin begins by emphasizing that type 2 diabetes represents the final stage of a long deterioration in metabolic health, which develops over many years. Early signs often go unrecognized and include symptoms like fatigue after meals, increased abdominal girth often described as "middle-age spread," and cognitive issues such as brain fog. Other early indicators can be elevated triglycerides, fatty liver, mood disturbances, and food-related fretfulness or circular thinking. Dr. Unwin shares his own experience of these very symptoms before making transformative changes to his diet and lifestyle. Importantly, he stresses that all these symptoms are reversible, offering hope that metabolic health can be restored.

The Flawed Medical Paradigm and Informed Consent

A notable concern raised is how medicine traditionally treats various symptoms—tiredness, brain fog, low mood—as isolated issues rather than manifestations of a common metabolic dysfunction. Dr. Unwin criticizes the paternalistic model which often excludes patients from fully understanding treatment options. He highlights the lack of true informed consent in prescribing lifelong medications like metformin, underscoring that many patients are not made aware of common side effects such as diarrhea. This lack of transparency contrasts sharply with the rigorous consent processes for even minor surgical procedures. The conversation calls for more collaborative, patient-centered approaches that empower people to actively manage their health.

Dr. Unwin's Personal Journey and Transformation

Sharing his own story, Dr. Unwin describes being a tired, overweight middle-aged GP frustrated with the rising burden of type 2 diabetes and obesity in his practice. After a patient confronted him with evidence that she had reversed her diabetes through lifestyle changes—independently learning about the impact of starchy carbohydrates—he realized there was a better way to treat this condition beyond medication. Encouraged also by his wife Jen, a clinical health psychologist specializing in behavior change, he embraced a low carbohydrate lifestyle himself and subsequently committed to helping patients do the same. Now in his late 60s, he runs regularly, is off all medication, and enjoys a vitality and engagement with medicine he never thought possible.

The Role of Diet in Reversing Type 2 Diabetes

Central to the discussion is the powerful effect of diet on metabolic health. Dr. Unwin advocates a nutrient-dense, low carbohydrate diet emphasizing protein, healthy fats (such as butter and olive oil), and plenty of green vegetables, while reducing or eliminating starchy carbohydrates like bread, rice, and potatoes. He explains how carbohydrates break down into sugars that spike blood glucose and require insulin to manage, a problematic process for insulin-resistant individuals. Using tools such as continuous glucose monitors (CGMs) to visualize blood sugar spikes helps patients understand the impact of specific foods. The "teaspoon of sugar equivalent" concept further simplifies understanding by quantifying carbohydrate-containing foods in terms of sugar content, enhancing patient education and motivation.

Carbohydrates, Insulin Resistance, and Metabolic Dysfunction

The episode touches on the physiological basis of insulin resistance, describing how excess carbohydrate intake, especially refined and processed forms, causes liver fat accumulation and pancreatic fat infiltration. This process undermines insulin's effectiveness, forcing the pancreas to overproduce insulin and eventually leading to type 2 diabetes. Dr. Unwin explains that reversing this cycle—through weight loss and dietary changes—can reduce liver fat and restore metabolic function. He references the work of Professor Roy Taylor, a pioneer in low-calorie approaches to diabetes remission, and the similarity in how bariatric surgery can also quickly reduce liver fat and improve diabetes, although surgery carries risks and does not necessarily address behavioral causes.

Remission of Type 2 Diabetes and Real-World Data

Dr. Unwin shares compelling real-world evidence from his NHS practice that low carbohydrate diets can lead to significant improvements in diabetes control and remission. Among his patients who adopt low carb, 50-73% achieve drug-free remission depending on the duration of their diabetes, with most others showing marked improvements in blood glucose levels. Importantly, improvements in markers of cardiovascular risk—including cholesterol, blood pressure, triglycerides, and kidney function—were observed, alleviating concerns about high protein or fat intake. The practice has also saved substantial costs on diabetes medication compared to neighboring practices. These outcomes have been replicated globally and affirm that type 2 diabetes need not be a progressive, irreversible condition.

Addressing Food Addiction and Psychological Factors

The conversation explores the often-undiscussed role of food addiction, especially to carbohydrate-rich and ultraprocessed foods. Jen Unwin's work, as a clinical health psychologist, highlights how many patients struggle with addictive behaviors around foods like bread, pasta, and sugary snacks and how this undermines long-term maintenance of metabolic health. Dr. Unwin provides an example of a patient whose food addiction to bread prevented surgery due to uncontrolled diabetes. He likens carbohydrate addiction to other substance dependencies, noting a significant portion of the population may meet criteria for food addiction, which dramatically increases the risk of developing type 2 diabetes. He and his wife have personally experienced and managed food addiction, eschewing "cheat days" because of the significant negative rebound effects.

Patient-Centered Care and Collaborative Decision-Making

Dr. Unwin emphasizes the importance of involving patients in treatment decisions, offering choices between medication and lifestyle changes rather than default prescribing. He advocates for extended appointment times to provide true informed consent and shared decision-making, which is often lacking in typical brief consultations. The episode critiques rigid adherence to clinical guidelines when those guidelines may not reflect emerging evidence or patient experiences. Instead, curiosity, continued learning, and individualized care are encouraged to improve outcomes and re-engage clinicians with the art and science of medicine.

Societal and Environmental Drivers of Poor Metabolic Health

The episode broadens to consider societal factors driving the epidemic of metabolic diseases. Dr. Unwin describes how the modern food environment—ubiquitous ultraprocessed foods, "perpetual autumn" eating patterns, and widespread consumption of seed oils and sugary products—contrasts starkly with ancestral diets and lifestyles. He recalls a time when metabolic health was the norm rather than the exception and laments the normalization of chronic illness. The conversation critiques current food policies and urban planning that facilitate fast food proliferation, advocating instead for taxation on harmful foods and subsidies for local, whole food production. There is a call for better cooking education and a cultural shift to make healthier eating easier and more accessible.

Prevention: Challenges and Opportunities

Dr. Unwin points out that prevention is poorly embedded in current healthcare systems, which are designed mainly to treat acute illness rather than chronic lifestyle-related diseases. He underscores political and economic challenges in prioritizing prevention given short election cycles and immediate pressures on health services. Nevertheless, he encourages systemic changes such as restricting fast food outlets, improving access to prevention-oriented consultations, and incorporating early metabolic markers—like fasting insulin tests and more accessible continuous glucose monitoring—to identify risk before diabetes develops. He stresses that tackling metabolic health earlier increases the chances of remission and avoids complications.

Practical Implementation: Family and Community Approaches

To bring the benefits of lifestyle change into everyday life, Dr. Unwin describes how he and his family have adopted low carb living, supporting each other with recipes and strategies to maintain health. He discusses challenges in accommodating teenagers and children, emphasizing compromise and creativity in meal preparation to make low carbohydrate foods appealing and sustainable. His approach includes making delicious, culturally appropriate meals with alternative flours and maintaining simplicity in food choices. Evidence of success extends to his grown children and grandchildren, some of whom have also benefited from gluten reduction due to sensitivities that have become more common with modern food processing.

Accessibility and Affordability of Healthy Eating

Addressing barriers of cost and convenience, Dr. Unwin notes that many patients believe healthy diets must be expensive, yet with planning and honest budgeting, a low carbohydrate approach can be cost-neutral or even save money by reducing spending on snacks and processed foods. He highlights practical tips such as choosing frozen over fresh produce when appropriate and making simple homemade meals like burgers and ice cream. He also promotes resources like the Freshwell app, which provides free, NHS-approved low carb recipes tailored for budget-conscious individuals to support dietary changes.

The Future of Medicine and Lifestyle Revolution

Throughout the dialogue, Dr. Unwin places hope in grassroots lifestyle medicine movements empowered by social media and data sharing, which challenge entrenched medical norms and encourage patient empowerment. He emphasizes curiosity, open-mindedness, and sharing evidence—both successes and failures—as key to moving medicine forward. His own evolution from a skeptical, tired doctor to a passionate advocate encapsulates the possibility for change at both personal and systemic levels.

Final Advice for Listeners

Dr. Unwin's closing advice to listeners is twofold: for those already on medication, especially insulin or sulfonylureas, he stresses the importance of consulting their physicians before making drastic dietary changes since medication doses may require adjustment to avoid hypoglycemia. For others, he encourages curiosity, self-education through accessible resources like the Public Health Collaboration website and the teaspoon of sugar infographics, and engagement with healthcare providers to explore low carb approaches. Ultimately, he offers a message of hope and empowerment—metabolic health can be reclaimed with knowledge, support, and determination.