In Depth

What’s at the heart of healthy eating? Dr David Unwin discusses low carb and its cardiovascular benefits

Two audience members turn to each other in excited awe. They have just been shown statistics revealing how eating full fat dairy helped adults with type 2 diabetes reduce their total cholesterol. This is a reaction being shared by many healthcare professionals within and outside of the diabetes community. Low carb, healthy fat eating is here to stay.

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Southport GP Dr David Unwin is answering questions following his talk at the Heart UK Charity Conference on 6 July. Having just presented findings from 107 case studies of people who went low carb, he is zeroing in on the heart benefits low carb, healthy fat eating can have.

The participants all had type 2 diabetes and had been low carb for 21 months, displaying excellent compliance. After the follow-up period, they had lower total cholesterol, higher HDL cholesterol, lower triglycerides, lost weight and had improved HbA1c levels. One third had come off blood pressure medication, and there were 51 cases of diabetes remission.

There was also a 10-15% reduced risk of cardiovascular events in the group. One man in particular aged 65 had a heart age of 79 before he went low carb; two years later his heart age was 70. The heart benefits are impressive, but not surprising. As Dr Unwin explained, insulin allows excess glucose to turn into triglycerides in fat cells. High triglyceride levels are common among people with type 2 diabetes, and lowering these can reduce the risk of heart disease.

Throughout the talk Dr Unwin elucidates the benefits of reducing sugar intake. Eating full fat dairy is one such way of doing this. Because low fat dairy often contains added sugar, which raises blood glucose levels, full fat is a far healthier alternative. Why is this the case? And haven’t we always been recommended to eat low fat? Well, excess glucose increases liver fat, raising insulin resistance and inhibiting beta cell function. Therefore, in people with type 2 diabetes, eating less sugar means less insulin needs to be secreted. This is important because people with type 2 need to lessen the strain on their insulin-producing cells.

Dr Unwin also reveals from a previous review that he found 1,400 of 6,000 patients had abnormal liver function. He knows that tackling sugar is paramount to lowering this number.

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When Dr Unwin first joined and got involved with the Diabetes Forum in the early 2010s he was blocked by moderators who didn’t believe a GP was interacting with the community. Years later, his research into those forum members who went low carb has helped his practice save £38,000 a year on its diabetes drug budget alone. Through advocating a low carb, real food lifestyle to patients, and the results that he has helped achieved, Dr Unwin won the NHS Innovator of the Year award in 2016. He is pioneering the low carb approach across the UK.

At the beginning of his journey, he asked a question: “Where does sugar come from in our diet?”

“I should have retired years ago, but the difference low carb has made has changed my whole practice.” – Dr Unwin

When he concluded that tackling starch, which turns to sugar in the body, was key to improving his patients’ health, his research led him to the Glycemic Index (GI) and the Glycemic Load – two measures of how foods impact blood sugars. He took his message of how eating low GI could help his patients to other medical professionals but was told that explaining GI and GL was too complicated; if other healthcare professionals struggled to understand it, so would patients. “Come back when you can explain it better,” he was told.

So he did.

At the Heart UK conference, Dr Unwin explains his realisation that made it simple: analysing food intake by teaspoons of sugar. One example he used was basmati rice, and how 150g equates to 10.1 teaspoons of sugar. “No wonder my patients were struggling,” he added, having long been recommended to eat starchy carbs.

Dr Unwin tells the audience how since his practice has gone low carb, the lives of not just his patients but his staff has transformed too. “I should have retired years ago, but the difference low carb has made has changed my whole practice.”

The longest period one of his patients has been free of type 2 diabetes is nine years. It’s an incredible feat, and serves to reinforce the good work that recommending low carb has done for Dr Unwin’s patients.

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A rapturous round of applause meets Dr Unwin once his talk concludes. Healthcare professionals from across the country have gathered to be here, primarily to hear about lipid profiles and triglycerides. There are uncertainties around low carb, particularly regarding its long-term safety, but Dr Unwin’s evidence appears to assuage doubts, with tangible heart health benefits ongoing for his patients, who continue to be healthier and happier since going low carb.

It was most likely more than just those two audience members who left the room awestruck.

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