Downsizing: Remission for All
Chapter Eight of my Sunday Times bestselling book, Downsizing. It's the story of how I lost 8 stone, reversed my diabetes and regained my health
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By 2025 it is estimated that there will be five million people in the UK – nearly five times the population of Birmingham – with a diagnosis of diabetes.
Five million of us living with this debilitating disease, searching for answers and seeking a healthier life.
The cost to the individual is well known, as is the price paid by society. The National Health Service ploughs £10 billion a year into the treatment of diabetes and that outlay will only rise as the number of sufferers grows. £10 billion. More than the entire policing budget for England and Wales.
Most of that money is spent on treating diabetes-related complications: the increased risk of dementia, sight loss and kidney disease, for example, not forgetting the circulatory problems that can lead to nerve damage and amputation.
However, if we can arrest the development of diabetes, we will be able to massively improve people’s lives and prevent the next generation from getting sick like we did.
And, while lifting millions of people out of the misery and hopelessness of a diabetes diagnosis, we can save the taxpayer a fortune. The good news is that we can stem the flow.
The solution is surprisingly simple and shockingly straightforward. I call it Remission for All. And I want it to become a reality in the UK.
Look at it this way. If five million people in our country contracted leprosy – a truly horrendous condition that rots your body from the outside in – we’d hear an awful lot about it.
Legions of people losing their lives and limbs to this disease would prompt a national crisis. There would be urgent questions tabled in parliament, our government would face a public outcry and citizens wouldn’t be able to move for action plans and emergency investment.
Yet with diabetes – a condition that rots from the inside out – nobody seems to lift a finger. The number of patients rises, and more of us suffer and die, but the response from the corridors of power is slow, muted and lacking in any sense of urgency.
And it’s not as if we’re waiting on some miracle cure or some billion-pound research to fix this, either. Type 2 diabetes can be stopped and reversed for millions of people, thanks to simple dietary changes and a modest increase in exercise; I’m living proof of that.
Experience has shown me that, with the right advice and the right encouragement, we can – every one of us – keep our condition in check. So why isn’t this message being heralded by those who govern us?
It is a question that makes me angrier than almost any other posed in the modern political arena. Now that I’ve come out the other side, relatively unscathed, I believe it’s my duty to address this conundrum.
It is time for a frank and honest conversation about diabetes in this country, and for radical action to tackle this burgeoning epidemic.
My burning ambition, in this context, is to establish a Remission for All movement. A nationwide initiative, propelled by people power, it would be driven by two principal objectives: firstly, to support the estimated 3.4 million UK citizens with type 2 diabetes in trying to regain control of their body and reverse their diagnosis.
Secondly, to pressure the government into implementing policy changes that may liberate patients from their condition, and help them to transform their lives.
The UK’s diabetes crisis is a ticking time-bomb, and we require strong leadership to help us tackle the food corporations, to implement changes to the dietary advice doled out to us and to fund new technology to arm people in their battle against diabetes.
But for so long it’s been too easy for the decision-makers to ignore us.
So let’s make some noise. Let us rise up, join together and form a five-million-strong Remission for All movement – a trade union of diabetics, if you will – to demand the answers and the action that we need.
My privileged position means that I can act on others’ behalf, not just my own, but I want you to stand up and be counted, too.
Because it is only when you speak up, and when we all speak up, that our private tragedies will become a priority for our politicians.
We have got to stop feeling guilty, and start getting angry.
Over the past few years, as I’ve attempted to manage my treatment, I’ve faced a number of barriers. They certainly aren’t unique to me, though. These issues and frustrations are widespread and they are holding diabetics back from getting better.
One of the main obstructions faced by type 2 diabetes sufferers, I believe, is a deep-rooted culture of shame. Being diagnosed with T2D is embarrassing. It shouldn’t be, but it is.
It is wrapped up with a real sense of self-loathing, coupled with a genuine belief that you have brought all this upon yourself, and that you are entirely to blame for the lifestyle choices you’ve made, the behaviours you’ve exhibited and the warning signs you’ve ignored.
When you’re consumed with so much guilt about your illness, you often find yourself feeling sheepish about asking for the help that you need. Sometimes, your self-esteem is so low that you don’t even feel like you deserve that help.
Before I turned my corner, I spent a long time in denial about my diabetes. Like many middle-aged men who are faced with fading youth and failing health, I felt extremely vulnerable.
I tried to maintain some kind of equilibrium by managing my illness with drugs and by trying (albeit half-heartedly) to monitor the damage it was doing to me.
But I didn’t own type 2 diabetes, nor did I fight it; I merely suppressed it. I surrendered to its terrible, inevitable progress. It took me a while to properly understand, and then to fully accept, that I had a life-threatening, life-reducing, life-debilitating condition.
Only after furthering my knowledge with reading and research – especially the work of Dr Michael Mosley and Professor Roy Taylor – did the gravity of this disease begin to hit home.
However, while I was able to discuss my subsequent health concerns with Dr Nazeer and Maggie, my diabetes nurse, I was unable to open up to others. I simply couldn’t find the inner strength, or the right language, to broach the subject with loved ones.
Instead, I continued to carry my guilty little secret around with me, shielding my illness from close friends and family for fear that they’d perceive me as weak-willed and lily-livered. In the cold light of day, I didn’t want them to see me how I saw myself: as an abject failure.
The same was true at work. I kept mum about my battle with diabetes in Westminster and West Bromwich, worried that my standing among colleagues, voters and constituents would diminish if news filtered out that I had an illness that was commonly seen as self-inflicted.
Society also dictated that MPs should be strong and robust, and wise and responsible, and in my mind, being a diabetes sufferer just didn’t fit that mould. As it transpired, of course, circumstances around my fiftieth birthday prompted me to flick that mental switch and make a stark decision.
I was the father of two beautiful children. I was a Member of Parliament. My life ought to have been a joy, not a trial. I could no longer bear the guilt of looking at my son and daughter and thinking that, if I didn’t do something, I might not be around to see them off to university, or to take Malachy to the pub for his first pint, or to give Saoirse away at her wedding.
I went to war against my own diabetes not only because I wanted to save my own life, but also to be present in my kids’ lives.
By now you’ll know how I addressed and tackled my type 2 diabetes. And you’ll know that my life has been totally transformed as a result. The impact of putting my condition into remission, and regaining my health, has gone far beyond shedding the pounds and sharpening my fitness.
I have more energy and enthusiasm. I have a keener focus and a calmer disposition. I enjoy restorative sleep and rejuvenated mornings.
Conquering your illness is an exhilarating experience. You discover a new zest for life, and a new zeal for the future. And, soon enough, friends, family and colleagues begin to notice the difference.
‘You’ve become much more kind and considerate since you lost the weight, Tom,’ someone very close to me remarked recently. ‘You’re like a different person, in fact.’
I confess that I look back at some of my ‘old self’ behaviour with great shame and regret, probably in the same way that a reformed alcoholic reflects upon their days of excess boozing.
Had I not been hampered by the double whammy of brain fog and body fatigue, I’d have been able to engage with my family and my colleagues much more meaningfully.
With a clearer head, no doubt I could have read more books, and absorbed more knowledge. With more acuity and lucidity, maybe I could have performed better in some elements of my parliamentary work.
I recently watched some of my archive Commons performances, and it was truly eye-opening. One in particular – a 2002 intervention demanding better diagnostic tests in sport, with reference to the brain trauma sustained by the late West Brom footballer, Jeff Astle – didn’t exactly show me in my best light. It was far too verbose – verging on the rambling, in fact – and it lacked sharpness.
As I played it back, I wondered whether I was in the throes of a diabetic ‘hypo’ that afternoon, due to a dip in my blood glucose levels. One thing’s for sure: I’d have definitely headed for the Commons vending machine straight afterwards for my obligatory KitKat Chunky.
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The revelation of my diagnosis at the ukactive Conference in 2018 (and having also spoken about it earlier on Good Morning Britain) proved to be a momentous step on my health journey.
The prospect of speaking at the conference concerned me for two reasons. Firstly, by confessing that I was a T2D sufferer, I was publicly revealing something that could be construed as a weakness (not always a good move for a politician); and secondly, by talking about my recovery, I was adding to the diabetes-shaming narrative that places the onus on you to fix yourself post-diagnosis, because you’re at fault.
As it turned out, opening up about my condition was liberating, and explaining how I’d driven my diabetes into remission unburdened me of a heavy weight.
I really needn’t have been so nervous, either, since the response from my audience couldn’t have been more warm and encouraging.
It is, of course, an intensely personal decision as to whether you openly discuss your own health matters, but, for people in the public eye, I believe such candour can have a hugely positive impact.
Just sitting in a TV studio and saying ‘Guess what, I’m a type 2 diabetic’ can have an amazing ripple effect, in that it can resonate with millions of people across the nation. I would really love to see more high-profile individuals leading the way.
Imagine if a world-famous actor or musician was prepared to speak out in public about their experience of living with T2D? It would make it so much easier to have a national debate about various issues that could ultimately save countless lives.
In retrospect, I wished I’d had the courage to open up about my condition sooner, as I might have been able to influence public policy much earlier. But I was so glad that, in the end, I plucked up the courage to say my piece.
My ukactive speech, and the ensuing media coverage, unleashed a huge wave of emails containing stories from type 2 diabetes sufferers across the country, some of whom were still battling with the disease and some of whom, like me, had managed to conquer it.
Tellingly, and touchingly, I received many messages from men in their forties and fifties without a formal medical diagnosis who, having seen me on the telly, had recognised their own symptoms. As a consequence, they’d been prompted to visit their GP, or to confide in their partners, or both.
Others who’d trodden similar paths to mine got in touch, too. ‘Hi Tom,’ began one of the emails that hit my inbox that autumn.
‘Lots of fellow diabetics want to join you in your plight. We have reversed the condition in exactly the same way. Low carb. It’s so exciting to read about your goals. Please count us in. We are here to support you and take forward the cause any way we can. Changes need to happen and the faster the better. Thanks.’
‘Well done in your “battle” with type 2 diabetes,’ commented the husband of a T2D patient.
‘My wife has also done well by sorting out both her diet and her exercise levels. I am really proud of her for her efforts, and I am glad to read of another sufferer who has decided to tackle the problem face-on.’
‘Congratulations, Tom! Bravo!’ wrote a well-wisher.
‘Well done and best wishes for a healthy future. Best thing you’ve done so far for the British people (and probably the world). For the mass target population (when you’re in government) we surely need the food industry to co-operate and almost certainly some amount of legislation (and never mind the misplaced howls of “nanny state” from the usual quarters). All best.’
Once my diagnosis was in the public domain, I soon found myself deploying my ultra-sensitive T2D radar. Sometimes I’d spot a colleague with a telltale clammy face and protruding belly – just as I’d exhibited, back in the day – and would try to find a tactful way in which to broach this most sensitive of issues.
I felt compelled to do so; I had developed an almost evangelical desire to get the early-diagnosis message out there.
‘Hi mate, how are you doing these days?’ I’d ask as we both filed into the Commons voting lobby, purposely initiating a conversation that, I hoped, would be rounded off with a friendly suggestion to perhaps visit a GP, or consider getting a blood test.
I couldn’t bear the thought of anyone suffering with ill-health, like I’d done for so long. I grew up in the trade union movement and, since then, every aspect of my politics has been shaped and underpinned by the principles of endeavour and collective action.
The power of that movement, after all, was to take what were private and individual tragedies (which were often tinged with shame) and turn them into a shared struggle for justice.
Whether it was someone unfairly losing their job, experiencing bullying at work or being paid less due to their gender, these inequities would be addressed and resolved together, in partnership.
I believe that we diabetics ought to take a leaf out of the trade union playbook. We should speak up, in unison, about what we need. That way we will be harder to ignore.
That way, too, the personal battle we each face – to obtain the information, the support and the treatment that we require – will be taken out of the private sphere of the doctor’s surgery and into the public realm of governance, where the big decisions are made.
Sadly, the political class continue to ignore us. The lazy stereotype of diabetics – that we are fat, indolent and lacking in self-control and self-respect – is a powerful one, and it gives politicians (and occasionally the media) a convenient excuse to turn a blind eye.
We are to blame, so the logic goes, and therefore we are never the priority. We are presented as somehow less deserving than those who suffer with other illnesses.
It is this passive disregard that leads to the ‘upstream’ spending of billions of pounds on the complications of diabetes – the amputations, the strokes, the dementia – that could easily be avoided ‘downstream’ (I don’t think I’m divulging any trade secrets when I confess that we British politicians aren’t exactly known for our long-termism, or for our grasp of logic).
But what about intervening much, much earlier? What about catching people before they fall into illness?
Currently, government attention in this area is focused on those presenting with pre-diabetes, whose blood sugar levels are dangerously high, but not so much that they can be diagnosed as diabetics.
These people are further back on the timeline to potentially having their feet removed by an NHS surgeon or being treated for impending blindness.
Naturally, it’s right and proper that we intervene at this stage – I wish that I’d been able to tackle my illness before it developed into full-blown diabetes – but the truth is that we could be starting a whole lot earlier. And in doing so we could be heading diabetes off at the pass for millions of people, before it starts to wreak significant damage.
What if we could start addressing nutrition before the pre-diabetes stage? Years before pre-diabetes, you become obese. That’s the trigger; that’s the early warning system. So why don’t we intervene then?
The honest answer from ministers is rationing or, in other words, the controlled distribution of scarce resources. Too many of us are obese for the system to cope. Too many people are heading for diabetes, meaning that government cannot spend the money up front to prevent them reaching that terrible place.
Fair enough, I suppose – there isn’t infinite cash to splash – but this is such a short-sighted view, even from the depressing vantage point of a bean-counting minister.
My despair and embarrassment about my condition has since catalysed into determination and anger. Determination to get better and to help others to do so, and anger at all those politicians and food manufacturers who get in the way of mass recovery.
I am committed to fighting my corner, however. Activism is in my blood. As an MP, I’ve always been a bit of a rebel with a taste for campaigning. I’ve resigned from frontbench positions under the last three Labour leaders and I’ve fought what looked like hopeless campaigns – against the Murdoch empire, for one – and have caused so much trouble for powerful people that at one point I was followed by private investigators who rifled through my bins on a nightly basis (only to find, back then, a lot of empty takeaway containers from the local curry house).
Well, I’ve got a new mission nowadays. To channel my frustrations, and your frustrations, into real action for change. We are going to turn Remission for All into a reality.
I have, as it happens, spent much of the last two years shaking the tree at Westminster. I’ve become an agitator, an irritant. I have asked awkward parliamentary questions of Conservative ministers (a method by which MPs keep these individuals on their toes, to demonstrate that an issue is important).
They have been grilled about the impact of banning the advertising of high-sugar milk products on public transport, for example (the health secretary at the time said he’d not assessed it).
They’ve been asked when the government would consider expanding the sugar levy from fizzy drinks to sweetened milk products (the then chancellor replied that he had no plans to extend it).
I suppose it’s a bit like playing political cricket; I’m bowling questions at ministers to expose deficiencies in their thinking, and holes in their strategy.
I am keen to maintain the pressure because I cannot think of another policy area – at such a senior level in government – in which a huge problem has received so little bandwidth.
And those ministers’ answers tell me that our government is still in complacency mode when it comes to our health, and when it comes to our kids’ chances of avoiding the same traps that have ensnared previous generations.
Eventually, through questions and scrutiny, you can establish facts that are so strong that ministers are compelled to take action. When I was investigating phone hacking it was the disclosure that journalists had intercepted the phone of a kidnapped schoolgirl that led to the prime minister being forced to act.
In the case of type 2 diabetes, I thought my revelation that over 150 diabetes-related amputations are made each week in the UK might gain some traction, and might prompt the government to further resource some targeted prevention programmes.
Sadly, although my parliamentary interventions attracted a bit of newspaper coverage, very little changed. It wasn’t just type 2 diabetics who ignored their own condition; there was a national collective denial about it, too.
There are many good people working for charities and campaign groups who are trying to support people through type 2 diabetes. Talk to the leaders of these organisations, however, and they’ll tell you that the NHS will collapse if the rate of increase in T2D continues to rise.
Yet their public demands of government are incremental, when what is needed is a massive step change. Type 2 diabetes is a public health emergency. It requires powerful leadership, a paradigm shift in thinking and the focused attention of legislators, regulators, retailers and food producers.
Unfortunately, I fear that the charities that seek to speak for us are captured by the same complacency as our politicians. Many of them lack ambition and urgency. And others – through dodgy deals with PepsiCo, for example – are difficult to trust.
In the spring of 2019 I decided that I needed to stimulate some fresh thinking. I needed to encourage an injection of new ideas that were deliverable, but that were not held back by the ‘computer says no’ approach shown by many of our health establishments.
Taking this into account, I set up a small independent commission, on a shoestring budget, to answer a simple question: How do we halt the rise of type 2 diabetes over the lifetime of a single parliament?
I was advised not to do it this way, simply because many people think it’s impossible to achieve, such is the degradation of our food supply. Yet how long are we going to leave it before we finally admit the game is up?
How many more millions of lives do we want to see blighted before we address the root cause of type 2 diabetes, namely our national diet?
How long before we confront the big food conglomerates and their army of lobbyists to say that enough is enough?
The high prevalence of processed foods and sugar-laden products already means that one in three pupils is leaving primary school overweight or obese, and that more teenagers than ever are being diagnosed with T2D.
I want to include type 2 diabetes as part of the debate at a general election, and with that in mind I’m hoping that my commission will report its findings in time for the political parties to promise meaningful changes in their manifestos. That’s my hope.
But the complacency found within our health and political establishment does not fill me with optimism. So I need your help. Five million type 2 diabetics demanding Remission for All would do it, I’m sure.
The tragedy of type 2 diabetes is that, if the research is accurate, at least two million of us can rid ourselves of the condition completely with simple nutritional changes, combined with a slightly more active life.
As I discovered myself, when I eradicated takeaways, processed food, refined sugar and starchy carbs – as well as upping my exercise – my blood glucose levels returned to normal, and I no longer needed to be medicated.
As a result of this change in diet and behaviour, my own type 2 diabetes went into remission, and I became physically and emotionally energised.
My experience as a type 2 diabetes sufferer has made me think much harder about tackling obesity-related health problems. The first thing we need to do, I reckon, is to scrap once and for all the ridiculous notion that we all share the same behaviours and the same body chemistry.
Key to my Remission for All movement would be a call to overhaul the ‘one size fits all’ dietary guidelines endorsed by the government. Many of us with T2D need to lose weight, but that doesn’t mean that we should have to follow a standardised eating plan.
This is a simple fact that all doctors and politicians need to get their heads around – I can’t stress this enough – because the current passivity about dietary guidance and treatment plans is killing people.
A single model of wellness is being adopted by health authorities before being applied to everyone, ignoring the evidence that we all have different bodies, with different biochemistry and with different triggers.
Of the people I know who have put their diabetes in remission, the majority have done so by ignoring Public Health England’s controversial Eatwell Guide (the more recent incarnation of the Eatwell Plate).
Don’t get me wrong, it helped me, to a degree, when I was first diagnosed. It showed me that my carbohydrate intake was off the scale and way beyond the ‘normal’ range, which helped me limit (but not eliminate) the rice, chips and bread that had formed the basis of a very poor diet.
Many prominent healthcare professionals have since debunked the high-carb, low-fat Eatwell Guide. They have instead advocated a low-carb, low-sugar eating plan as a means of not only losing weight, but also tackling blood glucose issues, with a view to putting type 2 diabetes into remission.
Having assiduously researched the subject, I carefully chose to follow a ketogenic nutrition eating plan, the principles of which, no matter how they were interpreted, directly contradicted the Eatwell Guide as regards the amount of carbohydrates a person should consume.
But, to me, this regimented diet was a revelation. It enabled me to tackle my sucrose addiction, and it also allowed me to control my eating habits and curb my hunger cravings. The massive weight loss that ensued then liberated me to take up exercise and become more active.
If we’re going to really crack this crisis, we need to give bespoke nutritional advice to diabetes sufferers. We should formulate individual eating plans that correspond to a particular patient’s requirements, rather than trying to be a catch-all for the whole population.
We have to offer customised diets that consider everything we know about nutrition, instead of rigidly adhering to one dietary doctrine that has somehow won through at the top, and is now carved into stone like the Ten Commandments.
Essentially, I believe that we have to ditch the Eatwell Guide as the bible of nutritional advice. I am not saying that it’s always wrong – I’m not saying that it’s always right, either – but I do feel that its dogmatic use by NHS practitioners is often counterproductive in terms of making people better, especially those with type 2 diabetes.
Although abandoning Eatwell might seem a controversial move, I’m pretty sure that most local doctors would be receptive to the idea, particularly if they received training to understand why so many voice their concerns about its inflexibility.
I get the distinct impression that most GPs (and medical students, for that matter) simply don’t receive adequate training in nutritional science, and as such are left wholly dependent on the unyielding orthodoxy of official advice.
During the Reformation, when Christians across Europe rebelled against the Catholic church, one of the major feuds centred around the claim that priests learned the Bible by rote, without understanding a word it said. They could give you chapter and verse in pretty good Latin, apparently, but didn’t really know the story of Jesus, let alone the theology underpinning it.
From my experience, discussing nutrition-related issues with general practitioners feels like talking to a pre-Reformation priest about the Holy Trinity. They know the words they’re supposed to say, but they don’t understand the meaning of it at all.
The Eatwell Guide is loaded with carbohydrates. It advises us to fill up on foodstuffs that are on the ketogenic nutrition ‘banned’ list.
Five years ago, I’d have never suspected that the spaghetti carbonara that I regularly piled onto my plate was one of the worst meals for me to consume. And, what’s more, the Eatwell Guide would have left me none the wiser.
For people like me, with type 2 diabetes, this advice is not just unhelpful; it’s downright dangerous. As far as I’m concerned, telling T2D patients to eat pasta in order to become healthier is like telling an alcoholic to drink vodka because it doesn’t taste like alcohol.
When I shed all my weight, I experienced a host of conflicting emotions. On the one hand, I felt exhilarated to have reclaimed my good health and to have ditched my XXXL T-shirts.
On the other hand, I felt angry and frustrated about the way I’d had to tackle my obesity. I shouldn’t have had to join the dots myself. I shouldn’t have had to ignore my own government’s nutritional guidelines to get myself well.
I shouldn’t have had to feel guilty for putting beautiful grass-fed butter into my coffee. And I certainly could have done without BOGOFs on crappy processed food when I was doing my weekly shop.
And all that was before I witnessed ‘Big Sugar’ firms blatantly targeting young children in the UK, even before they reached primary school. That’s when my anger really turned to rage.
In the previous chapter, I discussed how our choices and options have been engineered in order to push us into obesity and diabetes. We are not solely responsible for the junk food that we eat or the sugary pop that we drink.
It is almost impossible for people to keep the weight off when the system is stacked against them, and I am sick to the gills of tabloids and politicians continually knocking and judging the overweight.
It is not our fault that we have developed type 2 diabetes. Our chances of getting better massively depend on the support and guidance that we are given.
While it may well be within our power to improve our health, our lifestyle and our longevity, this doesn’t mean that the onus should rest on us to do it on our own.
We need food manufacturers, retailers, policymakers and politicians to work together to make it easier for people to eat more healthily and get more exercise.
This is one of the reasons why I think Remission for All is a necessity, as it would encourage a national debate about diet and nutrition issues for those suffering with type 2 diabetes, or those susceptible to the condition.
Sitting behind the current quota of 3.4 million type 2 diabetics, you see, are another million undiagnosed type 2 diabetics. And sitting behind them are over 12 million people who are at risk of the disease. As families and communities – and as a country – we simply cannot afford the personal or financial cost of that potential increase.
It is quite clear to me that we need to challenge those clinicians whose default position is to offer prescription drugs as the first-line treatment for type 2 diabetes patients (as well as those pharmaceutical firms who may have financial motivations for medicalising us).
Indeed, I do believe that we’ve now reached the stage where every GP in the land should receive specific diet and nutrition training, to enable them to offer patient-centred guidance for those diagnosed with T2D.
It is time to adopt a far more holistic approach, and to promote a deeper sense of partnership between doctor and patient.
It is my understanding that many GPs feel tethered to the Eatwell edict, and – for fear of being reported to official bodies, and jeopardising their professional careers – are deterred from offering conflicting advice.
As a result, they are still having to recommend carbohydrate-heavy diet pro-grammes to their T2D patients, promoting the consumption of the very foodstuffs that played havoc with my own insulin levels.
There do exist, fortunately, some forward-thinking GPs who are bucking the trend.
These progressive practitioners are freely advocating low-carb, high-fat diets as a way of preventing and managing T2D, the ultimate aim being to reduce the need for heavy medication and to maximise the likelihood of remission.
Among their number is Southport-based Dr David Unwin, the self-styled ‘Low Carb GP’, who has become something of a legendary figure in the world of diabetes.
His bespoke Low Carb Program has seen extraordinary results, with many of his patients putting their T2D into remission, which, as a consequence, has had a transformational effect upon their lives.
His message is a simple one, based upon simple recommendations that many dieticians would concur with. In order to lose weight and regain their good health, Dr Unwin believes, patients with type 2 diabetes need to cut down on sugary food and starchy carbs and need to increase their intake of leafy green vegetables.
It took the counter-intuitive, revolutionary inventiveness of this pioneering Merseyside GP to demonstrate just how badly carbohydrates affected me, in the starkest of terms.
His team set up a study to examine the glycaemic index of commonly eaten foods (the GI being the level at which food raises blood glucose levels), before converting that figure into its equivalent in teaspoons-worth of sugar.
They discovered that a portion of basmati rice – one of my staple foods when I was 22 stone (140 kilos) – had a GI equal to ten teaspoons of sugar. So, over a lifetime of rice-eating, I worked out that I’d consumed a total of 39,000 teaspoons of sugar, which amounted to 390 kilos of the stuff.
Even more worryingly, this was possibly a conservative estimate. No wonder I spent years experiencing sudden spikes in blood glucose levels.
In 2018, Dr Unwin’s GP practice saved nearly £60,000 on drugs for conditions including hypertension and type 2 diabetes through, in his words, his ‘passion for offering patients the alternative of lifestyle medicine and support’.
His weekly graphs – which demonstrate how his patients’ HbA1c levels are impacted when they link their diet to the glycaemic index – should be the envy of every GP.
I truly believe that his credo is the way forward and, in an ideal world, should be rolled out to every health centre in the country. It works, it costs virtually nothing and it saves the NHS tons of money further down the line.
Best of all, medics like Dr Unwin give people like me their lives back. Yes, I have to make do without my beloved basmati rice, and I’m sorry for the damage this has done to my local curry house’s bottom line, but it’s a price that I’m more than willing to pay.
So we know that the current guidance doesn’t work and that we can do so much better for those with a type 2 diagnosis. We know that people need individual, personalised advice rather than a one-size-fits-all axiom.
And we know that more GPs need to be trained properly in nutritional science so that their patients can benefit from the latest research.
There are, however, other cost-effective measures and technological advances that may be game-changers, insofar as they can improve the health of individuals, and can also save some money for our beleaguered NHS.
According to a good friend of mine, a diabetes nurse, a gadget called a continuous glucose monitor (CGM) represents the greatest advance in diabetes treatment for a quarter of a century. CGMs allow patients to monitor how their body responds to food by indicating which products cause a spike in blood sugar.
If obesity is the air raid siren for diabetes, then a CGM is the radar, allowing individuals to track, in real time, how they react to certain foodstuffs.
These nifty devices are currently prescribed for type 1 diabetics on the NHS, for the obvious reason that they are potential lifesavers. But their capacity goes far beyond that.
In my view, relatively soon they’ll replace the finger-prick testing kits currently used by many type 2 diabetics.
I actually tested out a CGM monitor for two weeks while researching for this book. They’re incredible contraptions, although I had to force-feed myself some chocolate Hobnobs in order to ascertain how my body responded to a sugar injection. Not particularly well, was the answer, although it wasn’t nearly as bad as I was expecting.
What this CGM gave me, however, was the acquisition of much more granular data. Knowing that biscuit X raised my blood sugars to level Y put me in charge of my body, and gave me a certain ownership.
Anyone who has struggled to lose weight and manage their diabetes will know that this feeling of self-control is all too rare during that lonely, difficult battle. But testing the CGM also made me feel somewhat maudlin, to be honest.
It made me feel quite sorry for the 30-year-old me, Tom version 1.0, the podgy bloke with a spiralling sugar addiction. If I’d had a CGM monitor at my disposal following a Friday night of lager and curry – particularly after guzzling a two-litre bottle of Coke the morning after – I’d have experienced a blood sugar spike of Himalayan proportions.
By understanding my own data in these extreme circumstances, I think I might have addressed my nutrition earlier, perhaps even before I’d broken myself enough to develop diabetes.
A fully functioning Remission for All movement would definitely include a call for every obese person to be given a continuous glucose monitor on the NHS.
I reckon they’d only need to use them for a few weeks before they’d begin to comprehend the damaging impact of high-sugar, highly processed food upon their general health.
The CGM might then provide the impetus for these poorly individuals to kick-start a new diet and fitness regime, which could prompt them to lose some weight, alter their lifestyle and ultimately ditch their medication. The NHS (and us taxpayers) would be much better off, too. Yet another win-win situation.
As I write this book, however, I can’t see anyone in power calling for this fabulous piece of technology to be deployed and distributed in this manner. This frustrates and infuriates me.
We are allowing people to get ill, and to ultimately die, because we aren’t being ambitious or imaginative enough about new technology that may arm us in our fight against obesity and poor nutrition.
On Monday 10 June 2019 I hit my eight-stone (51-kilo) weight-loss target, just under two years after commencing my diet and fitness plan. This milestone occurred in the midst of the Brexit crisis in parliament, possibly the most stressful stage in my career to date; I’d never known such pressures of work at Westminster and, as deputy leader, had never experienced so many demands on my time.
Though delighted to have shed every single one of those 112 pounds – I couldn’t quite believe that I’d done it – I found myself being dogged by a deeper, existential question. If I hadn’t lost that eight stone, would I still be alive today?
In all honesty, and without being melodramatic, I think I’ve dodged a bullet. I genuinely do.
Looking back to the summer of 2017, when I ate too much food and did too little exercise, I reckon I was weeks or months away from having a heart attack.
Had I not decided to ring the changes when I did, I think I’d have definitely keeled over at some point. I can’t see how I could have carried on dealing with my chock-full diary and my ever-increasing workload without having some kind of physical breakdown.
I have no intention of returning to that state of affairs, of course. In fact, I’d rather give up my role in politics – which I adore – than lose my health. My life is just too precious to even think about downing a Coke or devouring a pizza.
Speaking of which, toward the end of 2019 I achieved another milestone. I finally hit the ‘unsubscribe’ button on the emails sent to me by my local pizza delivery service.
All those 2-for-1 deals, money-off vouchers and free delivery offers that had seduced me for years were finally consigned to history. For a while I’d just ignored them – I was perversely satisfied by the fact that I had the willpower to do so – but the time soon came for me to delete them for ever.
And, you know what? It felt absolutely bloody brilliant. I live in hope that, one day, there’ll be millions of other type 2 diabetes sufferers who, having transformed their lives through diet and exercise, will also find themselves zapping those fast-food outlets from their inboxes.
I want them to experience that same sense of satisfaction. I want them to be proud of their accomplishments. I want them to go on to live a life free of guilt, and full of joy.
And then I want them to join forces with me in promoting a hugely important message. Remission. For all.
The next (and final) instalment from Downsizing will be shared next Wednesday. Missed the previous chapters? Find the links below
Finally - if you’re enjoying Downsizing, take a look at my new book, Lose Weight 4 Life.
Thanks for continuing to share these chapters.
Remission for all indeed. I haven't had a HBA1C test for 18 months "due to Covid pressures" no doubt. I know that the CGM has been brilliant for my husband with T1 diabetes, but it's not funded for T2's like me in our area. Are the costs of a monitor and test strips and the lancets are the same/similar as the CGMs I wonder..
Well, you're making me laugh now at least x