March 16, 2018

NHS Speech …

Last week, I was invited to speak at an NHS workshop for redesigning diabetes care services within the Morecambe Bay Clinical Commissioning Group. We were also invited as Dia-Beat This! and had 15 participants attending, including four of our five reversees.

Thank you to all who could attend. For those who couldn’t attend, here’s the 15 min speech in text form:

NHS Better Care Together Speech, March 7th 2018

Hello, thank you for inviting me to speak today. I’m Eddy Marshall, I’m a 54 year-old television director and also the Co-Founder, along with my wife Claire, of Dia-Beat This! which is a Type 2 diabetes reversal project.

I didn’t set off to become a diabetes reversal activist. Like a lot of things in life, it was something that just kind of happened.

In January 2015 I was diagnosed with Type 2 diabetes. Although I was overweight and had been for a good few years, as I was also reasonably fit and have no family history of diabetes, so I was quite shocked to learn I had Type 2 and it was already, in the words of my doctor, quite advanced. My HbA1c had come back with a reading of 10.0. Claire and I have a six year-old son, who was 3 ½ at the time. I’m quite keen to see him grow up, maybe even have kids of his own one day.

Anyway, when I asked my doctor about the possibility of reversal, I was told that for someone of my weight, that this was very unlikely. The actual words used were, ‘I’ve never seen anyone reverse it from where you are.’

I was told that I had a ‘lifestyle disease’, with the implication was that I’d brought the diabetes on myself, although I wasn’t asked any questions about my lifestyle or my diet. I was basically told to go home and take the medication and that I’d be on medication for the rest of my life.

I didn’t accept the doctor’s opinion that my situation was hopeless. I read up on Type 2 reversal, I changed to a low carbohydrate diet, and by May of that year I’d lost 50lbs, very easily. I had also effectively reversed my Type 2. A year later, I was signed off, with no signs of diabetes. Despite some fluctuations in my weight, I’ve maintained that reversal ever since.

I think controlling or reversing Type 2 through diet is actually pretty straightforward, for most people. I certainly didn’t find it all that difficult. What I find interesting and frustrating is that despite certain sections of the press constantly covering diabetes control and reversal, how little this seems to be recognised, or even as far as I can tell, even discussed in medical circles. The September 2017 edition of the British Medical Journal that placed diabetes reversal on its front cover was notable in just how unusual it was.

So, being a filmmaker, I started making a documentary on Type 2 reversal, and in the course of creating that film, in late 2016 Claire and I began setting up educational groups for people with Type 2, to see if the low carbohydrate approach I’d used could work for other people. To date, this has been an entirely self-funded project. We wanted see what would happen and to gather material for the film.

We ended up with four groups, spread all around Morecambe Bay, who did a 16 week Type 2 reversal course between January and May 2017.

From that first group of 35 people, we have already have five full reversals and, we think, more on the way.

We have 15 of the people from our groups here today. There are four people here today who’ve reversed full Type 2 diabetes (myself, Cliff, Phil and Simon) and two more who’ve reversed their pre-diabetes (Mark and Ivan). Over the course of the day, please do ask all of them about their experiences. They’ve all done amazingly.

Our criteria for reversal, by the way, are very stringent. If we used the same reversal criteria as the recent DiRECT trial that you may have heard about, we’d be nearly doubling our number of reversals.

Our participants lost a lot of weight, on average 22lbs over 36 weeks. They’ve all improved their health, they’re all much wiser about food and they’re maintaining their changes well.

You should also know that registration on Dia-Beat This! includes the participant’s surgery being informed of the proposed changes in their diet, as this can necessitate lowering doses of sulfonylureas and hypertension medications. We also recognise that a low carb diet is not suitable for all people and informing the participant’s GP invites their input in deciding if low carb is a suitable course for their patient.

All that said, what we’re talking about here isn’t rocket science. It’s not complex. I can explain the basic facts of Type 2 control and reversal to anyone in about 30 minutes. Actually, that’s five minutes for me to nail their feet to the floor and 25 minutes to explain the process.

But the starting point for all this means questioning a lot of the current advice on Type 2 and on diet.

For example, we discard the ‘Eatwell Guide’, that tells everyone to obtain one third of their daily calories from carbohydrates. Plenty of people in this country have become ill doing little more than follow official dietary guidelines.

We question the usefulness of the DESMOND diabetes education course, which echoes the carb-heavy ‘Eatwell Guide’ and doesn’t mention the possibility of Type 2 reversal.

And any official comment which dismisses out of hand even the notion of Type 2 reversal, or the possible benefits of a low carb diet in addressing diabetes, has to be ignored.

So, after pushing all this to one side, what can we see?

Well, for one thing, a lot of gold-standard, peer-reviewed science that shows that a low carb diet is of markedly greater benefit to health than a low fat diet, or even a low GI low calorie diet.

We’re also left with a considerable body of anecdotal evidence that people can and frequently do reverse their Type 2 diabetes. I know anyone here from a science background will, very likely, think of anecdote as completely worthless.

Now, I greatly respect science. I have to. I wouldn’t be standing here today without the benefit of medical science, nor would many millions of other people.

But I don’t love dogma.

There are definitely situations where anecdote, especially anecdote that is so consistent and so routine, ought to be taken very seriously and studied for truths that may be hard to ascertain by other means. And stories matter. Truthful, emotionally resonant stories can be very, very powerful motors for initiating positive change.

All this aside, the main thing we’re left with is hope. Because all current advice repeats the same mantra – that Type 2 diabetes is invariably chronic and progressive. This does not have to be the case.

There is hope for people with Type 2 and people with this disorder ought to be given the information they need to address, control and sometimes reverse it.

And remember, this isn’t theory, we know this is possible because we’re doing it. We’d like that possibility to be offered to more people.

Of course, not everyone will want to change his or her diet, or his or her lifestyle, and that’s absolutely fine. No one should be shamed for anything they choose to do, or not to do. However, we believe that people with Type 2 should be offered a choice – and I’ll return to that in a minute.

What are the implications of Type 2, in this area? How best can we use what are, in real terms, diminishing resources?

This next section is from one of our Lancaster participants, Mike, who can’t be here today but wanted to share his experience of changing his health:

‘In the past 12 months I have reduced my Hb1AC to a good level and kept it there for 12 months. At the same time I have completely come off medication, in this case Metformin, when at the time I joined the group I had been told to increase it.

In my eyes this is a significant success that can be attributed to the lifestyle changes made during the Dia-Beat This! group sessions – namely, changing to a low carbohydrate diet and the consequent weight loss, to monitoring changes to blood sugar levels and increased exercise.

One essential key to the process was to monitor the changes to my blood sugar on a regular basis. This helped me determine what was affecting my blood sugar and enabled me to make changes with solid factual information. Without the monitor and test strips, I would have been blind to the effects of the changes I was making.

The biggest issue I had was getting test strips supplied, essential to monitor changes – although I could have had an endless supply of Metformin!

My doctor was somewhat supportive, my diabetic nurse less so.

Today, 12 months on, I am controlling my condition well and continuing to make improvements. Even so, my recent visit to the diabetic nurse resulted in another refusal to provide test strips.

So, the current NHS approach is one of not helping me continue to remain healthy, despite consequence of my failure being an increase in health costs to support ulceration, sight loss, amputation, etc.’

The practice of ‘medicate and park’ isn’t working. It’s doing nothing to stem either the increase of Type 2, or to push existing cases back towards remission. And how could it, when the possibility of remission, or reversal as we prefer to think of it, is so little recognised or accepted?

I’m going to offer one idea that might be very useful: Many people have a greater interest in and capacity for positive health changes than is generally recognised.

Some of you may have heard of Dr David Unwin, a GP who practices at Norwood Surgery in Southport.

For those of you who haven’t, Dr Unwin is quite famous in some sectors of the diabetes community for his pioneering work in reversing his patients’ diabetes, using a low carbohydrate diet. He’s been featured on TV several times and in 2016 his approach was recognised with the ‘NHS Innovator of the Year’ award.

This began in 2012, when David had a patient walk into his consulting room that he just didn’t recognise. The reason he didn’t recognise this patient was that she’d lost a lot of weight – and, as it turned out, she’d also reversed her Type 2 diabetes.

David was fascinated by this. In 25 years of practice, he’d never encountered even the idea Type 2 reversal before, let alone a living example.

So, he quizzed this patient and was told that she’d discovered an online forum on low carbohydrate diets and tried it for herself, with remarkable results.

David decided to trial this approach at his surgery, out of hours. He invited patients with Type 2 to give the new low carb diet a try. They did – and it worked.

And this brings us back to the issue of choice.

I’ve had the good fortune to meet David several times, along with his wife Dr Jen Unwin. David was the Guest of Honour at our first Dia-Beat This! Celebration event in May last year, and I’ve interviewed him on camera, as part of the film I’m making.

This is a direct quote from that interview:

My question was: ‘Part of the reason we’re speaking today is that, perhaps uniquely among British GPs, when passing a diagnosis of Type 2 diabetes, you give patients the option of controlling or reversing the illness with dietary changes, rather than just putting them straight onto medication. What is the patients’ typical response to this option, when it’s offered to them?’

Dr Unwin replied: ‘It’s really interesting. For the first 25 years of my medical career, I never asked patients what they thought about going onto lifelong medication. But if you ask them, if you ask people, it’s not what they want. So now, for the last four years, I’ve asked every single patient about this and given them a choice. I’ve given them an option – are they really interested in trying diet seriously, or maybe medication, which would they prefer? And every single patient, for four years, that I’ve given that option to, every single one, has opted to try diet first.’

Dr Unwin immediately went on to say that this approach, of offering a low carb diet and its consequent improvements in health was, as of 2016, saving his practice around £38,000 per year in diabetes medication alone. I probably don’t need to add that this is a recurring saving, due to the lifelong nature of Type 2 treatment.

So, right there we have a combination of a low cost form of dietary therapy that delivers potent health improvements and leads to major NHS cost savings and most importantly, leads to significant improvements in all key wellbeing indicators.

To help people reverse their Type 2 through diet, the NHS infrastructure is in place. All that needs to change is the information.

To wrap this up, we at Dia-Beat This! believe that the way forward has to be about diet, it’s about patient choice and, most of all, it’s about giving patients the necessary credit for their own intelligence and recognising their ability to determine, for themselves, the course of action which is their own best interests.

And if the patients’ choice is for dietary therapy, the information needed to support that choice is actually fairly straightforward. No one needs to go on a stringent fasting diet that needs close monitoring and it’s not about socially prescribing exercise either, what’s needed are simple but profound changes in thinking and in diet.

I would love to see the Morecambe Bay CCG to become the first in the county to halt the rise in diabetes and maybe even start pushing it backwards.

This might sound a naïve ambition but there are other people trying to do the same thing.

I’m in touch with former advertsing man Dan Parker and Dr David Cavan, the author of ‘Reverse Your Diabetes’, a book which quite simply saved my life, who have a project called ‘Living Loud with Diabetes’ and who are presently working towards to implementing a diabetes education and reversal programme in Brighton.

My own feeling is, when faced with a continually advancing health threat like Type 2 diabetes, doing the same old things isn’t enough.

Something more radical is called for. We believe that better education, with a focus on Type 2 control or reversal though diet should be, has to be, the key.

It’s a terrible cliché to close a speech with a quote from an eminent figure but I came across one that I found it hard to resist.

This is from Professor Christiaan Barnard who, as I’m sure you all know performed the first ever human heart transplant in 1967. He was quoted as saying,

‘I saved the lives of 150 people through heart transplantations. If I had cared about preventative medicine earlier, I would have saved 150 million.’

As you might guess, I could talk and talk and talk some more on this subject but there isn’t time today, so if anyone would like to speak with us further, please do.

Thank you.’

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