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The Energy Reboot Blog

by Moira Newiss

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A New NHS Prescription To Reverse Metabolic Mayhem

A couple of weekend ago I was at the Public Health Collaboration conference in London where the leading lights in the world of metabolic health met to discuss how to reverse chronic disease with lifestyle medicine. It is an annual event; each year amazing presentations are given by researchers and practitioners who are challenging our assumptions about chronic disease; demonstrating it doesn’t have to be progressive and can potentially be reversed. From diabetes to obesity to depression and bipolar disorder, new scientific understanding is helping us understand that many of the same biological processes are at play but result in different symptoms.

You might think that sounds farfetched, but inflammation and hyperinsulinemia (which is raised insulin levels) are two of the key mechanisms that are involved in all of these conditions. The work of practitioners like Dr David Unwin, a GP in Southport, has shown that lifestyle interventions, in particular diet, can make a huge impact. He has reversed diabetes in 140 of his patients and saved £70,000 in prescriptions by getting his patients to adopt a low carbohydrate diet. He does this through his usual 10-minute GP appointment plus a support group that provides education and allow his patients to come together to learn how to change what they eat.


A researcher at Edinburgh University, Dr Iain Campbell, an international expert in the field of bipolar disorder, has discovered how the right nutrition can help to manage and even reverse the condition. He accidently worked out how he could resolve his bipolar symptoms when he tried to lose weight with a low carbohydrate diet. He has since gone on to lead trials and has recently been part of a team to secure a £4million grant to develop a metabolic hub for mental health at Edinburgh University which will support further research and work out how to deliver practical solutions to implement lifestyle interventions. He speculated that hyperinsulinemia may adversely affect the production of energy by mitochondria in the brain and has recently published the results of the first trial of a low carbohydrate diet for bipolar disorder. Many people didn’t want to stop the diet as their symptoms had improved so much.


I myself am a metabolic health practitioner, helping people to reverse health problems like obesity, diabetes, heart disease, chronic fatigue and mental health conditions. But I also spent 20 years as a senior manager in the NHS. In those 20 years I witnessed the continued epidemic of metabolic health problems creating unprecedented demand that NHS resources simply couldn’t cope with. We applied all kinds of innovative solutions to redesign and transform services so they could become more efficient, and this helped a little. But, sadly, we did not manage to make services more effective at reversing chronic disease or provide any significant level of high quality evidence based lifestyle interventions. Yes, there are small pockets where this is happening, but it is not being adopted at scale, certainly not enough to turn the tide. In part this is due to guidelines which are designed to prevent harm but which have the result of stopping practitioners going beyond the basics. Many of the guidelines are based on clinical trials and many practitioners feel that they aren’t applicable in a real-life clinical setting. For example, asking a patient to adhere to a calorie controlled diet might work in short term clinical trials but it makes people miserable and hungry, making them rely on will power and potentially leaving them deficient in nutrients. In practice professionals with a knowledge of lifestyle medicine know that a nutrient dense low carbohydrate has a better long term clinical impact and patients like it and can sustain it given the right support.


The NHS still adopts the Eat Well guide as the gold standard for what we are supposed to be eating, known in the metabolic health world as the Eat Badly Guide. This might sound funny, but it is shocking. Anyone working in this field knows that suggesting that someone with diabetes or obesity eats the Eat Well plate means simply that they will get worse, they also know that if someone adopts a low carbohydrate diet they will likely get better. For goodness sake the Eat Well guide even includes ultra-processed food! The public are not stupid, everyone knows ultra-processed food is bad for you. Perhaps this might be why diabetes is still talked about as a chronic progressive illness, it is of course if you eat badly! But if you eat nutrient dense low carbohydrate food like nature intended us too then you get better blood sugar control, lose weight and potentially stand a good chance at reversing your health problems.


The problem with our chronic disease record is not a secret, everyone knows there is a problem. What isn’t known is that there is quite a simple and cost effective solution - providing a lifestyle prescription! We have moved some way towards this with social prescribing including exercise which of course this helps. The government acted to bring in stricter legislation on smoking which brought big benefits. But diet is the biggest problem relating to poor metabolic health and chronic disease which needs tackle urgently and research has proved that you simply can’t outrun a bad diet. Diet needs to be the foundation for lifestyle change.


I’m calling on our Government to implement nutrition on prescription, the right kind of nutrition, a low carbohydrate approach, and the support to help make change behaviour and create new healthy habits. In addition, we need government action to tackle the problem of ultra-processed foods just like they did with smoking. If this happened, my bet is that we could turn around the Titanic that is the NHS and set it on a new course to avoid the current course that has been set for a metabolic health tragedy. We all desperately need and want the NHS to stay afloat, there is so much going for it, our NHS staff save lives and provides an amazing service when we need acute care. If we had a metabolically healthy population the NHS demand will rebalance and it can focus on what it does best. Its not rocket science, it just needs visionary leadership from people who understand how a nutrition prescription can be implemented to best effect and deliver us a society with the best quality of life.


What exactly needs to happen? I would say that in addition to nutrition on prescription we also need to tackle the food industry. The food environment has change massively over the past 70 years. Food processing was only invented during the second world war to help feed our troops overseas. Since then it has become a multi trillion dollar business and it is making us sick. The day before I went to the Public Health Collaboration conference I was at the International Food Addiction Consensus Conference where world experts gathered to agree how best to persuade the world Health Organisation to include food addiction as a diagnosis. They agreed to petition the WHO to ask for Ultra-Process Food Addiction to be made a medical diagnosis. Ultra-processed foods are food-like substances, they are not real food. They go through an industrial manufacturing processes that you cannot replicate at home, combine high levels of sugar and fat as well as many additives often with chemical sounding names that would be better in a chemistry experiment. The food companies making these products spend millions of pounds formulating them to hit the ‘bliss point’, the exact combination of text and flavour that makes you want to eat more of them. We need the UK government to take action too to limit the sale of these foods, to tax them appropriately and to put health warnings on them.


We need to usher in a new era of lifestyle medicine. From the top down and the bottom up we need to educate our workforce and our patients about the best lifestyle choices, particularly focusing on what they eat. Food is a confusing world for my people, often having been brought up to think a diet is about counting calories and trying to avoid fat. We know in the real world this doesn’t work and often leads to cycles of dieting and weight regain because metabolism is depressed. In addition, it can lead to nutrient deficiencies and of course it isn’t sustainable as you can’t cut calories forever. In the real world we know that cutting out processed food is the best starting point and eating real whole foods that are low in carbohydrates is the sustainable long-term solution to prevent and reverse chronic disease. It sounds simple and it is not radical, but it does means re-educating our whole population and re-educating our professionals, which is a big task. But it would be worth it.


Imagine a world where everyone enjoys good metabolic health and as a result avoid the burden of chronic disease! That’s what the Public Health Collaboration have as their vision. They have already started by running courses for patients to learn how to eat real food. GPs already have access to the RCGP module ‘Type 2 diabetes and the low GI diet’ which is beginning to gain traction and change practice. The PHC is delivering a low carbohydrate course for people with Type2 diabetes through The Lifestyle Club, a 8 week online course delivered by health coaches. This is all a fantastic start but it is just the tip of the iceberg and we need a proper strategy and delivering plan from the NHS to expand this work.


We have a growing grass roots movement of practitioners leading the way. We have thousands of trials of low carbohydrate diets resulting in reversal of many different health conditions. We have economic data showing it saves the NHS loads of money! We have a new profession of health coaches who can help deliver this type of intervention in a primary care setting in person or online. Group coaching can make this an extremely affordable option. Health coaches need to be integrated into primary care services, they don’t have to be in the surgery as they can just as easily work from home. The few GP practices adopting this approach tell me that it brings joy back into their work to see people getting better, coming off their medications, getting back to work and generally having a better quality of life.

Technology can help too, something like 97% of the population have a smart phone and can engage with educational content and health coaching through an App. This allows services to be personalised to show them the most relevant content and enable them to join a health coaching session at a time and place that is most convenient. The UK & International health coaching association has a growing membership of skilled coaches trained to high standards that are ready to launch the lifeboat.


I feel like we are at a pivotal moment in time for the NHS, something radical is needed to change the model of care to enable its survival. The current rise o chronic disease is simply not affordable or sustainable. Where are our visionary leaders at the top of the NHS who care about chronic disease and metabolic health? Will they work with us to find a way to change services and build better solutions? I’d like to challenge our NHS leaders to come for a lesson in metabolic health, to get their management teams enlightened so that they can come on board with the health revolution that needs to happen. We want our health service leaders to help us chart the right course to get us all to a better destination then where we are currently headed, instead please set sail to the port where a long, happy and healthy life is on offer.


I want to know which political party will work with us to deliver better health? Better metabolic health! Which party will look at the evidence with a different lens, listen to those professionals who are reversing chronic disease, be interested in saving money on medication that can be used to usher in a new era of health coaching? I am looking around and all I can see is more of the same.... don't our politicians understand that rearranging the deck chairs on the titanic won't save it from sinking? We want to reinforce the foundations of our health and to do that by starting with eating real whole food. This is not rocket science, but if we keep doing the same thing expecting a different result, it is simply insanity as Albert Einstein told us!


How do you turn round the titanic? How do you find the funding to do this in an already cash strapped system? A good question and a tricky one, I’ve been in NHS management, and I know there is never funding going spare. But if we don’t address our poor metabolic health as a nation our healthcare costs are going to spiral. More staff NHS will burn out and leave making it harder and harder to deliver high quality healthcare in the current model. We know from pilot sites that the savings potential with lifestyle medicine in huge. In one GP practice alone Dr Unwin saves £70,000 on diabetic medication alone compared to the other local practices. That doesn’t include the acute hospital admissions that often happen with diabetes and the complications that come as the disease progresses such as amputations, eye problems, wound care, kidney failure and the need for dialysis. It doesn’t include other diseases that often come with diabetes such as obesity, high blood pressure, cancer, mental health problems etc… Even if we just replicate the diabetes prescription savings across England alone this would yield almost £25million. But the evidence shows the savings could be much greater than this because prescription data shows that for diabetes £14billion is spent on drugs. The figures become mind boggling when you start adding in other drugs like statins which come in at £1.2billion and £1.2billion for blood pressure medication, and yes these too can be deprescribed with a healthier lifestyle. The reality is the savings to the whole health system could be into the trillions.


The cost of the new model is easily going to be less than the savings it would generate. Surely we have waited long enough for what is a relatively simple intervention to radically revolutionise our health service. Could our politicians please step up and call for action to start reversing our metabolic mayhem? Could our NHS leaders put this at the centre of their next NHS strategy. By 2050 we could have seriously different health outcomes, seriously better! I want to see a commitment to a new Nutrition Prescription for the NHS!

 

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