Public Health Collaboration Annual Meeting 2024
In a nutshell
Type 2 Diabetes is not a disease, it’s a symptom of chronic malnutrition
Dr. David Unwin has eliminated symptoms and medication with a low carbohydrate diet
Dr. Ken Berry and Eddie Abbew are, respectively, revising dietary guidelines and teaching kids about the value of nutrient-dense real food
The Public Health Coalition (PHC) is an organization started by Dr. David Unwin, an English GP who has eliminated Type 2 Diabetes (T2D) in many of his patients. I’ve written about his work before. I attended the PHC 2024 annual conference and summarise here what I observed and heard there.
Remembering those who were taken
This was a theme introduced by Dr. Ken Berry (kendberry.md on Instagram) at the beginning of his talk. It highlights just how normal now it is to accept that people die from a poor diet. We’ve forgotten that lives are taken by following contemporary dietary and medical advice.
Ken’s objective is to make a change. Since I changed my diet in 2017 to stop the progression of heart disease, I’ve deliberately tried not to become frustrated or angry by how my health was damaged by the dietary and medical advice I followed. Nevertheless, I’m glad that he did what he did at this conference. More people do need to wake up to the individual dangers of industrially processed food ingredients. If getting pissed-off helps with that, then all to the good.
Conference attendees
The people attending this conference are the sorts of (older) people you might expect to see at a weekend Farmer’s Market. They were mostly in their 40s to 60s, mostly (60% to 70%?) women, informally dressed, outwardly healthy looking, and middle class.
I’d guess that the attendees were there for a couple of reasons. Many use it as a support group. Some of the speakers and attendees appear to have had a tough time with food addiction, obesity and T2D and readily shared how this group has helped them. The other reason appears to be ongoing education. I’m in that latter group.
Type 2 Diabetes
What is Type 2 Diabetes and what is its cause?
This was the major theme of the conference and it was led by David Unwin. He pointed out that T2D is not a disease, it is a state of metabolic dysfunction caused by malnutrition. Unfortunately, we treat it as a disease by administering insulin, despite knowing since the 1960s that it is a condition caused by too much insulin…!
How can we diagnose early, treat, and maintain good health?
It’s important to remember that T2D is a late stage diagnosis that is preceded by a very long period (years?) during which the symptoms of poor metabolic health can be identified and potentially fixed.
One powerful way to identify developing ill-health is with a continuous glucose monitor (CGM). The CGM allows the user to identify changes in blood glucose after eating food. They can see if a particular food or drink causes their blood glucose to rise above a safe level and for how long. This is important because it is believed that a rise above a safe level of blood glucose for as few as six hours may be enough to damage the (glycocalyx) lining of blood vessels. The CGM, therefore, gives the user a tool with which to identify and avoid unhealthy carbohydrate foods. In this way, the CGM is a more useful tool than the popular HbA1c 3-month average measure of blood glucose. Dr. Unwin advocates for the Freestyle Libre CGM.
Blood insulin should become a routine diagnostic. You may recall that blood glucose may not be high because our bodies constantly produce insulin to keep it in a healthy range. However, when insulin is kept high trying to control glucose, insulin resistance and chronically high insulin results, and those may lead to various types of ill health including T2D (Figure 1).
Figure 1: Chronically high insulin and insulin resistance from eating high carbohydrate food leads to “chronic disease”
Maintenance of healthy blood glucose and insulin is the holy grail of T2D reversal. Many patients have improved their health but struggled to maintain a healthy nutrient-dense diet. I suspect proper support has a huge role to play here.
Education
Support begins with educating people about the dangers of consuming industrially processed food. People stopped smoking when they understood how truly unhealthy the habit was.
One group of people can have an enormous impact of patients’ views of nutrient-dense food. Doctors, and GPs in particular, should be given more information about the harm caused by seed oils, processed carbohydrates, and refined grains. One significant step in the right direction will be revised dietary guidelines.
Dr. Berry is forming a group called the American Diabetes Society (ADS). The ADS will issue dietary guidelines that correct the mistakes of the American Diabates Association (ADA) in their guidelines. The latter continue to advocate for a carbohydrate-rich diet and treatment with insulin if T2D develops. Thus, despite knowing for 60 years that T2D is caused by too much blood insulin, the ADA recommends insulin therapy.
One of the panels discussed alternative names for T2D that communicated more of the reality of the condition. Two of my favourites were “end-stage insulin resistance” and “carbohydrate toxicity syndrome”
Finally, there is an important role for support groups to educate and help with maintenance. The PHC itself offers such support regionally through their Lifestyle Club. I met members of that group and found them to be very friendly, approachable, knowledgeable, and willing to help.
Government policy
Two broad themes emerged from various discussions. Firstly, there is value in providing doctors with financial incentives to treat patients with nutrient-dense food and get them off medication.
Secondly, the food provided in schools and hospitals should be based on nutrient-dense real food and not the currently high content of industrially processed ingredients.
Types of Diet
A strong message I agree with is that we have become too focused on diet type and have lost sight of the need to consume real food. A focus on real food to which we are naturally adapted removes us from the destructive and pointless arguments around things like vegan, vegetarian, omnivore, paleo, low carb, ketogenic, and carnivore, for example. It also serves to remind us that there is no such thing as a universally appropriate diet. We are all quite different and should identify the nutrient-rich natural food that is best for us personally.
People at this conference tended to discuss things like real food, low carbohydrate, ketogenic, and carnivore. Dr. Anthony Chaffee (anthonychaffeemd on Instagram) showed an interesting graphic which I’ve tried to reproduce below (Figure 1). It shows that low carbohydrate, ketogenic, and carnivore are subsets of real nutrient-dense food and represent increasingly restricted sources of carbohydrate.
Figure 2: Low carbohydrate, ketogenic, and carnivore diets are all subsets of nutrient-dense real food
Mental Health
Two speakers spoke about various aspects of mental health. Dr. Iain Campbell suffered for years from bipolar disease before he discovered the ketogenic diet and Dr. Rachel Brown (carnivoreshrink on Instagram) is a practicing psychiatrist who cited numerous case studies showing the use of the ketogenic diet in reversing mental health issues.
Campbell’s story of overcoming debilitating bipolar disorder is inspiring. He is now engaged in clinical research.
Both speakers mentioned the 100-year history of using the ketogenic diet to treat childhood epilepsy. It has been shown that after two years on the ketogenic diet, some patients can be taken off medication and never have another epileptic episode. In other conditions, it has been shown that symptoms are reduced after just two weeks on a ketogenic diet. Unfortunately, in one case study cited, it was observed that months of symptom reversal under a ketogenic diet, were stopped by the patient eating root vegetables as part of a traditional roast beef lunch.
Finally, an association between forms of mental health, heart disease, T2D, and weight gain have been found.
Microbiome
The microbiome was discussed briefly by a number of presenters and panelists, often dismissively. The best point was made by Professor Benjamin Bikman (benbikmanphd on Instagram). He believes that we are at the very earliest stages of our gut microbiome knowledge, that its study increases human health research complexity by many orders of magnitude, and it is presently impossible to understand. Therefore, we should continue to conduct basic research into its function but it is still too early to manipulate it therapeutically to affect human health. It is presently a very low yield thing to worry about.
I mostly agree with his position. I think certain foods are good for my gut microbiome (e.g., fermented food and plant fibre) and I consume them for that reason. However, I’ve recently concluded that our present lack of knowledge means that most proposed therapeutic manipulations of the microbiome carry significant risks to human health.
Making cooking cool again and empowering the family
One of my favourite speakers was Eddie Abbew (eddie_abbew on Instagram), a former competitive weightlifter turned advocate for cooking and eating real food. It’s an understatement to describe his approach as unconventional…his lack of respect for the status quo is hilarious. Consequently, I suspect, his Instagram following amongst young people on Instagram is enormous. If anyone can make cooking cool again, Eddie Abbew can.
Summary
My primary objective in attending this conference was to find out more about doctors and diagnostics I can use to help assess the state of my heart disease progression. I achieved that and will report separately if they turn out to be useful.
My secondary objective was to learn more about metabolic disease generally. I also achieved that and have summarized what I learned in this article.
I take away three compelling messages. David Unwin has shown repeatedly that metabolic dysfunction, at least T2D, is malnutrition not a disease, and it can be reversed with low carbohydrate nutrient-dense food. His case studies provide the evidence needed to convince people like me and act as the basis for Ken Berry’s proposed new T2D food guidelines under the ABS. Finally, and maybe most importantly, Eddie Abbew is going to teach our kids how important it is to eat nutrient-dense real food.