00:04
Hey everyone, it's Mikki here. You're listening to Mikkipedia and this week on the podcast, I speak to Dr. Glenn Davies. He is one of New Zealand's most vocal champions, reversing type 2 diabetes through therapeutic carbohydrate reduction. From rural general practice to a mission hospital in Papua New Guinea, Glenn's clinical journey has been anything but conventional. But it was discovering the power of low carb and fasting, and we talk about how that happened.

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that made him feel like a healer again. Since then, he's helped over 150 patients in Taupo put type 2 diabetes into remission, an achievement that's not only reshaped his practice, but challenged the conventional approach to chronic disease management. Glenn was named general practitioner of the year in 2021 and has just gone on to be involved in and lead research to help

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other GPs along the way and assist them in being able to do the same. In this conversation, we explore what remission really means in clinical terms, the systems that help sustain it and the biomarkers that shift most consistently with a therapeutic carbohydrate approach. also shares insights on the psychology of behavior change, the risks and rewards of keto and the real world barriers to scaling this model across New Zealand.

01:32
We have a frank conversation of the level of knowledge that GPs have to prevent and treat the modern day health crisis that New Zealand, like most countries, is facing and how what they learned in medical school is just so vastly different from the challenges that we have now. And we spend a good deal of time talking about this. Super interesting. For those of you unfamiliar with Glenn, he graduated from University of Otago in 1989.

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worked in a mission hospital in Papua New Guinea for two years and over time went into rural general practice and it wasn't until he went to a conference and heard Professor Grant Schofield speak that the penny dropped in terms of low carb, healthy fat, ketogenic diets and fasting. He runs the Reversal New Zealand Return to Health Clinic in Taupo and links clinicians and coaches

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together in a way that allows for sustainable behavioral change. I have got links as to where you can find Glenn and the Reversal NZ program in the show notes. Before we crack on into the interview, I'd like to remind you that the best way to support this podcast is to hit the subscribe button on your favorite podcast listening platform. And that increases the visibility of Micopedia and it makes literally thousands of other podcasts out there.

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so more people get to learn from the experts that I have on the show, such as Dr. Glenn Davies. All right, guys, enjoy this conversation. Dr. Glenn Davies, thank you so much for taking the time to talk to me. And I actually feel it's a bit remiss on my part that it's taken me this long to reach out for a podcast because I've been meaning to for years. I mean, you are so well regarded with good reason in this, not internationally in the type two diabetes space.

03:26
And of course in New Zealand, and I'm just really thrilled to have this opportunity to chat to you about it. Well, thank you so much for the invitation and yeah, we should have spent a lot more time together through the years, shouldn't we? Yes, I know, right? But I mean, you've had quite a long history, I think, in, I mean, how long have you been a medical, how long have you been a doctor for actually, Glenn? So if you can do the maths, 1989 was when I graduated. So.

03:54
Yes, I should know what I'm doing by now. Well, yes, yes. And as other doctors in the same boat should also know that. you've really practiced like it feels like your career has been very varied, I suppose, over the years from rural New Zealand to like a mission hospital in Papua New Guinea. So I imagine that in your sort of background, you've obviously seen a lot. But of course, I'm interested to know

04:24
What sort of drew you to metabolic health? Or did metabolic health find you? Like, what's the deal? Yeah. Well, it's interesting thinking about that because, you know, 1989 is probably towards the end of that period of time where we didn't really have much chronic health problems or, you know, really a lot of metabolic issues, you know, probably started in the 1980s, didn't it? And New Zealand was a bit behind.

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United States. So I probably started my career when these illnesses were becoming more prominent. And through my career, we've got to this point now where they're at epidemic proportions. And I was thinking about it, it's a bit like boiling the frog, isn't it? It's grown with me during my career. And so you don't really notice something that's happening so slowly like that. Yeah, so that was just

05:24
sort of an interesting observation I had this morning. I've grown up with chronic disease. Yeah, but your question, what drew me to it? So one event that happened was a patient of mine, Wayne, he came into my room between clients and he told me that I was not using a swear word on your podcast, useless, with the swear word before it. And he suggested that

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I should occasionally do some reading, which was a good suggestion. And he dumped six books on my desk. So one of them was What the Fat by Professor Grant Schofield and Karen Zinn. And the other one was Jason Fung's The Obese, oh sorry, The Diabetes Code. Yeah, The Diabetes Code. So he's also done The Obesity Code, both brilliant books. And those two books had a profound impact on me.

06:21
And then very close to that time, I heard Grant Schofield lecture at the GP conference in Rotorua. And he suggested this entirely new concept to me that diabetes could be reversed. It was the first time that I even heard that idea suggested. We're talking type 2 diabetes, of course. And it was profound. But the thing that really impacted was

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The lecture I went to immediately afterwards was from a bariatric surgeon who said diabetes can be reversed. so I heard these in two consecutive lectures, a concept which was brand new and I'd never heard before. And I went, I've got to find out more about it. And so those three events, I think, was what changed something for me. And when I think about it, I was completely brought up in this

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infectious disease model or the GEM theory. That was just what I was taught. That was everything that I was taught. And the pharmaceutical model, a pill for every L, that's just what I grew up in. And then I started getting this discontent and I started asking my mentor, you know, as a GP, what do we actually do? And do we actually achieve anything? That was, I guess, the starter questioning period.

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And then this challenge that came from Grant, the bariatric surgeon, my patient Wayne. And then this period of, actually don't achieve anything substantial in my day. I have good fun. I have all these conversations with people, but do I actually truly make a difference? The realization, no, actually I'm not doing anything substantial. And that birthed this whole

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journey of we've got to do things differently. The model has to change. We have some new understandings, some new tools, and a whole new approach to this new spectrum of disease that didn't exist before 1980. And we're still using these models which are no longer fit for purpose. So we need a whole revamp of the entire system.

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I think these concepts of insulin resistance and carbohydrate restriction are really the keys to redesigning our health system. Yeah, super interestingly in hearing you reflect on your practice as a GP, like I often wonder, well, when I wonder like how many clients or patients go into their doctor's office with resources like that, that might just be dismissed by the person that they're giving it to. So it takes a certain type of person to not

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be too offended to have that interaction with their patient, but then actually look further and explore. Not everyone, I think, would do that. And I know this from the clients that go in that I have to their GPs who are absolutely dismissed out the gates on any ideas that they bring to the table. It's just not even a conversation. Obviously, that's not all GPs. hopefully, you know I'm not suggesting that.

09:46
Like the majority of patients that you might have seen, because I always want to, how do GPs keep all of this information in their head to see all of the variety of people with their problems? Well, we don't make you, we've got chat GPT. Oh, thank gosh. I know. It is a whole lot easier. I totally agree. But were the majority of people you were seeing, were they actually presenting to you with similar problems, like with metabolic health related issues?

10:15
Yeah, well, it's changed like I was alluding to before. We virtually only saw infectious diseases and injuries, didn't we? And that's quick and easily fits into this 15-minute or 10-minute consult, or back in the UK, 12 and 1 1⁄2-minute consult, or six-minute consult. But it fits into that. Now you're dealing with these complex chronic conditions that you can't manage in those short

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period of time and they need a whole new approach. Just back to your comment, Wayne has an IQ of about 160. So I think that's why I actually listened. You know, I really listened to him. mean, you know, it's pretty hard to formulate a strong argument with someone with an IQ of 160. I better actually do as he says. I really like that. That's nice. Hey, I don't know if you remember, but I'm interested to know

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what the vibe in the room was when you sort of heard Grant say it's reversible type 2. Because you have gone down quite a different path to a lot of your colleagues clearly. was that a, you might not recall, but was there a potential sort of feeling in the room of, yeah, this guy's onto something or no? No, I think he was just viewed as a bit out the gate.

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So no, I think I might have been the only one that went up and spoke to him at the end of the lecture. So no, I think it didn't impact. But we're talking, I think we're talking around 2016. And if you think about, know, What the Fat, for example, it was one of the earliest books. And Grant and Karen have been talking about this.

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when people didn't even understand what a carbohydrate was, I think. Now when you're having this conversation with people, virtually everyone will say, my daughter has done keto, or my uncle's on a low carb diet, or I've been following someone online. You're no longer having to introduce the idea. So the other thing that happens is

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GPs have been brought up in this pharmaceutical model and this germ theory model. Anything which contradicts that is considered to be unworthy, isn't it? nutrition is not really considered powerful. Supplements are not considered powerful. Herbal medicines are disregarded. Unless it's backed by pharmaceutical studies and part of guidelines, it's largely dismissed by

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standard medicine, but I would challenge that because what we're doing is not working. So we need to really be looking at a whole new approach. And I like the idea, starting with the idea, I know nothing about this topic. That really encourages you to learn. When you go, I already know everything about this. There's nothing more to learn. You're not a lifelong learner in that situation.

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One of the issues with the GPs sitting in the room, they were going, well, I already know everything about diabetes and it's in the guidelines and what Grant's talking about is not in the guidelines, so it must be wrong. Yeah, no, 100%. And to that point, for many years, because I went through the university system with my nutrition degree and then my postgraduate work, et cetera, it almost makes you more arrogant and your blinkers are on even tighter because you're like, I went through the...

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ivory tower. This is where you learn knowledge. Don't talk to me about herbals or my previous, my practice husband's brother, actually. He was into Mark Sisson and Mark's Daily Apple and Primal and Paleo well before I'd heard about them. He was telling me about them. like, oh, well, that's obviously rubbish. You just get so arrogant when you are, I think, in the system that has

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the holder of knowledge or the holder of truth. And it's not until you, and I think that's harder barriers to break than sort of people who haven't had that background, right? So how do you create a lifelong non learner? Tell them that they're the brightest cohorts that left school and you've given them the best possible education they can have. You've created a lifelong non learner. Tell them that they're not actually that clever.

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and the stuff that we're teaching you, we don't actually know if it's right or wrong. You've created a lifelong learner. And so I think that's one of the biggest issues with medical graduates. They're not incentivized to learn. Yeah, such a good point. We've talked about type two diabetes reversal, obviously, and you said that discovering low carbon fasting made you feel like a healer again. I've seen that written. so one, my question is like,

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When you found this information, did you start practicing it yourself? So first, yeah, like how did it change your own diet practices? Yeah, yeah, good question. Yes, it did. And I'm sure all of us in this area have paid with all of it, haven't we? We've paid with fasting and we've paid with intermittent fasting. We've paid with strict keto because that's really fun.

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I was in the room to be checking your ketones and we've worn continuous glucose monitors. because I don't have any chronic health issues myself, I've ended up in a low-carb paleo sort of space. But yeah, I've definitely played with it. And one of the most fascinating parts of wearing a continuous glucose monitor was seeing my

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I don't have diabetes, but seeing my blood sugars go up close to seven, just getting out of bed in the morning to feed the chickens, you know, that was an astounding fact. Yeah. And in fact, I was speaking to a client this morning about, because she occasionally wears a CGM and she was concerned about the blood sugar spikes from her cardiovascular exercise and from the sauna and from the cold plunge.

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I'm interested, I think you and I are on the same page with CGMs. I think they're so valuable for people for understanding food and stress and sleep restriction. But of course, there's a lot of pushback from people who think that if you don't have type 2 diabetes or of course type 1 diabetes, then the CGMs not, they shouldn't be an option for you. You're actually just creating this orthorexic thinking. I don't agree with that premise. I think

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that with everyone and with what we know of metabolic health in the community, just because you don't have a diagnosis does not mean that you don't have to care about your blood sugar. I love what you just brought up there. know, this idea that everything's fine until you have diabetes. know, and Grant Schofield uses this term. says that pre-diabetes is pre-nothing. You know, it's like we've got to

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recognize insulin resistance and recognize that insulin resistance is a problem. I think we should get rid of this whole name type 2 diabetes. think we need to rename it. I'm happy to do that with you right now. we need to be calling it insulin resistance. We need to be calling it compromised insulin resistance. And we need to be calling it something like uncompensated insulin resistance.

18:27
And we need to be recognizing insulin resistance, whether that's ordering a C-peptide and a fasting insulin or using some other method. we need to diagnose that. We need to be putting that as a classification in people's notes. And that's when we need to be intervening. As soon as you have a rise in your HbA1c, as you know, you've decompensated. The body is no longer coping. That is a significant.

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real problem and it breaks my heart to see GPs seeing an HbA1c of 41 or 42 and filing it and not even necessarily telling the client or the patient that that's a problem. And then they come back in six months time and have it repeated and it's gone into the diabetic range and they say, you know, great, now there's something we can do. We can start you on some medicines. That whole process is

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has to change. And I would, if we diagnosed insulin resistance, that whole thing would change. I love the way that you think about that, Glenn, because even another client this morning, and I were talking about her history with her A1C, and she'd gone from 43 to 50 down to 39, and she got herself a CGM and was able to do it. She just said that my, she said her HbA1C was in the

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pre-diabetic quotes range for years, GP never did anything about it. And so she didn't realize that it was an issue until it was 50, because that's when she found out about it. I'm not sure where this sort of concept of like, it's such an arbitrary number, it? That 41, you know? And things just, in that 39, you're sweet, and at 40, you're fine, and 41, you know,

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there's an issue and then we'll file it under pre-diabetes. So the problem is that the pharmaceutical model says unless there's a medicine for it, there's nothing we can do. GPs don't recognise the power of carbohydrate restricted nutrition and lifestyle change. So they're basically just waiting until it hits 50.

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they know what to do because then they have tools. Up to then they don't have tools. Well, they do, but they don't recognize that they have tools. The population knows and many, many people in the community know, but medicine hasn't recognized that we can make lifestyle changes from before the blood glucose starts to rise. And that's what we need to change. this term pre-diabetes,

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has to disappear from our language because the pre, oh, I'm fine. Nothing's a problem. I've got pre. Let's call it insulin resistance, compensated insulin resistance, and decompensated insulin resistance, or organ failure. It's a form of organ failure once you've got diabetes. You have got so metabolically unwell that your body isn't compensating at all.

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It's a big, big problem. And calling it pre, it's like, oh, OK, nothing I have to do. It's a terminology that has to change. Yeah. And you mentioned C-peptide. Is that something that a GP can order? Because I've heard other doctors say fasting insulin isn't as, it's not as helpful as what it could be because, you know, it's pretty labile to change. Yeah. So C-peptide is my preferred test.

22:20
So if people don't know, every time you make an insulin, it's linked to a C peptide. There's a one-to-one relationship. Insulin's a very volatile molecule. C peptide's much more stable. Its only function in the body is to hang around for us to measure. That's not true. I'm sure it does other stuff.

22:46
You know, it's really hanging around in a much more stable form. And we can use that as, I believe, a really practical way of determining if someone has insulin resistance. Now, many doctors believe they can't order it. I've never had a problem ordering a C peptide. Clients aren't charged for it. It's a simple blood test. You do it fasting, of course, if you want to know what the fasting level is. And you do it.

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postprandial if you wanted to know what the postprandial impact is. And sometimes you do actually need to know that. We might be getting a bit technical, but sometimes you are left with asking, does this person have type 1 or type 2 diabetes? One of the ways that indicates that is doing a fasting and then a postprandial C-peptide. And I find that a really useful thing to do. The other nice thing about C-peptide

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is if someone is on insulin, you can measure a C peptide and you're only measuring the endogenously produced insulin, you're not measuring the injected insulin because clearly there's no C peptide associated with what you inject. Yeah, okay. And obviously that we're talking in the context again in type 2 diabetes in that instance. Glen, so do you think then it is valuable for people to

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to get fasting insulin and C-peptide measured, and then also the postprandial C-peptide as well. If people feel they want to explore their metabolic health further because they think something's up. Yeah, it really depends on what the client's asking you. But throwing a C-peptide in as part of your annual check, to me, would be

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the most important test. What do we do? We do renal function, liver function, full blood count, iron, B12, a prostate, a PSA, and a CRP, don't we? What if we just did none of those and we just did a C-peptide? I think we would be picking up the insulin resistance and doing more for that person. So if there was one test to do annually,

25:08
It's gotta be the C-peptide. you know if you can get that on mytests.co.nz? I imagine you could actually. The website where you can just order your own tests. Not sure because I'm lucky I can order them, yeah, yeah, true. I'm sure you can. Yeah, and then are you happy with the parameters that are provided by the laboratories as to what's normal and what's not? No, no.

25:37
They say something like up to 750 is normal for non-obese people, and then up to 1,440, I think, is normal for obese people. clearly, there's an issue there, because the people with obesity also have insulin resistance in many cases. And the two conditions are

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are linked and happening at the same time. So I use 750 as my normal. Okay. Now that's really helpful because yeah, that's because getting the test is one thing and interpreting it is quite another. And of course I would always recommend that people get these kind of tests interpreted with the health of a health professional or, you know, a health coach who obviously works in an organization like yours or a nutrition professional, you know, someone a bit like me and similar.

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Glenn, what do you mean by reversed or in remission with type 2 diabetes? So how do you actually verify that? Is it with the C-peptide? Yeah, I had to actually look up the definitions this morning. I use the term reversed. And what that means to me is that if someone has reversed their diabetes,

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their HbA1c is now less than 50. So it's either in the pre-diabetic or the normal range. And they're off all of their medicines apart from metformin. So that's my definition. Looking it up this morning, it said it needs to persist for three months. I'm probably a little bit slack on that. But that, me, shows they've made significant changes. The term remission.

27:26
I tend to use them pretty interchangeably, but I'm not sure if you're aware of is there a distinction between the two? I think there is, but I've forgotten what they are. And I use them interchangeably. I use the term reversed. And then I talk about reversing pre-diabetes. That's if you've gone from HbA1c of 41 to 49 down to 40 or below. And as you're saying, they're arbitrary, but

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going along with that, there's a whole lot of other changes that have occurred. But I guess by definition, that's the definition of reversed. Yeah, no, that's really great. I think I said this into you in an email that the latest number I had was over 150 topo patients have reversed diabetes. But it's got to be more than that now, right? I don't think you've updated your website. No, I think...

28:21
I think we're at something like 220. Yeah. Yeah, yeah, Now, but just going off track a little bit, if you recall, there was a PricewaterhouseCoopers report saying that by 2040, type 2 diabetes will be costing $3.5 billion per year.

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I just asked CHATGPT to do a little bit of maths on that for me, because I don't have access to a health economist. But it works out that each diabetic is costing $14,000 per year. Now, if you make a whole lot of assumptions here, but if you assume that if you reverse somebody's diabetes, they go from costing $14,000 per year to zero, which is probably not a fair assumption. But if you did do that,

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You multiply that 220 by that number. It works out close to three million dollars per year saved. Now, I'm not suggesting that was done by a health economist. It's really just to create the concept that this actually is saving potentially a lot of money. If you did, if you said that 220 people were pre-diabetic, it's 1.27 million per year. And this is ongoing.

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And that cost zero dollars to create. This was just, you know, one general practitioner with some support from others and a whole lot of clients that did a whole lot of hard work themselves that has saved, let's just say, over a million dollars per year. Why is the government not looking at that and going, OK, we can spend zero dollars and save a million dollars

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per year per GP. Why are we not all over this? To me, that's the big question here. And that's the question I'd be like to ask the politicians. This is good economics. Ignoring the fact that people improve their health, they become empowered, they feel better, they're less likely to get cancer, they're less likely to have a heart attack, they're less likely to get Alzheimer's. Forgetting all of that, this is good economics. Why?

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Why is it being absolutely ignored, particularly here in New Zealand? How do you need to get in front of to ask that question to, Ben? Yeah, I think what we need to do is we need a health economist, not just check GPT to do the numbers, and then we need to present that to any politician who will listen, because it's good numbers. It is, and...

31:12
And I appreciate your frustration because I feel almost resigned to the fact that it wouldn't make a difference who you talk to because for whatever reason, governments never listen. Like, I'm just thinking about experiences in the past where you make recommendations on things like the guideline, like nutrition, as if they care about nutrition guidelines anyway. mean, the government doesn't give a shit really. They do not care at all about any of this. And it just absolutely blows my mind. Like, prove me wrong.

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who in today's government actually cares? Yeah. I would love to be able to sit down with Mr. Winston Peters. I read an article recently where he was talking about his own nutrition. Yes. I think he gets it. Yeah. I understand he's a very busy man, but I think he might listen. So I'd love an opportunity to...

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even have five minutes with you Mr Peters if there was ever a chance. That'd be amazing. That'd be amazing. Anyone who knows good old Winston Peters, him to listen to this episode. That'd be amazing. I know I get a little bit, to be honest, I get a little bit angry and raging inside when I think about the government. Any government actually, not necessarily like this current one or the last one.

32:39
Okay, so back on track though, what are some of the common denominators amongst the people who are successful? Like is there a person that you are in a clinic with and you sort of know immediately this is going to click and help them? Yeah, that's a fascinating question and I don't know because I've done as little as send somebody a text saying stop physis.

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and they've reversed their diabetes. That was the entirety of the intervention. An SMS message from the computer when I've seen their HbA1c stock physis. And that's all that it took compared with a complete health coach supported intervention with monthly HbA1c's. And they both work. And I don't know. I think every client, every patient,

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should have the opportunity to make this change. So they need the information, they need the education, and they need to be offered the support. And what causes somebody to run with it, take it up, take it up full on, or make a few changes, I think is very variable. And I don't think I've identified all those factors yet. But I talk to everyone about it.

34:06
Dr. David Unwin, I'm sure you're familiar with him. He's perhaps one of my greatest heroes. He's a UK general practitioner who almost single-handedly has changed the way that type 2 diabetes is managed in the NHS. So absolute legend. A GP. And all he did was sitting in his office, no sorry, not doing a whole lot more than that, but largely sitting in his office talking one-to-one to people and offering them the opportunity to talk about their diet.

34:36
You know, that's largely what he did. And his stats are 50 % of the diabetics in his practice have reversed their type 2 diabetes, which is really, really good stats. And I just like the fact that you offer people the choice. And when David Amman says he offers people the choice between changing their lifestyle or going on a medicine, he says 100 % of them choose the lifestyle change. If I ask

35:06
If I went into a room of 100 GPs and I asked them, how many people do you think would choose the lifestyle change over the medicine? I bet you they would say 100 % will choose the medicine. The reality in the real world and David Unwin's world anyway, is it's 100 % of people choose the lifestyle change. So there's a huge discrepancy between what the doctors perceive people want and are able to do and what they actually do. So

35:36
I think that the majority of people will choose the lifestyle change if they're offered that option rather than medicine. And about 50 % of them will achieve full remission of their diabetes, which is pretty cool. And those ones who don't, I'm sure, have also made significant changes and are probably on the way. So that's what has to change. We have to offer everyone the opportunity and the support if they want it.

36:05
behavioural change is hard. Not everyone is going to take it up at that time, but everyone deserves the opportunity. And that's all I would ask for that every GP, every health coach, every nurse offers their clients the opportunity to restore their metabolic health. Yeah, amazing. And for what it's worth, Glenn, and I think probably quite a bit, David Unwin spoke very highly of you when I spoke to him.

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about his work as well. So I think you're a bit of a legend in his eyes also. Thank you. said once, I said, sorry, don't interrupt you, but I said, I want to be New Zealand's David Unwin. And when I met with him last year, I said, I'm so disappointed all I've achieved is the same haircut. That's brilliant. mean, you could, doesn't he have a bow tie? You could sort of do that as well. that would be- Would it go well with my sweatshirt? Next level.

37:02
That's true, actually. That is very true. But to your point about the GPs, I just find that fascinating because this is something which I see a lot is that in the framework of our health system or whatever, GPs really have such a critical role because they are the people that the general public look to for information. they are valued higher than the likes of someone like me.

37:31
Regardless of the fact that I specialize in nutrition, I have clients who will second guess what I've told them because their GP who knows next to nothing about this will tell them otherwise. And so I 100 % agree with you that something has to change in the way that the GPs are communicating information and their knowledge is probably going to have a hugely profound effect because that's the grassroots stuff, right? Like we talked about politicians need to get behind this. Well, I mean, they do, but it's actually

38:00
the GPs in the room with the people. Yeah, so let's look at that a little bit. We have a germ theory medical environment. We don't have a host theory environment. That goes back 200 years, doesn't it? Then we have the pharmaceutical industry with a very, very strong influence over medical student training. And then that

38:30
those two things affect the way that doctors think. And we talked about it before, but doctors don't think nutrition is powerful. You and I recognize nutrition as perhaps the most powerful tool we have. It's the chemotherapy of medicine. And in my view, a ketogenic diet, for example, is a hugely powerful, strong metabolic change. Doctors haven't been taught it.

38:58
I think it's six hours of training in a medical degree. And most of that was just the biochemistry of B12 and iron. So we're not taught it. How do we introduce it into medical curriculum, into GPs training, and then get GPs to start thinking in terms of host theory rather than germ theory, and then viewing medicines as your plan B, as your second line option?

39:25
either for the people who aren't ready to change, maybe choose not to, or have tried and they need a little bit of extra assistance. That's the role of medicines. It's not first line, particularly not in type 2 diabetes. And just if I could say this fact, insulin in type 2 diabetes is malpractice. you understand insulin resistance and hyperinsulinemia,

39:55
There are very, very few type 2 diabetics where insulin is going to help the problem. It certainly will lower their blood glucose, but that glucocentric model has got to change to an insulin-centric model. And I would love if we could even get GPs to understand the system that the cell is packed. This is not type 1 diabetes where the cell is devoid of energy and starving.

40:23
This is a system which is over full with fuel. I'm thinking, and I'm sure you can picture the picture too, know, Jason Fung has that model of the Tokyo underground with the underground pushers, the men that are pushing people into the train. I printed out the picture, but you and I know the picture, don't you? The train.

40:53
The train is full of people and then you've got these men that are pushing people in and then the platform is full of people. There's just glucose everywhere. This is not a cell which is devoid of glucose. This is cell that's full. You know, to just push more men there to put more people into the train carriage is not helping the problem. It's compounding it. You know, and that's the issue. Insulin and sulfonylureas, which are

41:20
increasing the amount of insulin are compounding the problem and fixing it is so easy. Stop having physis. Do you need those lollies? Could you just have one tin-tan instead of the whole packet? Sometimes it's really, really simple stuff like that. It's not having to do the full metabolic health education. Sometimes it's simple. insulin is malpractice.

41:50
in 99 out of 100 people with type 2 diabetes. Yeah, that's a pretty powerful thing to say, Glenn. I can't imagine, I do wonder, your colleagues listening to this, who have done exactly what you've just described, how would they respond to that? You know, I think I would be probably taken in front of the medical council, but it's a profound misunderstanding of what type 2 diabetes is.

42:19
Once you understand what type 2 diabetes is, that it's a cell packed full with fuel and packing more fuel into it is not the solution. In Jason Fung's analogy, half those people that are standing on the platform need to work from home today. OK, you guys are not getting on this train. You're not going to the office. You guys can work from home. You've solved the problem, haven't you?

42:47
It's the supply of food, which is the problem. And you don't sort it by insulin. In this analogy, consider two guys trying to push everyone into the train. Let's have 10 solve the problem. No, haven't solved the problem. You've come out with the problem. Yeah. Yeah. And it's so simple the way that you describe that.

43:12
I don't know, it really does baffle me that more people aren't aware of it actually. I think that's my, yeah, it's a little bit. Well, you've got the companies selling insulin who are compounding this problem because type 2 diabetes is this huge potential market for them. If you're one of the top executives in an insulin company, you go,

43:42
Yeah, type 1 diabetes, absolutely. It's a contained market. Type 2 diabetes is expanding extraordinarily. How can we persuade the medical profession that people with type 2 diabetics require insulin? And we've seen that recently. There were ads supporting the use of insulin in type 2 diabetes recently. Another thing.

44:11
Our PHO pays $155 for us to introduce insulin in a new patient. So we're incentivized for this malpractice. There is no money, not a cent, for reversing somebody's diabetes. So we are incentivizing malpractice, and there is no incentive whatsoever to sit down with someone. And it takes longer. It's much quicker to write a prescription for insulin than to talk to somebody about

44:40
insulin resistance, metabolic health, diet, and what do you actually eat? Of course that takes longer. That should be what's been funded. That is super interesting because of course people often talk about doctors being swayed by pharmacy and by the people who are selling the drugs, but in fact it's a systemic thing sort of built into our health system. Yeah, it is. And you know, the pharmaceutical industries, know, the people working in there aren't bad people.

45:10
You know, probably not even the executives are bad people. They're salespeople seeing an opportunity. The level is one step above that. It's this whole germ theory that goes back 200 years and longer that needs to change. Yeah, super interesting. Glenn, I was going to ask you, so what's the minimum effective dose here? But you literally said it before. Hey, stop drinking fizzy's. like fundamental principles for sort of low, like are you, for your

45:40
type two for your clients that you work with or patients? Is it about a therapeutic carbohydrate restriction? Is it like go super low keto? Like what in your mind is sort of like the ideal situation? Yeah, wonderful question. So my answer is you use the coach approach. You meet the client where they're at. You ask inquisitive questions. You find out.

46:09
about the challenges they're facing, whether those are economic or a big family or no time, and you find out what they can do. you know, there will be people who go strict keto, buy a continuous glucose monitor, get a care sense tool, work out glucose to ketone index. Absolutely, there will be people. They're often engineers.

46:35
Absolutely, there are people that will do that and get incredible success, but that's not where everyone is. so often the question is, what's something, what's one thing that you could do? And they might say, it could be as simple as I'll stop the physis. And that's great. And can you come back and see me in a month? And let's see where that's going. Or it could be, I just can't.

47:04
face it at the moment. I've got work pressures, kids pressures, school, I'm not well, I can't do it. And that's absolutely fine. And the answer then might be, well, should we look at a medication in the meantime until things are less hectic? It's meeting someone where they're at. However, to answer your question, I love keto. If a ketogenic diet, which is any diet that

47:34
creates the metabolic changes required to produce ketones. Whatever that might be, I think is the ideal solution for type 2 diabetes. And as a doctor, I love people being in ketosis because I know that they're burning fat and I know that they're changing their metabolism. yes, interesting. What's my view on carnivore for type 2 diabetes? Often, it's hugely, hugely effective.

48:03
and people get extraordinary results. But I think it's perhaps for a short period of time because I do think that the very high protein and gluconeogenesis becomes, eventually becomes an impact. And I like to move people back to keto, is higher in fat and more moderate in protein after a period of time. yeah. Go ahead. Yeah, that makes perfect sense. And I also wonder,

48:33
I can't recall who I was listening to about this, but I'm mindful of older men, particularly having a ton of red meat and the increasing ferritin levels and the potential oxidative stress and cardiovascular disease. I don't know, this is not really into the weeds, but I do think about that with carnivore. I'm mindful of that for people who might be already at

49:02
increased risk for cardiovascular? don't know. Yeah, it's interesting that the one area in this metabolic health discussion that I don't think we've really got the full understanding. I mean, I don't think we've got the full understanding of all of it. By no means is still so much more to learn, but it's in that cardiovascular space that I think we still

49:30
need a bit more understanding. I'm pretty confident with telling people to eat a whole lot more saturated fat. But I think there's still more understanding in the LDL cholesterol, the LDL phenotype, some of these genetic abnormalities that probably impact the LP little a. There's a whole lot of

49:59
stuff there that I think we still, I don't think we can be arrogant in that area. think we can be pretty arrogant in the metabolic health space and the diabetes space. I think we've got that pretty well sussed. think we've still got work to do in the ischemic heart disease area. Yeah, yeah, no, completely. And it's always super interesting seeing different studies come out and people debate them online, but just actually learning.

50:27
more about it. And I've signed up to Ben Bickman's insulin metabolic classroom. And I love like just learning and engaging in that sort of material. Just things like that just open your, I mean, it's all about learning really, being a lifelong learner to your point. So Glenn, I'm interested in, I've got quite a few questions here, but I'm sort of looking at the time and I'm really interested to talk about your

50:55
the whole New Zealand project. Can you give us a little bit of information? I was at a conference last year where Karen was presenting a poster on, it seems like quite a large undertaking that might move the needle a little bit in the ways that we're talking about. So can we just talk a little bit about that and just sort of your role and what it is?

51:23
So this project has been led by now Professor Karen Zinn at AUT University. And it's a three-year implementation science project looking at low-carbohydrate nutrition and type 2 diabetes. The point about implementation science, we're not proving that low-carb nutrition treats type 2 diabetes. That's already proven.

51:51
just a little sideline, not yet in the New Zealand guidelines, despite it being dramatically proven. So anyone listening to us, why is it not? Why is it in the Canadian, the American, the Australian, UK, and not the New Zealand? But anyway, so hopefully part of this will be to at least get that to change. But implementation science, how do you move that

52:20
effective theory into general practices. So year one was looking at and reporting on the science that we already have. So that's the work we've done in Taupo. The work at Tureki Medical Center, that is also outstanding. And also some work in Auckland. So looking at that group and reporting on that, both qualitatively and quantitatively.

52:46
Then stage two was getting about 20 general practices involved and looking at what do you have to do to move that program into general practice. And then year three, is now, so we're still in year two, but year three was how do you roll that out nationwide and make low-carb nutrition the normal way that type 2 diabetes is managed. So that's what that project is. There was a health research council grant

53:16
fund there. And then there's a few little interesting projects that have come out of that. One is called Blue Zone Mango. So Mangakeno is the small community where we have a general practice. So could this little community of Mangakeno become one of the world's Blue Zones? Can you use these public health initiatives in a whole community? So that's one of them.

53:43
And another one is looking at different models of health care. So one of the ideas is, can we use capitation funding so general practices are bulk funded? Could you take some of that capitation? And could you get a cohort of people who are improving their metabolic health for a year? Could you put extra resources into that group? And this coincides with

54:10
prescriptions for long-term conditions are now going to be moved to 12 months rather than having to be repeated every three months. So people who just are happy just carry on taking their statin or their metformin and other diabetes medicines, Jardians, they just get that prescribed once a year and they get invited again the following year. So that's one of those ideas. So a lot of projects that will come

54:40
out of that. Karen said we're probably going to be able to report on the quantitative findings in about two months' time. I think that'll be a significant international publication. That is awesome, Glenn. a lot of what we've discussed is the system and what might need to change in that. And just over the course of the last 10 years, have you seen a significant shift in how your colleagues approach type 2 diabetes with

55:11
the changing information? No, no, no, not in the slightest. All that's happened is the pharmaceutical medicines argument has become stronger. But we've now got better tools. We can use GLP-1 agonists as well as Jardians. We've got these amazing new medicines that are going to change diabetes.

55:40
And the reality is, no, they're not. I could be proven wrong, but the approach is wrong. This whole topic of the GLP-1 agonist is really fascinating. But when has a medicine rather than a lifestyle approach made any significant difference to type 2 diabetes? And why do we think this one will be different? I believe this is the false promise of medicine.

56:10
Medicine has repeatedly given these false promises and each new medicine comes along with all the hype. This will be the solution. This will be the solution. And when you've watched that through a 30 year career, you're going, no, I just don't believe it. It will win. I might be proven wrong. And I think if we use these GLP agonists intelligently and they're coupled with lifestyle change, absolutely. But just

56:39
going in, getting a prescription and leaving again with nothing else, I think it's going to be a recipe for failure or at least a recipe for needing to use them for the rest of your life. Yeah, no, 100%. And I guess to your point, that whole lifestyle prescription, like that can't occur in a clinic that has GPs with, what did say, eight minutes? Was that as long as you've got basically? I know it's an average, but.

57:04
15 minutes. There you go. Luxury. Looks great. Yeah. And you've got health coaches in your clinic, right? Yeah. So you must, I don't think general practices can function without health coaches because health coaches are the expert in behavioral change. And if they're well trained, they'll also be trained in low carb nutrition. You combine

57:30
low-carb nutrition with behavioral change, you've got the recipe for success. If you're just sitting down and prescribing medicines, that's the recipe for just getting what you've always had, a progression of the tsunami of chronic disease. Because the medicines are just treating the symptoms, not treating the cause. And that applies to whatever chronic health condition you're talking about, whether that's hypertension, whether that's gout.

57:58
whether that's Alzheimer's, whether that's cancer, whether that's type 2 diabetes, it's treating the symptoms. We need to be treating, identifying the cause. And public health is all around preventative medicine. We need to be going back even one step and changing the food environment, seeing if we can do something about this ultra-processed I don't know what the word is. Danger. And changing that.

58:26
And I think we need the change to occur systemically. So we talked before about at a government level, but I think this change is going to be driven from the bottom up. think this is going to be the public is going to eventually ask for these changes. And what do they talk about? A groundswell of needing about 15 % before you get change. know, once we get to 15 % and people start demanding

58:55
access to high quality foods. I think we're going to start to see government listing. 15 % is about the point where they say all these votes here, maybe we should listen. Okay, and how far away is that do you think? In your lifetime? you asked me that really interesting question. What would success look like by

59:23
by 2030. I thought, yeah, that was a, I think, yes, in my lifetime, I think we will see these changes. by 30, I would love to see this idea of active enrollment introduced into general practices where people come for a year into a lifestyle medicine program, but run within general practice.

59:53
I would, within the next four and half years, I'd like to see that established based around low-carb nutrition and behavioral change. I'd love to see, I think we will see within the next four and a half years, the guidelines change so that low-carbohydrate nutrition is at least acknowledged as a tool. I would love to see a diabetic diet in hospitals. I don't know how many people you've spoken to recently who say,

01:00:23
the diabetic diet is still jelly and ice cream, you just get a smaller serving. It's seriously horrendous. cannot believe what they are continuing to say. I get pictures all of the time, in my DMs. And I've stopped posting them because people take my criticism of it as a criticism for nurses and doctors. And I'm like, no, no, no, no, no, no. This is the system. it is horrendous. Yeah.

01:00:50
And yeah, I'd love to see a public health campaign identifying the dangers of ultra-processed food and identifying ultra-processed as the cause of the problem. Then is there some way of making the ultra-processed not the most available choice and making high quality proteins and vegetables

01:01:19
the available choice, and that might take some government intervention to do that. To me, it would be quite simple. You put a tax on the ultra processed food or the companies making it, and then that money is transferred directly to reduce the cost of either the production and manufacture or the sale of the high quality proteins, the healthy fats, and the vegetables. To me,

01:01:46
I don't think that's going to happen in the next four and a half years. I think that might take 10. So I see that last part happening in the next 10 years because the ultra-processed food industry is very, powerful. And we're noticing all the advertising that the tobacco companies used to use. We're now seeing exactly the same strategies being applied to food, aren't we? And who used to sponsor cricket?

01:02:15
who sponsors cricket now. So Benson and Hedges used to sponsor cricket and now it's KFC. We're just seeing a transfer from one toxic substance to another, just using that as an example of food that's not cooked at home. Yeah. you know, I'm wholly in agreement with all of that. And it's interesting, I was speaking to someone else earlier about how in the social media space, which is such a

01:02:44
which is the place that people get their information from. People in my industry are diluting the messages around food and are softening the edges, saying things like, there are no good or bad foods and absolute BS like that. That is not helping the situation because I think people actually need to understand the true impact of these foods and not just sort of sugarcoat it like, it's all right. You can have just a little bit, everything in moderation. That's, yeah.

01:03:13
It's fascinating. That's a whole other topic, but we've talked about this a lot at Whole NZ. Do we use the term low-carb nutrition, or do you talk about ketogenic diets? And the ketogenic diet has become a dirty term to some extent, and so we're using the term low-carb nutrition, but are we doing what you've just mentioned? Are we just diluting the messaging? Because a ketogenic diet is a

01:03:43
powerful tool. yeah, yeah. Hey, Nikki, I've done quite a few podcasts. And one thing I noticed is that you as the interviewer never, never get asked any questions. You're, you are an absolute legend and expert in this area. What, what would be your sort of summary statements on, you know, the state of the management of type two diabetes? That's such a good question, Glenn. And

01:04:12
I don't feel like in my professional integrity that I could, that, or like, I don't understand actually from a professional integrity perspective, how low-carb nutrition, how the powerful sort of nutrition therapy potential of something like a ketogenic diet is just not on the table for in those, I suppose, those big organizations that make those decisions around the guidelines and things like that.

01:04:42
The constant beat down of people who advocate for low carb nutrition is just mind blowing to me actually. And I know over the years that Karen has had, has come up against it. I absolutely know that Grant has come up against it. And I've never been in a position where people bothered with me, you know, but I always was there to sort of see it. And it's just bloody mind boggling to me. And the GP thing is just,

01:05:12
again blows my mind that they can really have so much power. And this was the voice of authority for generations of New Zealanders, yet they're not in a position or they don't choose to do, choose to acknowledge how powerful nutrition could be as a therapy. I think to my point earlier about how the information that I share with clients is very often dismissed, because what would I know? Because I'm just a nutritionist, which is just...

01:05:40
mind blowing to me as well that that's the attitude. I actually feel a little bit like I think you're probably more hopeful than I am of change, which is great because you're the one in it doing the change. So you know a whole lot more about that than me. But this is just coming from, you know, what I see in the trenches, I guess. Yeah, I think what's changing is the, know, going back 10 years, you had to tell someone what

01:06:10
what we were talking about. Now everyone knows what we're talking about. We just got to do the behavioral or the persuasion part and give the resources. That's what's changed. I think that's a really significant change. that's why I'm hopeful because the public get it, the public know about it. And this will be a bottom up change, I believe.

01:06:37
Probably the same thing will keep happening. If you're a GP and you keep seeing person after person, person after person coming in who's lowered their HbA1c, at some point you must go, well, that's really interesting. What have you done? Rather than dismissing it or it won't last. Or you've probably raised your cholesterol and put yourself at a heart risk. Maybe you should stop. Maybe you should check your lipids because you're

01:07:07
you've probably put yourself at risk, you know. And I see that often. I see people being told to stop doing their low carb diet because the saturated fat will kill them. of course, you and I know, that's the case. Yeah. Do you the other thing, Glen, is you mentioned it, and this is a message that has to change as well, is the idea that it is hard because that is what is sold by almost, you know, oh no, like people don't stick to a ketogenic diet. So why would we bother?

01:07:36
advocating for that. It's too hard for them. So if people have this narrative in their head that, oh, it's just going to be too hard for me. So why would I bother? Yeah. Why would you? You've really, really nailed something there. It's like, GPs say to me over and over again, I have been telling people for the last 50 years to change and not a single one has. And I said, you hit the nail on the head. You've been telling them, you know,

01:08:05
When has that ever worked? And what health coaching has introduced to us is this idea of behavioral change is not part of that paternalistic model when we tell people to do. It's the exact opposite. And that's the reason that GPs have become so disillusioned with behavioral change. Even understanding motivational interviewing, is taught, they have not seen success.

01:08:32
And therefore, they believe that people are unable to change. Now, whereas you and I know that it's the exact opposite, it's just that it has to be done in a different way. And that's what health coaching and call out for pre-cure that trains really good health coaches, that's what's changing. And getting those health coaches trained in behavioral change in your practice so that you don't have to tell people what to do, you just take them next door to the health coach.

01:09:02
and let them look after that. 100 % Glen. Well, I mean, I know I asked you maybe a third of the questions on my script, but I've really enjoyed this conversation. I love thinking big picture and I've really admired the work that you're doing. And I love that you are optimistic because you're in there doing it and making the change, which is fabulous. I know that people can work with you and your clinic. Like how can they find out more

01:09:31
find more about either, how do people find GPs like you and clinics like you so they can actually make that step? Because I think that's one of the hardest things for people is actually to find someone that is able to sort of be the advocate, I guess, be the GP they need. I would approach Whole NZ. I think you'll find that Whole NZ, which is going to become

01:10:00
the place you go for diabetes or up-to-date modern diabetes management. And I see it becoming a big, yeah, the place that people would go. I imagine not quite yet, but I imagine we will have lists of health coaches and doctors and nurse practitioners, nutritionists, dieticians who support this view of metabolic health. And I think we will see

01:10:29
whole NZ influencing the guidelines and having perhaps being that voice that is big enough and strong enough to talk to government on these issues. So that's where I think I would be looking. Yeah. That is awesome, Glen. Thank you. And where can people connect with you? Or nah, shall we not even?

01:10:59
No, I always feel a little bit uncomfortable. I really want to be talking about the topic of metabolic health. And I don't want it ever to seem like it's selling something. I'm really not wanting to. And I'm not particularly special in this area. You would get the same or better information if you went and saw Mickey or.

01:11:27
a low carb dietitian or a health coach. Maybe I've got the advantage of being able to order the lab tests easily and write the prescriptions when people also need prescriptions. But I'm not the reservoir of knowledge about low carb. I'm just one of the people who talking about it. And I mean, I guess at the very least, people just stop drinking fizzy, right?

01:11:54
I mean really. Glenn, thank you. This has been a fabulous conversation. I've really enjoyed chatting to you. Thank you so much for your time. Welcome. Thank you.

01:12:17
Alrighty, hopefully you enjoyed that as much as I enjoyed doing it. Really, really loved chatting to Glenn and appreciated the time that he took and you could just hear his passion in his voice. I feel so privileged to have the opportunity to speak to people like Glenn, who really is making some profound differences out at that community level. And if there are general practitioners listening or you have friends who are GPs who are just might be on the fence or actually just don't know enough.

01:12:46
I highly recommend that you get them to check out this podcast and then they can take it into their own hands. This is life changing stuff. All right team, next week on the podcast I bring to you the conversation I had with Dr. Spencer Ndowski who is an obesity specialist medicine. It's a bit of a turn on this conversation that I've just had. Again, great information in that putty as well.

01:13:12
Until then though, can catch me over on Instagram at threbsandx @mikkiwilliden, Facebook @mikkiwillidenNutrition, or head to my website mikkiwilliden.com. And why not sign up for my recipe portal for 12 bucks a month. It could literally change your life. How's that? All right, team, you have the best week. See you later.