WEBVTT 1 00:00:00.131 --> 00:00:03.473 Just imagine for a moment that doctors don't exist. 2 00:00:03.513 --> 00:00:06.075 There are no doctors in this country. 3 00:00:06.095 --> 00:00:07.916 There's no emergency department. 4 00:00:07.936 --> 00:00:09.057 There's no GP surgery. 5 00:00:09.077 --> 00:00:12.239 There are no statins, no insulin, no stents. 6 00:00:13.140 --> 00:00:15.161 Would you do anything differently? 7 00:00:15.601 --> 00:00:35.431 from now on you would probably make some healthier choices and you'd probably look a few more times before crossing the road because if you got hit by a car or you had a heart attack or you developed diabetes and the treatments just didn't exist then for a lot of people let's be honest that would be game over 8 00:00:36.331 --> 00:00:44.075 But, you know, we rely on healthcare to fix us up, to patch us up so we can carry on with our lives. 9 00:00:44.735 --> 00:00:50.318 And that way of thinking is completely and fundamentally flawed. 10 00:00:51.058 --> 00:01:03.085 The thing is, even with doctors existing, everything you do either adds a bit of time to your life or takes a bit of time away through the choices that you make every single day. 11 00:01:03.245 --> 00:01:05.786 You know, let's be honest, some of you might be thinking that that is... 12 00:01:06.206 --> 00:01:34.742 an odd way to look at the world to look at this sort of thing but i have been part of that safety net for the last 10 years working as a doctor patching people up and if you come off your bike on a country road on a 60 mile an hour road you know we can save your life we have amazing surgery we have amazing painkillers we have amazing anesthesia it absolutely works these days but 13 00:01:35.642 --> 00:01:59.632 what it cannot do is undo the 20 or 30 years that came before the moment you arrived just say you had a heart attack we cannot completely undo those previous decades that led to that point and that is what i want to unpack with you all today now i should say that this is my take on the nhs the national health service in the uk because that is the system that i've worked in 14 00:02:00.512 --> 00:02:01.753 over the last few years. 15 00:02:01.813 --> 00:02:04.816 And it's the one that I know from the inside. 16 00:02:05.496 --> 00:02:22.870 If you're watching this from the US though, or other places in the world, yes, your healthcare system might be set up completely differently with insurance and costs and access shaping what happens to you in ways that I can't really talk about in this country. 17 00:02:23.510 --> 00:02:26.073 And the same goes for other places like Australia and Canada. 18 00:02:26.133 --> 00:02:27.333 And wherever you are, 19 00:02:28.695 --> 00:02:34.644 But the thing is, a lot of healthcare systems have been through the same evolution that I'm about to talk about. 20 00:02:35.165 --> 00:02:42.956 They were built initially to fight things like infections and treat injuries and help with issues. 21 00:02:43.016 --> 00:03:05.528 childbirth because so many people used to die in labor but these days it's completely different healthcare today is now left holding this huge wave of slow chronic disease that they were never designed for so the details might be a little bit different where you are but i think it's going to be completely relevant to most people watching this 22 00:03:05.908 --> 00:03:25.048 So today we're going to cover six reasons why prevention is so important, but also so difficult from the history of the health service through to the food, through to the money and the politics behind it on how you and I should actually be making decisions every single day. 23 00:03:26.129 --> 00:03:39.373 And if you're new to the channel, then I make these videos because I've spent years treating the end stages of these disease that were building silently for decades before anybody actually decided to do anything about them. 24 00:03:39.913 --> 00:03:47.635 So if this is the sort of thing that you want in your YouTube feed, then a like and a subscribe really does help. 25 00:03:48.115 --> 00:04:15.030 with all of those things and it helps me to keep making these videos for you so thank you so so much right then so the nhs the national health service this was designed to solve problems that barely kill anybody in this country this day and age when it started back in 1948 the wards in the different hospitals were full of infections like tb and pneumonia and complications of childbirth 26 00:04:17.191 --> 00:04:27.039 And what those have in common is that they arrive very fast and respond very well to something decisive in that moment. 27 00:04:27.079 --> 00:04:38.789 So we built a system exactly around that, around antibiotics and surgery and obstetrics and vaccinations and anaesthesia, all of those sorts of things. 28 00:04:39.170 --> 00:04:41.371 And the amazing thing... 29 00:04:42.192 --> 00:04:56.360 is that it worked it worked so well that if you're badly injured in a crash today the machinery of the healthcare system around you is world class and if you're in labor and something goes wrong 30 00:04:57.380 --> 00:05:02.922 You and your baby are safer than in any point in history. 31 00:05:03.182 --> 00:05:06.723 And Steph, my wife, can talk firsthand about that. 32 00:05:07.703 --> 00:05:09.743 She had an emergency C-section in the end. 33 00:05:09.903 --> 00:05:12.484 It was terrifying, but everything was fine. 34 00:05:12.844 --> 00:05:13.504 Steph is fine. 35 00:05:13.544 --> 00:05:16.865 George is thriving better than we could have imagined. 36 00:05:17.185 --> 00:05:21.567 It is an amazing time that we live in in terms of healthcare in one way. 37 00:05:22.827 --> 00:05:33.895 The diseases that sit on trolleys in front of me in the A&E these days, though, consist of things that we didn't really expect back then. 38 00:05:34.195 --> 00:05:42.622 So things like heart attacks and type 2 diabetes and fatty liver disease, several common cancers as well, strokes and dementia... 39 00:05:43.462 --> 00:05:47.124 Those things didn't arrive just that night. 40 00:05:47.724 --> 00:05:50.125 Those things took decades to build. 41 00:05:50.305 --> 00:05:57.588 And the thing is, you cannot fix a 20-year problem in a four-hour target, which is what we have in the UK. 42 00:05:57.608 --> 00:06:03.911 We have to see and diagnose and treat and discharge or admit within four hours. 43 00:06:04.471 --> 00:06:07.833 It is completely unachievable for most places in the UK. 44 00:06:08.633 --> 00:06:16.339 So essentially, we're asking a system designed for very fast problems to hold back very slow problems. 45 00:06:16.899 --> 00:06:18.100 And it is buckling. 46 00:06:18.140 --> 00:06:32.891 It has been buckling for years, not because the staff aren't good enough or don't work hard enough, quite the opposite, but because quite honestly, what we have was never the correct tool for this job that we have these days. 47 00:06:33.231 --> 00:06:36.893 And that leads me very nicely onto our modern food environment. 48 00:06:37.514 --> 00:06:44.418 A huge amount of the food in any normal British supermarket and American supermarket, I guess, as well. 49 00:06:44.998 --> 00:06:53.864 It has literally been designed by people whose actual job is to make sure that you eat more of it and spend more money. 50 00:06:54.644 --> 00:07:03.776 And that is what happens when very clever food scientists are paid to make a product that people cannot put down. 51 00:07:04.818 --> 00:07:09.464 The exact combination and ratio of ingredients that makes food 52 00:07:09.804 --> 00:07:30.719 crisps or chocolate or donuts or pizza just really nice when it's sort of going down the throat and the perfect color on top of that cake or the perfect packaging on that chocolate bar all of these sorts of things billions and billions of pounds and dollars have been spent on all of these different decisions so when they create just you know your average ultra processed food what they do 53 00:07:31.419 --> 00:07:52.267 is this they take a whole food they strip out the fiber and the water and most of the structure they make it really soft so you barely have to chew it they pack loads of energy into a very small volume and hit it with combinations of salt and sugar and fat that basically just don't exist together in nature 54 00:07:53.107 --> 00:08:04.613 Your fullness system when you eat works on how much you've chewed, how far your stomach has stretched, and what hormones your gut releases as the food goes through. 55 00:08:04.653 --> 00:08:11.437 So it's like a slowly filling gauge, and that food is going in far faster than that gauge can read. 56 00:08:11.797 --> 00:08:20.222 And because of the way these foods are made, when you eat them, you are finished before your body has had chance to say stop. 57 00:08:20.742 --> 00:08:26.144 And so very often you eat more than you actually need, if that makes sense. 58 00:08:26.164 --> 00:08:32.227 Now, there is a study on this exact topic, and I'll put a link as always in the description below. 59 00:08:32.627 --> 00:08:44.472 What happened in the study is that researchers kept 20 adults living in a research unit for four weeks, so every mouthful that they had was measured. 60 00:08:44.492 --> 00:08:46.413 They could monitor everything they ate. 61 00:08:47.173 --> 00:09:05.092 And each person spent two weeks eating mostly ultra processed food and then two weeks eating mostly unprocessed whole food in a random order with both diets matched for calories and sugar and fat and salt and fiber, all of that sort of thing. 62 00:09:05.693 --> 00:09:09.774 Now, these people could eat as much or as little as they liked. 63 00:09:10.054 --> 00:09:18.577 On the ultra-processed weeks, these people ate around 500 calories a day more without noticing. 64 00:09:18.877 --> 00:09:22.858 And they gained around a kilo in weight in just a fortnight. 65 00:09:23.478 --> 00:09:26.259 And when they were on the unprocessed diet... 66 00:09:27.019 --> 00:09:32.443 they lost roughly the same amount because they naturally ate less. 67 00:09:32.723 --> 00:09:41.089 This is a small study, I get that, but it is about as tightly controlled as human nutrition research actually gets. 68 00:09:41.149 --> 00:09:42.991 They controlled pretty much everything. 69 00:09:43.351 --> 00:09:53.378 Now, the bigger population studies linking these sorts of food, ultra processed food to heart disease and cancer and early death, all of those are really worth reading. 70 00:09:53.418 --> 00:09:57.301 There are loads of these sorts of studies and I'll put a few in the description below for you. 71 00:09:57.321 --> 00:10:01.944 So if you get time, just click on a couple of them and take a read. 72 00:10:01.984 --> 00:10:04.226 They are really, really, really interesting. 73 00:10:04.506 --> 00:10:15.114 Now, for a lot of people in the Western world, we have taught ourselves that the least nourishing food available, the worst food that you can eat, is a treat. 74 00:10:15.234 --> 00:10:16.535 It is a reward. 75 00:10:17.315 --> 00:10:21.638 And just think about maybe somebody you know, or maybe this is you. 76 00:10:21.698 --> 00:10:25.361 Although, you know, the chances are if you're watching this video, then, you know, maybe it's not you. 77 00:10:25.381 --> 00:10:28.043 But, you know, everybody knows somebody who... 78 00:10:28.563 --> 00:10:33.645 who goes to get a McDonald's after swimming because they did really well. 79 00:10:33.825 --> 00:10:39.147 Or if it's somebody's birthday, there is loads of junk food and cake and crisps. 80 00:10:40.128 --> 00:10:44.770 Or if it is a Friday in the office, people will bring in crisps and chocolates. 81 00:10:45.290 --> 00:10:46.531 We even had it in A&E. 82 00:10:46.591 --> 00:10:51.533 If it was somebody's birthday, it would be their job to bring in all of this crap food and... 83 00:10:52.313 --> 00:10:55.576 people would share it, or on a night shift, quite often people would get pizzas in. 84 00:10:56.257 --> 00:11:01.702 And the thing is, yes, it tastes good, and we associate it with good times. 85 00:11:01.722 --> 00:11:04.945 I'm not saying that we should necessarily stop celebrating with food. 86 00:11:05.005 --> 00:11:08.048 It's just that it's a shame that we don't... 87 00:11:09.089 --> 00:11:13.414 you know, do the same with whole, really nourishing food. 88 00:11:13.434 --> 00:11:23.907 There is something about the food environment that has led people down this very strange path with junk food, with very, you know, poor quality food. 89 00:11:24.267 --> 00:11:26.750 And the reason this is worth pulling apart is that 90 00:11:27.711 --> 00:11:31.674 In this sort of scenario, it becomes a social issue. 91 00:11:31.834 --> 00:11:35.597 If you say no, then you are the awkward one at the table. 92 00:11:36.198 --> 00:11:41.602 And it is a hard thing to change because you will be in the minority in most scenarios. 93 00:11:42.703 --> 00:11:51.425 When George gets invited to a birthday party, probably in a couple of years' time, three years' time, there is going to be junk food there. 94 00:11:51.665 --> 00:11:57.646 And when he goes round to a friend's house after school, there will probably be junk food there as well. 95 00:11:57.886 --> 00:11:59.686 And we cannot change that. 96 00:12:00.226 --> 00:12:06.347 And we don't want to be the parents who say something because we don't want to be the difficult ones. 97 00:12:06.528 --> 00:12:08.348 In the grand scheme of things, really... 98 00:12:09.188 --> 00:12:12.729 If most of what you eat is good, then it's not a huge deal. 99 00:12:12.769 --> 00:12:15.370 This is just something we're going to have to accept, and that is fine. 100 00:12:15.830 --> 00:12:28.153 What we can do is make sure that the vast, vast, vast majority of what we do eat day to day is as nourishing as possible to try and offset some of what is obviously inevitable. 101 00:12:28.773 --> 00:12:33.576 But that brings other problems as well because that option might not be available to some people. 102 00:12:33.897 --> 00:12:39.701 You know, whole natural food is very often expensive and that is a huge problem. 103 00:12:40.161 --> 00:12:45.085 Now, the business of producing food that is making us ill... 104 00:12:46.442 --> 00:12:51.585 Let's be honest, these are also some of the biggest employers and taxpayers in the country. 105 00:12:52.005 --> 00:12:55.607 And that is very often what gets missed in these sorts of conversations. 106 00:12:55.647 --> 00:12:58.429 This is why very little ever changes. 107 00:12:59.109 --> 00:13:04.612 Those food factories are often in towns where there isn't much else going on. 108 00:13:04.692 --> 00:13:12.977 And behind them sit farming and haulage and packaging and retail and thousands of thousands of jobs. 109 00:13:13.537 --> 00:13:15.878 that don't look like food jobs. 110 00:13:16.278 --> 00:13:25.422 They pay corporation tax, they pay VAT into the treasury that now has another chancellor after just a couple of years. 111 00:13:25.782 --> 00:13:28.343 Everything seems to change in this country so fast, doesn't it? 112 00:13:28.843 --> 00:13:37.467 These food companies fund a huge amount of the advertising that keeps broadcasters and platforms running and they employ... 113 00:13:37.987 --> 00:14:01.868 people who lobby you know quite legally and quite effectively to shape the rules so a food factory isn't just a few hundred people it can employ tens of thousands of people across the entire economy so any government that is moving very hard on ultra-processed food who wants to do the right thing they are potentially putting at risk lots of jobs 114 00:14:02.629 --> 00:14:07.335 You know, the cost of living crisis because food will get more expensive as well. 115 00:14:07.936 --> 00:14:12.181 And a very loud argument about freedom of choice. 116 00:14:12.221 --> 00:14:16.907 You know, people might say, well, we should be able to choose what we eat, even if it's really bad for us. 117 00:14:18.266 --> 00:14:24.509 And the problem is that the health benefits probably won't be seen for another 10 or 20 years in a lot of cases. 118 00:14:24.849 --> 00:14:28.751 And so you can see how complicated all of this is. 119 00:14:29.131 --> 00:14:45.379 The right thing to do for any government, obviously, would be to try and phase out ultra-processed foods, as easy as that sounds, and to try and back farmers and other people promoting really good healthy food in the name of trying to prevent disease down the road 120 00:14:47.961 --> 00:14:53.017 on the National Health Service and help people to live longer and healthier lives. 121 00:14:54.185 --> 00:14:55.965 It's not as easy as that though, is it? 122 00:14:56.145 --> 00:14:57.826 It is incredibly complicated. 123 00:14:57.966 --> 00:15:05.588 And when the benefits won't be seen until multiple governments down the line, you can see why none of them ever address it. 124 00:15:05.848 --> 00:15:17.971 Now, if you walk into a doctor's appointment tomorrow with early type 2 diabetes, just say that your HbA1c has been climbing and you are now technically over the threshold, you are now diabetic. 125 00:15:18.591 --> 00:15:22.312 The quickest thing that can happen in that 10-minute appointment 126 00:15:24.292 --> 00:15:50.111 with metformin which is the most common type 2 diabetes drug and look I'm not having a go at GPs here they are working inside a system that gives them just five minutes if that per appointment and I used to work in general practice just for a few months and they are some of the most hard-working doctors I have ever ever ever met so 127 00:15:50.571 --> 00:16:04.355 Now, in some situations, medication is absolutely the right approach in things like after a heart attack or a stroke, where the risk is far too high to sit and wait for lifestyle changes to work. 128 00:16:04.375 --> 00:16:13.738 And I've done a couple of videos on statins recently that go through how they work and who should take them and the risks as well. 129 00:16:14.638 --> 00:16:29.591 The problem is prescribing with no education attached to it because that teaches somebody, that teaches that patient that the cause of their illness has now been handled, that that risk is gone. 130 00:16:29.971 --> 00:16:33.554 I used to have high blood pressure, but now I take medication and I'm fine. 131 00:16:33.694 --> 00:16:34.354 But the thing is... 132 00:16:35.135 --> 00:16:46.019 Whatever caused that hypertension in the first place, whatever you were doing to cause that diabetes in the first place, that medication doesn't solve any of those underlying causes. 133 00:16:46.319 --> 00:16:55.222 And then there's the other half of all of this, which is that a lot of us have absorbed this idea that there is a treatment for everything. 134 00:16:55.582 --> 00:17:01.844 So asking for a tablet feels reasonable and changing the thing that caused it feels reasonable. 135 00:17:02.084 --> 00:17:04.326 A bit like you've been told off. 136 00:17:04.446 --> 00:17:07.108 A lot of people don't want to put the work in. 137 00:17:07.368 --> 00:17:08.989 I don't mean to cause offence by that. 138 00:17:09.069 --> 00:17:12.572 That has just been my personal experience over the years. 139 00:17:13.092 --> 00:17:16.455 I would say most people want the medication. 140 00:17:17.195 --> 00:17:23.800 Probably not most of you watching this because the fact that you're watching this video means that you are probably in the minority, which is a great thing. 141 00:17:23.861 --> 00:17:25.081 Keep watching these videos. 142 00:17:26.042 --> 00:17:30.404 But just look at what happens when the support is there. 143 00:17:30.564 --> 00:17:42.049 There is a trial that I will link in the description below for you where around 300 people diagnosed with type 2 diabetes and they were diagnosed within the last six years, so fairly recent diagnoses. 144 00:17:42.709 --> 00:17:48.332 They were treated through their ordinary GP practices in Scotland and the north of England. 145 00:17:48.672 --> 00:17:54.435 Now, these practices, this collection of GP surgeries, were randomly assigned. 146 00:17:55.495 --> 00:18:07.385 Some of them ran this very structured weight management program and had a period of total diet replacement followed by very careful food reintroduction and ongoing support. 147 00:18:07.705 --> 00:18:09.126 That was the big program. 148 00:18:09.647 --> 00:18:13.310 The others just carried on with their usual care. 149 00:18:13.470 --> 00:18:14.450 So two different groups. 150 00:18:15.311 --> 00:18:24.015 At one year, 46% of the program group, so almost half, half of those were in remission. 151 00:18:24.395 --> 00:18:34.460 They were off their diabetes medications with normal blood sugar compared with just 4% on the usual care. 152 00:18:34.880 --> 00:18:38.702 You don't need me to tell you that that is an enormous difference. 153 00:18:38.742 --> 00:18:40.963 That is life-changing stuff. 154 00:18:40.983 --> 00:18:41.543 Right. 155 00:18:41.763 --> 00:18:45.104 Most of a room versus almost nobody. 156 00:18:45.964 --> 00:18:50.246 None of which means you need to stop your medication just by listening to me. 157 00:18:50.746 --> 00:18:53.787 You know, you've got to speak with your own doctor. 158 00:18:53.867 --> 00:18:57.088 I cannot be giving personal medical advice to stop your metformin. 159 00:18:57.148 --> 00:19:00.269 Please just take this as general education only. 160 00:19:00.609 --> 00:19:08.472 But the thing is, it's worth asking your doctor what the lifestyle route looks like alongside the tablets. 161 00:19:08.492 --> 00:19:08.932 Okay. 162 00:19:09.092 --> 00:19:14.999 And if you do make changes, ask for the relevant blood tests to be rechecked every three months. 163 00:19:15.079 --> 00:19:21.727 And the main one in this scenario being your HbA1c, which is your average blood sugar over the previous three months. 164 00:19:22.829 --> 00:19:23.950 And if they're, 165 00:19:23.990 --> 00:19:30.335 just not playing ball, then get a second opinion, get a third opinion or go private if you need to. 166 00:19:30.715 --> 00:19:40.764 The sad thing is that I would say a lot of doctors, I wouldn't say most, but a lot of doctors just won't be in a position to give you this lifestyle advice because it isn't taught. 167 00:19:40.904 --> 00:19:43.246 In medical school, we don't get taught this stuff. 168 00:19:43.526 --> 00:19:44.487 We have to learn it. 169 00:19:45.107 --> 00:20:00.331 for ourselves and read the research, which is a terrible way of training doctors in this day and age when most of the stuff that kills us is, you know, this lifestyle stuff caused by the choices that we make every single day. 170 00:20:00.351 --> 00:20:02.371 The whole thing is just completely backwards to me. 171 00:20:02.591 --> 00:20:10.273 Now, the most useful decision that I ever made about my own health was to start behaving as if medicine 172 00:20:15.176 --> 00:20:15.439 Thank you. 173 00:20:15.961 --> 00:20:22.303 And to me, that doesn't mean ignoring doctors, you know, quite the opposite, because I still want my blood pressure checked. 174 00:20:22.403 --> 00:20:29.244 I still want the screening programs later on in life, like the FIT test, you know, the bowel cancer screening test. 175 00:20:29.264 --> 00:20:32.825 There are loads of things that health care offers that are really good. 176 00:20:33.325 --> 00:20:43.868 I still want somebody to look at this new mole that I might get in 10 years time and to look at it with a dermatoscope and maybe take some biopsies if I'm concerned. 177 00:20:46.308 --> 00:20:50.772 is the assumption sitting underneath the decisions. 178 00:20:51.073 --> 00:21:01.722 Because if you believe that there is a stent or a tablet waiting at the end of the road for you, then a bad decade of food and sitting all day will. 179 00:21:02.242 --> 00:21:04.003 It feels survivable. 180 00:21:04.483 --> 00:21:10.566 And if you assume that there isn't any of that, then today's walk and today's dinner becomes the actual medicine. 181 00:21:11.006 --> 00:21:21.932 Every choice you make nudges the line by an amount so small that you cannot feel it, which is why it is so easy to ignore. 182 00:21:23.092 --> 00:21:30.621 20 minutes of walking after dinner is not going to change your life this week or next week or maybe even next year. 183 00:21:31.382 --> 00:21:34.145 But in 10 years, it could save your life. 184 00:21:34.445 --> 00:21:35.506 It absolutely could. 185 00:21:36.127 --> 00:21:39.951 Eating less ultra-processed food isn't going to save your life tomorrow. 186 00:21:40.412 --> 00:21:43.195 But in 30 years, you might still be alive. 187 00:21:43.215 --> 00:21:43.535 Whereas... 188 00:21:44.136 --> 00:21:46.757 If you didn't make any changes, you might not be. 189 00:21:47.037 --> 00:21:48.297 This is what it comes down to. 190 00:21:48.377 --> 00:21:51.919 This is why it's so hard to do because we're talking about huge timescales. 191 00:21:52.179 --> 00:22:04.243 Being a bit more active and reducing your blood sugar spikes and increasing the amount of fiber that you eat and becoming a bit less stressed because of other social things that you're introducing to your life, they absolutely have... 192 00:22:04.903 --> 00:22:19.805 tiny effects on your arteries and your other organs day in day out and those tiny changes over years add up to massive massive changes in trajectory so 193 00:22:19.845 --> 00:22:48.267 don't try and overhaul everything today in one big go just pick one thing that fits your life right now something easy that you can do and protect that change keep doing it consistently and let it compound and when you feel comfortable with that once that's become part of your routine then maybe pick something else and do that one on top for a few more weeks by the end of the year you will be a completely different person 194 00:22:48.807 --> 00:22:51.489 So I hope you found that video useful today. 195 00:22:51.529 --> 00:22:53.630 Let me know in the comments what you thought. 196 00:22:53.731 --> 00:23:01.456 I always read the feedback and it's probably the most valuable thing that you guys do for me is to leave your comments below these videos. 197 00:23:01.976 --> 00:23:05.699 Have a great day wherever you are and I will see you next time.