You’re Eating SUGAR Every Day… And You Don’t Even Know It | Dr. David Unwin
What if your 'healthy' breakfast is the reason your blood sugar is rising every year?
What this episode covers
- David Unwin (UK GP at Norwood Surgery, awarded by the Royal College of GPs for diabetes-remission innovation) has built one of the strongest UK primary-care evidence bases for low-carb T2D remission, with a documented cohort achieving substantial medication-free remission.
- He argues T2D is often reversible in early stages and can be significantly improved even in later stages, through dietary intervention rather than progressive medication.
- Highlights how common 'healthy' carbohydrates (rice, bananas, wholemeal bread) act as hidden sugars and uses 'teaspoons of sugar' infographics to make glycemic load visible to patients.
- Treats food-addiction-like behaviors as clinically relevant for many patients and emphasizes patient hope as a determinant of long-term success.
- Mainstream-aligned within the low-carb-for-T2D evidence base; among the more measured voices in the space.
Why it matters
If your fasting glucose, HbA1c, or triglycerides are creeping up, the window where dietary intervention can fully reverse the trajectory is now, not after a formal diabetes diagnosis. Prediabetes and early-stage type 2 diabetes respond strongly to dietary intervention, with remission rates highest in the first years after diagnosis and declining over time.
What stands out
- T2D is often reversible in early stages and can be significantly improved even in later stages with structured intervention.
- Wholemeal bread is not 'healthy' for an insulin-resistant person; the glucose response is similar to white bread.
- Excess carbohydrate intake, especially in the context of insulin resistance, is a major driver of fatty liver in many patients.
One key action from this episode
If your HbA1c is rising, the most-tested dietary intervention is sustained low-carb (under 100 g/day) with biomarker tracking every 12 weeks; for established T2D, do this with clinician oversight because medications need active adjustment in the first weeks.
What to do
Actions discussed in this episode. This is what one expert recommends — the full topic compares and ranks across experts.
- Action: Run a structured 12-week low-carb trial under 100 g carbs/day, replacing refined grains and sugar-sweetened beverages first. Limitation: If you are on diabetes medication (especially insulin or sulfonylureas), do not start without clinician oversight. Doses often need to drop within 1 to 2 weeks. Fork: If 100 g feels aggressive, start at 150 g/day for 4 weeks, then step down. Most adults tolerate the transition better with a stepwise approach. Cost of Wrong: Stopping medications without clinician input risks hypoglycemia (low blood sugar) in the early weeks. Going low-carb without tracking biomarkers means you do not know if it actually worked. Reinforce: This is one of the most consistently studied and clinically implemented dietary approaches for T2D remission in primary care. Other structured interventions (e.g., low-calorie programs like DiRECT) can also achieve remission; the broader principle is structured dietary change with biomarker tracking, not low-carb specifically.
- Action: Reframe your food choices using 'teaspoons of sugar' equivalents to make glycemic load visible. Limitation: The framing is informal; absolute teaspoons numbers vary by source. Use it for relative comparison, not exact accounting. Fork: For more precision, a 14-day continuous glucose monitor trial shows you exactly which foods spike your glucose most. CGM costs around $80 to $150 for 14 days through Stelo or similar. Cost of Wrong: Trusting marketing labels (whole grain, low fat, healthy) without checking the actual blood-sugar effect on you specifically. Reinforce: Most patients change behavior more after 2 weeks of seeing their own glucose data than after years of reading nutrition labels.
- Action: Track HbA1c, fasting glucose, fasting insulin, and triglycerides at baseline and every 12 weeks. Limitation: Standard primary-care visits often skip fasting insulin; you may need to ask specifically. HbA1c lags real changes by roughly 3 months. Fork: HOMA-IR (calculated from fasting glucose and insulin) gives a simple insulin-resistance tracking number. Triglyceride-to-HDL ratio is also a useful early marker. Cost of Wrong: Tracking only weight or 'how I feel' misses the underlying biomarkers that predict long-term outcomes. Reinforce: Biomarker tracking is what turns 'I think this is working' into evidence you can act on.
Full context, impact ratings, and timing — available in related topics
Questions to take to your doctor
- Given my fasting glucose, HbA1c, and triglycerides, am I at the prediabetic or diabetic stage where remission is realistic?
- If I start a low-carb trial, how should we adjust my current medications, and on what schedule?
- What biomarkers should we track every 4 to 12 weeks to know if it is working?
- Is my liver function (ALT, AST) consistent with fatty liver, and does that change the urgency?
Full doctor prep with ranked questions available in the full topic page
Context
The expert emphasizes translating research into actionable steps, focusing on what the evidence actually supports versus common assumptions.
Mainstream-supported: low-carb intervention drives T2D remission in primary care (Unwin's cohort + DiRECT + Virta), early-stage diabetes is more reversible than late-stage, fatty liver responds to the same intervention.
Likely true with realistic limits: 50 percent primary-care remission rate is achievable but requires specific clinical infrastructure (regular check-ins, patient education, medication adjustments).
What this does NOT prove: that every T2D patient will achieve remission, that low-carb is the only path (DiRECT used a low-calorie liquid diet), that long-term (10+ year) remission durability is fully established (data is still maturing).
What low-carb does NOT replace: medication adjustments under clinician oversight when starting, insulin therapy for T1D, lifestyle factors beyond diet (sleep, movement, stress).
Where people go wrong
- Stopping diabetes medications on your own.Insulin and sulfonylurea doses often need to be reduced within 1 to 2 weeks of starting low-carb. Stopping without clinician input risks hypoglycemia (low blood sugar) which can be dangerous. Metformin is generally safer to continue while transitioning, but any change in diabetes medication should run through your clinician.
- Treating low-carb as 'just eat meat'.Sustainable low-carb means protein, green vegetables, healthy fats, and lower carb. All-meat (carnivore) is a different intervention with thinner long-term evidence and harder long-term adherence for most adults. Vegetable variety matters for fiber, micronutrients, and sustainability.
What to expect over time
- Weeks 1 to 4Cravings and energy fluctuations as the body adapts. Glucose readings drop within days; medication adjustments often needed in week 1 to 2 if applicable. Sleep and mental clarity often improve in this window.
- Weeks 4 to 12HbA1c starts shifting (it lags by roughly 3 months). Triglycerides drop. Fatty liver markers (ALT, AST) improve. Body composition changes if applicable. Energy stabilizes.
- Months 3 to 12HbA1c reflects the new glucose pattern. Many patients reach the medication-free remission threshold (HbA1c under 6.5 percent without meds). Long-term durability depends on continued adherence; relapse is common but learnable.