Downsizing

by Tom Watson

  During the Reformation, when Christians across Europe rebelled against the Catholic church, one of the major feuds centred around the claim that priests learned the Bible by rote, without understanding a word it said. They could give you chapter and verse in pretty good Latin, apparently, but didn’t really know the story of Jesus, let alone the theology underpinning it. From my experience, discussing nutrition-related issues with general practitioners feels like talking to a pre-Reformation priest about the Holy Trinity. They know the words they’re supposed to say, but they don’t understand the meaning of it at all.

  The Eatwell Guide is loaded with carbohydrates. It advises us to fill up on foodstuffs that are on the ketogenic nutrition ‘banned’ list. Five years ago, I’d have never suspected that the spaghetti carbonara that I regularly piled onto my plate was one of the worst meals for me to consume. And, what’s more, the Eatwell Guide would have left me none the wiser. For people like me, with type 2 diabetes, this advice is not just unhelpful; it’s downright dangerous. As far as I’m concerned, telling T2D patients to eat pasta in order to become healthier is like telling an alcoholic to drink vodka because it doesn’t taste like alcohol.

  When I shed all my weight, I experienced a host of conflicting emotions. On the one hand, I felt exhilarated to have reclaimed my good health and to have ditched my XXXL T-shirts. On the other hand, I felt angry and frustrated about the way I’d had to tackle my obesity. I shouldn’t have had to join the dots myself. I shouldn’t have had to ignore my own government’s nutritional guidelines to get myself well. I shouldn’t have had to feel guilty for putting beautiful grass-fed butter into my coffee. And I certainly could have done without BOGOFs on crappy processed food when I was doing my weekly shop. And all that was before I witnessed ‘Big Sugar’ firms blatantly targeting young children in the UK, even before they reached primary school. That’s when my anger really turned to rage.

  In the previous chapter, I discussed how our choices and options have been engineered in order to push us into obesity and diabetes. We are not solely responsible for the junk food that we eat or the sugary pop that we drink. It is almost impossible for people to keep the weight off when the system is stacked against them, and I am sick to the gills of tabloids and politicians continually knocking and judging the overweight.

  It is not our fault that we have developed type 2 diabetes. Our chances of getting better massively depend on the support and guidance that we are given. While it may well be within our power to improve our health, our lifestyle and our longevity, this doesn’t mean that the onus should rest on us to do it on our own. We need food manufacturers, retailers, policymakers and politicians to work together to make it easier for people to eat more healthily and get more exercise.

  This is one of the reasons why I think Remission for All is a necessity, as it would encourage a national debate about diet and nutrition issues for those suffering with type 2 diabetes, or those susceptible to the condition. Sitting behind the current quota of 3.4 million type 2 diabetics, you see, are another million undiagnosed type 2 diabetics. And sitting behind them are over 12 million people who are at risk of the disease. As families and communities – and as a country – we simply cannot afford the personal or financial cost of that potential increase.

  It is quite clear to me that we need to challenge those clinicians whose default position is to offer prescription drugs as the first-line treatment for type 2 diabetes patients (as well as those pharmaceutical firms who may have financial motivations for medicalising us). Indeed, I do believe that we’ve now reached the stage where every GP in the land should receive specific diet and nutrition training, to enable them to offer patient-centred guidance for those diagnosed with T2D. It is time to adopt a far more holistic approach, and to promote a deeper sense of partnership between doctor and patient. It is my understanding that many GPs feel tethered to the Eatwell edict, and – for fear of being reported to official bodies, and jeopardising their professional careers – are deterred from offering conflicting advice. As a result, they are still having to recommend carbohydrate-heavy diet pro-grammes to their T2D patients, promoting the consumption of the very foodstuffs that played havoc with my own insulin levels.

  There do exist, fortunately, some forward-thinking GPs who are bucking the trend. These progressive practitioners are freely advocating low-carb, high-fat diets as a way of preventing and managing T2D, the ultimate aim being to reduce the need for heavy medication and to maximise the likelihood of remission. Among their number is Southport-based Dr David Unwin, the self-styled ‘Low Carb GP’, who has become something of a legendary figure in the world of diabetes. His bespoke Low Carb Program has seen extraordinary results, with many of his patients putting their T2D into remission, which, as a consequence, has had a transformational effect upon their lives. His message is a simple one, based upon simple recommendations that many dieticians would concur with. In order to lose weight and regain their good health, Dr Unwin believes, patients with type 2 diabetes need to cut down on sugary food and starchy carbs and need to increase their intake of leafy green vegetables.

  It took the counter-intuitive, revolutionary inventiveness of this pioneering Merseyside GP to demonstrate just how badly carbohydrates affected me, in the starkest of terms. His team set up a study to examine the glycaemic index of commonly eaten foods (the GI being the level at which food raises blood glucose levels), before converting that figure into its equivalent in teaspoons-worth of sugar. They discovered that a portion of basmati rice – one of my staple foods when I was 22 stone (140 kilos) – had a GI equal to ten teaspoons of sugar. So, over a lifetime of rice-eating, I worked out that I’d consumed a total of 39,000 teaspoons of sugar, which amounted to 390 kilos of the stuff. Even more worryingly, this was possibly a conservative estimate. No wonder I spent years experiencing sudden spikes in blood glucose levels.

  In 2018, Dr Unwin’s GP practice saved nearly £60,000 on drugs for conditions including hypertension and type 2 diabetes through, in his words, his ‘passion for offering patients the alternative of lifestyle medicine and support’. His weekly graphs – which demonstrate how his patients’ HbA1c levels are impacted when they link their diet to the glycaemic index – should be the envy of every GP. I truly believe that his credo is the way forward and, in an ideal world, should be rolled out to every health centre in the country. It works, it costs virtually nothing and it saves the NHS tons of money further down the line.

  Best of all, medics like Dr Unwin give people like me their lives back. Yes, I have to make do without my beloved basmati rice, and I’m sorry for the damage this has done to my local curry house’s bottom line, but it’s a price that I’m more than willing to pay.

  So we know that the current guidance doesn’t work and that we can do so much better for those with a type 2 diagnosis. We know that people need individual, personal-ised advice rather than a one-size-fits-all axiom. And we know that more GPs need to be trained properly in nutritional science so that their patients can benefit from the latest research. There are, however, other cost-effective measures and technological advances that may be game-changers, insofar as they can improve the health of individuals, and can also save some money for our beleaguered NHS.

  According to a good friend of mine, a diabetes nurse, a gadget called a continuous glucose monitor represents the greatest advance in diabetes treatment for a quarter of a century. CGMs allow patients to monitor how their body responds to food by indicating which products cause a spike in blood sugar. If obesity is the air raid siren for diabetes, then a CGM is the radar, allowing individuals to track, in real time, how they react to certain foodstuffs. These nifty devices are currently prescribed for type 1 diabetics on the NHS, for the obvious reason that they are potential lifesavers. But their capacity goes far beyond that. In my view, relatively soon they’ll replace the finger-prick testing kits currently used by many type 2 diabetics.

  I actually tested out a CGM monitor for two weeks while researching fo
r this book. They’re incredible contraptions, although I had to force-feed myself some chocolate Hobnobs in order to ascertain how my body responded to a sugar injection. Not particularly well, was the answer, although it wasn’t nearly as bad as I was expecting. What this CGM gave me, however, was the acquisition of much more granular data. Knowing that biscuit X raised my blood sugars to level Y put me in charge of my body, and gave me a certain ownership. Anyone who has struggled to lose weight and manage their diabetes will know that this feeling of self-control is all too rare during that lonely, difficult battle.

  But testing the CGM also made me feel somewhat maudlin, to be honest. It made me feel quite sorry for the 30-year-old me, Tom version 1.0, the podgy bloke with a spiralling sugar addiction. If I’d had a CGM monitor at my disposal following a Friday night of lager and curry – particularly after guzzling a two-litre bottle of Coke the morning after – I’d have experienced a blood sugar spike of Himalayan proportions. By understanding my own data in these extreme circumstances, I think I might have addressed my nutrition earlier, perhaps even before I’d broken myself enough to develop diabetes.

  A fully functioning Remission for All movement would definitely include a call for every obese person to be given a continuous glucose monitor on the NHS. I reckon they’d only need to use them for a few weeks before they’d begin to comprehend the damaging impact of high-sugar, highly processed food upon their general health. The CGM might then provide the impetus for these poorly individuals to kick-start a new diet and fitness regime, which could prompt them to lose some weight, alter their lifestyle and ultimately ditch their medication. The NHS (and us taxpayers) would be much better off, too. Yet another win-win situation.

  As I write this book, however, I can’t see anyone in power calling for this fabulous piece of technology to be deployed and distributed in this manner. This frustrates and infuriates me. We are allowing people to get ill, and to ultimately die, because we aren’t being ambitious or imaginative enough about new technology that may arm us in our fight against obesity and poor nutrition.

  On Monday 10 June 2019 I hit my eight-stone (51-kilo) weight-loss target, just under two years after commencing my diet and fitness plan. This milestone occurred in the midst of the Brexit crisis in parliament, possibly the most stressful stage in my career to date; I’d never known such pressures of work at Westminster and, as deputy leader, had never experienced so many demands on my time. Though delighted to have shed every single one of those 112 pounds – I couldn’t quite believe that I’d done it – I found myself being dogged by a deeper, existential question.

  If I hadn’t lost that eight stone, would I still be alive today?

  In all honesty, and without being melodramatic, I think I’ve dodged a bullet. I genuinely do. Looking back to the summer of 2017, when I ate too much food and did too little exercise, I reckon I was weeks or months away from having a heart attack. Had I not decided to ring the changes when I did, I think I’d have definitely keeled over at some point. I can’t see how I could have carried on dealing with my chock-full diary and my ever-increasing workload without having some kind of physical breakdown. I have no intention of returning to that state of affairs, of course. In fact, I’d rather give up my role in politics – which I adore – than lose my health. My life is just too precious to even think about downing a Coke or devouring a pizza.

  Speaking of which, toward the end of 2019 I achieved another milestone. I finally hit the ‘unsubscribe’ button on the emails sent to me by my local pizza delivery service. All those 2-for-1 deals, money-off vouchers and free delivery offers that had seduced me for years were finally consigned to history. For a while I’d just ignored them – I was perversely satisfied by the fact that I had the willpower to do so – but the time soon came for me to delete them for ever. And, you know what? It felt absolutely bloody brilliant.

  I live in hope that, one day, there’ll be millions of other type 2 diabetes sufferers who, having transformed their lives through diet and exercise, will also find themselves zapping those fast-food outlets from their inboxes. I want them to experience that same sense of satisfaction. I want them to be proud of their accomplishments. I want them to go on to live a life free of guilt, and full of joy. And then I want them to join forces with me in promoting a hugely important message.

  Remission. For all.

  Epilogue

  There are occasions, as a politician, when a single statistic can stop you in your tracks. It was while attending an event at the House of Commons in the spring of 2019 that I found myself chatting with the CEO of the Outdoor Industries Association, a group that lobbies parliament on behalf of such organisations as British Cycling, National Parks, Ramblers and the Canal & River Trust. Andrew Denton was an impressive character – in his spare time he was a triathlete, mountaineer and paraglider – and it was while discussing some government-related issues that he shared a jaw-dropping stat.

  ‘Did you know, Tom, that three-quarters of kids in this country spend less time outdoors than high-security prisoners?’ he said, referring to a 2016 survey that had identified that 74 per cent of children played in the open air for under an hour per day (an hour being the daily norm for inmates) and, furthermore, that one in five youngsters never spent any leisure time outside whatsoever.

  ‘My God, how appalling,’ I said. ‘That’s nothing short of a national tragedy.’

  Our conversation played on my mind for days. Not only had Andrew’s words challenged me as a policymaker, they had, perhaps more deeply, challenged me as a parent. While my son and daughter spent a decent amount of time outdoors (Malachy loved running around the gym and Saoirse was a keen netballer), I still had fatherly concerns about the number of hours they spent watching Netflix and playing on consoles. Were my kids too reliant on screens for their entertainment? Was I doing enough to encourage them into the great outdoors? Did we visit enough of our country’s beautiful parks, forests and beaches?

  The following week I set up a meeting with Andrew to discuss the problem of these confined lifestyles.

  ‘You really made me stop and think the other day, Andrew,’ I said. ‘So much so, in fact, that I’d like to start work on an outdoor recreation policy, as part of my remit for sport. Something for the next Labour Party manifesto, maybe.’

  I told him how I wanted to help encourage everyone in the UK, young or old, to have more active lifestyles without breaking the bank, and how I wanted to work in tandem with groups and organisations to improve access to outdoor pursuits.

  ‘Yeah, that all sounds very interesting, Tom,’ replied Andrew, slowly nodding his head.

  ‘But what would be really great,’ I added, ‘would be if you could get on board in some way. Help me to set up a consultation, perhaps, or put me in touch with a few of your contacts in the industry. I doubt anyone knows more about these issues than you.’

  ‘Okay, now please don’t take this the wrong way’ – he sighed – ‘but do you know how many similar conversations I’ve had with politicians, of all persuasions? Dozens. And nothing ever comes of them. Nothing. Let’s just say that, over time, I’ve become a little cynical.’

  Well, that was me put in my place.

  ‘Listen, I get where you’re coming from,’ he continued, ‘but I’d only be prepared to help you with this if you walk the walk, not just talk the talk. If you’re going to practise what you preach, you’ll need to sample the great outdoors yourself. I mean, when was the last time you climbed a hill?’

  I paused to think for a moment.

  ‘When I was in the Scouts, I reckon.’

  ‘My point exactly.’ He smiled.

  In the space of an hour, the persuasive Mr Denton had convinced me to take part in a quartet of outdoor challenges that would span a period of six months: climbing Snowdon in mid-Wales, kayaking along a network of canals in the West Midlands, cycling the 46-mile (74-kilometre) Prudential RideLondon and tackling a half-mile open-water swim in the Serpentine. We came up with the idea
of grouping them all into an ‘#Adventures4Health’ initiative that would see me joining forces with the OIA (and ukactive, its umbrella organisation) to promote the benefits of outdoor recreation and helping them to raise the media profile of each event.

  Tom, what on earth are you letting yourself in for? said a little voice in my head.

  ‘An absolute pleasure doing business with you,’ said a grinning Andrew, vigorously shaking my hand.

  Though I’d never been in better shape health-wise, the prospect of these physical challenges gave me the collywobbles. I could barely swim, I hadn’t been up a mountain for three decades, I’d never been in a canoe (cramming myself into a seaside dinghy was the nearest I’d got) and I was still a little unsteady on my bicycle. #Adventures4Health was way beyond my comfort zone, and would prove more challenging than anything I’d done hitherto.

  That said, Andrew’s comments were spot on. If I wanted to shape policy to help others explore the UK’s green spaces, and to find an activity that they enjoyed, it was down to me to set a good example. By speaking openly about my own backstory – how a middle-aged fat bloke lost weight and got active – I would hopefully strike a chord with others in similar predicaments.