Following his successful event in Auckland promoting his latest book ‘The 8 Week Blood Sugar Diet’, Dr Michael Mosley sat down with our Communications and Marketing Coordinator, Michael Wood to discuss his latest book and what people can do when faced with the threat of diabetes.
What do you feel is the most significant challenge facing people who are making lifestyle changes?
I think it’s about knowing what to do and when to do it. It’s getting reliable information and then getting support. Any change is really hard, so you have to have a clear plan, you have to believe in that plan and you need the support of those around you if you’re going to make it work.
Do you believe that diabetes is taken seriously enough as a life-threatening disease?
I don’t think so. I think there’s a wider problem and the problem encompasses just basically raised blood sugar levels. So there’s a wide spectrum from prediabetes all the way up to developing diabetes. I think people are completely unaware that even when treated, type 2 diabetes will cut ten years off your life; that it is a significant cause of amputation of limbs, that it doubles your risk of heart disease, that it’s a preventable cause of blindness etc.
This is a very serious condition, but it’s also important to understand that if you have prediabetes, you’re likely to develop diabetes and I think people are totally unaware of the threat that raised blood sugar levels poses to their health.
Getting the right information to make lifestyle choices is obviously very important. Could people be doing more to access the correct information?
I think so, but it’s also about making them aware of it, which is why I wrote the book – it’s to make a noise. Hopefully people will hear about it and that will make them spring into action; visit your website, visit my website, do something. I think it’s mainly that blood sugar levels have not been seen as a significant thing. People are kind of aware of the risks of fat in your blood and we know about the threat of cholesterol when it comes to heart disease, but people are really quite unaware that sugar poses, if anything, a much bigger threat, in the short term and in the long term. I would like to do what I can to help change that and obviously Diabetes New Zealand is doing precisely that.
We have a very diverse population here in Auckland; do you think that the lack of access to information for some ethnic groups needs to be addressed?
I think it’s hugely challenging and the same is true in the United Kingdom and in the United States, where there is clearly a massive diabetes problem, particularly type 2 diabetes. I guess that what the research shows is that all groups, when they are given information and support, they respond in pretty much the same way.
There are certain ethnic minority groups that are much more at risk of high blood sugar levels and it attacks them more aggressively and at a younger age and it’s incredibly important that they are aware of this threat. The danger is that it becomes so widespread amongst a community that it’s just seen as ‘the norm’ and you have to be able to challenge that. I guess that’s the job of the leaders of the community – to be aware that this is not an inevitable disease, that you can actually prevent it happening, that you can do something about it.
The concept of a ‘sugar tax’ is very prominent in New Zealand currently. Do you believe that the use of legislation is a viable option when tackling obesity and diabetes?
I think it’s not just sugar, but sugar is a good starting point. It’s empty calories, there are very few benefits, we know that sugary drinks are profoundly bad for you and there’s very little good to be said about it and it tends to badly affect people from more disadvantaged areas. I think there’s a very strong case for some form of a ‘sugar tax’, at least to explore it. It seems to work quite well in Mexico. It’s like tobacco; the war on cigarettes was fought on many fronts and I suspect that if we’re going to change the amount of sugary and other bad things for us, we’re going to have to attack it on a multitude of different fronts.
Do you believe that this would be a longer process? Sugar has become such a large part of people’s diets and is found in many different products, compared to tobacco which is concentrated in a small number of products.
Indeed. I think the thing about tobacco is that way back in the 1950s, when they did some studies, nobody believed that cigarette smoking could be causing cancer, because everybody smoked. The assumption when Sir Richard Doll did his studies was that air pollution was the most likely candidate for causing cancer and then it became obvious it was tobacco. It has taken us probably twenty or thirty years to change attitudes to tobacco, so I’m not underestimating the scale of the problem, but I do think it is a clear and obvious problem and you might as well start with attacks on sugary drinks because they are the easiest target.
In Mexico, it’s already been demonstrated to be effective, so why not? You will raise considerable revenue, which you can use towards improving the health of people and there is no obvious downside because there are no merits in sugary drinks, it’s not like they’re bringing health to a subsection of the population – there is nothing good to be said about it.
When people are trying to make lifestyle changes, where does the burden of responsibility lie? Is it with the individual and their willpower or does the state have a significant role to play?
I think that we fully recognise that willpower and education is not enough. That’s why with things like tobacco and alcohol we have put ‘sin’ taxes on. We recognise that for whatever reasons humans are prone to doing bad things to themselves and you can argue, ‘well, where do you stop?’ I think it’s very difficult with the pressures put on us from advertising etc. to lead a healthy lifestyle. I think we need help. We see that with tobacco and alcohol, so I see no problem in extending that to sugar.
A lot of your work focuses on diet and what people are eating and drinking. How do you see the balance between the importance of diet and the importance of exercise?
Basically, it depends on what you want to do. If you’re primary goal for example is to lose weight, then it’s got to be calorie restriction because exercise is not a terribly good way of losing weight. If you want overall health, then exercise is absolutely critical because exercise will help you maintain weight loss once you’ve lost it, it will do lots of good things if you have type 2 diabetes, or have any problems with your blood sugar levels or if you’re insulin resistant.
It’s really important, not only to do aerobic exercise – heart and lungs, going for a walk, going for a run – but also strength exercises; whether it’s sit ups, press ups; anything which basically builds muscle. You don’t have to go down to the gym and use weights – there are some very simple exercises which can be done and easily found on pretty much any kind of exercise website. You start gently and then you get into a habit. The main thing is habit – you have to have a few simple rules. I always take the stairs for example. I find it very depressing seeing people just standing on escalators, I don’t understand why they just stand there, particularly on the way down. At the bare minimum, they could walk down the escalator. So you just need a few simple things that you can incorporate into your life and it will make a really big difference.
Considering the nature of your work, a lot of people will ask about the background to it and the nature of the research you cite. What is your response to people when they push you on the legitimacy of it?
Absolutely, I’m delighted! My book is full of references to scientific studies, it’s based on the work of Professor Roy Taylor at Newcastle University, who has worked in this area publishing for four years in reputable journals and has been peer reviewed – I think that is the only way to go. I absolutely celebrate anyone looking and wanting to know real scientific information. The thing that frustrates me is when people condemn it without actually looking. They say there is no evidence and that’s simply because they are utterly unaware of where the evidence is. People should open their eyes to what is going on in the world. There is a lot of terrible information out there, but what you need to be aware of is that there is also some very good information and it needs to be peer reviewed, it needs to be from good medical journals. All the stuff that I write about has references in it.
In terms of the feedback that you get from the people within the scientific and academic field, are they particularly receptive of your work?
I’ve been delighted I must admit with how positive the response from the academic community has been. It’s partly that Professor Roy Taylor is incredibly well known and very reputable, so when you see also his name on the cover and you know he’s endorsed it, then endocrinologists and others say ‘yeah, ok, let’s give it a go’, because they know that he is a first-rate scientist and he would not be involved in anything that is remotely dodgy. Professor Taylor has a massive study ongoing which will deliver in 2018 and the evidence is building all the time. As I said, I’ve been delighted with how open minded people are and it’s reasonable enough to say not everyone is going to benefit from this and that’s absolutely true.
People are going to be different in terms of what lifestyle changes work for them. How careful are you to acknowledge this and include the caveat that the effectiveness of this approach depends on the individual and their specific circumstances?
Oh absolutely. I think this is an option. The book is full of caveats and there is also a link to Professor Taylor’s website where you can print out a two page document to give to your doctor about how to manage these changes because it’s important that this is done in conjunction with your doctor, particularly if you’re on medication and particularly if you’re on anything other than metformin. If you have high blood pressure for example, that’s going to come down pretty fast, so it’s important that your doctor is fully engaged in the process. If you have prediabetes, then there are less risks obviously because you haven’t started on medication, but again if you are on any form of blood pressure treatment you need to go and talk to your doctor because that is one of the things that will be affected.
Essentially what Taylor says is that the important thing is to lose abdominal fat – try and reduce that. Whether you do it fast or slow, it doesn’t matter. It isn’t going to work for everyone – for people who have had type 2 diabetes for say more than eight years, there is less chance of success because your pancreas is likely to be more damaged than if you are newly diagnosed. You need to bear all these things in mind, as well as if you really want to do it. Some people are not going to want to do it, they’re going to want to just continue on with their medication and that’s fine. Some people will start and find it too challenging and that’s why I offer different ways of approaching it. I don’t think there’s any one way, but I do think that in the end if you are significantly overweight, if you do carry a lot around your tummy, then getting rid of some of that through a combination of diet and exercise has got to be a good thing.
Dr Mosley’s latest book, ‘The 8 Week Blood Sugar Diet’ can be purchased here.