Imagine a society where everyone enjoys good metabolic health. Motivated by this vision, the Public Health Collaboration (PHC) www.PHCuk.org was founded in 2016 with a mission to ‘empower, inspire and educate people that most chronic diseases can be prevented and reversed by maintaining good metabolic health through sustainable lifestyle changes.’ With the NHS celebrating its 75th anniversary, the theme of this year's PHC Conference at Sheffield's Crucible Theatre (19 and 20 May) was ‘Fixing the NHS – One Person at a Time’, and 400 delegates, together with a further 100 watching online, saw a total of 24 speakers share their expertise on how we can harness the power of lifestyle to help fix the NHS together.
PHC director Sam Feltham reminded delegates that the need to fix the NHS was acute given that type 2 diabetes (T2D), cardiovascular disease (CVD), obesity, cancer, dementia, and stroke cost the NHS £35 billion annually and take up 50% of GP appointments and 70% of inpatient bed days. However, it became clear over the course of the weekend that a spirit of curiosity, combined with a determination to assert evidence-based science in the service of common sense, can meet this challenge.
Insulin resistance and T2D
From the United States, professor of cell biology Benjamin Bikman of Utah's Brigham Young University, considered the role of insulin resistance – defined as a reduced response to the hormone insulin – in metabolic syndrome. Prof Bikman noted that metabolic syndrome is characterised by increased waist circumference; raised blood glucose, blood pressure and triglycerides; and low concentrations of high-density lipoprotein in the blood. Further, with an estimated 33% and 58% of UK adults having metabolic syndrome and hypertension, respectively, insulin resistance is intimately related to what he calls the ‘plagues of prosperity’ like obesity, type 2 diabetes (T2D), CVD, cancer, and fatty liver.
Given insulin's role in diabetes and its crippling societal effects, those working in primary care should be encouraged to learn that T2D need NOT be a progressive disease, but that many patients can achieve medication-free remission. Both Prof Roy Taylor of Newcastle University, and Southport GP Dr David Unwin showed how their respective approaches had achieved impressive success rates, with Dr Unwin's low-carbohydrate approach, allied to the continuity of care that epitomises primary care at its best, making lasting differences to patients' lives … plus savings on medication.
Further underlining how lifestyle changes can shape a healthier society – while reducing expenditure – registered dietitian Helen Gowers described how she oversaw the development of The Lifestyle Club (TLC) www.thelifestyleclub.uk – of which she is now director – a programme for people with T2D. TLC is an exciting innovation in primary care, and following a successful pilot in 2021, TLC is now active in 37 GP surgeries in England, helping over 600 participants, 88% of whom complete their course. Several Primary Care Networks are commissioning TLC using Additional Roles Reimbursement Scheme funding, and TLC's treatment goal is remission of T2D.
Nutrition and cancer
Two speakers focused on the role of nutrition in cancer. In 2013, aged 27 years and while studying for a Master's degree in nutritional therapy, Andrew Scarborough was diagnosed with an aggressive, untreatable anaplastic astrocytoma brain tumour. After surgery and following four months of chemotherapy Andrew abandoned the treatment and embarked on a palaeolithic ketogenic diet (PKD). A decade on, Andrew's tumour has not grown, and he is now a keen student of tumour biology and is conducting a landmark study into metabolic aspects of cancer Andrew Scarborough – IBTA (theibta.org).
What is a PKD? This was explained by neurobiologist Dr Zsófia Clemens who is CEO of the Palaeomedicina Clinic in Budapest, Hungary. A PKD is essentially a very low carbohydrate/high fat diet that can either be fully animal-based or 70% animal-based/30% plant-based, and Dr Clemens provided a series of clinical case studies to illustrate how a PKD can be used to treat cancer, diabetes, and autoimmune diseases, achieving high success rates compared to standard therapies. One patient she described had a glioblastoma and had thus far survived for 8.5 years on a PKD.
Protecting the NHS
In the context of the PHC's theme of ‘Fixing the NHS’, Kent-based GP Dr Bob Gill provided a sobering reminder that political attempts to privatise the NHS and introduce the US-based concept of managed health care have a long history. For example, in a 1988 document entitled ‘Britain's Biggest Enterprise: ideas for radical reform of the NHS’ Conservative MPs Oliver Letwin and John Redwood argued for, inter alia, reorganising the NHS into an independent trust; establishing joint private/NHS partnerships; extending the principle of charging; installing a system of health credits; and instituting an NHS insurance scheme.
Nutrition and the brain/mind
In medicine, as in life, categories are illusory, and the concepts of nutritional and metabolic psychiatry were explained by US-based, Harvard-trained psychiatrist Dr Georgia Ede who noted low response rates to typical psychiatric medications; and showed how diet can address insulin resistance and excess dietary sugar to ameliorate a range of psychiatric disorders and reduce or eliminate the need for medication.
Also pursuing the theme of nutrition and the brain was Patrick Holford, founder of the Food For the Brain Foundation Our Mission Statement | Food for the Brain Foundation who explored nutritional aspects of Alzheimer's disease, such as the role of homocysteine concentrations in the condition. Interspersed through the conference were lively panel discussions on food addictions; plants in the diet; the relationship between public health and the food/farming system; and the question of exercise and whether one could outrun a bad diet (spoiler alert: no).
Finally
During his inspiring address, philanthropist and PHC Patron Steve Bennett quoted anthropologist Margaret Mead: ‘Never doubt that a small group of thoughtful committed individuals can change the world. In fact, it is the only thing that ever has.’ It seems to me that primary health care is comprised of many small groups of thoughtful committed individuals, and one might reasonably speculate that the intellectual impetus provided by organisations like PHC will motivate many to not only help fix the NHS, but also make it flourish … as it is meant to do