Transcribed using AI transcription, errors may occur. Contact Mikki for clarification

00:03
Hey everyone, it's Mikki here. You're listening to Mikkipedia and this week on the podcast I speak to Dr James Muecke, Low Carb Advocate and Ophthalmologist and Australian of the Year in 2020. James and I talk about his advocacy work in the health space as it relates to diet, which might seem a stretch from his original career path as an ophthalmologist. He talks

00:33
how he discovered the link between his professional work and just the underlying sort of health issues, his experience with patients, and later his role as an advocate in the public health space. He's been very vocal here since his award, and even before his award in 2020. And we discussed the pushback that also inevitably comes from being out there and sort of fighting for, I guess, food justice.

01:01
in this modern day food environment. So James and I have a really great conversation and we also of course discuss at length some of the issues with a high carbohydrate diet and the potential for type 2 diabetes with eye health and just health in general. So Dr James Mueke is an Adelaide based ophthalmologist and he graduated with honours from Adelaide University Medical School in 1988.

01:29
Following his internship he lived and worked as a volunteer doctor in Kenya in 1989. After completing his ophthalmology training in 1995, he worked as an eye surgeon in Jerusalem for 12 months and undertook subspecialty training in eye cancer in London, then returned to Adelaide in 1998 where he's been a visiting consultant and senior lecturer at Royal Adelaide in Women's and Children's Hospitals.

01:56
James has founded the not-for-profit organisation, Sight for All, in 2008. We discussed that in today's conversation, which is about addressing the fight against blindness in the aboriginal and mainstream communities of Australia and some of the poorest countries of the world. His commitment to social impact in humanitarian endeavours has earned him a number of awards, including the Order of Australia in 2012.

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Australian Medical Association's President's Leadership Award in 2013 and in 2020 he was awarded the Australian of the Year for his 30 years of humanitarian work and sort of beyond that is his work out there in that sort of governance and advocacy space for low-carb diets. So I have put a link to a site for all in the show notes and also to a couple of the articles that that

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in today's conversation.

03:21
Dr. James, Mookie, thank you so much for joining me this morning. I am super excited to chat to you about your work, both in your profession as a, um, am I right? Ophthalmologist, is that right? Ophthalmologist, it's a tongue twister. It is a tongue twister. With an eye surgeon, that's much easier. Okay. Eye surgeon. Brilliant. Would be great to chat to you, um, about your professional work, but also outside of your surgery, your...

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advocacy for diet on that public health level, which in itself could be like this full-time thing that you would be doing. I know many people are actually in that role. I really want to dive into, I guess, your journey along that and where you're at. Can we kick off first by giving just a bit of a brief on your training and career, and at what point did you, I guess, happen upon...

04:17
a low carbohydrate approach that might be effective for your patients? Sure, sure. Well, I've been in the medical profession for about 40 years. That's including medical school. I've been an ophthalmologist or an eye surgeon for now 35 years, I think. So it's, I'm getting to the end of my career actually. And in fact, I was explaining to you before that I have a problem with my right hand, which has meant that I had to go up surgery.

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back in 2012 and it's tele-forcing you to an early retirement, but it's okay because I've found this whole new passion to get involved in. I actually co-founded a not-for-profit called SiteFraud back in 2007 or eight, I think it was, so it's been 16 years ago and that's dedicated to fighting blindness. Our focus has been Asia, which is home to half the world's blind adults and two-thirds of the world's blind kids.

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So it's a big problem and we've been training, equipping colleagues in many countries and now 10 countries in Asia to be able to deal with the blinding problems, comprehensively deal with the blinding problems in a sustainable way in their various countries. And so that's been a great passion of mine. I'm still involved. I was chair for 15 years that I recently dropped off the board and I'm now acting as a patron or as an ambassador for Site4ALL. So I'm still very passionate about it.

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In 2018, I found that Cyphers focused not so much on Tendent, but realized that we had a big blinding problem in Australia and that being diabetes, specifically type 2 diabetes, which as you know, makes up about 90% of cases. Now why there's such a blinding problem in this country? It's actually the leading cause of blindness amongst working age adults in Australia.

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blindness in our First Nations people, our Aboriginal people, as I'm sure it is in your First Nations people as well. So why is that? It's because there's about two million people in this country with diabetes and well over half are not having their regular all-important sight-saving eye checks. And so I felt that this was important. We've been doing a lot of work around blinding issues in Australia and in our First Nations people. But I thought it was about time we really highlighted this.

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paid more attention to this critical issue in our country. So one of the things I did in 2018 was I wanted to do a documentary about the experience of blindness, what it means to be blind. When I interviewed 10 people who are blind, 4 kids who were born blind and they had fascinating stories, extraordinary stories, but that's all they ever knew. So they coped with their disability very well.

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I also interviewed four people who were slowly going blind at the end of their lives due to age-related macular degeneration, which is the leading cause of blindness in now, in let's say, a low-income country such as Australia, New Zealand, and their stories were not particularly, I mean, they were all interesting, of course, but they were slowly going blind, so adapting, I had lots of family support, the main issue was the loss of independence.

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Two people that had a really, really profound impact on were two people that lost their vision in the middle of their lives due to diabetes. One was a corporate high-flying executive with Hype One Diabetes who was just too busy to have her eyes checked and she became blind as a result and remains blind. And the other was a man from a lower social economic demographic. His name is Neil, Neil Hansel, and he's more than happy for me to use his name.

08:06
And his story was so deeply harrowing. He developed type 2 diabetes at the age of 26. And then at the age of 50, he talks about going to bed one evening with no more sight and waking up the next morning blind in both eyes and hearing me this day due to his type 2 diabetes. And so he's been a fabulous advocate. I mean, his story was so powerful. He talks about the last thing that he saw before he went to bed that

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fateful evening with a beautiful smile on the face of his wife before he fell asleep. And it was such a harrowing story that when we were recording the interview, myself, Neil, the film director, the sound of the ever are in tears, his wife are in tears. It was just such a powerful story. But I saw it.

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Firstly, this is a great story to be able to encourage Australians and New Zealanders because we actually have a Royal College of Ophthalmology which incorporates both Australia and New Zealand. So I thought this is a really powerful story to encourage Australians and New Zealanders to have their eyes checked if they have diabetes or if they're neurosomal with diabetes to prevent this horrendous lining outcome that can result. It's actually the most huge complication of diabetes.

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So Neil helped me to, well, we actually created a TV commercial, which paid nationally back in 2018. He helped me create another TV commercial in 2021, which paid nationally, which really showed the impact of type 2 diabetes on the family. So, you know, winding the clock forward, in 2019, I was fortunate to be nominated for South Australian Year.

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So when I made my, I was expecting to receive that month award, but I did receive the award. And when I received the award, I got up and made a speech encouraging Australians with diabetes of all sorts to have their eyes checked on a regular basis to prevent this horrendous outcome that we're seeing in this country. And then once you receive the local award, you then go to the national award, which was in 2020 of the Australia Day weekend.

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late January 2020. Once again, I was not expected to win that award, but I happened to win Australian of the Year in 2020. Extraordinary. And so in that time between receiving South Australia of the Year and being awarded Australian of the Year, which was a few months, I thought that if I happen to win this award, what is our biggest health crisis at the moment? I'm a doctor. It's type 2 diabetes. Surely as a doctor, then this would be the focus of my

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of my work and my messaging. And so when I received the award, that's where I turned my focus too. And it's been all consuming because of my hand disability. I'm actually now down to pretty much just a half a day a week. And the rest of the week I spend in a pro bono, acidity just completely immersed in this world of type two diabetes. And it's been a fascinating, all consuming journey. Yeah. So interesting. And I think.

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James, the link between diet and type 2 diabetes for many people is now, if I say common lot, people are much more aware of how important, I mean people have always been aware about how important diet is, but the message isn't always a low carbohydrate one. And in fact, it's something which has taken quite a while for medical bodies to even adopt and promote as sort of first line type.

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So when was it in this journey for you, was it sort of, did it become clear to you of how important diet was with this? So as part of this whole process, I think it was late 2019 that I started reading more deeply about type 2 diabetes and I read Jason Thong's amazing book, The Diabetes, and I found out that type 2 diabetes could be cancelling or reversed naturally. That's the title of the subtitle of his book. This was a revelation to me.

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medical doctor at that time, a medical doctor, probably 30 odd years. I had no idea type 2 diabetes would be put into remission. It was certainly not part of my training many years before. I'd never even heard of this. It was quite an extraordinary finding. And how do you put it into remission? Quite simply using a low carbohydrate real food diet. So that was an amazing, amazing thing to me. And

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In 2020, when I received the award, I was actually put on the expert advisory group, the National Diabetes Strategy in Australia. I think they thought that I could be a good advocate as part of that group. Little did they know that I was going to be a pain. My one mission was to get remission of type 2 diabetes into that document, which it did for the first time ever and that was published in 2021.

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So, yeah, that was an extraordinary time and quite a turning point in this whole process. In late 2020, I gave a National Press Club address talking about the barriers to preventing and reversing type 2 diabetes that I encountered during my year as Australia, the year 2020. And while the big barriers was quite simply our Australian dietary guidelines, which I vacate for or recommend that say.

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my carbohydrate eating approach. I think 65% of our diet should come from carbohydrates. Now, that's all well and good. And it actually states that I think in the early pages of that document that it's intended, that the dietary guidelines are intended for the average healthy Australian. But when you realize that most Australian, most Kiwis are not healthy, I mean, birds of our adults, overweight or obese, and a quarterback

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majority of Australians are not healthy. So these diamonds are not appropriate majority of Australians. But more than that, bodies such as our Royal College of GPs, Diabetes Australia, were recommending that people with diabetes of all sorts eat by the Australian Dietary Guidelines. Now, if you have diabetes of any description, you are in essence at its core, you are intolerant of carbohydrate. So

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recommending a high carb eating pattern to people who are carb absolutely makes no sense. And since what was going on and diabetes straight back in 2020, the very first sentence in their type two diabetes webpage on their website was type two diabetes is a progressive disease. Clearly it's not a progressive disease. And when in 2021, the national diabetes strategy was published,

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I started chatting to my patient, something that I never thought I would do. I mean, I was a guy at the end of the line, treating the end stage complications of this abligning, life-changing and deadly disease. I never thought it was my role to have discussions about diet. So what I did was I, initially I chatted to my patients and said, you're aware that your type 2 diabetes can potentially be turned around, potentially put into enlistment. I mean, one, I'll

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let's say the first hundred patients was even aware that this was a possibility. So clearly this was a conversation and it was not being handled by, by, it was a conversation not being had with the, with the patient between the patient and the GP. So, uh, well, I said, it is, it is definitely a possibility. Uh, and it's actually now in our national diabetes strategy. I think you should have a chat to your GP about it. So I wrote back to the mutual GP saying, can we explore this extraordinary opportunity or to our patients? Hypertreat diabetes is a delinition.

16:11
Most of those letters were ignored. Some of the letters were taken on board, but merely by the patient pushing the GP to actually explore this concept. I had some endocrinologists who were coughing into those letters who actually disowned their patients, told them to go elsewhere. It's just extraordinary. What do you think is at the heart of that reaction, James? I'm really always interested to understand better people's reactions, particularly to something like this.

16:40
I think there are lots of potential reasons from the GP point of view. They just simply didn't know about it. My son, he's now in sixth year medical school, was in second year medical school and they had the opportunity to do nutrition at an elective. So it was loaded compulsory in our major training grounds and yet our poor dog is responsible for more disease and death than smoking alcohol and inactivity combined. So it's not being taught in medical schools. And then you...

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actually educated in medical school to medicate a patient. And it goes on from there and you have bodies and they're being funded by the pharmaceutical industry or the food industry. You have researchers, scientists, doctors, specialists being funded by the pharmaceutical industry or the food industry. And this all sways people, not necessarily in a egregious way, but it might sway people like me.

17:40
I was using medication to try and stem this rising tide of loss of issues of Linus. I never thought to use diet to potentially turn type 2 diabetes and it finding complications around. I wasn't doing it in any sort of unethical or egregious way. I just simply didn't know. So when you're being taught to medicated patients, not being taught, then you can actually

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reverse someone's chronic disease with diet, then it's just simply a lack of awareness. So this is one of the things I've been doing in my role, trying to raise awareness at medical school level, at the GP level, at the specialist level, it goes on and it's been done. And also, of course, I train our dietitians and nutritionists who are a part of this process.

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Yeah, so interesting, isn't it? My colleague and friend, Karen Zinn, is a dietitian here in New Zealand. She's very much at the sort of cold face of low carbohydrate eating for chronic disease and health, et cetera. She had a number of complaints made against her in the early days of us doing this, which was...

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earlier than the time that you were talking about, like maybe 2013, 2014. And of course, there were registered dietitians in Australia that were struck off for advocating a low carbohydrate approach. I mean, definitely the tide has changed a little bit. Even in your period, we're talking 2020 initially for you, but over the last four years, do you feel it's becoming more mainstream?

19:27
Absolutely. But the message still needs to get out broadly. I think the turning point, as I mentioned, was the National Diabetes Strategy, the opportunity to put revision into that document. Yes. Then in 2022 or through 2021, 2022, I was writing to GPs and endocrinologists. I was getting some pretty hostile letters that came from endocrinologists saying, just saying all of these horrible things. And I would write back.

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in response to those, it was pointing out the flaws in their arguments. And there was one in the premonitor saying, well, we did this stack of the AT that every patient died within six months who went on a low-carb diet. What? Like that's not my understanding. And, you know, this was a time when most people smoked cigarettes, you helping you tease out diet, it's possible for people. So it was quite extraordinary, but I was getting these.

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There was back saying, oh, it's not safe and it's not sustainable and et cetera, et cetera, et cetera. So I thought, well, okay, what we could do is let's have a round table discussion between the endocrinologists in this city, South Australia and Adelaide and the low carb practitioners. And so that's what I did in 2022. And I got Gary Setke, who is a colleague from Tasmania, an orthopedic surgeon who was actually chopping off the feet and the legs on a weekly basis.

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patients with type 2 diabetes, who have been gained green as a complication, the second most severe complication, killing these patients to simply cut back on their sugar and carb intake. I think it was primarily sugar intake ordered by one of the dieticians at his hospital and had a several year investigation. And fortunately, he was ultimately cured. But it's an extraordinary story. Yeah, it is. However, in 2022, we had this, was more than a roundtable meeting. It was actually a whole seminar.

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room full of practitioners and it was quite an adversarial affair. It was quite an unpleasant experience for both Gary and myself. But at the end, I said, clearly, I have patients now that put their type 2 diabetes in remission, clearly it can be done. I mean, your concerns are one of safety and one of longevity. So let's look at some of these safety issues and how can we deep strive patients who, that's the main issue.

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with respect to safety is that patients who are on insulin, if you drop their carb intake, that can actually go hypoglycemic. If they're on SGLT2 inhibitors, that can also be problematic as well. So let's look at how we can actually put a patient's type 2 diabetes intervention, de-medicate them safely. So one of the low carb practitioners, Dr. Lorraine Lord-Smith, who's a GP here in Adelaide, got together with Steve

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past person of the Australian Diabetes Society. And through 2023, they wrote guidelines for therapeutic hyperhybrid reduction, which was published earlier this year. So again, this is another powerful turning point. Because Australia has now endorsed these guidelines, the Australian Diabetes Society has endorsed these guidelines. So we're actually moving in the right direction, but still most of my colleagues have no idea about it.

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I had, as I mentioned, I had a number of patients who I talked to, but it was only the patients who had sight-threatening eye disease. I didn't call raw to call the patients with diabetes who were just simply having screening. These were patients I was actively treating with laser, with injections into their eyes, sometimes on a monthly basis into both eyes. And one patient who was the first patient that I had this experience with that was a

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a guy called Beb and Bruce again, he's happy for me to use his name. He was having eight week re-injections of an antibody into both eyes to keep his, what we call diabetic macular edema, the swelling, the central vision area, the macular retina in the back of the eyes, keep the edema away to keep the swelling stocking going blind as a result. This every eight weeks in both eyes. And he had been on that for years. I tried to extend it out beyond that interval. No luck. Anyway.

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between injections, I sent him to the nutritionist. I started working with the nutritionist and that only one nutritionist time that I was able to understand was involved in this process. And her name is Rachelle Martin and Bevan went to see Rachelle Martin between injections and probably in that six-week interval because I usually have two weeks between pines. In that six-week interval, he came back to me and he come off his insulin.

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That was amazing. And then after the next pair of injections, another six weeks later, he came back and he'd come off all his medicines or his diabetes or his oral medicines. He lost a bunch of weight. It had never felt better. And he was also single. And it's now, I think, about three years since he sat on that journey. And I saw him a week or two ago. He's now all injections. He's competing.

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finishes injections now and I'm not seeing him again for another six months. So, extraordinary story. And what I'm finding almost universally is patients with type 2 diabetes, even with type 1 diabetes, with Juicic hydrate intake, I'm seeing the macular edema pretty much dissolving away. Another really memorable case was a young middle-aged woman that diabetes for some years and she came off her insulin within a couple of weeks.

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And she was boardlined for needing injections into her eyes. And I thought, well, okay, let's try putting a type two diabetes intermission using low carb or ketogenic diet, sent her to a Sheil Martin nutritionist. And over the next nine months, her macular edema resolve just on dietary change of lung. There was no other changes to her medicine of the part I'm coming off her insulin. So extraordinary, extraordinary. And that case was published recently.

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And first ever case of its kind to be published. Amazing. A series of 15 patients who have reversed their macular edema, just with diet alone and not all the injections. And that was presented at the ward of Femology Congress just last month. And I'm finding the same in patients with type one. I'm finding the same with patients with what we call retinal vein accretion who often get edema of the macula. Patients with type two diabetes, even with

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pre-diabetes, insulin resistance, metabolic dysfunction, reduce the carpet, take the finding and improvement in their swimming. So it's almost every patient I would say that engages in this process. We see the benefit. I have the amazing opportunity in ophthalmology to see in the back of the eyes and see the damage that's being done and I can see the damage repairing itself. And so this is something that's going on throughout the body. We see a whole raft of horrendous complications that can be turned around by...

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reducing carb intake, reducing sugar intake, reducing seed oil intake as well. Yeah, so interesting. And those stories, and I was going to ask you about the type 1 patient as well, because that, obviously, clearly similar complications come with having type 1 diabetes. So I'm super pleased that you sort of engaged with that.

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James, you mentioned Jason Fung as someone you originally read. Who were other people that you turned to in this space? Obviously, you've got some amazing colleagues in Australia, like the likes of Gary Vickie and of course, Peter Bruckner. But elsewhere, who were other early or ongoing mentors or colleagues that you work with? Oh, always too many to name. Yeah.

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And I would hate to leave anyone out of that with this, but I've got several hundred people now in my contacts list, which I'm constantly communicating with. But some of the notable ones, those images with Gary Setke, who's been an incredible mentor for me, I speak to Gary almost every week. Amazing.

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That was another pivotal book in my reading and Peter's platform, Deceit Diabetes, which has now been embraced by Diabetes Australia. So again, it's an incredible story. And Paul Mason, who's a physician in Sydney, always been an incredible mentor to me. Melva Vodin, who's a dietician or an ex-dietician in WA now living in Melbourne. Gosh.

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Anthony Caffey, you're a physical training in WA. The disc goes on. There's so many people that have either reached out to me or I've reached out to them and who've mirrored me, guided me, educated me. There are lots of books that I've read through the time. I've also been in touch with people in the UK, sorry, Harking, for example, people in the US, Nina Tyshaw, for example. I mean, there's just so many that have all been wonderful. And so I'm kind of standing on the shoulders of these.

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times that they've been leading the lights and it's fuel. Yeah. And it's so interesting, isn't it? Cause you, you name, you know, several people who, um, I think the listeners will be well aware of most of them, not all of them, but most of them. And it feels like when you're listing them off, I'm just sitting here thinking, you know, so many people are, um, are now out there advocating for the same approach. Yeah. It doesn't seem to make.

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a difference when we're thinking about the public health space and the preventative space and the diet space. You mentioned that you did a speech to the National Press Club outlining some of the challenges or some of the flaws in those dietary guidelines. Your point that most of the adult population is in fact unhealthy, so these dietary guidelines are no longer appropriate.

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It's such a sticking point, isn't it? Like it's so great that the Diabetes Australia is now on board with this message. And that will obviously feed down into people who need it from a treatment perspective, but ideally we wouldn't need to be treating it in the first place. So what are your thoughts around that, James? And how was your talk received and what are your thoughts on that? The talk, I think the talk was buried. It wasn't, so you couldn't even access it online for weeks.

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It certainly didn't go down that well and I got lots and lots of arsey letters from people. So it was a kind of a stressful experience to do that. It's hugely brave by the way. Like, and then I feel like, were you somewhat ignorant of what it would be like or? I kind of know. I knew, I thought it would be, I thought I'm really the ultra-processed food and the sugary drinks industry would be the industries or the organizations that would come after me. But actually they've been.

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purely quiet. And back in late last year, we had a parliamentary inquiry into diabetes, which was instigated by a health minister, after my lobby him, that we do something about this chronic disease epidemic. So we had that and I gave evidence at the parliamentary inquiry and I gave evidence, I tried, I've actually come up with a whole strategy about awareness, accountability and assistance to

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try and turn this chronic disease epidemic around, particularly the type 2 diabetes epidemic. But I didn't overwhelm the committee with the evidence. I just selected three areas which needed attention. One was our dietary guidelines, one was our diabolical food environment, and one was our planet grounds for health practitioners, specifically medical school and training with dieticians.

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I did talk about that there needs to be an investigation into how this happened, how back in 2019 to 2013, the industry influence crept into the creation of those dietary guidelines and needs to be accountability for this process. They need to also look at how these guidelines actually work. Well, clearly not because of the obese type 2 diabetes epidemic. We now see type 2 diabetes in kids as young as three in this country.

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Northern Australia leads the world for type 2 diabetes amongst children. We have an obesity epidemic in infants and children. It's straw-ramp. So it clearly doesn't work. And actually, is it doing harm? I'll ask the question, is it doing harm? Well, yes, it is because bodies such as College of GPs, Diabetes Australia, the Dieticians of Australia keep on recommending the patient with type 2 diabetes to eat by the Australian dietary guidelines as I mentioned before.

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did kind of ram down the throat of the committee of the parliamentary inquiry and the report has been recently released and the report does say there needs to be more promotion of low-carbohydrate diets for people with all types of diabetes which was a fantastic result. There was also mention of the need to have specific guidelines for patients with again, all types of diabetes on how to eat.

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what's the most appropriate way to eat patients with these diseases. So we're definitely gaining traction. It's definitely moving in the right direction. There's quite a bit of pushback. Last week, I wrote, I didn't write it last week, but I wrote it earlier in the year, but it was published last week in Opinion Pete about the integral role of red meat, both in our health and in the health of our environment. And a couple of days later, there was an article published about

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with me causing environmental damage. Also, there was a story in the Australian newspaper about two of my patients who'd reversed their type 2 diabetes and reversed their macular edema, as I mentioned before. And then a couple of days later, there was an article which was published broadly in this country saying the low carbohydrate diets actually cause type 2 diabetes.

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follow-up articles weren't kind of some rebuttal of my articles. But Peter Brooker has done, and Zoe Harkin is about to do an analysis of that study, which came out of Monash University, which is deeply flawed. And yet it was raved by journalists and it came quite, you know, quite significant news. But once again, my opinion piece is being eerily quiet.

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really heard nothing about it. So it's apart from the rebuttals, apart from those couple of pieces or articles that were published in the days afterwards, there was no request for me to speak to the media about this. I mean, it's bizarre. You think that there's a huge outcry and interest in this story. And tumbleweeds, basically. Yeah.

35:19
Yeah, it's interesting, isn't it? Because I suppose when you are advocating for the reduction of something in the diet, like carbohydrates, the first question, well, not the first question, but one of the questions will be, well, what do you eat then? And of course, if you are an advocate of red meat, as I am as well, that's almost as an unpopular message as reducing whole grains in the diet. So can you just chat us through, James, because I saw that you'd, I'd seen this sort of multiple

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your newspaper article, your opinion piece, then of course that low carbohydrate diets increase the risk of diabetes. I knew the timeline with that. Can we just sort of, just for the interest of our listeners and also so I get more of an idea of your opinion on red meat in the diet, every single place I went to for your article was behind a paywall. So I didn't in fact read it, but I obviously saw the headlines.

36:16
Oh, I can send it to you. There's one where it's not behind a paywall. Amazing. So I'll send you that link. Yeah. So the narrative, the all pervasive narrative at the moment is there's a couple, one, or there's a number actually, one that's saturated fats bad food, but based on no solid evidence whatsoever. In fact, there are multiple studies showing that there is no evidence of saturated fat to diseases such as cardiovascular disease to type 2

36:47
But the other pervasive narrative is that red meat is bad for our health, is bad for the environment and it's morally a terrible thing to do to kill and loss of food. So looking at each of those just briefly in turn, red meat being bad for your health, how can the thing that we evolved to eat be the thing that's causing all these disease? I mean, these are virtually non-existent prior to the 60s. What we've noticed over the last hundred or so years is a rise in sugar consumption.

37:16
a rise in C-dol consumption. We know that sugar and C-dols are the major drivers of metabolic dysfunction, the core metabolic dysfunction being insulin resistance. And they are along with highly refined flour, they are the key ingredients to most ultra-processed foods. Well, ultra-processed foods now make up 62% of the diet in America. Yeah. 66%, two thirds of the diet are kids in America, over 50% in the UK.

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The last record here some years ago was over 40% of our diet. I suspect we're nudging closer to 50% of our diet as opposed to processed foods. So how can you separate or tease out red meat as being the culprit when you've got all these modern food-like substances which have become the norm? I know. And again, it's by the food industry, it's driven by the cereal grain industry, it's driven by the sugary drinks industry, it's driven by the fast food industry. This narrative that red meat is bad for you, but it's based on the lowest evidence.

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epidemiological, what we call observational data, which is a very low level of evidence. And you just simply can't tease out the confounding factors which obscure the result. And you certainly can't tease out ultra processed foods, which are the most likely culprits here. For example, they don't differentiate between a piece of grass-fed side of low-carb veggies in a glass of water.

38:45
They don't differentiate that from a takeaway meal. They say takeaway burger with a sugary bun, sugary sauce. Fries. Fries, deep fried in Theodore's and a sugary drink. They don't differentiate between those two. So there's no way you can say that red meat is the culprit here. Yeah. And I, 100% am on the same page as you. And the other thing, which I think it's really, it's good for us to chat about this and remind people.

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why we read these headlines that say red meat is bad for us, yet they remind them of some of the flaws in the research that's actually describing it. I would also say that the mechanisms with which red meat is supposed to impact negatively on our health are mechanistic studies that haven't been replicated in human trials, or if they have come up in trials.

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with humans, they're not, these are acute changes and they're not chronic and they certainly do not also associate with disease outcomes. So it's frustrating as advocates of a more sort of minimally processed diet to hear some of the backlash of when you advocate for red meat, et cetera. Absolutely. And one of the big ones. I mean,

40:10
The three key ones are type two diabetes, sorry, red meat causes cardiovascular disease, red meat causes type two diabetes and red meat causes cancer, particularly bowel cancer is a big one. If you look at the International Agency for Research into Cancer, the data or the studies they use to base their findings that red meat is linked to colorectal or bowel cancer. The six mechanistic studies, three were human, three were done on RAN. The three human studies.

40:38
based on Aldate and Marcus. But the three which were formed on rats, the three studies, each of the studies, the rats were injected with powerful carcinogenic chemicals, cancer-causing chemicals before being said red meat. Yes. Just beggars' beliefs. I know. And they actually take this seriously. It's actually laughable, some of the evidence that they put forward. So there's obviously agendas behind this, powerful agendas,

41:08
I noticed you look at all of these, the websites of Cancer Council of Australia, Heart Foundation Australia, it's Redme Causes Cancer, Redme Causes Happy Vascular Disease, last it's throughout. Then if you delve into these websites, for example, Heart Foundation Australia, their major sponsor is Sanaterium. Yeah. Sanaterium is an all-processed food company owned by the Seventh-day Adventist Church.

41:37
to demonize red meat based on the visions of a 17 year old girl in the mid 1800s when honey simply did not exist. So you can see where the vested interests lie. Yeah. And also I would say that it's not just the grain industry that follow this narrative either. Like there are like the meat industry also sort of toes a very careful line with their promotion of their own product. You know, I...

42:07
I jumped on beef and lamb a few weeks ago and had a look. One of the big articles on how much red meat you should eat or how much protein you need stated as a headline that 130 grams of cooked meat has 60% of your protein needs. And it was like I was almost flabbergasted that they would have something on there that would suggest that you need very little.

42:35
of this amazing super food in order to meet your requirements. And in fact, it actually resulted in a few emails being sent through Beef and Lamb because they accidentally saw my social media and then emailed me about it. But I feel like the food industry is a, I don't know, there are so many mixed messages that people receive from in food industry with that, with unawareness of that agenda. Exactly. And I talked to that.

43:04
red meat advisory council occasionally in Australia. And I say to them, you need to employ or engage the best PR agent in this country to descend your position because we're hammered at the moment by all these various industries who are pushing this plant-based narrative. They're pushing the message that we should have a high carb diet, which is clearly not good for us. And it's just staggering that they're not engaging this. They're all tit-toeing around it. Yeah. And I...

43:33
I got a letter from the Red Meat Advisory Council in response to my piece last week about red meat saying, thank you for your continued advocacy. We don't believe, we don't agree necessarily with your stance on grain fed meat, but thank you for what you're doing. And I had to go back to them and say, well, actually grain fed beef is not good for us. It's not great by which I mean, it's...

44:01
not as devastating as a monocropping, which is quite literally destroying the topsoil in an unsustainable way. But I think what we should be doing is moving this country and New Zealand as well towards a regenerative approach to our agriculture, to our livestock rearing, which is much more sustainable, much better for the soil, ultimately produced, lasted beef, which is much healthier for us. Yeah, 100%. And I think the...

44:29
You raise the objection that I often hear as well with regards to red meat and health is colon cancer, colorectal cancer. It's one of the leading causes of cancer amongst certain age groups and I often see it. I see plant-based diets advocated for the reduction in risk. It's good to chat to you who is so well aware of the research from the IARC and where you

44:58
there are flaws in that sort of base research, because that's something which people are hugely concerned about. Exactly. And if we look at the Bradford-Tule criteria, the link between red meat and cancer comes in at 1.2, so 20% increased risk. It's less than even being a male, which is I think 1.5. But to actually, to full-fill what's called Bradford-Tule, Bradford-Tule-1.

45:28
criteria that an association could possibly meet causation, it should be higher than two. So this is a way below the Bradford Hill criteria. So association, correlation does not equal causation. And this is unfortunately what most people are not aware of. Most of my medical colleagues wouldn't be understanding of it, and certainly the general public, even journalists who continue to pump out the rubbish. Yeah. And people, not just social media, but any sort of media they tend to.

45:57
jump on terms like this 20% increased risk, because that in of itself, in isolation, sounds like a remarkably increased risk of anything. But when you understand those absolute numbers that you might be talking about one in 30,000 and then the increased risk is 1.2 in 30,000 cases. So it's almost meaningless, but it certainly doesn't appear that way with these inflammatory type headlines.

46:26
Absolutely. And what people are sailing to, again, medical practitioners, the public, the media, et cetera, sailing to engage in is how, and what we read with is our health. Yeah. We are seeing an epidemic again of B12 deficiency. I know 60% of vegetarians and 40% of vegans have vitamin B12 deficient. Vitamin B12 is critical for our brain development, our brain health. We also seeing iron deficiency anemia. I'm not sure the stats here in Australia, but in the U.S.

46:56
40% of young women are lino efficient and that's resulting in anemia. And actually speaking to some surgical colleagues here just the last few days, they're quite often having to infuse prior to surgery young women who are lino efficient and this is driven by this lack of red meat in the diet or the coming back of red meat in the diet. Red meat is also a great source of

47:23
the hormone which is important for mental health and happiness. And you wonder why we're seeing this mental health epidemic as well. So red meat is, and they're just some of the micronutrients that I mentioned. And going back to your point about reducing our consumption of red meat, the flip side of that, actually it's very hard to overeat red meat because of its protein content, it's very hard, it's very satiating eating red meat. And so,

47:52
are like ultra processed foods which are designed to be the opposite. They're actually designed hyper palatable and it encourages over consumption. They're also loaded with sugar, which we know is highly addictive. So these are addictive substances and we have in industry, the ultra processed food industry, the sugary drinks industry and the fast food industry who are paying on people's addictions with their essentially addictive products.

48:19
We know that type 2 diabetes is strongly associated with food addiction. So we're once again preying on vulnerable people with type 2 diabetes often from more socio-economic areas again that compounds their vulnerabilities. And we see this disaster. So there's huge accountability that we need to see here from our government to stop the predatory marketing that's going on by these industries, which is I think a big driver.

48:48
I know when I go to the supermarket, I'm sort of chemist these days, Officeworks, you name it, you're a checkout counter and there's, you're being enticed by half price, some sugary drinks. It's a diabolical. So it looks as though our government is going to be, or at least the state government is going to reduce the predatory marketing of these industries which go on everywhere in our food environment, in our environment in general, actually, every bus stop you'd see

49:17
process should be pronounced. It's just diabolical. James, what do you think it's going to take to actually reverse, not necessarily type two diabetes, because we already know what it takes to reverse that, but to reverse some of these bigger systemic challenges that we face, and not just Australia and New Zealand, but it's a worldwide thing. One, what do you think it will take? Two, do you think it will happen in your lifetime?

49:44
Yeah, so, great question. So there's, I come up with a strategy which involves awareness, accountability and assistance. And not talking about awareness as in labeling, unfortunately, that has been shown to work and it doesn't change population health, but we need this broad awareness, which has to begin at the earliest stages, you know, we have a gestational diabetes epidemic, so really should begin during pregnancy, but certainly during those early years of school, killing kids that

50:12
Red meat is not the culprit, saturated fat is not the culprit. What we should do if we want to avoid this whole argument of vegan versus carnivore and everything in between is just reduce our consumption of sugary drinks, added sugar, foods, fiber and cedars, ultra processed foods and minimize our consumption of refined carbohydrate. That's what we should be doing both to prevent metabolic dysfunction and also to potentially turn it around.

50:37
So an awareness and broad awareness needs to happen amongst the public. There also needs to be awareness, which we're starting to gain some traction amongst medical practitioners and diet practitioners that actually, once again, that saturated fat and red meat is not the culprit and carbs are the culprit. So this is starting to happen. We're starting to see this. So we need accountability from

51:01
Again, various, various places. We need accountability when it comes to our dietary guidelines. Our dietary guidelines are currently being reviewed. It's not a treated experience process. Who knows what's going on? We won't know until 2026, but hopefully, scenes of the old process through the industry are not playing a major role in it, which is good. I like the last iteration of the guidelines. We need accountability from local governments as to, as I mentioned, this

51:28
predatory marketing that's going on everywhere in the food environment. So we need this correction of the food environment. We need accountability at schools that continue to sell junk food in touch-ups and canteens and still use junk food as fundraisers and birthday parties in school. You go to school and on and on. I could talk about this for hours. And the final A is assistance. So we need assistance for

51:55
general practitioners so they understand and have the guidelines to be able to reverse metabolic dysfunction using real food as medicine rather than always tuning to medications. We need assistance for patients with metabolic dysfunction so they can have access to a real food. Sometimes it might need to be subsidized. We need assistance for patients with type 2 diabetes specifically, but perhaps also

52:25
continuous glucose monitor so that they can see the impact of various fluids on their blood glucose levels and then do something about it. As I said, we're going well, but we need all of these things to happen at once. One of the key things which we haven't talked about is a tax on sugary products. We know that's being shown to work in many different jurisdictions around the globe. I think over 100 have shown that it reduces purchase and consumption of sugary products.

52:55
But here in Australia, both major parties have not engaged with that process. And it seems they will not engage with that process, despite calls from the Australian Medical Association and others that this is something that we should be looking at and myself as a result of that, I've moved away from all meaningful attacks on sugar products. It's only one of the multi-pronged strategy as I mentioned before, there are lots of different things that we need to happen and it all needs to happen at once.

53:25
tax on sugar products is just one of those. But as I said, I've moved away from that. And I'm now really been lobbying the local health students, South Australia and the federal health minister saying what we should be doing is removing the tax breaks for the marketing and the research and development of these various industries that market their unhealthy foods at us. So currently about $5 billion every year,

53:54
Coca-Cola alone. Do you imagine what that $5 billion could be used for? It could be used to have this awareness campaign I've mentioned. It could be used for putting healthy foods in school lunch program. It could be used to subsidize patients with type 2 diabetes in the lower socioeconomic areas to have access to real food rather than the line of processed food. It could be used to provide a CGNs to patients with type 2 diabetes, et cetera, et cetera, et cetera.

54:24
Yeah, that's super interesting actually that there's a tax break for food industry. What's the justification for that? It's just a tax reduction for those companies. On note of the pre-diabetes, this is where I think education, I don't mean to sound, I don't know how this will sound, but education to GPs out there who get HbA1c's run on their patients and see HbA1c's at 37, 38, 39.

54:51
that is not necessary, it's not a diagnosable pre-diabetes, but there's not, I feel like that 40 is like an arbitrary cutoff that they use. Up into 40, you'll find 41 pre-diabetes. That is not how health works. And I feel like there needs to be more of an understanding that if your HVONC is getting up there, then having a conversation with your patients about strategies to reduce that will overall improve outcomes.

55:21
Absolutely. And in fact, in my recent presentations, I've been talking about a continuum of metabolic dysfunction which begins with patient resistance. Yeah, passes through prediabetes on the type 2 diabetes. Now our HbA1c is 6.5. Okay. The other units. Yeah. So, me myself as an eye specialist, I'm seeing patients with prediabetes with retinal disease. Yeah. We know that the retinopathy...

55:47
pathology involving the retina starts before the diagnosis of type 2 diabetes. And that's just the one complication. We know that many patients that actually begin before the diagnosis of type 2 diabetes and the big one cardiovascular disease, heart attack, stroke, 80% of patients with type 2 diabetes will succumb to heart attack or stroke. That starts to rise after an HVA1C of 5.5. So it's below the pre-diabetes level.

56:15
So, again, this has to be made aware and often, as you say, this HVA1C is the holy grail. Let's say, certainly, you don't suddenly develop prediabetes, you don't suddenly develop type 2 diabetes. This is a continuum metabolic dysfunction. Type 2 diabetes, also, really, we should rethink this because it's the end stage, really bad guy at the end of this continuum of metabolic dysfunction.

56:45
But we need to be aware that the metabolic dysfunction is sounding way back with insulin resistance and when the blood glucose level starts to rise, we're already way advanced down that track. What we should be doing is looking for blood insulin levels. So the GPs are not performing blood insulin levels and this is a critical thing that needs to be measured. The other thing, the other really critical marker that needs to be measured is pride

57:14
should be aiming at the triglyceride level below one at the moment. I think something like 40% of the Australian population has triglyceride of over 1.4. And we know that they're increased risk of cardiovascular disease. Yeah. Yeah. 100% agree with everything you're saying, James. I have just one question, which is related way back to when you were discussing people you were interviewing

57:43
Neil who went to bed being able to see woke up blind. How often does it happen? Fortunately, not very often. It's incredibly rare. It's a powerful story. And I suppose ultimately it's a story to try and make people aware of the potential to this disease. But it's very, very rare. Usually there's two major

58:11
complications that we see with diabetes and to pack on the eyes. One is sudden bleeding into the eye due to what we call vitreous hemorrhage. The vitreous is the deli which fills the back of the eye. So vitreous hemorrhage and that results from new blood vessel formation. So just going back a couple of steps, when you have mockage of the fine blood vessels of the retina, which is the light, the light sensitive layer of tissue that

58:40
blockage of those blood vessels you get. A lack of oxygen, so is skinnier and that triggers the in-growth of new blood vessels in a sense, they're trying to heal this damaged area and they're fragile and they can suddenly bleed into the illness. So this is what happened to Neil literally overnight in both eyes at the same time. Fortunately, and as I said, he's still blind to this day. Usually the way it would proceed, the patient with diabetes, if they suddenly get sotard in one eye.

59:08
And that was spurred of blood into the jelly and the patient said that things will speak floating around and they go and see their optometrist and oh goodness they have they have retinal disease, which is quite advanced. And sometimes that's a presenting sign of type 2 diabetes or diabetes in general. Now probably type 2 diabetes. Yeah. So it's rare, but it's certainly a complication that we watch out for.

59:36
Form of vision loss in diabetes is what we call diabetic macular edema, which I mentioned before, which the other main issue when you have diabetes, it causes damage to the blood vessels with the leakage of fluid into the tissues throughout the body, including the retina, including the macula, the central vision area of the retina. And that causes a buildup of fluid, like a puddle of fluid to develop at the central vision area. And that can cause blurry distortion of vision and ultimately it's a violent risk. Yeah.

01:00:05
That's the most common and in patients with diabetes, it can be that presenting symptom of patients with type 2 diabetes, the disorder vision, look inside their eyes and they've got some swelling of the macula. There's generally patients with diabetes, they have type 1 diabetes, which usually happens in younger people. It's sudden, dramatic onset. It's deadly if it's not treated with insulin immediately. Those patients won't

01:00:33
develop any signs of retinopathy for several years. So there's no urgency, but ultimately they need to have their eyes checked every couple of years. And if they develop retinal disease, you might start seeing them more frequently every year. If they don't have sight-threatening eye disease, if they have sight-threatening eye disease, they might need to be seen more frequently every three to six months. Yeah. Patients with type 2 diabetes, we don't know how long they've had the diabetes for. So they need to be seen immediately to check for retinal disease. And then sometimes you need to

01:01:02
start treatment straight away if they have CYTS Vagina. Yeah, interesting. And people with type 1 diabetes, the pathology or the progression is the same as the oedema that you were describing and or the capillary, the capillary bleeds same processes? It's not something I'm so aware about or understanding. I believe that type 1 diabetes, the progression to

01:01:32
what we call proliferative retinopathy or neovascularization, those new blood vessels that can lead, that's more prevalent in type one with the macular edema is more prevalent in type two. But I'm wrong on that. But I believe that's the case. So either way, you see both complications developing in both patients and what's extraordinary in Aboriginal people. I do have a few First Nations people that I'm seeing and I'm actively treating retinopathy, but they tend to develop.

01:02:01
kidney disease very rapidly and off eye of kidney disease very rapidly. And so well before they're even engaged in the eye screening process. But certainly this understanding, this need for eye screening is not happening. You know, as I mentioned, I think earlier, well over half of Australians are not having

01:02:30
This is a thing that needs to be made aware of. When Neil Hance sort of the type 2 diabetes at the age of 26, he had no idea what lay away from him. He's lying in both eyes. He's had nine amputations of his left leg, including the whole left leg. In March 2020, he's had two heart attacks and a stroke. So he's had all gametes. And the other really scary one, I think to me, the most feared complication should be

01:02:59
not loss of vision, but should be dementia. So, with type 2 diabetes, dementia, I had two parents that both succumbed and lost their lives to dementia. And so I realized how broadly this disease impacts on not just the individual, but on the entire family. Yeah, for sure. And I know that you will be aware of it. I'm not sure if the listeners will be, but there is emerging evidence to show how...

01:03:27
helpful with ketogenic diet is it improving symptoms in dementia patients as well. So, diet is such a critical piece of all of this. And of course it is because it's so obvious and it just makes it so frustrating that health professionals are yet to wake up to that idea because I hear from people multiple times each month that...

01:03:54
their doctors, endocrinologists, even the gastroenterologists don't think that diet plays any role with regards to the condition that we may be talking about with my clients, but ultimately there is evidence for diet to play a role in all of these conditions. This is why the work that you do, James, is just so important to increase awareness, particularly in amongst your colleagues and those people who are the touch point for the general population, because people listen to their doctors.

01:04:23
much more so than they might other people that they will be in contact with. Absolutely. And we're pushing hard here in Australia. Peter Bruckner's Defeat Diabetes Group and the newly formed Australasia Mediabolic Health Society are now pushing the Royal College of GPs to have a course to raise awareness of these really critical issues that we've talked

01:04:53
their CPD continuing professional development. They need to be exposed to CPD courses. We have recently started at the beginning of this month, 10 module course on metabolic health, which has gone to dietitians through Dietitians Australia to all the dietitians in the country. We've also put it out to the Nutrition Society as well. So what we hope is that, and also I mentioned we've been talking to medical schools. I think we've talked now about a quarter of the medical schools in Australia.

01:05:22
we're looking at including metabolic health and remission of chronic disease and type J diabetes in their courses. So we're going to start to see this shift. I mean, if you look at smoking, that was on the thing and that took decades to turn around, but it certainly turned it around. And I think this is even more sinister and the industry is driving this even more sinister than the smoking industry. And it's actually...

01:05:49
more than just one thing, it's more than just tobacco. So it's a much more complex beast. So I think it's going to take decades to turn around, but we see it going in the right direction, which is reassuring to me who I'm an ultimately a very optimistic, positive person. That's awesome. And then I appreciate your optimism and I somewhat share it over the next few decades. And I always think that, yeah, smoking took 50 years. This is going to be, I heard

01:06:18
my friend and colleague, Grant Schofield, talk about is, you know, this will happen one coffin at a time. So with all of the people who are sort of up here in terms of nutrition, you know, as new blood comes through, hopefully, we'll see. Yeah. I gave a presentation to a group of magistrates last year and I asked them the question, you know, Q&A time after my presentation.

01:06:47
I can ask you guys a question. How do you think we should get around this? And the universal message back was that we need a class action. And yeah, maybe that's what we need actually. We need patients who've been told for decades to eat a high carbohydrate diet when they're clearly not following a bit to actually do something about it. We need people like Neil Hansel, who's been devastated by this disease and family of people who are devastated by this disease. We need them to...

01:07:15
take action, we need this grassroots kind of movement to say, hang on, you know, you'd be telling us the wrong thing for so long. And we have this predatory industries that are driving this. We need, we really do need this, this actually to happen. Yeah. So are you telling me, James, that you're going to become the next Erin Brockovich? Is that her name? You know who I'm talking about, don't you? Yeah. That would be amazing. Someone needs to.

01:07:45
Yeah, well, I mean, I'm doing it quietly behind the scenes and I'm going to start writing a book about all of this very soon, which will be interesting. Probably won't be read by too many people, but ultimately, hopefully, by the time it's released, we will have already seen this big shift continue in my path. Nice one. Dr. James, thank you so much for your time this morning. Can you just let people know where they can find out more from you and the things that you're up to?

01:08:15
Yeah, so if you're interested in site for all's work and we actually, just a brief note on site for all, we draw on ophthalmologists from Australia, New Zealand and further afield to help train colleagues, as I mentioned, in poor parts of the world where we have about 10,000 voluntary hours every year, or at least before COVID we did, of specialists who donate their time and their expertise and their goodwill to our projects, which are

01:08:43
impacting now on over a million people every year. So that's why I won the award, unfortunately. So New Zealand has played a very critical role in that. So, Cyp for All, we have, you can subscribe to our newsletter on our website. Amazing. There are social media handles, LinkedIn, Facebook, Instagram, probably YouTube as well. If you're interested in my work, which is specifically around advocating for better metabolic health and time to diabetes, then I have a

01:09:13
Facebook and Instagram site. I don't have a Twitter or an ex account. I was getting enough to do just on those three sites. So you can look up Dr. James, mukee, mue, cke. That is awesome. Thank you, James. We will put links in the show notes to Site4ALL, to your LinkedIn and also to a non-paywalled site.

01:09:38
version of your article on red beet and health because I think that's also would be a really good read for people to engage with. So thanks so much for your time this morning. Great to speak to you Mackie and thank you for all your doing to raise awareness. It's important these podcasts are really critical to help us get the messages out there so thank you very much. 100 percent.

01:10:09
Alrighty then, so super interesting and particularly with regards to the media's take on some of the studies that are out there and as you know I did a mini-micropedia on that sort of misinformation and Monash's media release on that type 2 diabetes study and also just you know how much influence that the media can have on just that information that is shared. So let me know your thoughts on this one guys.

01:10:36
Next week on the podcast, I speak to Tony Boutagy, all about strength training, and it's a super cool conversation. I think you're really gonna love it. Until then though, you can catch me over on Instagram, threads, and Twitter, @mikkiwillidem, Facebook, @mikkiwillidenNutrition, or head to my website, Mikkiwilliden.com, and book a one-on-one call with me. All right, team, have the best week. See you later.