Show Notes

• Defeat Diabetes website
• The Diabetes Code book by Dr Jason Fung
• Unstress episode with Dr Gary Fettke on controlling insulin
• Unstress episode with Dr Michael Mosley on the fast 800
• Unstress episode with Dr Peter Brukner on diabetes care
• Low Carb Down Under Conference

Timestamps

• [00:00] – Introduction to Dr. James Muecke and his mission
• [04:25] – The impact of type 2 diabetes on vision health
• [10:00] – Dr. Muecke’s personal journey and medical awakening
• [23:54] – The role of diet in reversing type 2 diabetes
• [43:32] – Defeat Diabetes and Diabetes Australia partnership
• [49:09] – Practical steps for managing type 2 diabetes with diet
• [57:02] – Final thoughts on sustainable diabetes management strategies

Dr James Muecke: The Future of Diabetes Treatment

Dr Ron Ehrlich [00:00:00] Feeling stressed, overwhelmed. It’s time to unstressyour life and focus on controlling what you can control. I’m Dr. Ron Ehrlich, host of the Unstress Health podcast, inviting you to join the Unstress Health community and discover a holistic approach that helps you more effectively face the daily challenges of our modern world and effectively recover each and every day. I’m stress Health is here to provide you with advice and support that is independent of industry and influence and influence. That’s easy to miss but difficult to ignore. Our focus is on building mental fitness. Your mind can be your best friend or your worst enemy. Mental fitness is the key. Our three phased approach Target mindset Whose positive intelligence quotient and move from self-sabotage to self-mastery. Secondly, the challenges We redefine what stress means in our modern world. And thirdly, Recovery master the five pillars of Health. As a member of the Stress health community. You’ll turn obstacles into opportunities with expert led courses, curated podcasts, personalised health assessments, supportive community, and much, much more. Join Unstress health today and together let’s not just survive but thrive. Click on the link below or visit unstress health.com. Well, today I have the pleasure and the honour of welcoming back to the program Dr james Muecke. James was Australian of the Year in 2020. He was awarded that for his social impact Organisation site for All, which creates low cost programs to fight blindness through research, education, infrastructure. Also raising funds to deliver eye health care projects free overseas to partner countries and communities, and train colleagues there in new sites. Saving skills. Well, that was what James was awarded the 2020 Australian of the Year. And that year, which many of us may recall was the beginning of the pandemic. And as an ophthalmologist, he decided that he would focus on diabetes because one of the one of the tragic side effects of diabetes is loss of sight. And he shares with us a very harrowing story in this program. But James, well, if he achieved Australian of the Year for work he had done prior to 2020, I think she may well deserve, along with Dr. Peter Brukner, who will be on the has been on the program before and is on the program will be joining us again in coming episodes. These two have championed a low carb approach to treating type two diabetes. Now to anybody who has received a diagnosis of type two diabetes from the vast majority of the medical profession will be told they will be on medication for life. That remission is not an option. And as you will have, as you will know as a regular listener of this program, that is simply not true. There is remission for type two diabetes and low carb approach, and healthy fat approach is really a breakthrough in this and together will defeat Diabetes was founded by Peter Brukner. I’m very proud to have been a supporter of that. James Mueke has been an ambassador for defeat diabetes and I believe one of the greatest public health initiatives in over 40 years in Australia has just occurred. And that is the collaboration between Diabetes Australia and Defeat diabetes. And this is a groundbreaking collaboration and James Mueke and Peter Brukner have been working tirelessly to champion this. So I was very keen to get James back on to give us an update of what has happened in this very important public health initiative. I hope you enjoy this conversation I had with Dr james Muecke. Welcome to the show, James.

Dr James Muecke [00:04:26] Ron Great to be back again.

Dr Ron Ehrlich [00:04:28] Yes, I was. I should say welcome back because we spoke just after you became Australian of the Year in 2020, which was wonderful, except 2020 wasn’t perhaps the best time at the just as the pandemic was breaking to pursue the passion that you have pursued then and since. Tell us tell us what that passion was all about and what drove it.

Dr James Muecke [00:04:53] Yeah, what actually dates back to probably 2018. And as an ophthalmologist, what I noticed over the 30 odd years of my career was the rise in in Type two diabetes particularly, and the rise in the number of patients that I was seeing that I was treating with vision, threatening what we call diabetic retinopathy or diabetes related eye disease. But it perhaps came to a head when I in middle of 2018, I think it was decided to undertake a little documentary. It was going to be a series of talking heads, talking portraits. And I interviewed a number of people who had who were blind really to get an idea as an eye surgeon, as an ophthalmologist, what it means to be blind. And I interviewed four kids who had been born blind or had fascinating stories. I interviewed four people at the end of their life that were going blind very slowly due to age related macular degeneration, and their stories weren’t so impactful because they adapted to their deteriorating vision and they had support from their families and they were managing quite well. But the two people, the two patients that I saw who had a deep impact on my thinking about all of this were two people in the prime of their life who went blind in both eyes due to their diabetes. And particularly a guy called Neil Hansel is happy for me to use his name. Neil tells his harrowing story of going to bed one evening with normal sight of the age of 50 and then waking up blind in both eyes at that morning. And he’s blind. So his story was was incredible. I remember the time I was in tears. He was in tears. The movie that the filmmaker, the cinematographer, the sound engineer, everyone was in tears of this harrowing story that this guy was telling. And I used Neal’s story to then ultimately create a TV commercial which aired nationally in Channel on Channel seven in late 2008 and encouraging people to have their eyes checked. You know, the reality is there are probably close to 150,000 people in this country with threatening disease due to their diabetes. Well, overall, there are about 2 million people in this country with with diabetes, the majority of whom have type two. But well over half are not having their regular all important sites having checks. And that’s why it’s become the leading cause of blindness, months working age adults in this country. It’s also the fastest growing cause of vision loss in Aboriginal people. So in 2008 or after that, that amazing experience I had, I felt our charity, the charity that I co-founded called Sight for All, which had a focus in Asia, which was home, which is home to two thirds of the world’s fine adults and half the world’s blind children. Our focus has been on Asia. But I also felt a responsibility, a deeper responsibility to focus on what was happening here in Australia. We’ve always had an Australian arm, but I just felt that it needed more focus, excuse the pun. And so we held a fundraising dinner in 2019. We used Neil and his story to help drive awareness around this need to have have objects. And it really rolled on from there. And fortunately I was nominated as South Australian of the Year. I wasn’t expecting to win that award, but I did. That was in late 2009 ten and then going on to the national awards in early 2020. I thought, well, okay, if I’m going to win Australian of the Year, I’m not expecting to, but if I’m going to win it, what is Australia’s biggest health crisis? Because surely I have a responsibility to tackle that, being a doctor. And so it was I felt strongly that it was type two diabetes. And if you consider that close to 2 million people in this country of roughly 25 million people have Type two diabetes that we know about, then this is where I should be focusing my energies. And so I started doing a lot of reading and reaching out to people who were able to mentor me and got me through this process. And in the when I won the award in early 2020, on the Australia Day weekend, I talked about sugar being a driver of this, and I still believe sugar is an important driver of this, but I realised that it’s actually more than just sugar and it’s my journey went on this amazing trajectory from that time.

Dr Ron Ehrlich [00:09:34] Well, you know, I did see the documentary and I think it is compelling, emotional, confronting, shocking, very powerful. And I would encourage I will have links to it, of course, for people to see that. But I’m interested on another level, on a professional level or a personally professional level, because you’ve been a doctor for 30 plus years. That’s fair to say.

Dr James Muecke [00:10:00] Well, I’ve been in the medical profession for 40 years now. 40 years, I guess, which is scary. And I’m on the on the retirement, but in the ophthalmic profession.

Dr Ron Ehrlich [00:10:09] Yes. Yes. And you’ve been observing type two. You’ve been observing all sleep problems and specifically type two diabetes as well. And for advice on what causes type two diabetes, you would, of course, just naturally go to Diabetes Australia or the Australian Healthy Eating guidelines because I’m not sure how absorbed in the study of nutritional medicine you were on your professional journey. Would you share that with us?

Dr James Muecke [00:10:38] Yes, I would. It is fair to say that I had very little idea at all about nutrition, science and the non-science, which often drives this whole space. So, no, I was I was very naive. I always saw my role with the guy at the end of the line to treat the insights. Complications of blinding complications, the most feared complication of of diabetes. So that was my role. I never thought of my role as being one that to talk to my patients about their lives, specifically about their nutrition and what was driving the type two diabetes. And if you look at is a night is 2021 the very first line in the title on the Type two diabetes web page of Diabetes Australia was Type two diabetes is a progressive disease. And they go on to mention the word progression progressive several times on that one page and that ultimately patients will need to go on medications and insulin and so and then experience complications. So basically once you develop type two diabetes, it was a done deal. You know, you you had this trajectory that you were going to be on. But what I realised probably wasn’t until late 2000, 19, 2020, early 2020, when I was reading around this subject, I think it was probably even in the Christmas break in 2019, 2020, leading up to the Australia Day weekend that I read a number of books. One of the most powerful books that I read was a book called The Diabetes Code by Jason Fung, who’s an arena physician from Canada. And I found out that type two diabetes could be reversed naturally through diet. So this was absolutely news to me and it was an extraordinary revelation. And then in 2020, because of my advocacy, because of my Australian of the Year appointment, I was asked to be on the Expert Advisory Group for the National Diabetes Strategy Refresh. And I was able then as part of that process, to get remission of type two diabetes into that document for the first time. So that was, I think, a big, big hurdle which has really allowed a whole bunch of things to happen since that time.

Dr Ron Ehrlich [00:12:48] Yes. And we want to talk about it because some of those things that you’ve been involved with, I would have to say probably the most positive public health initiative in 40 or 50 years in Australia. And we’re going to come to that spoiler alert. We’re going to come to that. But I’m still want to stay with with you as a practitioner because this is part of what the big problem is. You’re a busy medical practitioner. You have faith in public health authorities and public health documents, specifically the Australian healthy Eating guidelines, which I have to say. I walked into a childcare centre picking up my grandchildren just a few days ago and there was the Australian Healthy Eating guidelines. And you referenced Diabetes Australia, who I remember reviewing their ten steps for lead leading life with diabetes. And step number one of the ten is ensure carbohydrates are part of every meal and stay on a low fat diet. And when I read that, I realised the key word there was with diabetes. If you wanted to live life with diabetes, you would follow that advice. But if you wanted to live life without diabetes, you wouldn’t. Yeah.

Dr James Muecke [00:14:02] It’s amazing. I mean, and fortunately, Diabetes Australia is moving in the right direction, which is.

Dr Ron Ehrlich [00:14:08] Which is exciting. It’s very exciting. But then, you know, I was just a dude during.

Dr James Muecke [00:14:15] During, during medical school, as I mentioned before, you know, there was no talk about nutrition and particularly specific to the appropriate nutrition pathway that people would need to be on to prevent prediabetes, Type two diabetes, the underlying metabolic dysfunction, which is. Insulin resistance. My son, who’s in medical school at the moment, he was in second year medical school a few years ago and he had the opportunity to do nutrition science as an elective. So it’s not even compulsory in most of our medical schools here in Australia. And yet our poor diet is responsible for more disease and death and smoking, drinking alcohol and physical inactivity combined. So it’s it’s troubling that the doctors. From general practitioners through to specialists and beyond are not receiving this really important critical information which could turn around a chronic disease epidemic.

Dr Ron Ehrlich [00:15:16] And I know that you are. You’ve been an advocate for this change. Tell us the message that you are essentially trying to convey to the authorities and to the public as well.

Dr James Muecke [00:15:29] Yeah. So the number of messages. But I think the critical one, if you look at the dietary drivers of type two diabetes, they are sugar, particularly the fructose element and refined carbohydrates, which are essentially sugar in disguise, starchy products such as highly refined white flour, white rice, pure white potatoes. And the foods prepared from Mars and the seeds oils, what we euphemistically called vegetable oils. But they’re made from seeds such as sometimes ethanol, etc.. And if you realise that ultra processed foods, which are the major components of most ultra processed foods, are sugar, refined carbs, most often highly refined wheat flour and seed oils, then you realise that ultra processed foods are clearly not good for our health. And there’s been a recent systematic review released in the British Medical Journal this year linking ultra processed foods to a number of chronic diseases, including type two diabetes. So my message is around about preventing metabolic dysfunction, and type two diabetes is really just in the stage of that continuum of dysfunction, which starts with insulin resistance. So preventing type two diabetes through changes of diet, which essentially is avoiding sugary drinks, sugar added to our foods, foods with added sugar, particularly ultra processed foods and foods containing or deep fried foods in the stores. And if most of us want to follow that advice, then the chance of ending up with type two diabetes would be very small indeed. Now, the other thing, which has become a really important part of my messaging, which started back in 2020, was the opportunity to put Type two diabetes into remission. And as I mentioned, I was able to get that very important message, a very important piece of information into our national diabetes strategy for the first time. And so when I was able to get that and that was published in 2021, I then started chatting to my patients because before that, you know, there was this uncertainty whether whether you would get reprimanded by our medical board for having these conversations with patients. Certainly there are examples and Gary Sick is an excellent example of that. A doctor colleague, a specialist colleague, an orthopaedic surgeon who was actually prohibited from practising his profession for two and a half years while he had an investigation simply for advising his patients to cut back on their sugar intake because he was just finding that he was amputating so many feet and legs for patients with type two diabetes down in Tassie. And that’s a fascinating story, as you know.

Dr Ron Ehrlich [00:18:17] Well, James, James Gary, was this second guest or third guest on my 400 episode podcast. And his wife, Belinda, who’s also an advocate for this. That is a shocking, compelling and confronting story for health care in general and practitioners in particular. So, yes, Gary’s has been a guest on this program, and so was Belinda conveying the trauma that they went through in conveying a message like you are doing now, not just as Australian of the Year, but actually making change?

Dr James Muecke [00:18:50] Yes, absolutely. And I mean, Gary’s story is extraordinary and disturbing. The good thing is now that it’s in our national diabetes strategy, there’s no need for doctors, dietitian, nutritionist to fear being reprimanded by their overseeing bodies because it is in our national diabetes strategy. It is under one of the major goals of our national diabetes strategy. So I was just mentioning so when one set was in our national diabetes strategy, I started having the conversation with my patients. Did you realise that your type two diabetes could be put into remission? Only one of the first, let’s say 100 patients who I had the conversation with was even aware that their diabetes could be put into remission. I’m talking about type two diabetes here. Only one of the first 100. And these are patients who had sight threatening eye disease who I was actively treating. I have a much bigger group, a broader group of patients who I’m just watching to ensure they don’t develop type two diabetes. Sorry. Background what we call background diabetic retinopathy or patients with background optic retinopathy that I’m watching to make sure that they don’t develop sight threatening disease. I’m talking about patients who actually had sight threatening disease, who I’m actively treating. So. I didn’t. What I then did was okay. What we need to do is, is make your GP aware of this amazing opportunity. So I drive back to the GP of the mutual patients and we explore this incredible opportunity to put our patients type two diabetes back into remission. And amazing, amazing bunch of results. And I would copy the endocrinologist in if the endocrinologist was if the patient actually had an endocrinologist. And specifically they had in the context that that I was able to communicate with and I knew. So most of these letters, as far as I can tell, were ignored. Occasionally patients and I recommended a local nutritionist in Adelaide who who I was aware of that was able to guide patients through their journey to put their diabetes into remission. So I recommended the local nutritionist and a few of the patients for the GP’s. And took this on board and sent the patient to the nutritionist. Unfortunately, a lot of patients couldn’t afford. Nutritionists and dietitians that are able to put Type two diabetes in their mission because it’s not covered by Medicare, it ends up being quite an expensive thing for them. And so some of them went alone in this journey. And as some of the patients actually insisted that their GP. You know, explore this opportunity for them. And then what I did was see patients coming back. And these were patients that I was injecting in their eyes with an antibody to try and save lives and stop them going blind. And I still remember the very first patient that came back to me, a guy called Baby Bruce. He’s also happy for me to use his name. So Bev, when he was having two monthly injections in both eyes, had been for years and I was unable to wean him off these injections. And he came back initially. He’d come off his insulin. He’d seen the nutritionist. The nutritionist was guiding him on a basically what we call a ketogenic diet, a very low carbohydrate diet, avoiding those products which I mentioned before, including acid oils. So came off his in some pretty quickly. He’d been on medications for ten years or more. Then he came off all these medications. In the process, he lost a bunch of weight. He then said he had never felt better. And ultimately, he said he also was starting to see better. And what I’ve what I found over the next 2 or 3 years was that I was able to slowly wean him off the injections, so much so that he’s now off his injections entirely. His Type two diabetes has remained in remission. And his macular I was treating him for diabetic macular oedema. The most common cause of vision loss in patients with type two diabetes. His macular has remained normal, so it’s super exciting. It was a super exciting thing for me to experience as a doctor and something that I wish every one of my colleagues would also have experienced as well. And, you know, I’m just in this little silo ophthalmology, and I’m seeing this one complication and we’re seeing this again and again throughout all the specialities of patients who put their type two diabetes in remission there. The fear, the side effects, the potential complications are also potentially reversing. I mean, unfortunately, if the damage is severe and it’s been longstanding. It’s not so easy. We won’t see. We might see a stabilisation of the situation, but we may not see reverse of the damage.

Dr Ron Ehrlich [00:23:55] But I can only imagine how that must have felt as a physician specialist who for 35 years had been managing a disease, managing disease to have cured, I don’t know, maybe cured isn’t the right word, but putting into remission is almost word for cured. Let’s call it remission. Cutting disease into remission where the patient no longer requires medication treatment and actually expresses the fact that they feel better than they ever have. How did that make you feel as a physician after 35 years, Jane?

Dr James Muecke [00:24:31] It was it still is the single most exciting moment of my 40 years in medicine. This one particular patient now, I’ve seen this being repeated time and time again. But this first experience was just so heartening for me. And what I’ve noticed, I’m now about to publish a case series and I’ve got at least 30 odd patients who have. We’ve seen a reduction in their macular oedema. We’ve been able to get a number of patients off injections altogether or at least reduce the frequency of their injections. Even patients who were not receiving injections, who put the type two diabetes into remission. I’ve just we’ve just published a study, a study of a young woman, middle aged woman, actually, who had type two diabetes. And within a couple of weeks, she came off her insulin once she started on this dietary change. And over a nine month period she was borderline. She had macular oedema, she was borderline requiring treatment. And probably a year or so ago. Couple of years ago, I might have started on treatment. But because we going down this pathway of dietary change and very quickly she put a type two diabetes into remission, I thought, well, let’s just see what happens to her macular oedema. And over a nine month period of time that I was watching her macular normalised again, but just not acquiring any treatment beyond a change in diet. And we just published that study and just put that out on social media. It’s super again, super, super exciting to see this change because of a change in dietary dietary consumption.

Dr Ron Ehrlich [00:26:15] You know, to just juxtapose your excitement with another episode we’ve done recently on on Burnout in medicine. I got to share the statistic that 44% of doctors and 60% of nurses suffering from burnout. And I can only imagine how draining, constantly managing and writing disease and prescriptions must be and overwhelming. And yet here you are after 40 years of practice, more excited than ever before. Far from burnout, I would suggest. I’ve.

Dr James Muecke [00:26:47] Been absolutely buoyed by this experience and speaking to a number of my colleagues. I’m sure you’re the same, Ron, but Laurie Lawler Smith, who’s a GP here in Adelaide, she is a low carb practitioner and she’s was getting towards the end of her career and really very burnt out and disillusioned and just treating chronic diseases, alleviating symptoms, prolonging life perhaps, but ultimately not very satisfied. And then when she learnt about this opportunity and started using it with her patients and seeing the turnaround and the metabolic dysfunction, the improvement in metabolic health, their mission of type two diabetes, reverse pre-diabetes, etc., etc. She also has given her a new lease of life in her own medical career. So we’ve seen this time and time again of medical practitioners who start going down this pathway and see and experience this. And it’s absolutely revitalising.

Dr Ron Ehrlich [00:27:43] Because at the end of the day, and we’ve done programmes on autoimmune cancer, heart disease, obviously diabetes lowering insulin level is a common denominator in making everything better.

Dr James Muecke [00:27:55] Absolutely. So unfortunately, insulin is a is a critical hormone in our metabolism. But if it’s persistently high, the level in the blood, the hyperinsulinemia, which is ultimately caused by insulin resistance, then the high level of insulin in the blood that can drive it’s inflammation. So it drives inflammation. It’s from the beginning. So it drives the formation of plaques in our blood vessels, which can lead to a whole bunch of things heart attack, stroke, peripheral vascular disease, gangrene. It also is potentially tumour genic and there’s some strong association data, mechanistic data showing that it may have a role in cancer formation. It also pays vitamin D production and it’s a fat storage hormone. So if we can get the levels down, if we can make ourselves insulin sensitive rather than insulin resistant, then that can only be a good thing. And how do we do that? Once again, by the dietary changes we talked about before, by minimising consumption of sugar, particularly fructose and minimising consumption of cells. Both of these things can independently give rise to insulin resistance in the body. So insulin resistance is the core metabolic dysfunction which we have to focus on. Unfortunately, we focus on as medical practitioners, often the sugar level in the blood, the fasting blood glucose level, but that only starts to rise quite late in the pace. So we’ve been looking at. Fasting blood insulin level which can in people who metabolic just metabolically dysfunctional will start to rise at a much earlier stage. And so that’s what we should be focusing on.

Dr Ron Ehrlich [00:29:32] You used the word remission. We’ve talked about the word remission several times. And it’s a very. And you said 1 in 100 of your patients who came to you via a GP or an endocrinologist. They don’t. People who are diagnosed with diabetes don’t. Isn’t the first stop apology, is it? I mean, it’s usually GP and endocrinologist and 1 in 100 had no idea that remission was even possible. And in my experience, and we’ve interviewed a lot of doctors, most doctors will repeat that, parrot that to their patients until they themselves get a diagnosis of type two diabetes. And many will go down the the path of medication and follow the party line and others will go, hang on. Maybe. Maybe there is another way. And they have an epiphany.

Dr James Muecke [00:30:24] Yes, absolutely. And I myself have an epiphany. Not only did I, as I mentioned back in early 2020 when I started reading about this and realising you could actually put type two diabetes into remission using natural using using change in diet. Around about that time I had some lower backache and I had a scan of my abdomen just to make sure I was nothing nasty going on there. And I found out that in fact I did have something nasty, which was a sandy liver and a fatty liver is also a significant sign of metabolic dysfunction. And so I actually had then a significant driver for me to want to turn around my metabolic dysfunction, and I did that. I really started back in early 2020 by reducing my consumption of ultra processed foods and all the foods that we talked about before. I looked back at my diet, which was pretty appalling leading up to 2019 20. It was pretty appalling. But over the last couple of years, I had an ultrasound done again, I think a year ago, and I’ve reverse my fatty liver and there’s no question changing it. Change your diet. Can actually we seeing this thing these studies also showing this. But I was able to turn around my fatty liver and completely improve my metabolic dysfunction. Fortunately, not too late. I think one of the critical things that I wanted to be aware of was, okay, if I’ve had this bad diet for so long and I’ve had a fatty liver, how am I arteries looking? So I actually went and had a coronary artery calcium score last year, which was all clear. I had a zero sign of Korea. Wow, that’s good. That’s very good. Am fortunate I caught it in time, it seems, but unfortunately not. Not so many people are lucky. And if you look at the fact that over two thirds of Australian adults and a quarterback kids are overweight or obese, that means the majority of US metabolic is metabolically dysfunctional. The majority of us will likely have insulin resistance. The majority of us are looking down the barrel of chronic disease.

Dr Ron Ehrlich [00:32:29] Hi, Dr. Ronnie. Here it. I want to invite you to join our unstressed health community. Now, like this podcast, it’s independent of industry and focuses on taking a holistic approach to human health and to the health of the planet. The two are inseparable. There are so many resources available with membership, including regular live Q&A on specific topics with special guests, including many with our amazing Unstressed Health Advisory panel. We’ve done hundreds of podcasts over listening to with some amazing experts on a wide range of topics. Many are world leaders, but with membership we have our unstressed glib podcast series where we take the best of several guests and carefully curated specific topics for episodes which are jam packed full of valuable insights. So join the Stress Health community. If you’re watching this on our YouTube channel. Click on the link below or just visit on stress health.com to see what’s on offer and join now. I look forward to connecting with you. Well, I think I think the statistic is something like half the population have a at least one chronic preventable, chronic degenerative disease. So that is quite sobering, whether that’s exactly right or not. But a lot of people are not. Well, if the evidence is anything to go by. You’ve mentioned lowering sugars, fructose seed oil and all this, but it comes down to a what is what is referred to often as a low carb diet. And and many and low carb means different things to different people, doesn’t it? Like, for example, dietitians, qualified university trained dietitians will say are 310g of carbohydrates is pretty pretty okay. That’s fine. And so a low carb to them is go to 200g of carbohydrates a day. What does low carb mean to you? It was explored this in more detail.

Dr James Muecke [00:34:34] Yeah. So low carb and I, I think probably the best term is low carb, healthy fat because I think a lot of the the messaging that we’ve heard for the last 50 years is that we should reduce our intake of saturated saturated fats and foods, contain a high level of saturated fats and preference. We should be consuming polyunsaturated ketones and margarines, which, as I’ve said to you, actually not a healthy thing to be consume.

Dr Ron Ehrlich [00:35:01] Ironically, James, that was a very big policy from the Heart Foundation for many years, recommending exactly the seed oils that cause inflammation, a good for ultra processed food on the shelf in the supermarket. But the Heart Foundation was recommending that sobering. I just sorry I did have to throw that.

Dr James Muecke [00:35:21] Yes, it is. And if you realise at 62%, I think at least of Americans, 62% of the calories of their diet are ultra processed food over 50% UK diet. I suspect we’re close to 50% here. We haven’t had a look at those statistics for a few years now, but I suspect nearly half of what we’re consuming are ultra processed foods and it’s really driving this metabolic mayhem that’s present in our society.

Dr Ron Ehrlich [00:35:46] But low carbs, again, let’s come back to what is low.

Dr James Muecke [00:35:49] Carb, so low carb, so low carb, healthy, fat.

Dr Ron Ehrlich [00:35:52] Healthy fat.

Dr James Muecke [00:35:53] A ketogenic diet is a is a type of low carb, healthy fat diet. And another encompassing term that we’re using more and more frequently is therapeutic carbohydrate reduction, basically reducing your carbs in a therapeutic way to try and turn around the metabolic dysfunction. So it’s quite a useful term, but it doesn’t incorporate the seed oils, the healthy fats that we should be focusing on. So if we look at a low carb, it’s less than 130g of carbohydrates a day. If you look at a ketogenic diet, I think it’s at least lower than 50g of carbohydrates a day of carbohydrates, some would say even less. 20 30g of carbohydrates per day is a form of ketogenic diet. That’s what we should be focusing on. Certainly if I had type two diabetes, I would be going for ketogenic level of carbohydrates in my diet. If I had pre-diabetes, I’d certainly be going low carb, less than 130g. And if I was metabolically metabolically dysfunctional like I was, if I had a fatty liver or insulin resistance like I had, then I would least go low to medium carb. And I would say that for the most part, I’m going to medium carb these days. So I have a sort of range of carbohydrate levels which which would work anyway for me. And some would say that we should be, you know, you have the carnival movement who say that we should avoid all carbs and plant source foods completely. And you have the big of movement who say that we should avoid all animal source foods. But I’m a happy omnivore. I like being an omnivore. I like the the variety of foods that omnivore ism gives you. And so that’s my happy place, I suppose.

Dr Ron Ehrlich [00:37:43] I remember Gary and Belinda Feki used the term they were vegetarians who supplement them there with meat, vegetables, you know, with meats and dairy and cheese and all of that. So I like that approach, too. I think it’s interesting when people have been bombarded for so many years with the low fat idea and then they hear the low carb. I think what is particularly challenging is when they want to tick both boxes. I’m going to be really super good. I’m going to go low fat and low carb. I think that’s challenging, don’t you? This is why the healthy fats is important.

Dr James Muecke [00:38:21] Absolutely. It’s very, very difficult. And if you look back to the messaging, which has been around for the last 50 years and it comes off the back of the trucks history and a fraudulent science, but ultimately, in 1980, the dietary Guidelines for Americans were released, which recommended reducing. Sorry, our fat intake, particularly saturated fats. Now, when you take fat out of a food, you take out its ability to satiate you, to satisfy you. You also take away the flavour of the food. So something had to replace it and it became carbohydrates. So this low fat, high carb diet, recommendation seeded dietary advice across the planet. To this day, we have in our dietary guidelines a recommendation which is a high carbohydrate eating pattern. And it’s clearly when when the majority of us, whether you could argue whether this dietary guideline advice is causing this to develop this function. But certainly if we realise that a significant proportion of our population have metabolic dysfunction, then I say the insulin resistant and if you’re insulin resistant means you’re unable to process the glucose load entering your body. If you realise that most carbohydrates break down to produce glucose, you are glucose intolerance or by default you carbohydrate intolerant. The last thing we need to be doing is consuming more carbohydrates. So a dietary guidelines have got it all wrong. We have to move away from this recommendations, high carb recommendation and to be fair on the dietary guidelines. And they they actually state in the early pages that these guidelines are for healthy Australians. But you realise the majority of Australians are not healthy, so these guidelines are not appropriate for them, but they’re being used by bodies to recommend to people with type two diabetes how to eat. So the Royal College of GP’s recommends people should, with type two diabetes, should eat by the Australian Dietary Guidelines. Diabetes Australia also echoes that advice. Even in the prediabetes section of the website they recommend people should be should have this by the recommended dietary guidelines.

Dr Ron Ehrlich [00:40:42] Advice is is. It’s interesting too, because a few months ago we had the honour and the privilege of talking to Dr. Michael Mosley, who sadly, as we both have reflected on, has tragically died. But Michael championed the fast 800 and and that was very much a low calorie approach. And I asked him, you know, well, the problem with low calories from my personal experience is that you get hungry, whereas low carb, healthy fats, you don’t. What’s your I mean, you would agree. I’m sure she would agree with that.

Dr James Muecke [00:41:17] Yes. An 800 calorie a day diet is essentially a starvation diet. And it’s not sustainable. It’s not enjoyable either. As you say, the low carb, healthy fat diet is both enjoyable and sustainable. I’ve been sustaining for several years now and quite happily so, there’s no question about that. Having said that, so the 800 calorie a day diet and there’s a study of the UK called the direct trial has shown that can put type two diabetes and duration is one of only three activity proven methods that can put type two diabetes in remission. One is the low carb, healthy fat diet we talked about already. One is a very low calorie diet, which is the 800 calorie a day diet, which essentially is a low carb diet and also bariatric surgery. So you would never obviously start someone off on a bariatric surgical approach, but it is there as a modality for patients who are really struggling. So I my my strong feeling is that we should be recommending patients start on a low carb, healthy fat diet, using real food, using natural food. The 800 calorie a day diet often relies on ultra processed foods or what I would call ultra processed food like substances, soups and shakes. And so even the direct trial, we’re starting to see that the people that can sustain that is starting to drop off. So why not start with a real food diet in the first place, which is a low carb, healthy fat? It’s certainly my recommended approach and it’s much more enjoyable. I think if you start off on this 800 calorie a day diet, it might be okay, just get things rolling with them, moving towards a low carb, healthy fat diet.

Dr Ron Ehrlich [00:43:00] Yes. Which brings us to a discussion about defeat diabetes, which both I know you and I have been great supporters of since its inception, and you are an ambassador for that. We’ve had Peter Brukner, who is the founder of that world famous sports physician on and something really exciting, really exciting. And I congratulate Peter and yourself on this has happened in Australia and it’s a global first. Could you just share that exciting thing with our listener?

Dr James Muecke [00:43:34] Sure. So Peter Brookes said developed a platform called Defeat Diabetes, which is a way of guiding patients. Through their journey to potentially put their type two diabetes into remission. And they’ve just signed an agreement with Diabetes Australia to make this accessible to their membership. So that’s super exciting. But there’s a really interesting history leading up to this point. So I mentioned that we were able to get remission into the National Diabetes Strategy. On the back of that, I started communicating with my patients. On the back of that, I was starting to get some pretty unpleasant letters from endocrinologists in South Australia who were kind of managing these patients with me. And I was able to respond to their rather hostile letters with, you know, science based arguments. And but then the I thought, gosh, you know, let’s get the endocrinologists in South Australia together with the like heart practitioners and just have a roundtable, just just address their concerns. What what is troubling the endocrinologist so much about this? So we held that back in muscle. It was it was later in 2022, we had this roundtable meeting with the endocrinologists and the local practitioners, and it was a rather unpleasant meeting, actually. But at the end I was able to encourage one of the endocrinologists and one of the local practitioners, Dr. Steve Strengths, and Lorraine Lawrence Smith, who I mentioned before. And they sat down together and over the next year they wrote guidelines for therapeutic carbohydrate reduction to help stop type two diabetes into remission for patients. And that was released published in earlier this year. It took a while to write it, but that was released early this year and subsequently endorsed by the Australian Diabetes Society and also endorsed by Diabetes Australia. And on the back of that, Diabetes Australia was having conversations with Peter Brueckner and the Ft Diabetes platform. So this is all rolled along nicely. And what’s happening now is that about early last year I had a meeting with Dieticians Australia saying, okay, you know, it’s time to embed this into your training of your dieticians. Also into continued professional development for dieticians who are out in the workforce. And they wanted to wait till the the guidelines were written. And as I said, it took it took the best part of a year. And then early this year, I met again with Dietitians Australia with the leadership there, and I said, okay, these guidelines are out now and what are you going to do about it? And so we have now created a ten module course on metabolic health called Essentials of Metabolic Health, which we are going to be delivering to Dieticians Australia a little later in the year. So super exciting. Again, if we can get I mean, I know there are a lot of dieticians waiting to have exposure to that, understanding that the science and the practice behind that. So that’s going to be happening. And what we’ll see is a huge shift. We have 78,000 dietitians around the country who hopefully will slowly take this on both at the undergraduate and postgraduate level. We’ve also Peter Brook has been in discussion with the Royal College of GP’s to inject this into a GP post-graduate training. And I’ve been in discussion with the number with the group. The actual group that’s hosting the course for dieticians is called the Australasian Metabolic Health Society. This is a newly formed group which gives legitimacy to this whole process. And so the Australasian Metabolic Health Society, in conjunction with Peter Proctor, is to fight Diabetes group. We’ve been chatting to a number of the deans of medical schools around the country over the last few months trying to embed this into into medical school training because it really all has to happen in advance if we are going to have dietitians certainly doing an about face on the recommendations to the way that patients should be consuming food, then this also needs to be a needs to be critically aware by the GP’s and so that because it often involves the prescribing medicating patients. So and also as medical students are coming out of the workforce also need to be aware. So this all has to happen at once and has to happen rather quickly because otherwise it’s going to be it’s going to be chaotic out there.

Dr Ron Ehrlich [00:48:17] Well, all of that sounds like a wonderful initiative. And, you know, I mean, I just did a workshop recently and there was a fellow in the group whose wife was a dietician and he was type two diabetic, and he was just packing away the at lunch at the tea breaks, putting away all the cakes and the. Scones that were out there. And I said to him and he said, no. My wife said, you can’t. You can’t, can’t. Remission is not possible. But, you know, for those people that don’t want to wait for the ten module doctor, you know, training to occur or for the year or two that it may take, people can just log on to defeat diabetes and within a week or two start making significant changes. So it’s not that complicated, really, is it?

Dr James Muecke [00:49:09] No, I would I would suggest that they need to do it in conjunction with their GP. So they are managing endocrinologists or physicians because often, as I mentioned before, I had a patient that came off French and within a couple of weeks. And so you can actually if you suddenly drop your carbs, you have to drop your insulin and it can actually be a little dangerous. So definitely do it in conjunction with your overseeing medical practitioner, No doubt about it. So, yeah.

Dr Ron Ehrlich [00:49:35] Yeah. Interesting interesting that that importance of if you are on that medication and I’m guessing is that would that be the same with metformin as well if a lot of people are on metformin is that that’s not quite as sensitive as.

Dr James Muecke [00:49:48] Knowing what the type of insulin is a critical one because that can suddenly become hypoglycaemic and that can be potentially dangerous. And the established two inhibitors, there are a number of those can actually cause can be problematic. And so it’s a number of the diabetes medications that patients are potentially on that can be problematic when you are undertaking this therapeutic carbohydrate reduction. Another great opportunity is through low carb down under and the Cabinet has a directory of practitioners, state by state around the country dietitians, nutritionist, specialists who can help guide patients through this process.

Dr Ron Ehrlich [00:50:31] Yes. And we’ve and they have a terrific resource of YouTubes that have been that have had millions, millions of views and some terrific science based. You know, you want the evidence. Well, low carb down under. We’ve had Rod Taylor and and he’s done a tremendous job there as well.

Dr James Muecke [00:50:49] Absolutely. And so that conference is coming up, having a little plug for the low carb down on the conference. I think it’s in September in Melbourne this year. So if anyone is interested in going along to that, it’s it’s it’s one of the most that’s the single most positive and uplifting conference I’ve ever been to. And as I I’ve been in medicine for 40 years, been plenty of conferences. And to be at a conference where you have GP’s specialists and talking about these extraordinary results of this thing in their patients and you have patients also getting up and speaking and talking about the extraordinary turnaround in their metabolic function that we’re seeing. It’s super, super exciting, super uplifting. It’s hard not to be a little bit evangelical about it because it’s it’s such an exciting new thing to witness.

Dr Ron Ehrlich [00:51:34] Well, I think I think actually medicine, the practice of medicine, one needs to be a little bit evangelical because I think it’s very much got bogged down as a conduit to a very successful pharmaceutical industry and a very poor public health outcome.

Dr James Muecke [00:51:50] You know.

Dr Ron Ehrlich [00:51:51] And I think we have the potential to turn that around and not only improve our patients lives, but our practitioners mental health. That’s a win win as far as I’m concerned.

Dr James Muecke [00:52:02] Absolutely. And as we were discussing before, we had taught medical school to medicate patients. We go to conferences throughout our life, often significant sponsorship by the pharmaceutical industry. I myself have been sponsored to go to conferences around the around the world by the pharmaceutical industry. So we essence, Braemar said pharmacy pharmaceuticals are the only way of dealing with these diseases, but it’s critical to realise that many diseases linked to resistance can be turned around by quite literally a change of diet. And I think this is the problem that I have with that. When you are taught to medicate, you don’t think of the alternatives. It doesn’t mean you are acting necessarily in a corrupt way. Certainly there are circumstances, but it just means you’re not aware of the alternative, which is actually a dietary change. And it was only because I read Jason Foreman’s book then I became aware of it. So I’ve been encouraging all of my colleagues to to explore this this different alternative path.

Dr Ron Ehrlich [00:53:02] Yes. No, no, I would I think that’s an important thing to say. And I would agree with you that I know many practitioners who practice, you know, using pharmaceuticals to manage their practice. And I know many integrative doctors and local doctors. And I think the thing they both have in common is they want the very best for their patients. There’s no question about that. I don’t think there’s anything corrupt about it. I mean, I think the way the information is delivered to them, I think this is a story, as you are a testament to that is very easy to miss. But once you hear it, very difficult to ignore. So I think that’s part of the problem.

Dr James Muecke [00:53:42] Absolutely. And this continued messaging and we’re seeing is that the whole narrative has become, for many years messaging that saturated fat is actually bad for us, which is to this day, there is no strong evidence at all to suggest saturated fat is bad for us. And there was a great systematic review in the Journal of the American College of Cardiology back in 2022, which exonerated. Foods that contain natural saturated fat, such as whole fat, dairy, eggs, red meat. The other thing which has become the other dietary recommendation, which has become so ubiquitous in our society is is red meat. The red meat causes cancer specifically, or particularly colon cancer. Red meat causes heart disease. Red meat causes Diabete, type two diabetes. And all of these significant health bodies are giving advice to their membership. So the Heart Foundation of Australia all over their website causes heart disease. There’s Cancer Council remake causes cancer Type two diabetes. Also, Diabetes Australia released a story in the Diabetes Management Journal last year written by a dietician as suggesting that type two diabetes was caused by red meat. So we just seeing this ubiquitously and it’s when there’s no strong evidence at all to suggest that inmate is actually bad for us, how can the food that we evolve to consume be causing this modern epidemic of chronic disease? Surely it is the the modern foods that we’re consuming, particularly the industrially created, ultra processed foods we are consuming now as at least half of our diet. Surely those are the things that are causing the problem.

Dr Ron Ehrlich [00:55:41] I think your key word there was natural foods because while red meat and I’m a great supporter of eating meat, but not all meat is equal and food that is grown naturally, grass fed, grass finished is not only good for the animal, not only good for the soil, not only good for the planet, but it’s good for us as well. Whereas animals that are in cages, in feedlots, in in that environment is unconscionably bad for the animal, bad for the environment, it’s bad for our health. So when people talk about red meat, I think we are literally talking about two different beasts, you know, and this is more nuanced as well.

Dr James Muecke [00:56:26] Yes, this is a whole discussion in itself. As Diana Rogers, author of Sacred Cow, says, it’s not the it’s not the counts of how. So It’s the exact realisation of the the ruminant an animal source food production, which is abominable. Unfortunately, only about 4% of cattle in Australia finish on feedlots as far as I’m aware. But also the industrialisation of of the mono cropping, which is also devastating to the environment. So this has to be a balanced discussion. I mean, it’s not a it shouldn’t be a one way attack on red meat and red meat production.

Dr Ron Ehrlich [00:57:02] No, no. James And I’ve been so looking forward to catching up with you. And I just applaud you and Peter and defeat diabetes and all the advocacy and what you’ve achieved, I truly believe, is one of the biggest breakthroughs in public health globally for the last 50 years. So thank you so much for everything that you’re doing and continue to do.

Dr James Muecke [00:57:26] Thank you, Ron. It’s an absolute pleasure. And if we can see this epidemic start to turn around, then I realise my job will be done. So it’s it’s an exciting thing for me to be a part of. And it’s on the back of a bunch of work that so many people are doing in this space. And you mentioned the fact that we talked about keys earlier. They were pioneers in this space, but there’s a whole bunch of professionals. And within this space that I’ve learned from and I’ve just been lucky enough to have that platform of Australian of the Year that gave me that access to be able to make these changes. So it’s, it’s, it’s an exciting times. There’s a lot of work that’s, that’s ahead. And if you realise, you know, we talked about remission as a strategy for patients with type two diabetes, but unfortunately not everyone will be able to do that. And there’s a variety of reasons why that might be. But some of the longer term studies to study, for example, showed that about 50% are still in remission at the five year mark. Okay. What about that other 50%? What’s going on with them? So that’s, I think, a really interesting thing to explore. But if you realise that type two diabetes is strongly associated with food addiction, you have. And addictive food ultra processed film. The addition of sugar makes it addictive. And you have an industry, the ultra processed food industry, the sugary drinks industry who preying on the addictions of people in often vulnerable people. Then you realise that this is something that needs to be addressed as well. So there’s a lot of work to be done, but thank you. Thank you.

Dr Ron Ehrlich [00:58:57] Well. Thank you. Well, as I said at the beginning of the program, if James receives an Australian of the Year award for his work for the site for all the social impact organisation that he has championed for for over 20 or more years, he will almost certainly, I believe, should be up for another Australian of the Year award, along with Peter Brukner, because what they have been championing and and as you heard in that program, almost breathtaking really, isn’t it? I mean, addressing the cause now, you know, I wrote about this in my book I’ve talked about at various times in this podcast when Diabetes Australia was celebrating its 75th anniversary, it issued a on its website, ten Steps for Living Life with Diabetes. And step number one was breathtakingly to include carbohydrates in every meal and to stay on a low fat diet. Now I realised that the key word there was with diabetes because if you wanted to live your life with type two diabetes without any chance of remission, then you would have followed the advice of Diabetes Australia and eaten carbohydrates with every meal, stayed on a low fat diet, kept on your medication, and you would most certainly have lived the rest of your life with diabetes Type two diabetes. However, if you are wanting to overcome type two diabetes and eliminate that from your life along with the medications and all the health risks that go with that, then you would not have followed that advice. But I must take my hat off to Diabetes Australia and their new CEO for collaborating before being brave enough to collaborate with Defeat Diabetes to actually address the cause. And it’s quite breathtaking to hear James’s story about their meetings with endocrinologists who generally are involved at the front line, along with chips, of course, at managing type two diabetes. And to hear the resistance for this, this is what I have said repeatedly, and that is ignorance is a wonderful driving force to to keep us learning. I mean, I’ve been in health care for 45 years, and the more I learn, the more I realise I have to learn. But when ignorance is combined with ego, arrogance and hubris and worst of all, formulates public health policy, then we have the terrible health outcomes in preventable chronic diseases that we do today. And you may well have already consulted with such an endocrinologist, but that is that is the reality of modern medicine. But when we have people like Dr. James Mukai and Dr. Peter Brukner and organisations like Defeat Diabetes and I would add on stress health as well, then we have some hope. And that hope is, is is there. And I see it as one of the greatest public health initiatives and I congratulate Diabetes Australia for their collaboration. We will have links to defeat diabetes in our show notes. We will have links to on Stress Health. I encourage you to join that community. This is an empowering story of prevention, which is what we are all about. I hope this find you will. Until next time. This is Dr. Ron Erlich. Be well. Feeling stressed? Overwhelmed. It’s time to stretch your life. Join the stress health community and transform stress into strength. Build mental fitness from self-sabotage to self-mastery. And together, let’s not just survive, but thrive. Expert led courses, curated podcasts, like minded community and support and much more. Visit on stress health.com today. This podcast provides general information and discussion about medicine, health and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences and conclusions.