Dr James Muecke – Australian of the Year 2020 Social Entrepreneurship, Diabetes & Resilience

Dr James Muecke is an ophthalmic surgeon and ophthalmologist. James has also been recognized for his work globally, particularly in South East Asia, and has been awarded the Australian of the Year for 2020. We talk about social entrepreneurship, what that actually means. Nutritional guidelines, diabetes and the importance of awareness, accountability and action.

Dr James Muecke – Australian of the Year 2020 Social Entrepreneurship, Diabetes & Resilience Introduction

Today that my guest is an ophthalmologist, but not just any ophthalmologist. My guest is Dr James Muecke. James is an ophthalmic surgeon and ophthalmologist from Adelaide, South Australia, and he has also been recognized for his work globally, particularly in South East Asia, and has been awarded the Australian of the Year for 2020. Now, this discussion is terrific.

I had the opportunity of talking to James earlier in the week and just felt that there was just so much to learn from this discussion about social entrepreneurship, what that actually means. He talks about the nutritional guidelines and the impact that has had because he’s chosen to champion in this year diabetes and specifically sugars and carbohydrates. And that journey has been an interesting one because as a clinician of many years experience his knowledge of nutrition, which he admits himself was not terrific. And he had accepted, as the vast majority of well-meaning health practitioners or medical practitioners in particular, who look at our Australian healthy eating guidelines and say, well, if their government-endorsed, then they must be right. And it’s been a revelation for James.

And he shares that with us in this podcast. In fact, he uses the words awareness, accountability and action to describe what nutritional guidelines really should be like. And he also comments on how they are very much left wanting in that respect. Look, it was just a terrific conversation. I so enjoyed talking to him. He is such an inspiring and articulate person. I hope you enjoy this conversation I had with Dr James Muecke.

Podcast Transcript

Dr Ron Ehrlich [00:00:05] Hello and welcome to Unstress. My name is Dr Ron Ehrlich, well, 2020 what a year and interestingly, almost ironically, 2020 is a term that is often used to describe the clear vision and other and I have said during this year that it’s an opportunity for us to reflect on a whole lot of things.

Dr Ron Ehrlich [00:00:28] So it’s perhaps appropriate today that my guest is an ophthalmologist, but not just any ophthalmologist. My guest is Dr James Muecke. James is an ophthalmic surgeon and ophthalmologist from Adelaide, South Australia, and he has also been recognized for his work globally, particularly in South East Asia, and has been awarded the Australian of the Year for 2020. Now, this discussion is terrific.

I had the opportunity of talking to James earlier in the week and just felt that there was just so much to learn from this discussion about social entrepreneurship, what that actually means. He talks about the nutritional guidelines and the impact that has had because he’s chosen to champion in this year diabetes and specifically sugars and carbohydrates. And that journey has been an interesting one because as a clinician of many years experience his knowledge of nutrition, which he admits himself was not terrific. And he had accepted, as the vast majority of well-meaning health practitioners or medical practitioners in particular, who look at our Australian healthy eating guidelines and say, well, if their government-endorsed, then they must be right. And it’s been a revelation for James.

And he shares that with us in this podcast. In fact, he uses the words awareness, accountability, and action to describe what nutritional guidelines really should be like. And he also comments on how they are very much left wanting in that respect. Look, it was just a terrific conversation. I so enjoyed talking to him. He is such an inspiring and articulate person. I hope you enjoy this conversation I had with Dr James Muecke.

Dr Ron Ehrlich [00:02:31] Welcome to the show, James.

Dr James Muecke [00:02:34] Thank you, Ron. Great to be back.

Dr Ron Ehrlich [00:02:36] I have not covered this issue of sight, and it’s a big omission on my part, but this was such a great opportunity to do just that. And there are so many other things we wanted to cover. I wonder if before we lobbed into all of your work prior to being and receiving this great honor of Australian of the Year and what you’ve done since, I wondered if we might talk about ophthalmology, because I think it’s often confused with optometry, obviously confirming considering the same thing. Tell us a bit about your own journey, what an ophthalmologist is and how you’ve reached this point.

Dr James Muecke [00:03:16] Sure also confused with opticians or optometrists orthopedists.

Dr Ron Ehrlich [00:03:21] Alright.

Dr James Muecke [00:03:21] There’s a bunch of them. So I’m an ophthalmologist, so I’m actually a medical doctor. I trained. I had six years of medical school and several years of training following medical school to become a doctor, a specialist. My training involved five years of training to become an eye surgeon.

So basically, if you compare the two, ophthalmology is a medical specialty which involves surgery and the ability to prescribe medicines and treatments to patients with eye diseases. Optometry is also a degree, but it doesn’t involve surgery and very limited use of medicines that they can apply in the management of eye diseases. But optometrists play a very important role in particularly in detecting eye disease and then referring to ophthalmologists to manage many of those eye diseases.

Dr Ron Ehrlich [00:04:23] And when we talk about eye diseases, I know so much of you well. You’ve done a lot of work, obviously, in Australia, but you’ve taken this overseas into developing countries. How do the challenges that we face from our sight vary from here in Australia to say, a developing country like the work you’ve done in Myanmar?

Eye diseases

Dr James Muecke [00:04:44] Sure, so “Sight For All” is the organization that I co-founded back in 2007, and so we have projects now in nine countries in Asia and Africa and also here in mainstream and Aboriginal communities. And there are quite significant differences between the spectrum of diseases that we see in poor countries versus high-income countries, not so much in the diseases themselves.

I mean, there are quite literally hundreds of eye diseases. Many of these are blinding, and some are actually deadly and disfiguring. In poorer countries, the leading cause of blindness is a cataract in somewhere like Australia, and in a high-income country, cataracts some years ago, some decades ago, used to be the leading cause of blindness.

Dr James Muecke [00:05:33] But it is no longer the leading cause of blindness. We now have a number of diseases in elderly people. Age-related macular degeneration is the leading cause of blindness in working-age adults. Diabetes is now the leading cause of blindness. And in children, the main disease, the main spectrum of diseases are inherited genetic diseases and kids. Now, if we look at poorer countries I mentioned before, cataracts, the leading cause of blindness is actually cataract. It’s a leading cause of blindness worldwide makes up about 50 percent of cases.

Dr James Muecke [00:06:03] But in poorer countries, roughly 90 percent of cases are due to cataract, I believe. So we would say that worldwide, roughly 80 percent of all blindness is avoidable. By that I mean it’s preventable or treatable. So 80 percent worldwide. Yeah, and in poor countries, in children, for example, the spectrum of diseases is quite different from the diseases that we see here in Australia, rather high-income countries.

Now, I was involved in a chartered blindness study in Myanmar back in 2007. And this was an incredibly confronting and a very, very powerful moment in my medical career, having never been involved in a childhood blindness study before, I wasn’t quite sure what I was going to discover during that.

I actually led that team, and we visited seven schools for the blind across a minimum amount of time. It was rated second only to Liberia as the poorest country in the world in terms of health expenditure. So we were expecting to be confronted by what we found. But little did we realize the experience is going to have a very, very deep, and powerful impact on all of us. So through that couple of weeks of the study, we found that nearly half of the kids had blindness that could have been prevented or treated. But what was particularly confronting and extraordinary was the cause of blindness that we found, and that was measles.

Dr Ron Ehrlich [00:07:45] Wow.

Dr James Muecke [00:07:46] Now, through my ophthalmic training, I probably read somewhere that measles could cause blindness, but I’d never experienced it in Australia and certainly never seen what it looks like. But to be surrounded by children in seven schools for the blind and subsequently into other countries where we undertook charity blindness study so in Cambodia in 2008 and Laos in 2013.

Now the way measles blind’s it actually causes inflammation, infection in the cornea, which is the front window of the eyes, and you get massive inflammation in the front section of the eye, and then the pressure control system in the eye becomes blocked. The eye then starts to expand with secondary glaucoma and in some instances, can actually rupture. So, some of the children that we are seeing. It’s hard to even truly describe it, but some children had grossly extended eyes, and others had grossly scarred eyes that have actually ruptured, essentially head popped.

Dr Ron Ehrlich [00:08:47] Wow.

Dr James Muecke [00:08:48] So it’s a terribly disfiguring disease. The pain that these children must have experienced would have been excruciating. But when they were admitted to the school for the blind, they were in the order of the age of five that the infection most likely happened some years earlier in their lives.

So they’d passed the active, infectious, painful stage and really just seeing the end stage of that irreversibly blinded by the condition. And what was I mean, that was confronting enough as it was, and literally to be surrounded by a sea of children that were trying to avoid, but then to realize that it’s a highly preventable disease, cost less than a dollar to prevent measles in a child. So you can imagine that was, for me, a phenomenally powerful experience and what I realized at the time. In fact, we returned to Australia. I wrote the paper up, and we published it in a peer-reviewed journal. And then I went back to Myanmar to meet with the health minister to say; we’ve got a problem here, we need to do something about this.

Dr James Muecke [00:09:53] So I was able to persuade him to train a children’s eye specialist for the country, what we call a pediatric ophthalmologist. There was not one specialized pediatric ophthalmologist in the country of over 50 million people at the time.

So in 2010, we brought a young eye specialist out to Australia, to Adelaide to train at the Women’s and Children’s Hospital, myself and my colleagues, to train to be a pediatric ophthalmologist. And he returned home at the end of his hands-on year of training, the very first in his country. And we actually set him up in the country’s first children’s eye unit in the capital city, major teaching institution Gangadhar Eye Hospital, where he works in the state. And he actually now provides close to 30000 treatments every single year, which in itself is quite extraordinary.

Well, it’s hard to believe. But as his competence and his confidence improve, he started training his own colleagues in 2015 for his training, the second pediatric ophthalmologist for the country and now trains at least to every single year. So it’s just one example of the work that we do with site for showing scalability and sustainability. Now, we’ve trained pediatric ophthalmologists now from nine countries across Asia, but our specialty has nine different subspecialty areas.

Dr James Muecke [00:11:12] And so pediatric ophthalmologist sorry, pediatric ophthalmology is just one of those. And we have been training and equipping colleagues across Asia in all of these subspecialty areas. And the work that we’re doing is now impacting over about a million people every year. So it’s really powerful. So it just gives you an example of the spectrum of diseases that we see and also how we’re dealing with those problems. Now, the situation in poorer countries, why is it so dire? Often the resourcing is not there.

Dr James Muecke [00:11:43] So they don’t have the quite simply, they don’t have the number of eye specialists, whether they be ophthalmologists, whether they be optometrists or even like eye care nurses. They just don’t have the numbers out there, particularly in regional parts of the country, to be able to deal with these diseases. And the other thing is, so there’s an accessibility factor. The other is the affordability factor. And quite often in many poor parts of the world, health care is not free. So here in Australia, we have free health care.

We have ready accessibility to eye specialists, even in the most remote communities, even in the most remote Aboriginal communities. We have an optometrist, an ophthalmologist that visit at least twice a year. So it’s those are the major comparisons between the two here in Australia. It’s more about educating the public, raising awareness about some of the critical blindness diseases, such as what I mentioned before, and diabetes being the leading cause of blindness among working-age adults.

Dr Ron Ehrlich [00:12:43] Hmm. Yes. And we’re going to come back to that. It’s interesting. I mean, I should say none of us should be surprised that so much of this is preventable because so many of the diseases we face per se in the West in the world are preventable. So the eye diseases shouldn’t be any less interesting to hear measles being so, such a big problem overseas and yet so little of the issue here. And dare I mention the word vaccination because that’s probably one of the reasons why we don’t have this problem.

Dr James Muecke [00:13:17] Exactly. And I would challenge any anti-vaxxer to spend a day in a school for the blind in Myanmar and see the impact of avoiding vaccination on a child and the devastating effect that that has on the child’s life, their opportunity to have a fruitful career and a satisfying life, but also impacting broadly on the family, on the community.

Actually, if we look at the number of years that a child has to live with their blindness, it comes second only to cataract as the leading cause of blindness in the world. So it’s a major problem, and it’s also a big driver of poverty in many parts of the world.


Dr Ron Ehrlich [00:13:56] And cataracts is another one because I mean, that has been totally revolutionized, hasn’t it? I remember 30 or 40 years ago when my own grandparents had cataracts done; they were in the hospital for a week wore glasses for two weeks. You know, it was a whole long, drawn-out procedure. Now it takes a day procedure. And I mean that cataract surgery is almost so routine now and so quick.

Dr James Muecke [00:14:20] It is it’s still a highly sophisticated operation, highly technical, but it is being fine-tuned with the help of incredible technology. So these days, the operation itself would take 15 minutes, give or take, done under local anesthesia and in many cases done just simply with a local anesthetic eye drop. So and it is day surgery. And it’s very, very low risk. And it’s incredibly now within 24 hours when their pads are taken off that the improvement in sight is palpable immediately. And so sight is our most precious sense so…

Dr Ron Ehrlich [00:15:00]  Absolutely, Yes. We don’t often see.

Dr James Muecke [00:15:02] Sorry to interrupt Ron, but we don’t often see here in Australia patients who have a much greater demand on their vision than they often do in poorer parts of the world. So we are removing cataracts at an early and earlier stage. But in poor parts of the world, people are quite literally blind.

And in fact, I was a couple of years before I mentioned that study in Myanmar in 2007, a couple of years before in 2005, we undertook an adult blindness study in a regional part of the country where we found that, yes, cataract was the leading cause of blindness. That was not a surprise. What was a surprise was the prevalence of cataract blindness. So close to 10 percent of the adults over the age of 40 were actually blind, while one in 10 people were actually blind and the vast majority of those were cataracts.

Dr James Muecke [00:15:49] And even the ones that had cataract surgery, many of them are also blind because they couldn’t have the equipment to be able to do the operation at the highest level when we remove a cataract. So cataract is the clouding of the lens inside the eye.

When we remove the cataract, we have to replace that with a plastic lens. And in many poor parts of the world, and particularly in remote and regional parts of those countries, either a lens is not replaced inside the eye, or they put a standard lens power in or they put in the appropriate lens power. And the patients are often no better off than when they had the procedure, may be better off not having had the procedure. And one of the other things which also staggered me and I was in my early 40s at the time; there were people, adults were younger than me who are blind from cataracts, something that we do not see here. So there’s something else going on.

All of us will develop a cataract if we live long enough. It’s called a senile cataract, which is part of the aging process that we were seeing cataracts in, people blinding cataracts, and people who are in their 40s.

Dr Ron Ehrlich [00:16:57] So I was that was one of the things I was going to ask. And that is having a cataract inevitable? And is that just part of our aging process? Clearly, it is. Do things predispose us, they must, to that developing earlier? What are some of the predisposing things?

Dr James Muecke [00:17:15] There are many, many causes of cataracts. Is the list that long? But the commonest cause is a senile cataract. It’s just simply the aging process in the eye. But a number of other cataracts. Oh sorry. And a number of other causes of cataracts I mentioned before measles.

So inflammation in the eye, either acute or chronic inflammation, but particular chronic inflammation can cause cataract. There are hereditary causes of cataract which can give rise to cataract in babies and in children. So we call a congenital cataract. And there are a number of causes of these infectious diseases.

Dr James Muecke [00:17:49] I mentioned measles, but also rubella and a number of other infections can cause it sometimes treatments. So steroids. So prednisolone, people who are on chronic prednisolone treatment or steroid drops can also develop cataract trauma to the eye can happen from blunt or penetrating injuries and cause cataract. And the list goes on—so many people.

Dr Ron Ehrlich [00:18:11] And macular degeneration is another one you’ve touched. You mention tell us a little bit about just one on, one macular degeneration, because I’ve heard there are, well, some predisposing factors there. But talk to us a little about macular degeneration, because that’s another one.

Macular Degeneration

Dr James Muecke [00:18:28] So macular degeneration is the leading cause of blindness in adults and particularly in elderly in Australia now. And this is a degenerative procedure process which involves the macular, which is the central vision area of the retina and this is called age-related because as we age, this is a condition that we see more prevalent in older people, people who are in their 70s and beyond, sometimes we see it in people in their 50s and 60s.

But there is a combination of genetic elements, and it’s probably quite a complex genetic process, the number of genes potentially involved, and probably also some environmental factors beyond just simply aging. Now, we don’t know exactly what those environmental factors are. There are a number of theories and diets, and particularly a diet in sugar and highly processed foods may be a driver of this as well.

But I also wonder myself, if we look back, if we turn the clock back 100 years where many people didn’t have artificial lighting, they often when it became dark at nighttime, they went to bed or just functioned with candlelight. So the illumination was a lot less. And they certainly didn’t have the TV to sit in front of for hours in the evenings. These days, with artificial lighting, our day is extended, probably at least 50 percent more than we would otherwise have done.

Dr James Muecke [00:20:04] And we also have the opportunity to watch the TV quite literally for some people from the hours and the TV is highly you know, it’s bright, it’s colorful, constantly moving and constantly stimulating the macula, processing the information that’s coming to it. And so my feeling about this is that the macula these days, in 100 years later, maybe even 50 years later in many parts of the world, is functioning probably 50 percent more than it might have done some time ago. And maybe we are just simply wearing our macular around.

Dr Ron Ehrlich [00:20:42] Hmm. Interesting, because we’ve done various programs on the breath. And, you know, there is an approach to breathe which says we only have a certain number of breaths in our life and we shouldn’t breathe too quickly because we’re going to use them up. So breathe slower, you know, be calmer, engage the parasympathetic nervous system more. And here you are saying, well, we’ve maybe given a certain amount of hours to be seeing life and here we are brightening it up and using it all up, perhaps far too quickly.

Dr James Muecke [00:21:16] It is possible. It’s just my own personal experience with I think with the breath. It’s not so much that we have a limited number of breaths. It’s I think the calming effect and minimizing the stress. And I know your podcast series is called Unstress and we’ll get into that. But I think just being mindful calming that breath down. Cooling the head down is a big driver of a much healthier approach.

Dr Ron Ehrlich [00:21:47] And it’s also a very timely reminder about, you know, you mentioned that chronic inflammation is such a driver in so many of these degenerative diseases, which in your case, you see the manifestation of it in the eye. I mean, it’s a reminder about this, the effect of chronic inflammation, per se.

Dr James Muecke [00:22:08] Yes, exactly. I suspect chronic inflammation plays a huge role in many of the modern diseases that we have and particularly chronic diseases.

Dr Ron Ehrlich [00:22:19] Now, you know, the other thing was, of course, that because of your so, you know, this entrepreneurship really I mean, I know you’re very passionate about social entrepreneurship. And I guess this is just a great example of it. But you go to a third developing country, let’s say a developing country, and you’ve seen something. And from the moment of seeing that to setting up a whole program is quite a big step. How did you make that in the initial stage? How did you come back here? I’ve got to do something about that. How did you get going on that?

How passionate Dr. James Muecke about social entrepreneurship?

Dr James Muecke [00:22:56] Well, if we look at just the whole world of social entrepreneurship, what does that mean? What is a social entrepreneur? And we all know what an entrepreneur is. Someone who starts a business takes risks in order to make money. So social entrepreneur is someone who starts a business and takes risks in order to solve a social problem. So I actually came up with my own definition of a social entrepreneur, someone who innovates for a sustainable solution to a social problem.

Now, I have thought about this a bit, and I’ve come up with, you know, the three key ingredients, which to me are critical for social entrepreneurship. It’s a spirit of adventure, a humanitarian spirit, and an entrepreneurial spirit. So probably the biggest driver of this is the humanitarian spirit. So where does the humanitarian spirit come from? Perhaps part of it is, is our upbringing perhaps part of it’s genetic. The way we learn from our parents. But I suspect for many people.

Just life experiences which are so powerful that just instill in them a desire to want to deal with a social problem or an environment and an environmental problem, that they’ve come across something that’s impacted them so powerfully that they want to do something about it is often what gives rise. So that humanitarian spirit, now myself as a doctor and I follow back to my childhood, I always wanted to be a doctor, and I just had this inbuilt desire to want to help people. I don’t know where that came from.

To be honest, I don’t have an answer to that. But it has been the experiences that I’ve had through my life that added to that, which has been a big driver of the way my career has unfolded. And I mentioned earlier; I mentioned two of those to you that adult blindness study in Myanmar and the childhood blindness study in Myanmar in 2007, which was so powerful, so formative. When you experience something like that, you really want to do something about it.

Dr Ron Ehrlich [00:25:04] Hmm.

Dr James Muecke [00:25:05], So that’s when the third key ingredient has to kick in, which is the entrepreneurial spirit. Now, I mentioned also the spirit of adventure. And I think, you know, quite simply, if you want to if you love traveling and you love traveling in poor parts of the world, and just simply that experience is an adventure in itself.

I think if you want to tackle social issues or environmental issues in a poor part of the world, you just simply have to have a spirit of adventure because, you know, it’s quite often a challenge. But if we take the fact that you have a spirit of adventure and you have had these incredible experiences and then want to do something about it, well, this is when you have to draw on your entrepreneurial spirit.

Now, myself, I never saw myself as an entrepreneur and never saw myself as a social entrepreneur. And when I had that experience in Myanmar, it wasn’t a difficult decision to know what to do about it. I just realized that we needed to change.

A children’s eye hospital for that country, you know, it was, you know, reasonably straightforward thing to do so the entrepreneurial spirit to me, there are a number of key ingredients to that, and so that the six key ingredients that I’ve come up with and probably think of a few more, that a social entrepreneur needs to be a creator. I need to be a communicator.

There needs to be an innovator, a leader, a problem solver, and a risk-taker. So those are just several of the ingredients that are needed to have an entrepreneurial spirit. And many of those, one can learn. And I think for myself. It was easy enough to say, OK, we need to try the children’s eye specialist, and so I organized that, and there was a bit of logistics involved in order to bring a doctor to Australia to train, but then to have all the mechanisms around that, which ultimately was one of the driving forces for me to set up “Sight for All” in 2008.

So I had that experience in 2007. I set up Sight for All in 2008, and we brought the doctor out here at the end of 2009 2010. So you have to raise money. So you have to rely on donations from the public, and in Australia, we need to be registered as a charity so that you can give tax deductions. And so in order to set up a charitable organization and particularly charitable organization that actually takes that Australian money overseas, we need to be registered with what’s called the overseas aid gift deductions came out of the Department of Foreign Affairs and Trade.

And now to do that, you actually have to have a registered organization. You actually have to have a board, a constitution. So you can see you have to build all of these the infrastructure around this process. You can’t quite simply just bring a doctor to Australia to train. And that’s that. You actually have to set up the whole structure around it. So the first thing is, is the I mentioned before and those ingredients have to be a creator. So you actually have to create this vehicle is the entity which is going to solve the social problem, you see.

The second thing is that you need to be a communicator. So I had to actually communicate that passion that I experienced by being involved in that childhood blindness study in Myanmar to get people on board to persuade people that this is something that we need to address, you know, to get a board together, to get donors to sponsor.

So you have to be a communicator. And then you have to be a leader if you’re going to actually create the vehicle, create the entity and start to persuade people to jump on board in your quest to hopefully change the world, then you need to lead that organization, and then you have to innovate. And so part of that innovation was bringing the doctor to Australia to train.

Dr James Muecke [00:29:19] We also found that there are a number of countries where we couldn’t bring doctors to Australia. I mentioned before that Cambodia and Laos, we also had similar results where we found nearly half the kids have blindness that could have been prevented or treated. And in both of those countries, measles was also a leading cause of blindness. But we couldn’t bring doctors to Australia for training. So we actually innovated.

We problem solved and created what we call a reverse fellowship program where we actually took the training to our colleagues, working together with them in their own centers, in their own countries, and dealing with the challenges that they face every single day. And, you know, the final thing I mentioned was being a risk-taker. So, you know, initially, when you set up a social impact organization or a charitable organization, a not-for-profit, you often start off with this voluntary model, and then you have to progress to a model which incorporates paid staff. And we have a small staff team.

We have four on our staff team, three full-time equivalents based here in Adelaide. So and that in itself entails risk. So you can see how all of these ingredients slowly build to create the platform to be able to solve the social problem. And it’s all-consuming. It’s a huge investment of time. I used to call it my second full-time career.

I’ve been 30 to 40 hours a week, as many hours as I was in my clinical job. So it’s it becomes quite a consuming thing. And my wife from the beginning was involved. She’s been actively involved in marketing and fundraising and running all our services, all of our events.

But my children have also been involved with this for the last 20 to 30 years. So it becomes really important and powerful and special part of your life. And after my family was the most, the most beautiful thing I’ve ever been involved in and know anybody will look back and say, yes, this has been a life well-lived.

Dr Ron Ehrlich [00:31:23] Hmm. Which, you know, two words that come to my mind as I hear you speak. James is articulate and inspire, and you clearly have done that very well. And that has led you to this great honor of Australian of well, firstly South Australian of the Year, which then led to Australian of the Year. And you’ve chosen to highlight this year in a particular way. And I and those two words, articulate and inspire, seem an appropriate segway into this. Tell us about what your focus has been on in this year and why.

Story of Diabetes

Dr James Muecke [00:32:03] So it actually, again, like many of these things, it’s an evolution, and it’s experiencing, as I mentioned before, about powerful experiences which can actually change the course of your life or fill you with a passion to want to do something about it.

And as an ophthalmologist, I was seeing for over 30 years now; I’ve been dealing with the end-stage consequences of the blinding complications of diabetes, in particular Type 2 diabetes, which makes up about 90 percent of cases. But in all of those years, I never thought too deeply about the underlying causes of Type 2 diabetes, which is that poor diet and a diet full of sugar, refined carbohydrates, and highly processed foods and felt that was the responsibility of the first line health practitioners, the GPS, the dieticians, and nutritionists.

I didn’t involve myself in that. And then in 2018 and in fact, he wasn’t a patient of mine, he was the man his name’s Neil Hansell, and I met him in 2008. I was wanting to put together a documentary already put together a documentary about the experience of blindness, what it means to be blind.

Dr James Muecke [00:33:12] And so I interviewed 10 people with my son, who’s a filmmaker and four children who are born blind, four elderly people who are slowly going blind at the end of their lives, and two people who had suddenly gone blind in the middle of their life just to get the spectrum of experiences and how that impacts on them and their lives and how they viewed the world and the two that were so powerful with the two that had suddenly gone blind and middle of their life. You can imagine. Yes. And both actually had diabetes. One was a young, high-flying corporate girl in her 30s who’d neglected her disease wasn’t having her eyes checked, and bingo, she lost vision in both eyes and is now blind in both eyes.

Dr James Muecke [00:33:54] And the other was a man with Type 2 diabetes who again had neglected his disease. He was from a poorer family. The other one was, as I mentioned, a corporate girl, so money wasn’t an issue here. But in Neil’s case, his priority was his family and raising money to support his family in their life. And like, unfortunately, many men had neglected his own health, wasn’t having his eye checks for his diabetes went to bed one evening at the age of 50 with normal sight, and woke up the next morning blind in both eyes and still blind to this day. And so his story was just heart-wrenching. And I interviewed him for about an hour and a half, and by the end, I was in tears.

Dr James Muecke [00:34:52] My son, who is the filmmaker, was in tears. The sound engineer was in tears. Neil was in tears. It was just just a harrowing story. It’s a powerful story that it made me really rethink this whole stance.

And if I could just wind the clock back just a little bit now in my internship, this was my first year practicing real medicine. And I was mainly just dealing with patients who had chronic diseases, often self-inflicted diseases. And certainly back then, smoking was the big driver.

But we were starting to see the dietary diseases, particularly diabetes, starting to emerge in the eighties. And I was becoming disillusioned. It’s not my personality. I like to be able to solve problems. And I just wanted a change. And that’s why I went off to Kenya to work as a volunteer doctor for a year. And this was really life-changing for me, because now for the first time, I was seeing patients that had diseases that weren’t self-inflicted.

And in fact, I don’t think I saw a single self-inflicted disease. These were mainly infectious diseases, malaria, TB, etc., patients got better. You were able to cure patients. And that really suited my personality. As I mean, I love a love project. I love completing a project. I think this is also why I love the idea of ophthalmology and particularly cataract blindness being such a major blinding problem in the world and being able to solve that with a 15-minute operation. It really, you know.

Dr Ron Ehrlich [00:36:13] It was wouldn’t it be nice if everything was like that?

Dr James Muecke [00:36:15] I know that then and then having that experience in Myanmar, particularly with the childhood blindness and the measles, which is a highly preventable disease, really made me rethink my whole, I suppose, modus operandi that that if for the first time I drove home how powerful prevention is in medicine. And one of the other things that I’ve now been involved in six charity plan and studies around Asia and in each of the schools for the blind we’ve visited, we do also see children who are visually impaired, even blind, because they’ve never been tested for spectacles. Because there was no one available in that country or in that region to be able to fit them into a pair of spectacles, a basic service that we just take for granted here in Australia.

Dr Ron Ehrlich [00:37:03] But well, look at you, and I look at you, and we have glasses on. We haven’t even, you know, don’t even think about that.

Dr James Muecke [00:37:09] That’s right. And in those parts, in many poor parts of the world, and particularly in regional parts of the world, I mentioned before that optometrists play a critical role. And in many countries there is no optometry service available to assist, to screen, to detect eye diseases, and to prescribe glasses. And so, you know, again, a highly profitable problem.

Dr James Muecke [00:37:32] And so when I then was having this confronting experience with Neil Hansell and just every year seeing more and more patients losing vision and going blind due to their diabetes, I just felt that there was a real need to do something here in Australia to raise awareness.

I mentioned before that, you know, we have free health care. That’s no excuse. We have eye specialists everywhere. That’s no excuse. So why well over half of the one point seven million people in this country who have diabetes, why? Is this happening? Why is it the leading cause of blindness in working-age adults is because well over half are not having their regular checks, so why are they not having their background checks?

Well, there’s a whole bunch of reasons that I mentioned to before when I was a very busy, high-flying corporate lady and the other was channeling his priorities and his money into the health of his family and the education of his family and the feeding of his family. And there are other reasons I’m sure you can think of. But it then made me really think deeply about this whole process and in the whole story is very interesting, actually. He was diagnosed with Type 2 diabetes, by the way.

He doesn’t mind me talking about this has been a big advocate. And in fact, he came onto the stage when I received my award the Australia Day weekend in Canberra in January. But he at the age of 16, when he left school and started earning money for the first time, he had a very busy job, and he was on the move all the time, and he was consuming four liters of Coke a day.

Dr Ron Ehrlich [00:39:23] Oh, my God. Wow. That’s a lot of sugar. That’s a lot of sugar.

Dr James Muecke [00:39:29] That’s a phenomenal amount of sugar. Now, I haven’t done the calculations on it, but the major toxic component of the sugar additive in soft drinks is the fructose component, which makes up 50 percent. And fructose is highly toxic to the liver.

In fact, it’s not recognized as food by the body. 100 percent of it’s actually taken up by the liver, and about a third of it is converted immediately to fat. So it’s a really, really toxic problem. And a big driver of insulin resistance, the fatty liver, which is a big driver of Type 2 diabetes anyway. So Neil is consuming, about four liters of Coke a day. He was on the go. He was thin; he was fit. He was active. So we can’t use weight gain as an excuse here. He was diagnosed with Type 2 diabetes 10 years later.

Now in children, so he was 16, and children with excessive sugar intake Type 2 diabetes can actually develop within a two-year period. On average, it takes about 13 years. So 13 years. Neil developed Type 2 diabetes in a 10 year period. He didn’t realize that he was addicted to sugar, so he was highly addicted to that.

Dr James Muecke [00:40:42] The other thing he didn’t realize when he developed Type 2 diabetes was the horrendous array of complications that were potentially going to confront him in his life and which actually have confronted him in his life.

So I mentioned that the age of 50, he went blind in both eyes suddenly, and he tells his story, which we’ve actually made into a TV commercial, where the last thing he saw before he made the statement, his wife’s beautiful face. And it said it’s really heart-wrenching. And but he’s also had now nine amputations. In March this year, he lost his left leg due to gangrene from his Type 2 diabetes.

So gangrene possibly of Lehman, the second most feared complication of this disease after the loss of eyesight. So he’s had nine amputations, and he’s also since he’s had lost his vision, had two heart attacks. So this is also a deadly disease. Ultimately, about 80 percent of patients with Type 2 diabetes and body complications, such as heart attack or stroke. And there are a number of other life-changing and life-threatening complications, 70 percent will ultimately develop dementia. Now, I lost a father to dementia and.

Dr Ron Ehrlich [00:41:51] Me, too.

Dr James Muecke [00:41:52] Yeah. So this impacts this is a disease on the entire family.

Dr Ron Ehrlich [00:41:58] Yeah, well, I mean, I have seen that the interview that Neil gave and the description of what happened and to go to bed one night and take for granted you’re looking you see the world and to literally wake up the next morning blind is so shocking and must be so confronting and good on him for being so open and sharing about that.

But it’s interesting to James that this was something that you’ve come to. I mean, you’ve been a medical practitioner, a specialist at the cutting edge, literally at the cutting edge for many years. And you’d left this to the dieticians and nutritionists. This was not something that what are some of the revelations that you’ve come to professionally, personally about some of the advice we’ve received over the years that may have led us all into this mess we find ourselves in now?

Dr James Muecke [00:42:59] Yes. What I call our dietary disaster. So, yeah. So it’s a long story. How long have we got?

Dr Ron Ehrlich [00:43:06] Well, James, this is an important one, because I think your experience is so common to so many well-meaning medical practitioners that this deserves attention.

Dr James Muecke [00:43:19] And it does. It really does. Absolutely. And that’s why I’ve been so public in my discussion about this during the year, using my powerful platform as Australian of the Year for 2020 to raise awareness about this critical, critical thing.

If we say now that about 15 percent, one five have either pre-diabetes or Type 2 diabetes in Australia, this is a serious thing, about three point seven million people with diabetes or Type 2 diabetes. But there are some parts of Australia’s lower socio-economic areas, such as Greater Western Sydney, where 50 five zero percent have pre-diabetes or Type 2 diabetes.

We are now seeing this disease in children, you know, as children as young as seven. We see here in Australia; this was a disease that used to be called maturity-onset diabetes. And it’s been devastating Aboriginal people as well. So it’s this is a critical thing and the biggest driver of this is our poor diet.

In fact, our poor diet Is responsible for more disease and death than inactivity, smoking, and alcohol combined, so that is the big driver of this and nutrition is something that I never got taught in medical school, and my son, who’s in second-year medical school, has just finished an elective in nutrition. He chose to do that.

Dr Ron Ehrlich [00:44:42] Good on him. Good on him.

Dr James Muecke [00:44:44] Exactly. He’s very happy rabbiting on this year. And I think he decided that he should do it, but it’s not compulsory and yet. The biggest health issues that we have in our society these days and globally is related to our poor diet, so doctors all need to have a grounding in nutrition. So it’s something I think we need to advocate for sure now myself.

You know, when I received the South Australian Award just over a year ago, I was at my speech. I talked about the fact that you know, we need to encourage people to have their eyes checked if they have diabetes. But then going forward to the national award, I wasn’t expecting to win it, but I wrote a speech thinking that if I do happen to win, then I’m going to use the platform to raise awareness of, you know, the root cause of Type 2 diabetes.

So I started thinking about the toxic impact of sugar in our life. And I came up with a concept that I called the five days of sugar toxicity. So the first-day addiction to sugar is highly addictive, and it’s been shown to be as addictive as nicotine.

Second, alleviation, we often use sugar to alleviate stress or to make us feel better when we’re down. The third day is accessibility. That sugar is cheap and absolutely everywhere in our lives. You can’t check out from most supermarkets and stores without being confronted, enticed by half-price soft drinks and chocolates, something like 75 percent of our food and drinks has added sugar.

Dr James Muecke [00:46:14] And the fifth day is advertising, and our world is flooded. We are bombarded constantly and with TV commercials and ads for sugary products. And when you realize it’s actually as soon as you step out the front door, you just realize how much how powerful sugar is in our lives.

So I came up with a strategy and then a way of dealing with the five days of sugar toxicity, but also two or perhaps even three overarching A’s. Firstly, awareness. So being aware that sugar is highly toxic, we use it to alleviate stress, being aware of how much added sugar is contained within foodstuffs and drinks.

The second overarching awareness. So, so sorry. Second, overarching is accountability. I mentioned awareness, really so accountability, so accountability of businesses and of the industry to do the right thing by people and by the health of our people, and also the accountability of government and accountability of government to take action so that the action is is the third overarching.

I and to be honest, you know, if we’re talking about action and if we’re talking about our diet being such a huge driver of chronic disease, we still see on TV ads and so discouraging us from smoking, but never on free to air TV have I seen any commercial raising awareness about the toxic impact of sugar, the dangers of ultra-processed foods, and the horrendous, devastating complications of Type 2 diabetes.

No awareness-raising strategies. So that’s something I’ve been campaigning. I’ve been lobbying the government to bits that actually have a broad public awareness strategy to raise awareness, not just Type 2 diabetes and obesity, but also tooth decay.

Sugar is the leading cause of dental care, tooth decay in our society, something like 40 percent of 10 to 10 to 12-year-olds have decaying adult teeth is the leading cause of surgical admissions to children the leading cause of days of school, 50000 days every year to tooth decay. So that’s another story.

So, you know, critical things that we need to be aware of that this is so vital and a number of other things that I’ve discovered during the year. And one of the big concerns that I’ve had is our Australian dietary guidelines, which are literally outdated now and they’re flawed.

That being conflicted by heavy industry influence. But they continue to discourage the eating of natural saturated fats, and natural saturated fats have never been shown to be linked to cardiovascular disease.

And they continue to encourage the eating of cereals and grains, which have been linked to carbohydrates and particularly sugars and refined carbohydrates, have been linked to cardiovascular disease. And yet. These are nutrient-poor and non-essential, there’s not a single biochemical process in our body that demands that we ingest sugar and refined carbohydrates, and yet probably close to two-thirds of our diet is carbohydrate.

Dr James Muecke [00:49:31] So this dietary guideline, which is very powerful, and in fact, I had a friend recently who said I didn’t even know we had dietary guidelines. I didn’t know we had dietary guidelines at the beginning of this year. But that they’re actually quite powerful. They’re actually very powerful. They inform what’s eaten in schools, child care, aged care, prisons, the Defense Force, hospitals.

Dr Ron Ehrlich [00:49:52] Well, medical practitioners like yourself who aren’t particularly literate in nutrition would look to those you talk about awareness and accountability would look to those government-endorsed guidelines for advice, which makes it even more disturbing.

Dr James Muecke [00:50:11] It is. And the guidelines in themselves, the advice, I believe, is flawed. But the guidelines say in the preface, the guidelines are intended for healthy people, but the average Australian is not healthy.

So two-thirds of adults over the age of 24, overweight or obese, overweight, metabolically not healthy. In the United States, 88 percent of Americans are metabolically unhealthy, and about a third of our kids are also metabolically unhealthy. So the average Australian is not healthy.

So those guidelines, which are intended for healthy Australians, are not appropriate. But the other thing which is concerning is that there are a number of bodies, including in the GP handbook for the management of Type 2 diabetes. They recommend eating by the Australian dietary guidelines. So this is a Type 2 diabetes is a disease of carbohydrate intolerance. And yet the management handbook for general practitioners is recommending that people with diabetes eat by the Australian dietary guidelines.

Dr James Muecke [00:51:13] It makes no sense. Even Diabetes Australia recommends eating by the Australian dietary guidelines. So one thing I’ve been lobbying that the guidelines need to be changed, but also these organizations which are endorsing the guidelines need to stop endorsing the guidelines.

And I’m pleased to report that through my lobbying a couple of months ago, Greg Hunt announced the guidelines are going to be reviewed, which is great, but they need to be reviewed. We need to keep industry out of it, particularly the ultra-processed food industry out of it with their conflicts of interest and needs to be created in the fair and independent way. But it’s going to take at least three years.

And in the meantime, we’ll probably see in the order of 50,000 people die of Type 2 diabetes; we’ll probably see in the order of 300,000 new cases there is about 250 new cases of Type 2 diabetes every day. So this is why awareness-raising is so critical here.

Dr Ron Ehrlich [00:52:06] And I know when we spoke the other day, James, that we were both lamenting or commenting on the fact that there was a subject we both covered in second-year undergraduate and that was biochemistry, which had all sorts of pathways like the Krebs cycle and gluconate genesis and oxidative phosphorylation and glycolysis. And we probably, you’d like me, couldn’t wait to pass that exam because thank goodness I never had to worry about those pathways again. Little did I realize that I had to worry about them every single day of my life.

Dr James Muecke [00:52:42] Yeah, exactly. And, you know, as you say, you used to have that exam, and the Krebs cycle gets locked away in the dark recesses of your memory somewhere. And in fact, I hadn’t thought about the Krebs cycle until this year. So how many years later is that? But the Krebs cycle is the critical cycle.

I mentioned before that there’s not a biochemical process in our body that demands that we ingest carbs and sugar. The Krebs cycle can create all the glucose that we need for energy in our bodies from fat and protein. So it’s such a critical piece of information that we need to be aware of. And one of the other things I think that I discovered this year, in fact, I was invited to be on the expert advisory group for the National Diabetes Strategy Review a few months ago, and I was reading through the strategy, and I realized nowhere in that document was there mentioned that Type 2 diabetes could be put into remission or potentially reversed.

Nowhere in that document. And I had our first meeting; I raised the very end of the meeting because no one else advised that. I actually said I shouldn’t in this document somewhere be the very important, very critical issue that Type 2 diabetes can be put into remission, and so I’m pleased to report that we now have remission in that document. So which will give GP’s and health educators, health practitioners who are also informed heavily by the dietary guidelines, the comfort that they can actually now discuss the opportunity for remission with their patients.

Dr James Muecke [00:54:16] This is something I think many health practitioners have been too scared to discuss with their patients because there are examples of health practitioners who have been reprimanded by a medical board or overseeing medical board for giving patients advice about their diet. Can you get that? You know, scientifically trained doctors have not been allowed to give dietary advice.

Dr Ron Ehrlich [00:54:37] Well, I know I have on this podcast spoken to one such doctor, and he’s an orthopedic surgeon in Tasmania, Dr Gary Fettke, who had who was dealing like you with the ravagers. So you talk about Neil’s amputations.

Well, it’s more than likely doctors like Gary Fettki were doing that. And Gary, quite correctly felt compelled to talk about what you’ve just talked about. And I think we’ve come a long way, James, to think, well, I wonder whether you would have got the Australian of the Year if you’d started talking about this before. But it’s good on you for doing it. And it’s one of the reasons I wanted to talk.

It’s music to our ears, James, because confusing health messages are a major source of chronic disease in our country. And that conflicting industry is a very big component of that. I think also another one I would add is the ego and reputation of practitioners who have been espousing a certain approach for their professional life to turn around and go, hey, actually, you know, I know I’ve been telling you for the last 30 years, saturated fats problem, but I think I was wrong.

Dr James Muecke [00:55:49] Yeah.

Dr Ron Ehrlich [00:55:50] That’s a big step professionally, isn’t it?

Dr James Muecke [00:55:52] It’s a huge step. And we do need to admit that at every level, you know, from the health practitioners and educators through to our Department of Health, it’s time to say, sorry, guys, we’ve got it wrong. And I mentioned before how powerful the guidelines were when the demonization of natural saturated fats happened back in the 70s and 80s, quite literally, thousands and thousands of low-fat products were created. And when you reduce fat in food, you take away the flavor.

You take away the ability to be satiated, filled right. And so you need to replace that with something. And quite often that’s replaced with sugar and carbohydrates. And so this has been a big driver in processed foods of this epidemic of Type 2 diabetes. So we do need to turn this around. So it does need to start at the top, and the awareness needs to reach practitioners and the public, because for so long what we’ve just known is that saturated fat is bad for us, but actually it’s not. It’s actually critical to our survival.

Dr Ron Ehrlich [00:57:00] You know, interestingly, James and I, obviously, through my role at the Australasian College of Nutritional and Environmental Medicine, come into contact with many practitioners. We’ve been going for 40 years who do study nutrition. And I also know many practitioners like yourself who have been working tirelessly in their own area and who have rather with the best of intentions, accepted the nutritional guidelines in good faith. And I think the influence of industry is a story that is very easy to miss. But once you become aware of it, very difficult to ignore.

Dr James Muecke [00:57:37] Exactly. And if we look at the guidelines and if we look at the cereal and grains section of those guidelines, the majority of the references for that section are funded by industry.

Dr Ron Ehrlich [00:57:48] Well, I know this is an article you shared with me before, but in a review published in the Annals of Internal Medicine in 2016, 33 of the 34 studies that were not funded by industry showed that sugar-loaded beverages cause obesity.

In contrast, none of the 26 studies that were funded by industry showed an association. Nutritional science is hugely conflicted by the food and beverage industry, and I’ll actually add to that the pharmaceutical industry. But that’s a whole other story. So the impact of industry on research is huge and really goes a long way to blurring a clear picture forward for well-meaning health practitioners.

I just wanted to take you to take a step back now, James, as as a professional and as a social entrepreneur, because we’re all on this health journey together through life in this modern world. What do you think the greatest challenge is for an individual on that journey? You’ve covered many challenges, but what do you think the biggest challenges for an individual on that journey in our modern world?

The Biggest Health Challenge

Dr James Muecke [00:59:08] Do you mean in terms of the health of their diet?

Dr Ron Ehrlich [00:59:11] Yeah, well, just in terms of their journey through life and its impact on their health, what are some of the things that what is the biggest challenge, do you feel that might affect an individual’s other health positively or negatively?

Dr James Muecke [00:59:28] I think the biggest challenge, actually, when we go back to those five days of sugar toxicity and the addictive nature of sugar, it is so incredibly powerful. And again, I mentioned I wasn’t aware a year ago that was addictive, and yet I was highly addicted. I’ve been addicted to sugar all my life.

I probably still am, actually. And you can see I’m tall and thin. But I found out early this year that I actually have a fatty liver. And I mentioned before that fatty liver is a big driver of Type 2 diabetes. So I’m what they call thin on the outside, fat on the inside. And we know that in the United States and I suspect here in Australia as well, there are more thin, metabolically unhealthy people than there are obese, metabolically unhealthy people. So it’s not obesity, which is the big problem here.

It’s actually not even the number of calories, but it’s the type of calories and particularly the sugar that we’re ingesting. And if you didn’t look at the fact that our world, our environment is so flooded with sugar, it becomes hard to resist. I know if I’ve got ice cream in the house, I can’t resist it, even though I’ve now detoxed for the most part from sugar, it’s such a powerful driver that we need to be aware of that. And once we’re aware of it, then we can start to put in place those personal mechanisms to try and avoid the sugary products in our life. So that’s it’s a really important thing. And just the awareness and but I think we also need to have.

This is where I say before the accountability of businesses and industry and ultimately, the government to stop the predatory sales and marketing tactics of industry and business.

So, for example, remove all of those sugary products from checkout counter so that you can go through checkout and not be enticed, compelled to buy those 2 for 1 chocolate in an evening before you even get home. So, you know, this is so important just to protect the environment of people who are addicted. And I would say that the vast majority of us are addicted to sugary products, at least have a physical dependency on it. So I think these things are very important, awareness, accountability.

But also, I think if we step aside from the whole sugar toxicity Type 2 diabetes issue, you know, having a positive approach to life is is really, really important. And for me, positivity is absolutely critical in building personal resilience is also critical in building resilience as part of a group or an organization. And even globally, you know we are in the midst of this COVID19 pandemic, which is impacting on the world globally, and we need to draw on our resilience. And so a positive approach is a really important part of this. And I’ve come up with this concept, which I call the four good things to forge a positive mind.

Dr James Muecke [01:02:25] And it helps me in my daily life 4 good things are good health. So, you know, when you’re suddenly confronted with life-changing moments of adversity, you can’t suddenly have good health, so eating well, you know, avoiding sugar and those highly processed foods I mentioned is a very important part of that for having health that allows you to deal with confronting experiences.

Also, exercise is very important in building health and mental health in particular. So the second is good sleep. When we don’t sleep well, we don’t deal with things, so we’re not as resilient. The third thing is good friends surround ourselves with people who are positive and uplifting, not people who are trying to drag you down toxic people. And the fourth is what I call good habits.

So when you’re stressed and when you’re chronically stressed, like many of us have been over the last few months, the body is up with the stress hormone cortisol is at a low level. And that’s not healthy physically. It’s not healthy. And mentally, it’s not healthy for us. And there are ways of dealing with that stress. And you can actually choose bad habits, unhealthy habits.

You know, we can smoke, and we can take hard drugs. We can drink too much alcohol. We can eat too much sugary food they all trigger the release of transmitters such as dopamine from the feel-good center, so they all work to make us feel better, but of course, ultimately they not healthy in particular if we do it in excess. But there are other good habits, healthy habits that we can take when we’re feeling stress.

So rather than reach for that block of chocolate or that, a bottle of soft drink, why not take the healthier option, you know, go for a walk out in the nature somewhere beautiful. Listen to your favorite music and reach out to someone else who’s having a tough time. Do a good deed.

These have all been shown to be as effective as sugar in balancing that cortisol reaction that’s flooding the body during the anxious time. So I think likely people with the message that you know, forging a positive mindset allows us to get through difficult times, build our own resilience. And there’s also a way of actually, you know, forging a more positive mindset through exercise, not just physical exercise, but that mental exercise and this has actually been shown through the neuroscientific field of neuroplasticity.

We can actually the way we pay attention can actually change the brain to change the way we see and do things. And there’s a very famous study that is that confirms this. And what I do every morning before I go to the computer or look at my smartphone, I think of three good things that I have to look forward to during the day.

Three things that yeah, something that’s appealing through my day. And at the end of the day, before I fall asleep, I look back at my day and say, OK, what three things have I experienced this day which has been wonderful, which have been positive, which I have to be grateful for. And, you know, it’s interesting, I’ve not had the easiest year this year.

And, you know, I saw all of my fabulous opportunities as Australian of the Year dissolve away within those early weeks of the COVID pandemic. But what I did, I used to get out every morning on most mornings and go for a walk-up in the Adelaide Hills. And that exercise was fabulous. And I’d get to the top the highest point, and I’d look down over the city. And often it was still damp down over the lights of the city. And think of three things that I had to look forward to during the day, and I must say at a stressful time of my life. I have never felt more positive. And when I moved into that more positive mindset, it allowed me then to think, okay, well, you know, what am I going to do to turn this around and allow me to then innovate?

Dr James Muecke [01:06:33] And that innovation is also a critical part of building resilience. And so for me, the innovation involved turning my message online rather than speaking at live engagements, conferences, dinners, etc. I then started creating keynotes, which I then delivered through these various Internet platforms. And so ultimately, the message has perhaps reached an even broader audience than I might have otherwise done. So, yeah, I think these things keep a cool head. Being positive and using innovation allows you to be resilient in your life.

Dr Ron Ehrlich [01:07:11] Well, you know, you have, I think, the two words that come to mind as I hear you, James, is articulate and inspiring. And again, congratulations on not only your amazing work as a social entrepreneur but also in this year, which you have reached a very broad audience as Australian of the Year for 2020. We’ll have links to your site, of course, but thank you so much for joining us today and sharing your wisdom and insights.

Dr James Muecke [01:07:38] Ron was wonderful to be with you this morning. I really enjoyed this. And I wish you all the best for Christmas and for 2021. Let’s here’s to the world opening up next year.


Dr Ron Ehrlich [01:07:47] Thank you. I had the honor of speaking to James on just a few days ago for the Australasian College of Nutritional and Environmental Medicine. We’d invited him to do a keynote for our annual general meeting. He was unable to do that. But we recorded a short 10 to 15 hours, 15-minute interview for that meeting. And as I was listening to James, there was just so many points at which I would have wished he was a guest on my podcast, because there I can stop and ask him questions and so and hear much more about what he was doing. And what he’s doing is what he has done is so incredible.

I think it’s so interesting to hear the Australian of the Year pick diabetes and sugar or carb and carbohydrates as he observes as to champion the cause, whereas a specialist ophthalmic surgeon because one of my earlier guests on this podcast was an orthopedic surgeon from Tasmania, Dr Gary Fettke. And Gary was crucified, professionally crucified for having the audacity to suggest just what James Muecke’s is championing, which we all know should be championed.

And that’s an indication of the power of industry and influence, which is a theme I cover a lot on this podcast, and we’ll be covering more of. But it’s an indication of the power of industry on all levels of health care, not just on industry and government, but on regulatory bodies and professional organizations that would actually take an orthopedic surgeon to task and threaten him with de-registration for having the audacity as he is cutting off the limbs of patients who suffer from Type 2 diabetes entirely preventable.

And as James has observed, reversible. And he was almost deregistered for that. It led to a whole three years, a nightmare if you are brought before regulatory bodies for anybody, but as a profession, as a health professional, where your registration and your ability to practice is can be removed. It’s a nightmare. It’s a nightmare that went on for Gary for three years, and he was eventually vindicated. And here we have James Muecke, Australian of the Year, spending 2020, championing something which he has only come to later in his professional career. So I thought it was terrific; it’s a terrific story of James.

I think he’s an inspiring individual and he’s been recognized for that. And he’s run with it beyond his work as a social entrepreneur to make a difference in Australia and globally as well. I will have links to his website. And look, 2021 is going to be an exciting year. We are looking at doing a lot of online programs. We’re going to be doing more podcasting. There’s the Unstress app, of course, do go online and leave us a review. We want to get this global, this message out to a much broader global community. So thank you so much for joining me today. I hope this finds you well. This is Dr Ron Ehrlich until next time. Be well.


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.