Empowering Vision: A Conversation with Dr. James Muecke on Eye Care and Public Health

[00:00:02] Welcome to the Unscripted Pharmacist.

[00:00:05] This is awesome today, it's my pleasure to introduce Dr. James Muecke.

[00:00:10] He's a man who's with a remarkable career and dedication he's had a profound impact,

[00:00:15] not just on the field of ophthalmology but also in the world of public health.

[00:00:20] Dr. Muecke is a highly respected ophthalmologist with over three decades of experience

[00:00:24] in treating and preventing blindness, not like he does it today though.

[00:00:28] His work has led to life-changing eye care in some of the world's most underserved regions.

[00:00:35] But his contributions extend far beyond the operating room.

[00:00:38] In 2020, Dr. Muecke was named Australian of the Year, a testament to his tireless advocacy

[00:00:44] for diabetes prevention and his efforts to combat the devastating effects of diabetic retinopathy,

[00:00:51] a leading cause of blindness worldwide.

[00:00:55] Dr. Muecke's passion for public health has made him a powerful voice in promoting healthier lifestyle.

[00:01:01] He is also a huge proponent of decreasing and reversing these non-communicable, non-communicable chronic disease.

[00:01:12] Today we have the privilege of hearing from Dr. Muecke as he shares his insights on the intersections of eye health, diabetes.

[00:01:19] I don't know if we can get all of this in but as well as public health.

[00:01:24] Please join me in welcoming our leader and visionary Dr. James Muecke.

[00:01:28] Thanks for being here, Dr. Muecke.

[00:01:29] Thank you so much for having me on the show this morning.

[00:01:31] We have to stop the afternoon where you are, isn't it?

[00:01:34] Yes, yes, it's middle of the afternoon and for your numbers, I think we're, we are 30. 30C.

[00:01:44] 30C right now but we will get into upper 30s here in California where it's quite warm, quite sunny.

[00:01:52] Unlike where you are which is on the outside of the world where it's winter and how's the surf?

[00:01:59] The surf in Edla, we're in a golf so the surf is not great and we go off.

[00:02:03] You're going to travel about an hour or two out to get a decent surf.

[00:02:07] Nice.

[00:02:09] Fantastic.

[00:02:11] I love the concept of going there and getting lost and just renting a van and just enjoying southern Australia with the paddleboard in hand.

[00:02:22] Oh, if you're a surf or a paddleboard, there's plenty of beautiful spots.

[00:02:25] I got it.

[00:02:27] Yeah, definitely come.

[00:02:28] Believe it or march, I point out that's the best time to be here.

[00:02:31] Yeah.

[00:02:31] Whether it's sunny and it's stable and it's just a beautiful time to be here.

[00:02:35] But also fantastic things to do in a round that way.

[00:02:40] Fantastic.

[00:02:41] So hey, tell me like,

[00:02:45] to die be these effects so many, so many people and it affects people that I know.

[00:02:54] But your complications that you're dealing with is so,

[00:02:59] it's not as common, is someone obscure and people don't realize until it's too late.

[00:03:04] And so tell us what happens when you have to sit down and tell them like,

[00:03:10] I love what you do when you're giving very good case studies and showing what it looks like through the eyes of a diabetic.

[00:03:20] I think that needs to be the take home message earlier on when we're talking about when people first get diagnosed with diabetes.

[00:03:28] Like this is what your vision could look like in five ten years if you don't make a change.

[00:03:33] And until it's like, oh, it's too late. Now I got to go see the path the knowledge is there's hardly any preventative care.

[00:03:40] But not only that, I think that people don't realize that this is fixable, not with a drug,

[00:03:47] but just everyday things that we do things that how we behave, what we eat, the type of foods of eat, the ultra process, garbage that we're eating.

[00:03:58] Tell me,

[00:03:59] I like this question the most, and that is this. Tell me what you thought when you discovered this little secret about what the real cause was a diabetic retinopathy.

[00:04:15] When was that aha moment and what did you do about it?

[00:04:18] Yeah, yeah well really started back in 2018 car.

[00:04:24] I mean as you say, I've been in this game for 35 years actually and that entire length of time I've been dealing with the blinding consequences that diabetes and effects on the eyes.

[00:04:35] So this is all types of diabetes that one which is essentially a autoimmune disease which is often post viral and usually affects children.

[00:04:46] But the majority of cases are of course a type 2 which in this country and in your country probably close to 9 years, in the cases.

[00:04:53] And we have in the order of 2 million people in this country with diabetes and it is now the leading cause of blindness amongst working adults in this country.

[00:05:05] Why is that? Well probably at least half probably quite a bit more than half of the 2 million are not having their regular all-important sight saving eye check.

[00:05:15] That's why it's become such a blinding problem. It's also the fastest growing cause of vision loss amongst our first nations people, our Aboriginal people. So it's a huge, huge public health issue and it is the most feared complication of diabetes.

[00:05:29] But extraordinarily, a lot of patients who when they develop type 2 diabetes are not aware of this raft of complications that await for them.

[00:05:41] And I often tell the story of the guy called Neil who he developed type 2 diabetes at the age of 26 and he had no idea what they await for him.

[00:05:53] And I met him in 2018 and his story was quite extraordinary. I was actually with my son doing a documentary about the experience of blindness, what it means to be blind.

[00:06:07] And I interviewed 10 people for kids who are born blind, Neil had fascinating stories.

[00:06:15] For elderly people who are slowly going blind into their lives due to a condition called age related macular genealogy and their stories were interesting but they were coping because it was a slowly progressive condition and they had family support and they just adapted to it.

[00:06:30] But the two that had this deeply profound impact on their lives were two people with diabetes who developed, who lost their vision in the middle of their life and the primary of their life both working age adults.

[00:06:44] And particularly Neil who tells the story of going to bed one evening with normal sight and waking up the next morning, blind in both eyes.

[00:06:54] It's almost possible to comprehend particularly for me as an eye specialist to actually comprehend the impact of that.

[00:07:02] And he's blind, he remains blind this day. He's also had to heart attack, so he's really been devastated by this disease which he developed at the age 26.

[00:07:13] So at the age of 50 he woke up blind in both eyes and talks about the last thing he saw with his sight over the last thing he saw was the night before which is a beautiful wife and a beautiful smile before they went to bed.

[00:07:27] So it's absolutely harrowing and I use the footage from that interview with him to create a couple of TV commercials, which one played nationally on one of our major channels, commercial channels back in late 2018, encouraging people to have their eyes checked.

[00:07:42] So that obviously the preventive horrendous outcome and the other one which played in 2021, which was really about the impact on his family, the devastating impact not just on the individual but on the family.

[00:07:55] So his story had such a powerful impact on me and this was at the time let's say 30 years of of our famology and I only ever saw my role as a guy at the end of the line, treating these in stage complications, these blinding complications.

[00:08:11] I never thought it was my role to have their conversations about life start particularly about life.

[00:08:16] But what I did and this really triggered me, this was the aha moment that you talked about.

[00:08:23] I started reading, I started thinking so I found profound and ran for many years not for profit course sites for all which are still in existence.

[00:08:32] I've just no longer functioning as a chair, I'm actually a patron and in 2018 we started focusing on the damage being what by type two diabetes in this country.

[00:08:45] We held a number of events as I mentioned we did that documentary.

[00:08:49] I've probably that point our focus had been primarily Asia which is home to half the world's blind adults and 2,000 to the world's blind kids and we have projects throughout Asia impacting on the lives of over a million people every year.

[00:09:02] But we wanted to bring it back to Australia and to really focus on diabetes being this major blinding issue in this country.

[00:09:11] And so as part of that process I just started reading a lot and I think the one book that had the most profound impact on me was Jason Fong's book, the diabetes code where I actually realised by reading Jason's book that types of diabetes could not only be prevented it could also potentially be reversed.

[00:09:30] This was a revelation to me. It was absolutely revelation to me.

[00:09:35] Now you mentioned in your very nice introduction that I was awarded a Australian of the year before you have that lovely honor, you have to be awarded South Australia in the years so our state is South Australia did like California.

[00:09:50] So in when was it said late 2019 I had that wonderful honor and at that time my focus was going to be to raise awareness of this line issue of diabetes and encourage people to have their eyes checked and I thought I've made my speech and I was really just focusing on that as the issue.

[00:10:10] And then going forward with that I certainly wasn't expecting to become Australian of the year there was some pretty stiff competition and but we had to prepare a speech and I prepared my speech and the time came was the Australia day weekend in late January and 2020 and amazingly my name was called out and so I was prepared and I thought well if I happened to be given the honor of Australian of the year.

[00:10:40] I'm a doctor what's Australia's biggest health crisis it's type two diabetes and surely that should be my focus so that's what I did I made that my focus and and there's been some extraordinary events that have unfolded since that time.

[00:10:55] Yeah you guys have some progress Australia is changing you guys are waking up and it's thanks to people like you the thanks to people like Gary Fettke you guys you guys are making some changes and going.

[00:11:09] I think it's Gary I think he's getting three is going to is going to put CGMs on I think on three different parliamentary members and just kind of watched them and like what a great idea like his advice was go find the right people of influence change them and then maybe it will trickle down so you guys.

[00:11:29] Cudos the world is waking up and it's starting with you guys and Australia's phenomenal.

[00:11:37] Well that's hope so because it's a it's a worldwide phenomenon I mean global East since 1980 type two diabetes has grown.

[00:11:43] Fourfold but it's been even more powerful in some other countries and communities in China more than a 10fold increase in type two diabetes than that since that time.

[00:11:53] In our first nations people Aboriginal people there's been more than an 8080 fold increase in type two diabetes in the last half century it's devastating poor people it's absolutely.

[00:12:05] It's absolutely criminal and so I'm actually meeting with the state health minister the afternoon after the podcast I'm meeting with the.

[00:12:14] Prevended health advisor to our national health minister so I've got some pretty important meetings coming up today and there and just continuing to put pressure on them but I think one of the most pivotal experiences and moments as opposed in this whole journey for me.

[00:12:32] Was you know you remember of course 2020 COVID hit and it was all the focus was on COVID and actually in a way.

[00:12:42] This incredibly powerful platform that I had as Australia to the year was absolutely devastating.

[00:12:49] Because of COVID and the one thing that happened was we had our national diabetes strategy refresh during that year so we have to do a review of the national diabetes strategy and because of the fact that I was Australian in the year and because.

[00:13:05] I was trying to raise awareness of type two diabetes I was actually put on that committee the expert advisory group.

[00:13:13] And my soul aim of being on that advisory group was to get remission of type two diabetes into that document which I managed to do and that was published in 2021.

[00:13:25] And that was a really pivotal moment because it meant you know that you've heard Gary Fickie's story about Gary being struck off back I think in in 2012 for.

[00:13:36] Telling patients as a medical doctor as a surgeon who was chopping off.

[00:13:42] Lines of patients every week with gangrene due to the type two diabetes he was starting to get them what would seem sensible advice cut back on you sure it cut back on your fine cover hydrate.

[00:13:53] And actually was struck off by how medical board and had several years of investigation.

[00:13:59] But it's really thanks to Gary and a number of other people in this space that I've had this incredible experience and the mentorship that Gary and others have given me.

[00:14:11] And the fact that we actually have that in the national diabetes strategy have that that opportunity for remission meant that we can now talk about it and we could now talk about it without fear of getting struck off by our regular three body.

[00:14:25] And whether that be as a doctor specialist, a nutritionist, a dietitian and it's been quite extraordinary what I've noticed since that time.

[00:14:38] When when when it was published in 2021.

[00:14:43] I thought it's now time to start talking to my patients about diet lifestyle.

[00:14:50] And in the middle of 2021.

[00:14:53] I think it was mid to light 2021 when the.

[00:14:58] The strategy was was relates to the contrast.

[00:15:01] So people a little bit more receptive.

[00:15:04] I mean, seems like so that now you're saying like is the debate a little bit more balanced where we're bringing evidence into this discussion versus this is how it is.

[00:15:14] And Pepsi guy over here says we can't listen to you because you know this is a is a problem for our conflicts of interest.

[00:15:23] Or do you feel like it's an even dialogue and people actually want to hear what you have to say.

[00:15:30] Well, let's say stop in my patience.

[00:15:33] Oh yeah, your patients. Yeah.

[00:15:34] So I'm actually treating every every week every day.

[00:15:38] The learning consequences of this disease and I have several hundred patients that I'm putting needles into their eye.

[00:15:47] Sometimes every month and both eyes and it's quite devastating for them.

[00:15:51] It's quite expensive for them and that's as I say just one of the raster complications that these.

[00:15:57] Poor patients have to look forward to if they don't.

[00:16:01] If they don't look to put their disease into remission.

[00:16:04] In fact, in 2021 the very first sentence on the type two diabetes webpage of diabetes Australia was type two diabetes is a progressive disease.

[00:16:16] In fact, we could then know have this opportunity for remission so I started talking to my patients and only the ones in those in those early days only the ones that I was actively treating with sight threatening disease.

[00:16:31] So I'd laser their eyes are sticking needles in their eyes and patient after patient had no idea of remission this opportunity for remission is concept of remission.

[00:16:47] They had no idea.

[00:16:48] And I think there was maybe one of that first 100 patients one percent of first 100 patients they had no idea.

[00:16:57] So the only one of the first 100 had an idea that it would hurt us it's opportunity for remission.

[00:17:02] So this is a conversation that wasn't even being had at the grassroots level with the general practitioner who is managing their disease.

[00:17:09] So what I decided to do was work with the GPs and so I'd write back to the mutual GP of all of these patients saying, can we explore this incredible opportunity to put their a type your diabetes in remission primarily with a change of die primarily dropping their carbohydrate intake as we know as you know as going to the patients know this is a disease of carbohydrate intolerance.

[00:17:38] So dropping their carbohydrate intake can potentially put their type of diabetes interimission.

[00:17:46] So most of those letters were ignored and often I had to sorry my friends just ringing on turn that off.

[00:17:55] So most of those letters were ignored.

[00:17:59] Some of the GPs actually took note and what I did in those letters are recommended the local nutritionists who specialises in therapeutic carbohydrates.

[00:18:08] Hydrate reduction in low carbohydrate ketogenic diet and and some of the patients started embracing and engaging it and unfortunately it's not cheap we don't have a.

[00:18:20] Government sponsored program where patients have access to nutritious and dietitians who can specialise in this approach.

[00:18:29] That's in here either.

[00:18:30] Now, and there's really hard to find someone like what you found finding a day to attend that will make that recommendation.

[00:18:38] Good for you.

[00:18:39] We have a we have a group called low carb down under who probably know and low carb down under has a state by state resource of all the GPs specialist nutritionist dietitians exercise physiology who.

[00:18:53] interested and involved in this space.

[00:18:57] But I'd meant the nutritionist one of the local nutritionists one of the few nutritionists actually did it so I'd say to the GP.

[00:19:05] Please can you send this patient to see the name is resale to see resale to explore the opportunity for a mission.

[00:19:14] So a few took on board which was exciting I got a few nasty letters from from endoclonologists but a few took on board.

[00:19:21] And I still remember the very first patient that I experienced their type to diabetes going into revision is a guy called Bevan and he was having eight weekly injections in both eyes had done for many years and I couldn't extend the injections out beyond eight weekly but there were they were controlling his.

[00:19:42] The injections are for a condition called.

[00:19:44] Macularer deema so diabetes related macularer deema which is swelling the central vision area and it's related to diabetes damage to the fine blood vessels of the right now at the macular the central vision area.

[00:19:58] And you get liquid you're fluid into the into the tissues and that course blurring and distortion of vision.

[00:20:04] So Bevan and it been having eight weekly injections in both eyes and there was no endoclon.

[00:20:09] He was I suspect of the time in his late 50s and he had 20 30 years ahead of him have injections.

[00:20:19] If something else didn't get him in the meantime because of course what he understood what he was being told was his disease was progressive and there was.

[00:20:29] There was no nothing you could do to avoid that so he came back between injections.

[00:20:37] I've seen the situation as he came back for his next pair of injections and it become off his insulin.

[00:20:42] Hello, yeah that was amazing start and then the next pair of injections had come off all his medicines or his diabetes his oral hypoclicemic medications.

[00:20:54] Extraordinary.

[00:20:56] And what does scandal look like.

[00:20:58] At that stage his scans.

[00:21:02] So he with the two monthly injections there was pretty much control of his macular deema so scans are looking pretty good but as I said they've it.

[00:21:11] I'm trying to go and let's say the nine or 10 weekly injections just started to see this well in coming back.

[00:21:17] So wasn't so much his scans were impressive that it came back and I remember him saying that he was thinking more clearly.

[00:21:28] He lost but he never felt better and he was starting to see more clearly although the scans and showing thing he was starting to see more clearly.

[00:21:38] And over the next.

[00:21:40] Actually couple of years I suppose this would be in 2021, 2021 I was able to.

[00:21:47] As he engaged as he put his type two diabetes and germination start to slowly but tenderly increase the interval between the injections go to nine 10.

[00:21:56] 11 12 weeks and I saw him quite recently and he's now I fall his injections.

[00:22:02] I got him out of six monthly injections and then stopped his now I fall his injections and he's really.

[00:22:08] It's it's to me it what why this one experience was the most exciting experience of my 40 years in medicine.

[00:22:17] The most that's never happened before had that never happened.

[00:22:22] You need like a little gone down this guy last a bunch of it is great no more than you can.

[00:22:32] I think that's on that no car probably we this is why people prefer the term remission it's like cancer you can put in the term mission but it might come back and certainly.

[00:22:44] We got to keep a watch on these patients and all people watch on beven probably for the rest of his life just to make sure.

[00:22:50] We've looked more written or disease so unfortunately it's not a cure and but it's life changing for him can imagine.

[00:23:00] Life changing for him it's also saving the government a bunch of money.

[00:23:05] The injections each injection would have cost our health system probably two and a half thousand dollars about two thousand dollars US in both eyes four thousand.

[00:23:15] Every eight weeks whatever that is every year us all his medicines plus all the other.

[00:23:22] Investigation and doctors appointments and communication he was going through so it's life changing for him and certainly save us a bunch of money for the government and for the taxpayer you multiply that out we're now in this country.

[00:23:37] Just the eye injections alone at the end of 2023 we wrap over 150,000 injections this is for a population of about.

[00:23:45] It's 25 26 million not sure what it is not nearly as much as the state we're 40 million in California.

[00:23:53] 40 million.

[00:23:55] Kind of a big state.

[00:23:57] That's it's even bigger.

[00:23:58] You're doing so use that 26 26 million you have 100,000 people 100,000 people taking injections 150 over 150,000.

[00:24:08] 150,000 and how much does it a shot.

[00:24:11] And I think it's kind of costed out about a quarter of a billion dollars every year.

[00:24:18] Oh yeah 375 billion that's a lot of money.

[00:24:22] It's not it's not it's not clearly not.

[00:24:25] As I can say this is the one there's only one of all of those complications that we see in the capital D.

[00:24:33] I am you know lots of visually said that the most feed complications but to me the most feed complications should be dementia.

[00:24:45] That's 70% of patients with type 2 will develop dementia and I last both parents my mother last year to dementia.

[00:24:51] So this again is a disease and impacts severely and heavily on the entire family and friends and the workforce.

[00:24:58] You know this is again this is just two complications Gary Fickie deals with the second most feed complication which is loss of limb due to gangrene.

[00:25:08] Oh yeah apple so but when it comes to these complications I guess we probably should back up would it be safe to say that your passion comes from the results not just within you because I know you've got a personal a really cool personal to-fi story as well.

[00:25:27] As what you see in your patients is that's what's feeling your fire is it I mean it almost seems like.

[00:25:36] You probably get up in the morning and you don't drive going to work because work is this work is spread this wonderful you know and fixing this misinformation and sharing great stories like this and your passion must come from results.

[00:25:51] Because when you see that what you never they never taught you in school there there was no cure.

[00:25:56] There's no this is the real cause you can reverse it with this like all these mechanisms they never told us.

[00:26:03] They never told you about insulin they never told you I'm sure about some of them the real mechanisms behind age related macular degeneration all the retinopathy this this macular edema.

[00:26:17] Like when you found that out like what happened like what was your response so you're like wait a minute.

[00:26:25] Why does somebody tell us that?

[00:26:27] Yeah yeah absolutely it's suddenly turned my whole of family practice on its head you mentioned that my personal story we can come to that later.

[00:26:37] That was just by the by I mean really that that that that that that that was an interesting aside but the the most powerful experiences with with my patients and with the results and it's quite extraordinary to realize that actually.

[00:26:55] Most likely all the leading causes of blindness in the world.

[00:27:01] I've likely metabolic likely related to poor diets so age related macular degeneration leading cause of blindness in in wealthier countries.

[00:27:12] Diabetic red nobety leading cause of blindness amongst working age adults faster screen cause of blindness most likely in the world.

[00:27:19] I'm going back to 2021 and those initial experiences and that was I told you the story about bevin but I didn't started to find.

[00:27:38] Whole bunch of patients who were also doing this and.

[00:27:44] Back then so I was down to a couple of days a week in my practice.

[00:27:50] Another story I have a newological problem with my right hand and I had to give up surgery back in 2012 and actually.

[00:27:57] In 2020 I was hoping to sell on my practice because it was just getting really difficult for me and it was really causing me a lot of discomfort with my right hand.

[00:28:21] And.

[00:28:21] I was injecting vast majority of patients I was injecting into their eyes was.

[00:28:27] Age related macular degeneration and that's another story where we can't unfortunately reverse the damage being done by that.

[00:28:35] We don't see the same impacts as we do with tightly diabetes and diabetic red nobety.

[00:28:44] So my practice was getting a bit boring and it was a bit you know, since there I said a bit like a production line just patients coming in and injecting their eyes.

[00:28:53] I mean doing them fantastic.

[00:28:55] They were really doing well most of the patients but the job works the job works right. Oh they were great.

[00:29:02] Absolutely absolutely it's extraordinary remember when I started using them for macular degeneration back in probably 17 years ago now.

[00:29:11] This was prior to that time this was universally lining disease and they were just going and there is pretty much nothing you could do about it leading leakage of fluid at the central vision area eventually scaling up and causing this devastating loss of vision.

[00:29:26] And then I remember just the first time I gave an injection and seeing that fluid pretty much dissolver way is quite extraordinary it's not quite so dramatic and impressive with diabetic macular demer that central vision area.

[00:29:40] Swilling that we see in patients with diabetes and it can often take multiple injections before you start to control their their.

[00:29:50] So it went from being this kind of dull pretty uninteresting practice that I had to be this vibrant extraordinary fascinating practice where I was actually not only.

[00:30:04] Helping my patients with their eyes but also helping them systematically reverse their type to diabetes so super exciting and as I said it was it has been the most wonderful experience and it's been an experience that.

[00:30:17] I wish all of my medical colleagues could have it is quite simply.

[00:30:25] Super powerful and super super exciting yeah so but it's hard to find people to talk to on this wavelength and go hey dog I got something really exciting and I can't stop you mean you almost feel like there's some sort of church missionary hang on a minute don't run away from me I got something I want to say share yeah it's.

[00:30:46] I don't get a lot of positive response from physicians because I feel like they might feel a little bit threatened especially from a pharmacist but you know when I tell him hey these jugs on work there's really no evidence for this.

[00:30:59] I'm hoping that they're starting to listen but it's a long road here.

[00:31:03] Yeah because of what we're trying to do is so it's is so dramatic yeah yeah it is and it's and there's lots of best interest so we can come back to that later but certainly when I was in medical school this was known as.

[00:31:18] Which is quite a long time ago now it was known as maturity on set diabetes we're now seeing children as young three in this country in Australia with type two diabetes it's young as free can you believe that.

[00:31:29] We're going to Australia Northern Australia leads the world for type two diabetes in children.

[00:31:35] Wow what's the youngest patient you've seen.

[00:31:38] And as an our the knowledge with with with the.

[00:31:42] The WHO definition for children is is under 16 and I haven't watched seen any kids with type two diabetes.

[00:31:51] And and and and read all disease either but it's has been reported I haven't seen it but most of those I'm in southern Australia most of the young children with type two diabetes are Northern Australia particularly from Aboriginal communities.

[00:32:06] Yeah so I'm so back time would you okay so what I'm just just theorizing this would it be a cool study to do.

[00:32:18] Injections versus lifestyle.

[00:32:22] I mean or you might like you use the vet the anti vet Jeff in the beginning to try to help get them out of this temporary situation because we don't you know this has got to be safe and then go from you know they get their injections like what you're saying.

[00:32:36] Make the injections further apart while you're doing this lifestyle intervention and see if.

[00:32:43] Yeah let's talk about that so so I mentioned that back in 2021.

[00:32:49] I was hoping to sell my practice in 2020 but the guy didn't buy it and so I stayed on injecting these patients and and when 2021 came I started talking about remission and I started seeing remission and my patients that was you know fabulous opportunity to stay on in the practice.

[00:33:07] I'm still there I've I've I've I'm down to about a half a day awake and I'm just doing injections on a Monday morning because the the person that bought my practice in late 2023 ultimately she didn't want to buy all of my patients or take over the care of all of my patients because he was a glaucoma specialist.

[00:33:25] So she let me with these this cohort of patients which I'm still treating and I'm still trying to hand them over but it's the longer it's gone the more exciting it's been because I've seen this incredible impact of of what we're doing so.

[00:33:38] So patients pulling their type to die a bit ladies in the so information started doing crazy interval between injections for those patients who are not only putting their diabetes into remission but just improving.

[00:33:53] They're metabolic health okay perhaps not going into remission in the true sense of the definition but and and maybe not even engaging with a nutritionists that I recommend it just coming back on their refined car ventake coming back on their sugar intake losing weight coming off their insulin or reducing their insulin dose.

[00:34:11] And you know and what I'm noticing almost universally is that I've been able to increase the interval between injections.

[00:34:21] In some and particularly for those ones sort of put their disease and remission I've been able to get them off their injections so what I did I think it would have been in 2022 then.

[00:34:32] I had some patients that came to see me with macular redeem or due to their diabetes due to their type to diabetes.

[00:34:40] I thought okay.

[00:34:43] This macular redeem is borderline I could put them on the bed and inject their eye or let's try.

[00:34:48] And I just changed their diet and see with that this will have an impact and I still remember this young woman she was 36 had type to diabetes for quite some years I think maybe eight years.

[00:35:00] Center of the nutritionist she came off for inch and two weeks.

[00:35:05] And she put her diabetes into remission pretty quickly and over the next nine months.

[00:35:12] Her macular redeem normalize on diet line and there was no other change.

[00:35:19] And we've just actually published that case study and so that's out there in the literature it's the first time it's ever been reported.

[00:35:27] Now we have something like 15 patients who I've put their.

[00:35:33] diabetic macular redeemate information they've diabetic macular redeem has resolved and that case series we presented at the world of themology, Congress in Vancouver last month.

[00:35:44] And that was super exciting we we also reported to case reports and what I've also noted is that.

[00:35:58] I have now 25 patients.

[00:36:02] More than 25 patients actually but we're going to be reporting that case series of patients who've been able to extend the interval between their injections and some cases even stop their injections despite the fact that they're not for their type to diabetes and remission so this is all super exciting really novel work that's coming out.

[00:36:21] I've never been reported before and.

[00:36:25] What we're hoping to do now because they obviously people love to see these randomized double blind controlled trials.

[00:36:32] In fact, I'm meeting the academic head of the part of our famology in our major eye teaching center in this city the South to noon as well but it really busy day ahead.

[00:36:41] And I'm going to talk to them about doing a randomized control trump with some patients.

[00:36:47] I continue on their injections and others with us with the diet that they're currently receiving the standard what we call the sad diet the standard American diet the standard Australian diet which is a diet.

[00:36:58] Pack with ultra processed food and surgery drinks versus patients who who reduce their carb intake and we'll do this.

[00:37:08] With the oversight of a nutritionist and we will see the difference and I've no doubt within it within a year or have a remarkable series of.

[00:37:18] Of results to share with everyone and hopefully.

[00:37:22] I know there was a lot of interest in this at the world of famology congress in in Vancouver last month.

[00:37:28] A lot of people were really super interested and excited about this so hopefully we'll start to see this across the globe.

[00:37:34] We'll see this tsunami of patients not just putting their type to diabetes and remission but also turning their diabetic eye disease around and that's hope that.

[00:37:44] And then the other one is that they're going to be a part of the fact that we can go back to the geoconologist side of them let's you know this through this with our patients this is an extraordinary opportunity.

[00:37:57] Right, so are you job okay so I'm I'm I'm a curious person so I kind of want to know like what's up.

[00:38:04] What have you found so far and you're probably like the inverse relationship between macular demer or injections and not a one see you know information.

[00:38:14] Or insulin insulin levels.

[00:38:17] I mean you're probably you know eventually you'll probably come up with some sort of protocol or recommendations say hey this kind of insulin reduction got us this type of anti veg f protocol or interval right we lengthen the interval and the interval lengthening is related to insulin levels.

[00:38:38] So you have all these labs that you're going to do and.

[00:38:42] Yeah, you're going to be part of the study's going forward.

[00:38:46] At the moment, tend to do the labs in my eye practice I often hear about them the patients who say my HV-81 see is now back to normal and you know so it's quite exciting to get that feedback from the patients they come back they talk about their loss of way.

[00:38:58] They talk about their their bloodshed coming down they talk about their HPA one see they're trying to improve all that sort of stuff but that tends to be.

[00:39:08] The GP combined with the nutritious to do that but there's a lot to do that that's it's an important part of it and.

[00:39:15] Blood pressure's down weights off hey I haven't haven't had numbers under 200 in years what are you doing doc this is great thank you so much.

[00:39:26] Yeah, I can imagine it's very rewarding isn't that it's for you're given the vision.

[00:39:31] Yeah, but I think for people who are type two diabetes I think it's more meaningful versus if you may be never were able to see you know what you're missing.

[00:39:41] Right as a type two diabetic that's got now you got cataract you can't see as well and I got these dark spots I can't and now I gotta go in frequently.

[00:39:51] And no one's telling them that this is so avoidable.

[00:39:55] Oh, no, no, no, no, no, no, this is a problem and this is why you're trying to get it into medical schools now we're.

[00:40:01] We're doing CPD what we call continuous professional development for for GP's just to get the word out there because most GP's don't know and actually.

[00:40:11] What I found with the number of the GP's have engaged in the process that small number of the engagement they're just blown away they weren't aware what's going on this is extraordinary you know.

[00:40:21] I always thought it's not sustainable though like you can't oh wait a minute yeah you had this patient for how long.

[00:40:29] It's dangerous they're all going to die and I had as I said I had some nasty others from indeconologists I had one in a chronologist who just in their disowned their patient.

[00:40:40] I had another in the chronologist who wrote to me really nasty that they're saying he tried this back in the in the 70s and I all the patients died and and actually do you realize back in the 70s most men most people with tattooed diabetes were smokers as well so you know you can't you can't.

[00:40:56] And then the pillar way the therapeutic carbohydrate reduction is being the young as being the the culprit in there in the demise and and we know now that it's safe and the end of chronologist get a bit worried because.

[00:41:10] It's it entails a change in medications often a dramatic change in medications particularly in children as I mentioned that lady came off from it.

[00:41:19] You know so they can go high pro glycemic and I had one patient who did it by himself actually unfortunately I'm hyper glycemic so I always suggest.

[00:41:29] Was that in conjunction with their GP Gary.

[00:41:32] But the end of the chronologist and the chronologist starting come on board so back in in 2022 I got Gary Fek here to add late and I wanted to because I was getting this bite back from the end of chronologists saying oh it's dangerous and are you know you can kill the patients.

[00:41:50] And that was not my understanding and and there were a bunch of low carb practitioners including GP nutritionist dietitians in the city so I thought well let's get.

[00:42:00] Get everyone together and let's have a round table meeting to discuss their concerns and see if we can move forward with this and it was quite an adversarial meeting it was actually more than around table was actually a whole room full of.

[00:42:14] Our practitioners.

[00:42:17] I think Gary has been forever scarred from that meeting.

[00:42:21] Hey.

[00:42:22] What is survive?

[00:42:24] Yes, and as a result of that.

[00:42:28] I actually at the end was was okay.

[00:42:31] Clearly can happen because we actually have patients who are putting their disease and remission.

[00:42:35] Okay there's a safety issue because the patients need to be deeper described, deminicated.

[00:42:39] Let's get together and and look at writing some guidelines for this.

[00:42:46] So so the following year, so this is late 2022 2023 one of the low carb GP's and one of the endocrinologists who is a bit skeptical.

[00:42:56] Interestingly that in the chronologists I saw in chatting at the end of the meeting with one of the nutritionists started.

[00:43:03] So sitting his patients to that nutritionist and actually she started putting their targeted diabetes and remission.

[00:43:11] So he then went from being a sked to go with the being a believer and actually I know he was presenting at the Australian diabetes Congress again last month about remission of type two diabetes.

[00:43:22] He was the former president of the Australian diabetes society.

[00:43:26] So they they those two got together and over the over the year took them a year unfortunately but in early 2024 early this year.

[00:43:35] The guidelines for therapeutic carbohydrate reduction for patients with type two diabetes how to deminicated how to be prescribed patients was released.

[00:43:43] And on the back of that that was endorsed by the Australian diabetes society it was endorsed by diabetes Australia and we're just seeing this massive shift and it's super exciting so Gary.

[00:43:52] Gary is a real hero and all of this and Gary and I.

[00:43:57] But a bit of a battering and they're meeting and I was really very stressful and thank the whole things been funny stressful but I think we're now over that and we're now meeting for medical schools trying to get this in the curricula.

[00:44:09] There's also another group called the feet diabetes which is Peter Brookners.

[00:44:14] Peter Peter's one of the luminaries in this area as well and so we're.

[00:44:19] He conjunction with.

[00:44:23] Peter Brookners group don't defeat diabetes and what we call we have an Australian offshoot of the American American.

[00:44:30] American.

[00:44:30] Medabolic Health Society called the Australasian Medabolic Health Society so we have a group here which is in its infancy really bedtime we have.

[00:44:39] And then we have a pair that was Peter Brookners to feed diabetes.

[00:44:43] We're going to be talking to GPs just on Sunday the first set timber we launched a 10 module course on Medabolic Health called Essentials Medabolic Health for dietitians.

[00:44:57] So this is a group that traditionally has been very anti-low calm so they're now taking on board nutrition nutritionists are taking on board so we're seeing this massive.

[00:45:08] It's hard.

[00:45:09] A 10 of the time so it's not it's funded by Pepsi.

[00:45:17] Sanitarium Kellogg's like how did you do that?

[00:45:21] Well I met with the president of dietitians Australia in early 2023 and I said.

[00:45:27] I told them about this.

[00:45:32] She said to me okay we're in the guidelines really come back to me and we can look at it.

[00:45:39] So when 2020, 2024, can we hear later I met again with the team from dietitians Australia and I said okay well quite simply it's now an international diabetes strategy cannot ignore it in longer.

[00:45:50] We've written guidelines for therapy to have a high degree of the law.

[00:45:56] It's not only that it's endorsed by diabetes Australia, it's endorsed by the Australian Diabetes Society.

[00:46:02] We have an Australian metabolic health society who must you know who taking this forward.

[00:46:07] You got to get on board and we're going to get left behind and when you realize in this country there are probably close to 8000 dietitians.

[00:46:14] They're the one group that can be instrumental in this process.

[00:46:18] They've got a lot of killing people who have taught to diabetes at high carb diet.

[00:46:25] Yes, they've had massive sponsorship from the serial and grain and the brick for serial industry in the past but they say they've shaken that off and hopefully they're embracing this new paradigm shift.

[00:46:37] You guys are educating the professionals and that's that I don't see that happening here.

[00:46:45] I think what you guys have stepped on a whole bunch of toes you've got ruffled a whole lot of feathers to get where you've gotten and I'm surprised you didn't get a whole lot of pushback like.

[00:46:56] I expected someone to come in and say you're going to lose your sponsorship right if you're going to go with this policy change.

[00:47:03] I think they put some their next on the line and kudos for them for being courageous as well.

[00:47:08] Yeah, that's right. I mean it's there are a bunch of public health bodies in this country.

[00:47:16] The heart foundation of Australia who is still sponsored by sanitarium, ultra-cocessed company and I've written to all of them or most of them at least saying, okay you've got to shake this sponsorship and I know running a not for profit.

[00:47:29] For 15 years we had an experience with a pharmaceutical company that we're being found sorry not a pharmaceutical company, an optical company there was sponsoring it's that got into a lot of strife and we had to drop their sponsorship and I was a lot of money and I really heard us.

[00:47:46] I thought about it was the right thing to do and so I think what we've got to do is drop this sponsorship of the ultra-processed food industry, the food industry in general of the sugary drinks industry, of the fast food industry all the ones that are causing us harm.

[00:48:04] And of course, you know many the medical scores are funded by the pharmaceutical industry many doctors are many of the academics many of the teachers many of the research in the truth many of the recent research.

[00:48:15] Right all of it.

[00:48:18] It's a mess.

[00:48:19] Yeah I think we have to and I've been diving is this right now since the CEO in a meeting year or two ago saying you've got a shake you can't continue to be funded by the pharmaceutical industry.

[00:48:29] Just happy to be in seriously massive conflict of interest.

[00:48:33] So what she took that on board and what they've been doing is looking at philanthropy for funding of their work so that's you know this time much this so much to talk about here come.

[00:48:44] You guys are moving things.

[00:48:47] Yeah the world is shaking over here in Australia things are changing over here I think it's great and so freaking excited for you guys.

[00:48:55] It's very inspiring and there's one kind of piece of the puzzle which I haven't quite solved yet.

[00:49:01] You know we know that about 50% plus of patients who have attempted will put their type two diabetes through the remission which big is a question.

[00:49:10] What about that other 50% miles half not being able to do it well one their pancreas maybe so sure that they just can't simply reverse their type two diabetes but what we're seeing and Rod Talis work out the UK.

[00:49:22] What we thought of as irreversible pancreatic damage might be just an entropy and actually can read night the the pancreas and the function of the pancreas but I suspect there'd be an element of patients who can't I suspect there's a small element.

[00:49:37] Then you've got why what are the reasons why someone might not be able to reverse their type two maybe they're not doing correctly maybe they need better guidance from.

[00:49:46] The healthcare professional stress leave there's so many variables that goes in there glucose.

[00:49:53] Look at very well but I think just sorry to interrupt the one thing we know the type two diabetes is strongly associated with food addiction.

[00:50:04] Yeah, it's very hard for people.

[00:50:06] So, we have a lot of vulnerable people we know that type two diabetes more prevalent in lower socio economic groups our Aboriginal first nations people are very.

[00:50:16] Very disinvantaged people like your your first nations people as well so you have food addiction.

[00:50:25] But you also have an industry or industries being the ultra processed food industry drinks industry praying on people's addictions with their addictive food.

[00:50:37] I don't know people with tattooed diabetes with a dick if you're you walk into the chemise these days and the the checkout counter is somewhere by half price chocolates and soft drinks the chemise.

[00:50:49] I think office works, office supply stores post offices little in the school markets and the general stores it's just a lot of bit invited will be cigarettes because it's the same scientists.

[00:51:03] Hi Jack in the food to make it so addictive you can't I mean I don't know like if you had some of these foods you would you would taste and go wow what an experience like what am I tasting this is insane like.

[00:51:20] Like every part of your tongue gets lit up at the right time so that you it leaves you wanting more but that's that's the tobacco industry those those are some wicked people that they know what they're doing.

[00:51:31] Absolutely fair when they when the tobacco industry collapse the food industry brought up many of the scientists and and.

[00:51:40] Hello yeah you know yeah we have we engineer these foods to be to be addictive and alluring and hyperpellable and ultimately this what encourages over consumption and I know in the US it's something like 62% of the calories in the US dollar office food and kids it's two thirds.

[00:51:59] In Australia when the UK it's now over 50% in Australia I think we're nudging close to 50% of our diet is all versus food and the awful.

[00:52:08] We children is is the problem though like when children at a very young age have a liver like an alcoholic have fatty liver disease and you know I talked to a abdominal radiologist not that long ago and he said one of his colleagues seen a six year old but I think he seemed like a 10 year old with fatty liver disease non alcoholic fatty liver disease like how how could this be.

[00:52:28] But you know I think.

[00:52:31] Robert Lestig a long time ago was like wait a minute why are these kids as tall as they are around.

[00:52:39] Because you have on the wick are our welfare program for women infinite children to make sure that they have proper nutrition it's sunny delight it's orange juice.

[00:52:50] You're saying this is healthy how can we get it out of people's heads that juice is horrible it's soda pop right.

[00:52:59] How how do we fix this problem when it comes down to public policy we can't I would love to see how your public policy is going to start changing for is like what are you're what are people going to be what's going to be available to them because here in the US it's just.

[00:53:15] You can get anything. Yeah yeah yeah it's not hot that's the only definition.

[00:53:21] Yeah we have a what's called a health star rating system which is a flawed system one because it's.

[00:53:28] Only a third of manufacturers use it because it's a voluntary process but also there are a number of ultra-process foods which get the healthiest five star rating and yet they're packed with sugar or fine caps and the sea doors.

[00:53:39] And this is you realize this is in the industry device designed by industry foreign industry.

[00:53:45] So our health star rating system is deeply flawed having said that a couple of years ago I think within early 2022 orange juice was downrated from five stars down to two stars.

[00:53:54] And so you've a lot of app raw and particularly from the industry and I had an interview on radio and I was being interviewed together with the CEO of one of the orange juice companies who is it was not aggressive he said oh my goodness you know this is going to devastate our business what are we what do.

[00:54:14] And you know rightly so I mean a glass of orange juice has as much sugar as a glass of cola and that's just a start.

[00:54:23] And so industry as we know will pivot and we know Coca-Cola is now having no sugar coke and it's now being involved more in the in in bottled water and so farmers will pivot industry will pivot but it has to.

[00:54:39] I grind it has to happen slowly it can't happen overnight because it would leave food insecurity for a lot of people it will devastate businesses that would devastate the economy this has to happen slowly.

[00:54:49] But we have it in a South Australia the Riverland area is a major orange growing area for our country the leading orange growing area for our country having said that our major export is wheat.

[00:55:03] You know the source of highly refined wheat flour which is metabolic disruptor it's.

[00:55:10] Yeah so you know we can't devastate these these industries so we got it's happened slowly give these industries these farmers time to pivot and it's going to happen we know this cigarette.

[00:55:24] Epidemic and the you may give disease related cigarettes they can decades to to reduce and I think this is going to take longer because isn't actually a much more complicated that was just one thing that was to go at essentially.

[00:55:36] No you can say there's cigars and pyrids and things but it's basically all the same thing it's nicotine and tobacco.

[00:55:42] But here you have a much bigger beast and so it's going to be a much bigger process to turn around but I think we need a brave government to take it on board to.

[00:55:54] And then we started to do that and unfortunately I think because of my kind of pestering of the health minister we had a parametry inquiry into diabetes late last year and there's been a number of suggestions as a result of that inquiry one that we are such low carb diets for patients with.

[00:56:12] And so, in fact we've talked to them all with all types of diabetes and another one was we should have rather than a blanket dietary guidelines we have dietary guidelines specifically for people with type to diabetes so again we're seeing this shift and but I think the the government has to stop.

[00:56:27] This predatory behavior of these of the ultra-processed future be drinks and fast food industry you know if I walk around my city everywhere bus stops buildings it's just plastered with predatory marketing of these very serious.

[00:56:43] Yeah, I agree with you. I think it would be a global collapse if we just everyone just changed overnight and has to go slowly.

[00:56:51] I mean really if you think about it over time the orange orchards needs to be changed into grassland but your wheat needs to be changed to grassland it's going to take some time but it's going to take.

[00:57:04] It's going to take a lot more people opening their mouth and going man look what happened to me because they're going to they should be telling 100 people like what a great experience this was I can see now I don't have diabetes I lost all the spake I mean it's gone is the steam roll in effect right it's like oh yeah I tried to act as well did you think about trying it again because maybe you didn't do it right right maybe there's a better way of doing this and and you haven't given it a fair shake.

[00:57:30] So now I think what you're doing in an.

[00:57:35] An Australia is phenomenal I think you are really shaking things up and could us to you guys keep it up that is amazing we need to you're leading the example here because people here when you are a diabetic and you're in the hospital.

[00:57:49] We are going to manage your diabetes but insulin I don't care what it takes I don't care if you know you've got to eat this entire tray with you know 100 grams of carbohydrates on it, but this is what you're going to get.

[00:58:01] Right this is this is this is what it's come down to for you and I love taking pictures of those trays like this is crazy I can't believe you're how much is how many grams of this this constant carbs they call it consistent carbs usually it was 70 grams of carbs three times a day at least because we're stuck on this stupid concept.

[00:58:19] That the brain needs dietary glucose and it's like now we'll make glucose from other substrate.

[00:58:29] Done be done it's not necessary to eat carbohydrates all the time we wouldn't we wouldn't be here so I think more of this discussion.

[00:58:41] I want to talk about this come join let's let's discuss this in a fair debate let's bring evidence let's talk about what we have but we also have these end of one.

[00:59:00] I'm an Anna one you're an Anna one you've you've changed your life around you've lost a bunch of weight and got healthier that's phenomenal.

[00:59:09] Yeah yeah no it isn't.

[00:59:11] Yeah it's so exciting but I appreciate you you know what maybe I'll have to do this another time when you tell us your personal story I know about your toffee story though.

[00:59:22] I do love it it's always something amazing yeah well he's and I was in hospital a couple of weeks ago I had an England on her new repair and I my breakfast.

[00:59:32] I was you know there's a heart healthy ticket against all the calves and the bacon legs or that's dangerous set dangerous.

[00:59:42] It's quite extraordinary but this is all based on our straight-in dietary guidelines which is kind of based on the US after guidelines which are high carb eating pet and they recommend up to 65% of our energy comes from from calves and this is this is a document that you use broadly it's used by cups.

[01:00:02] childcare through aged care prisons hospital defense forces by army of health at medicine health policy makers and health providers and it's just.

[01:00:12] Diabolical what's currently being reviewed and it's not going to release to 2026 but hopefully we'll see a shift away from this.

[01:00:20] I think it's a demonization of red meat demonization of saturated fat.

[01:00:24] Celebration of I've seen or as a margin of reins it's got to see this shift we have to otherwise we're going to be in big trouble and on on on my own health journey.

[01:00:35] Back in 2020 I actually had a.

[01:00:39] I was an ultrasound now was maybe an MRI scan for my I have some lower back pain and the week before I think I had a patient heard some low back pain had a scan actually had cancer in their lower back.

[01:00:50] So I just got more bush I think it's musculoskeletal but let's do and I found out I had a fatty liver and you know if you if you can see me I'm quite tall and thin and I was tall and thin and back thin but I still had a fatty liver and I realized what I was consuming was was dying.

[01:01:05] I thought it was driving me driving into resistance and probably driving me towards type 2 diabetes but quite literally within a couple of months drop down.

[01:01:15] See dollars are 10 that around and recent scan shows no fatty liver so this is I'm now talked about.

[01:01:23] Diabetic metlerodema reversing but what we're seeing in virtually all the complications unfortunately if you have advanced retinal disease we're not going to see a reverse or we might see criminal stabilization but we're not seeing reverse.

[01:01:35] So equally with other things like gangrene and and and also.

[01:01:42] But we are noticing almost universally is this improvement in all of the potential complications of this disease.

[01:01:50] Yeah that's fantastic. I love what you're doing keep it up that's fantastic thank you so much for being on our podcast so people want to get a hold of you.

[01:01:59] How do we get a hold of you?

[01:02:02] I'm on Facebook Instagram and LinkedIn. I haven't got a and an XOR Twitter account. I do but I don't use it.

[01:02:11] I have enough enough enough attacks on those platforms without doing this to Twitter.

[01:02:18] And then if people are interested in the work we're doing with my nonprofit site for all.

[01:02:23] So the site for it's like GHD FOML L dot org and you can sign up to our newsletter or also follow us on socials as well.

[01:02:32] Right so there is so much to diabetic retinopathy if you're diabetic free diabetic and you want to know how bad this can get.

[01:02:42] It's blindness. There's nothing worse than blindness not being able to see the world around you and it's all a preventable is just by what you're putting in your mouth.

[01:02:52] You have to just learn to say no and be bold and courageous and take a step forward and go, you know what I'm not going to be like everybody else today.

[01:03:00] Today's a different day. I'm going to do things a little bit differently and I'm going to stay out of Dr. Mewki's office and all right.

[01:03:06] I'm going to stay away from my doctor. Yeah, okay well thank you so much. I appreciate it and can I never have a good one.

[01:03:17] Thank you.