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The Health Evolution Collective Podcast

Aug 14, 2020


Dr James Muecke AM graduated with Honors from the University of Adelaide Medical School in 1987. Following his internship, James lived and worked as a doctor in Africa and subsequently as an eye surgeon in the Middle East, battling malaria, wild animals, and rebel soldiers. He founded Sight For All in 2008, turning his boundless energy into a fight against blindness in the Aboriginal and mainstream communities of Australia and some of the poorest countries of Asia and Africa. Sight For All’s comprehensive and sustainable projects are now impacting on the lives of over one million people each year.

 His commitment to social impact and humanitarian endeavors has earnt him a number of awards including an Order of Australia in 2012, the Australian Medical Association’s President’s Leadership Award in 2013, and Ernst & Young’s Social Entrepreneur for Australia in 2015. James is Australian of the Year for 2020.

James is a researcher, a teacher, an author, a musician, a photographer, and a film producer, and uses his many skills to deliver passionate, fascinating, and at times confronting presentations about his life, his work, philanthropy, resilience and social entrepreneurship. A neurological condition impacting on his dexterity has forced James into a premature retirement from surgery. Not letting his disability slow him down, James has redirected his vigor to crafting films, and has a number of powerful documentaries under his belt and several compelling projects in production.


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Dr James Muecke (00:00:00):

Very high level review study that showed that natural saturated fats in our diet have never been shown to cause cardiovascular disease. So it's really important for people to know that it needs to be shouted from the rooftops.

Tracey McBeath (00:00:28):

What an absolute pleasure it is today to be talking to Dr James Mucke Australian of the year. Thank you so much for being here.

Dr James Muecke (00:00:35):

Thank you, Tracey. And thanks for including me in your show.

Tracey McBeath (00:00:39):

Well, very, very honored and very excited to get to talk to you. The first question I have for you is what was it actually like to be named Australian of the year?

Dr James Muecke (00:00:50):

Well, it was obviously fabulous experience. The weekend was just amazing. And to be honest, I wasn't expecting to be named Australian of the year. I was actually surprised to be South Australia of the year and Australian of the year, but going forward towards the, Australia day weekend, I really didn't expect if they were going to award it to yet another doctor from Adelaide. So when my name was read out, it was a surprise, but a lovely surprise. And, it's a great honor. And particularly, you know, I have to acknowledge a sight for all, which is the organization that I co founded back in 2008, which is really why I received the award, the work that Sight For All is doing fighting blindness, through many of the poor communities of the world, even here in Australia and particularly in Aboriginal communities. So it's a great recognition for the organization, which I feel very passionate about.

Tracey McBeath (00:01:43):

Fantastic. Can you talk a little bit about what that work is? I was going to ask you about Sight For All, why you started it, and what some of the work that you've done through that organization.

Dr James Muecke (00:01:55):

Sure. So really as a doctor, I've been interested in public health, particularly in poor communities, really ever since I graduated. In fact, I worked in Africa as a general doctor following my internship. I had a passion for surgery in particular microsurgery, so the thought and I loved using my hands. So the thought of using microsurgery to fight blindness in poor communities was something that really appealed to me. So, following Africa, I came back to Adelaide and trained as an ophthalmologist and, you know, really what's happened since that time is just number of experiences that I've had and just continue to fuel this passion of fighting blindness in poor communities. And, and, when I eventually came back to settle in Adelaide, that was in 1998. I started getting involved in a number of research and teaching projects in Asia and Asia is home to half the world's blind adults in two thirds of the world's blind children.

Dr James Muecke (00:02:53):

And it was a these experiences and several key experiences really, instilled in me a humanitarian spirit and a passion to want to make change in my profession, what I was doing in some of these countries in Asia, and one of the ones that I recall vividly, and there were a number of experiences, but perhaps just one was the most powerful for me was in 2007. And I was involved in a study in Myanmar and Southeast Asia. I was part of a team from Adelaide from the world's Adelaide hospital. And we were undertaking a study to determine the causes of blindness amongst children in this country, which was at the time was certainly one of the poorest countries of the world. And the results were, were absolutely staggering. We found that nearly half of the kids have blindness that could have been prevented or treated. But the thing that really had such a deep and profound impact on myself and the team was the leading cause of blindness

Dr James Muecke (00:03:51):

We found that was measles, and to be surrounded by children who were blind and horribly disfigured from measles in schools for the blind across the country. And in fact, we also found this in our studies in Cambodia and Laos to have this experience when measles blindness is completely avoidable is just devastating. It was one of the most powerful experiences of my clinical life. And it made me realize as an eye specialist that there's so much more to blindness than simply cataracts. And it also really drove home the power of prevention in medicine. So this was a really pivotal moment for me. And, that was in 2007 a year later, I was involved in setting up a Sight for All. And on the strength of that study, we were able to bring up an eye specialist from a young eye specialist, from Myanmar to train as a children's eye specialist here, the women's and children's hospital in Adelaide.

Dr James Muecke (00:04:51):

So he went back to his home country in 2010 as the very first pediatric ophthalmologist. We set him up in the countries first children's eye units, where he works to this day, and he's now providing close to 30,000 treatments every single year, which is impressive in itself. But what I find particularly inspiring the work of this young man is doing is that he in 2015 started training his own colleagues. And he's training a second pediatric opthalmologist for his country, and he now trains at least two every single year. So it really shows you the scalability and sustainability of the work we do. And, and, and that's just one example of many examples. We've trained pediatric ophthalmologists, across Asia now from nine countries. And that's just one sub-specialty area of the profession. We've been training across all nine sub-specialty areas. And we're now impacting on about a million people every single year.

Tracey McBeath (00:05:44):

How amazing and completely life changing. One thing that stood out there with when you were talking was you mentioned prevention. And I know personally, a lot of doctors who just get confronted with the end result every day. And, you know, I know a few that have changed to move more into the prevention role of things. So it must be heartbreaking when you see things coming up that are preventable. I mean, the fact that measles they're getting that from measles, I find that mind blowing, but I'm also not that this was going to be the topic at all about discussion, but, I'm also very concerned about, you know, the Western world living in this thing now of growing resistance towards immunizations, when you've seen firsthand, what it's like in those places where these children don't get access to this stuff. And what does that do to you to experience that I must just profoundly change you.

Dr James Muecke (00:06:37):

It does. And in fact, this was the driving force behind me setting up Sight For All, and just the continued experiences such as that one, which just drives and fuels that passion ongoing. And I would challenge any anti-vaxxer to go and sit in the school for the blind in an impoverished country and not be swayed by the benefits of vaccination and the herd immunity that, even in those studies I mentioned, so that was a 2007 Myanmar Cambodia, 2008, even as late as 2013 and Laos, we were also finding children who are visually impaired, even blind because they've never been tested for spectacles quite simply because there was no one there to provide a basic service that we take for granted here in Australia. So again, really powerful stuff. And this has driven an optometry training program that we've been implementing in each of those countries that I would.. Let me wind the clock back to my internship with the 1988.

Dr James Muecke (00:07:32):

And I became disillusioned with medicine. At that point in time, I was mainly just seeing and treating patients who had chronic diseases that were predominantly self-inflicted diseases, such as nutrition related diseases, such as type two diabetes, and of course, smoking related diseases, which were very prominent back then. And I was frustrated by the fact that I was just simply, um, alleviating symptoms, prolonging life, but actually not able to impart a cure. And, and I'm, you know, my nature is one I love to have a project and I love to be able to complete that project for that, with a positive outcome. And so I just wasn't getting the satisfaction and that's why I wanted to go and spend time in Africa, which as a general doctor, I mentioned before I worked as a young voluntary doctor in a little rural hospital in central Kenya.

Dr James Muecke (00:08:26):

And that was really, again, a pivotal moment for me in my life, because now for the first time I was treating patients who had diseases that were not self-inflicted, there are many infectious diseases such as malaria. And so I love the fact that I could now cure people. And that was really something very powerful for me. And I mentioned before that I had this passion for microsurgery, and that's why I had this idea that that eye surgery was something quite special that I could actually cure blindness. And because the leading cause of blindness in the world is cataracts and it forms the vast majority of blindness in the world in developing countries. It's half of world blindness, but in developing countries, the vast majority of blindness. So being able to cure blindness with a surgery, which is very sophisticated and yet incredibly positive results that's was so appealing to me. So I went from a prevention model to being able to cure,patients. That was a real driving factor for me. And it wasn't until several years later when I had these experiences in Asia and seeing young children who are blind through completely avoidable diseases, such as measles or a lack of spectacles that I didn't return to this idea, that prevention is so critical in our lives. And certainly we see many examples of that here in Australia as well.

Tracey McBeath (00:09:56):

Can I just ask you what actually is the cause of cataracts? Is there, I mean, is it preventable at all or is that just something that happens? Sorry. Excuse my ignorance.

Dr James Muecke (00:10:08):

So there are many, many causes of cataracts, but the vast majority of causes is what we call senile cataracts. So wherever if I live long enough, everyone will develop cataracts. So there are a number of other causes, for example chronic prednisone or steroid use can cause cataracts, chronic inflammation in the eyes, et cetera. But really the majority has just simply seen our cataract or due to aging. Diabetes also increases, cataract formation as well. So what was interesting actually, I go back to 2005 and again, another study in Myanmar was at this time it was an adult study in a regional area of the country. And, I was in my early forties and we were, examining people from the age of 40 up. And I was seeing people who were younger than me at the age of 40, who are severely, visually impaired or blind from cataract.

Dr James Muecke (00:11:04):

This was something that I absolutely did not see here in Australia. So this was another really powerful moment of my life to see young people who are blind from cataracts. Why was this happening? I have a number of theories as to why we were seeing cataract developing so early in younger people. One of these was simply chronic, dehydration. This was a regional area. It was a very hot and dry area. People were subsistence farmers that were really working hard in the fields and probably not replenishing their fluids. And I suspected dehydration may actually play a role in formation of cataracts in these populations. So, that was a really, really powerful moment. There were a small number of, people who had actually had cataract surgery, but many of them remained blind because the cataract surgery was a poor quality.

Dr James Muecke (00:11:52):

And so this was powerful moment that allowed myself and my colleagues at the Royal Adelaide hospital, in the department of ophthalmology to set up a program, which was in funded by Ozaid in Australia to really increase the quality of the equipment so that they could undertake cataract surgery at a high level. And in turn this allowed them to reach more people with the surgery that they were providing. And we've seen really since that time, that project finished in about 2013,I think, we've seen a massive increase in the number of cataract surgeries performed every year in those regional eye centers in Myanmar. That was just one of the elements of the work that we were doing at the time.

Tracey McBeath (00:12:39):

Fantastic. So can I ask you now about, you touched on type two diabetes as being one of the potential causes of cataracts, but you've been vocal this year around the debilitating consequences of type two diabetes. So why is that

Dr James Muecke (00:12:57):

The consequences of type two diabetes? If we look at Australia? Well, if let's say let's look at the world as a whole, in the last 40 years, we've seen a four fold explosion in type two diabetes worldwide, and this has actually been even more profound in some communities and countries. In China, for example, there's been a more than 10 fold increase in type two diabetes in that time period in Aboriginal communities here in Australia about an 80 fold increase in type two diabetes . And we're now seeing type two diabetes in kids in Australia in kids as young as seven. And there's even a famous case of a three year old child with type two diabetes in the States. So now this is something that is quite extraordinary back in the sixties type two diabetes was virtually unheard of.

Dr James Muecke (00:13:45):

Now seeing around about 250 cases of type two diabetes every single day in Australia. So there's about 1.7 million Australians with type two diabetes, and there's about 2 million with prediabetes. So, this is really diabetes waiting to happen. And there are some areas of Australia, some poor social economic areas, particularly such as Greater Western Sydney where half of the adults have type 2 diabetes or prediabetes for the first time in history a nutritional diseases and a preventable disease. So this is quite extraordinary. And I think it's driven by a modern diet, which is high in sugar, refined carbohydrates, which to me are sugar in disguise. And also highly processed foods is driving this.

Tracey McBeath (00:14:34):

I've talked to Belinda Fettke before - Dr Gary Fettke's wife, she's been such a campaigner for people understanding all this stuff. And she was saying to me that Gary used to do amputations very rarely early on in his career, and it got to the point where he was doing two or three a week. I think the consequences people don't really understand. It's kind of, I can just take some medication or, and I'll be, I'll be right. I don't really think people do understand it because it is a slow and progressive disease. So can you just talk, talk to us and help educate people a little bit on that?

Dr James Muecke (00:15:13):

Sure. it's a slow disease. And as you say, it's progressive or it can be progressive, but equally it's also reversible. It's preventable and it's also reversible. So it doesn't have to be a slow chronic progressive disease, which ultimately ends in severe disability and death because it is certainly in the early stages, potentially reversible disease. How myself as an ophthalmologist, as an eye specialist became interested in and involved in it. Well, like Gary Fettke an orthopedic surgeon removing people's feet to the gangrene from their type two diabetes. I was seeing people who are losing vision, even going blind due to this insidious disease. So 90% of all diabetes is type two diabetes or the blinding complications we see in people with all types of diabetes. And I was seeing every year more and more patients who are losing vision. And I was noticing that the treatments that I was needing to give to patients was also rising.

Dr James Muecke (00:16:15):

And in fact, one of the treatments that I give is an injection into the eye of an antibody, which helps seal up blood vessels at the central vision area, which are leaking fluid into the central visionary causing blurring and distortion of vision. And just recently I received the stamps for Medicare. The chart shows a progressive increase in the number of injections given Australia wide. And last year, by the end of last year, there were over 90,000 injections given, to try and curb vision loss from diabetes. I suspect this year it's going to be up over a hundred thousand. This is a hundred thousand injections every single year in Australia for a disease, which in itself is preventable. So it makes me upset. It makes me angry, but I think one of the turning points for me was in 2018 when I met a man whose story had an impact on me. He had neglected his type two diabetes.

Dr James Muecke (00:17:14):

He went to bed one evening at the age of 50 and woke up the next morning, blind in both eyes. And he remains blind to this day. The poor man has also now had nine amputations, the gangrene of his left lower leg due to his diabetes, he's also had a heart attack. So there are a myriad of complications, life changing and life threatening complications due to type two diabetes. Blindness is the most feared. Second is amputation from gangrene, but it also causes impotence. It causes numbness, tingling, pain in the hands and feet. It causes kidney failure and people who have kidney failure needs to have blood filtered by dialysis sometimes as much as seven hours a day, four days a week. And I've also calculated that in Australia via something like 60,000 hours spent by patients with type two diabetes, having their blood filtered by dialysis 60,000 hours, this is not a great way to lead your life it's hours which are lost to family and friends to your work and to the things that you love to do.

Dr James Muecke (00:18:20):

So, devastating statistics, but it also causes life threatening diseases such as heart attack and stroke. I mentioned before. So the top three causes of death in our society, heart attack, dementia and stroke, and all three of these diabetes is central to the process. And I suspect if we actually looked at the more closely, type two diabetes would be the leading cause of death and disability in our society these days. Also phenomenally expensive costing our health system, probably the order of $20 million every single year in terms of treatment of diabetes and its complications and lost productivity in the workforce. So it's a, it's a high impact disease.

Tracey McBeath (00:19:04):

Yeah, it sure is. And as you say, it's preventable and reversible, if you change your lifestyle early on . I've seen that as well. And I study at the nutrition network with professor Tim Noakes. He's a fine example of someone who was diagnosed with type two diabetes and is put it into remission through lifestyle. So why is the conversation? I mean, you're trying to change the conversation. I know, but so many in the medical profession are not interested in the fact that this is preventable. It's about medication. It's about managing the symptoms as opposed to going and really looking at reversing the disease. So what are we up against here? Because it's just, I hear it virtually every day. I hear stories of people that I know who go to the doctor and say, I'm changing my lifestyle.

Tracey McBeath (00:20:01):

I'm cutting out the sugars and the carbohydrates. And it's like, well, no, no. Why are you doing that for you? Shouldn't be having saturated fat. You know, you need to be having oats for breakfast. All this misinformation that's still being perpetuated out there. And then of course you should be taking these tablets. And if you don't take these tablets, well, what's wrong with you? Why you're not taking them. There's just such a, I don't know, we've got such a long way to go in terms of educating people out there. So, so what can we do?

Dr James Muecke (00:20:32):

Uh, yes. So there's, there's, it's a big conversation in itself. And, you know, if we look at there's a study that came out recently in 2017, that showed that over over half, I think something like 56% of patients with type two diabetes were able to reverse their type two diabetes in a 10 week period with simply a low carb, low sugar diet. So we know that adopting such a diet is actually critical in this whole process. I think also including periods of fasting is very important as well. And of course, exercise is an important part of lifestyle, but I think really diet is the critical thing here. And if we go back to a little bit of history, you know, in the decades after world war II, it was noted that there was an increase in heart disease and heart attacks. And it was presumed that this was due to a fatty diet causing fatty blockage of the coronary arteries.

Dr James Muecke (00:21:28):

And this was based on no real science and no strong evidence whatsoever. And so what happened, and there's still a lot of lot history and misinformation leading up to this point, but in 1980, the dietary guidelines for Americans was released and this guideline recommended reducing our fat to 30% and upping our carbs to 60%. And rather than seeing a downturn in the heart disease, cardiovascular disease, cardiovascular disease, actually soared. And along with that type 2 diabetes, which I mentioned since that time, we then saw that four fold increase in type two diabetes. So there's a lot going on here. There's a lot of vested interests. There's religious ideology, there's industry interests, and it's a real quagmire, which was very, very difficult. And there's also, I think, another, a number of other factors, which I've dubbed the five days of, of sugar toxicity. And, it was a way of me getting my head around this whole space and just to go through those briefly.

Dr James Muecke (00:22:33):

So the first is Addiction, sugar is highly addictive. It's been shown to be as addictive as nicotine. So it's consumption, activates the reward center in our brain, leading to the release of the neurotransmitter, dopamine, which is a feel good chemical makes us feel good when we may have sugary treats. The second A is Alleviation. We often use sugar to alleviate stress or to make us feel better when we down to counter release of the stress hormone cortisol when we're anxious. So the third day is accessibility. Sugar is cheap and quite literally everywhere in our lives. I walk into most service stations without encountering a wall of confectionary. And you certainly can't check out for most supermarkets and stores without being enticed by half price, soft drinks and, and confectionery and chocolates. The fourth A is addition, an astronomical amount of sugar is added to a food and drink something in order of 75%.

Dr James Muecke (00:23:30):

And the fifth is A is advertising, world that is flooded with ads and TV commercials for sugary products. So these things which make sugar, such a difficult thing to kick. And if we look at those five A's in their entirety, what let's look at the first two A's it's about personal awareness being aware that sugar is highly addictive in it, we're using it to alleviate stress. I think if people we are aware of that and me as a doctor, wasn't aware of that until quite recently, then you can then start to curb the pool of sugar related products. And then the other three A's accessibility, addition and advertising is really about accountability of businesses, industy and government to do the right thing by the people of Australia. And again, there are a number of strategies that we can look at that we can help to turn that around.

Tracey McBeath (00:24:21):

I love those A's. My concern is that I guess the reach of the pharmaceutical industry, certainly a lot of the low carb GPS that I know will speak very openly about the fact that their colleagues are just not interested in doing what they're doing. Their stand alone, a lot of them. And I definitely know it's growing. I mean, there's definitely a ground swell of change, but I was reading a book the other day called Mistakes Were Made, But Not by Me. And it looks at the cognitive dissonance, that we sort of go through when we come across information that doesn't match our beliefs. And they talk about the pharmaceutical industry in terms of their reach and the gifts, the little gifts that they give doctors and things like that, which does play a part in whether they're going to prescribe that medication or not. So that to me is a really big thing that we need to look at sort of changing in some ways, because I can't see how they, most doctors will be interested in not prescribing medication and looking down the lifestyle path, which doesn't make pharmacology rich. I mean, that's about getting people off medication.

Dr James Muecke (00:25:30):

That's right. Again, it's quite a detailed area we can examine in more detail. So there's no biochemical process in the body that demands that we must ingest carbohydrates. Carbohydrates are nutritionally deficient, and they, we don't need to ingest them. They're not essential to our survival as our health. Whereas fats and proteins are essential. We can't survive without them. In fact, we can generate all the glucose that we need for the energy in our bodies, simply by the fat and proteins. So to have a dietary guidelines, a dietary dogma, which is recommending that we have a diet that's high in cereals and grains which are high in carbohydrates, particularly refined carbohydrates is exactly the diet that is driving this epidemic of obesity and type two diabetes. And it's, it is extraordinary to think that doctors are still not aware of this. And I suspect it's simply been a campaign of misinformation, but there's also probably, when you've had decades of an understanding that saturated fats are bad for our health and you have had an understanding that breakfast is such an important meal of the day when this is in our minds, it's actually very hard as as doctors to actually turn that around.

Dr James Muecke (00:27:02):

Now, this is we're talking decades and similar to smoking it. It took a long, long time for this to be reversed. And there was such campaigns of misinformation that happened at the time. So, it's really important for doctors, for my colleagues to be aware of the evidence, which has been around for a long, long time now. And certainly in June this year, there was another really important meta analysis, a very high level review study that showed that natural saturated fats in our diet have never been shown to cause cardiovascular disease. So it's seriously important for people to know that it needs to be shouted from the rooftops. These are foods such as unprocessed meat and particularly red meat, dark chocolate, eggs, full fat dairy, all the products for the last 40 years that have been demonized. We need to be aware that these products are actually critical to our health.

Dr James Muecke (00:27:54):

And so I think it's really time now for people to take this on board. And that's why I'm speaking about it so much. I've been hoping to speak at a number of medical conferences this year. In fact, I was speaking at the Australian medical association conference, the major GP conference, and both of those conferences were canceled and they've gone online, but unfortunately my role in those conferences has been dropped because they're all about COVID-19. So a really disappointing opportunity. Sorry a really excellent opportunity, which is disappointingly been dropped now for me. So I'll keep on speaking about it because I think it's so critical to our health as a nation. I think we have the opportunity to turn it around here. And in fact, I've, I've recently written a number of times to the NH&MRC and to the department of health outlining the flaws and the conflicts of interest, the bias, which is inherent in our dietary guidelines. And I was delighted to hear a couple of weeks ago that Greg Hunt has announced that they're going to be reviewing the dietary guidelines. I think it's really time for this to be happening.

Tracey McBeath (00:29:01):

Absolutely it is. And I do want to ask you about the dietary guidelines, but just something that you touched on then that you're saying that you were dropped because of COVID being main focus at the moment. And isn't it interesting because we know that people with type two diabetes are more likely to get COVID. It's people who are metabolically unhealthy that are more likely to pick this up. So it could not be more relevant to have a discussion now about diet and what people are eating.

Tracey McBeath (00:29:28):

It is the perfect time. And I sense that this is happening. And if you look at the first three months of the COVID-19 pandemic, there are 102 deaths from the virus, which is of course tragic. But at the same time, we had over 5,000 deaths in Australia from type two diabetes. 5,000 deaths, which went unrecognized essentially, and certainly unheralded. So it's just critical information that we need to then be aware of going forward. And I know during the lockdown, and I'm so sorry to hear the lockdown that's happened in Melbourne and South Australia is not far behind, but during a lockdown period, of course, people are stressed about a many number of things and particularly about their opportunity to work and living and provide for themselves and their families. So during stressful times, people often turn to sugar and excessive eating refined carbohydrates. And so we know that in those early weeks of the, the first wave, the things that went flying off the shelves, weren't just toilet paper, they were the refined carbohydrates for the pastas, the white flour, the white rice all missing, and the barely been restocked to this day.

Dr James Muecke (00:30:38):

So I have no doubt that people will be turning towards these refined carbohydrates, sugary treats, and all the soft drinks went as well. So I suspect what we will see it, it hasn't been, it hasn't happened at this point in time because I suspect most people haven't gone to see the doctor so the diagnosis of type two diabetes hasn't increased over the past few months, but I suspect there will be tail and eventually we'll see that there'll be a rise in type two diabetes during this time because of the unhealthy diet, lack of exercise. Also the fast food and takeaway that I'm sure people are eating during these times. And it frightens me that that we'll see a burst in type two diabetes. I'm certainly now after that first wave and the lockdown of Eastern South Australia, I noticed that we were seeing more patients coming who had put their appointments off.

Dr James Muecke (00:31:31):

So as an eye specialist, there are people who are seriously putting their eyesight at risk, and I have had a number of patients already have lost irreversibly vision from diabetes, from macular degeneration and other vision threatening conditions, because they delayed their appointments because they are worried about going to the doctor. So despite our reassurances, as a practice that we were doing everything to keep them safe, they were still not coming. Even yesterday in my practice, I had patients who were canceling appointments because they were worried. And so this is really important for patients not to neglect their health during these times, not to neglect their appointments, particularly if they have things like type two diabetes, or if they have vision threatening diseases, it's really critical for them to maintain their appointments so that they don't put themselves in a worst health situation. So this is a trying time, not just because of the risks and the complications of the virus, but also the other health issues that surround us. And as well as the economic issues that are playing out at the moment.

Tracey McBeath (00:32:32):

Absolutely. So in talking about the dietary guidelines, so you've been instrumental in getting them reviewed, which is absolutely fantastic. A couple of things I want to ask you about that. Well, firstly, what would you like them to look like? So what are, what are the changes that you are pushing for in terms of review? And also, I guess, who are the stakeholders? So who are going to be involved in that process if you know that at this stage?

Tracey McBeath (00:32:57):

So the last time the Australian dietary guidelines was reviewed was in 2013, sorry, that's when they released, I think they started the review process in 2009. And if you actually look at the Australian guide for healthy eating, which is the pictorial representation, two thirds of the food stuff are plant based and the cereal and grain sections is enormous. If you actually look more closely at the references, let's say the references to the cereal and grain section, there were 73 references that were used to draw up the current set of guidelines and all but 10 of those were industry funded. So that in itself immediately puts bias into this whole process. There's also a handbook of questions, which guide the literature review, which I understand the Dietary Association of Australia played a big role in, but there's significant bias within this within this as well.

Dr James Muecke (00:33:55):

And if you look at the questions, there is significant bias within the questions. And if you look at the meat section, the question actually biases the search to find a link between the consumption of red meat and cancer. In the cereal section, there's one question that biases the search to look for the health benefits of cereals and grains. And so there was no balance yet. You didn't have a question that said, let's look at the risks and benefits of red meat and the risks and benefits of cereals. They actually biased. So it's a strategic deception biasing the literature search. So there's serious bias within this whole process. And there were key members of that working group that also had contacts and connections to industry at the time. So although the NHMRC who over saw this, suggests that that bias was managed, how can that bias ignored really. Also, if you look back at the 2003 guidelines where it was recommended that we reduce the saturated fats in our diet, when the 2013 guidelines came to be reviewed, it was recommended that that evidence hasn't changed and that recommendation to reduce the natural saturated fats in our diet still be maintained. So there was no opportunity for the natural saturated fats, which is so critical to our health to actually be revived in the current set of guidelines. So I think that this is critical going forward that be reinstated as a really important part of our health.

Tracey McBeath (00:35:25):

So we sort of have a history and following what the US do with things like dietary guidelines. And I'm sure you're aware that they just had a big review of theirs. There was a big group led by Nina Teicholz - the Nutrition Coalition that was pushing for all the evidence to be put on the table. And unfortunately it's been largely ignored and the the reviews come in and it's even more bias. It's got even less red meat in it and is more plant based. So, you know, devastating really for them. Do you hold hope that we might be able to stand alone a little bit and not follow in their shoes when it comes to the review we're about to undertake?

Dr James Muecke (00:36:03):

Absolutely it's critical that we don't follow those guidelines. There was a four person subcommittee on those guidelines who had significant personal and ideological bias. The process lacked transparency, it excluded a large number of rigorous studies. It relied primarily on weak data for its conclusions and almost all the committee members had long lists of conflicts of interest with the pharmaceutical companies, food industry, supplementary company. So how can it not influence their decision making? So it's really critical that we don't make the same mistake that we don't go down the same bias pathway with the review of our dietary guidelines. And I'll be writing to the NH&MRC and the department of health, recommending that we look very critically at who was involved in drawing up our last set of guidelines, and missing them from the process because we don't want that same bias. The same conflicts of industry, the same ideological and industry bias to creep into what is going to be informing our nationwide nutritional health policy.

Tracey McBeath (00:37:09):

Yes, absolutely. So what can we do as individuals to help in that process? Is there anything that we can do? Can we write to our politicians, or is it more just waiting for the process to start before we can get involved?

Dr James Muecke (00:37:23):

Yeah, I understand. I think writing and people talking about this and I had a number of media opportunities, which is fantastic in my role as Australian of the year this year. I'm fortunate in that people are open to listening to what I'm saying, and I will continue to write and to continue to seek media opportunities to talk about this. So I think this is a great opportunity for us to turn around our chronic ill health, which is driven by our poor nutrition, really, really good opportunity. So I think having the public also being aware and also writing to their local members to their politicians and just keeping this in the spotlight, I think it's very, very important. When the next review of the guidelines will be released. I think if I understand it will go out to public scrutiny. So hopefully we will get people looking at the guidelines and scrutinizing it to see whether there's any bias in the references - is there any industry or religious bias within the references, the literature, which guide the review process and guide the next edition of the guidelines. So, you know, hopefully we do have significant interest from the public so that that can be scrutinized and we can ensure that we don't have any conflicts going forward.

Tracey McBeath (00:38:36):

Yeah. So you said that you have been overwhelmingly listened to, and people are receiving what you're saying. Has that been the case, have you, or have you had any sort of negative kickback or pressure to maybe not speak out as much as you are?

Dr James Muecke (00:38:50):

Yeah. In fact, after the Australia day weekend, I got back to work on the Tuesday morning and there was an email waiting for me, a troll email, and I've had a number of troll emails condemning what I'm saying. And of course there's every chance that they're coming from the sugar industry. There are a lot of industries that don't want to hear this, there is the sugar in Australia, the processed food industry. Of course, the beverages industry as well. They don't want to hear these messages, but this is where I'm calling on accountability. These businesses, these industries are driving this terrible epidemic of poor health in favour of profits. And so I think really they need to be held to account, and this is the time to do it. And to be able to change around, and see that we need resilience and we need innovation. We need innovation in businesses and industry.

Dr James Muecke (00:39:39):

You know, we saw it with the tobacco industry. If we look back, you know, there was an uproar in Australia in decades past when the tobacco industry was potentially impacted, but I understand that the tobacco farmers were able to - once they actually were no longer allowed to farm tobacco, they then went into farming, avocados, mangoes, and things like that, and actually making more money. And so potentially, you know, sugar cane farmers, they can use the sugar cane for clean, fuel and ethanol or they can do. You know, it's actually been modeled in a number of countries where there's been a levy on sugary drinks that there's been no impact on jobs. And so with the fact that 80% of our sugar is actually exported, if they model that there's going to be very little impact on jobs in Australia and that sugar cane founding sector.

Tracey McBeath (00:40:27):

So you are a fan of pushing for a sugar tax.

Dr James Muecke (00:40:32):

Yeah, so I called at the award ceremony, actually I made a speech and it had a lot of media attention and in those days afterwards, it was all about Dr Muecke calls for a sugar tax. But I was actually calling for a multi-pronged strategy, not just the sugar tax. The sugar tax is one of a number of things. And if we go back to those five A's of sugar toxicity in particular the three A's of sugar toxicity, sugar toxicity, accessibility, you know, what I've been calling for is to move products away from checkout counters and stores and supermarkets. With addition, we need a clear and transparent labeling system so that we know how much added sugar is in our food and drinks. And it's the addition A where the tax or levy comes into it, but there's certainly some good, strong evidence and solid reasoning behind it.

Dr James Muecke (00:41:16):

We know that in Australia, in the decade leading up to 2017, there was a 30% increase in consumption of sugary drinks. We know from many studies that sugary drinks have been linked to type two diabetes. And we know also from about 17 studies worldwide that a levy or a tax on sugary drinks has resulted in a reduction in purchase and consumption. So it makes sense to me. And so in Australia, it's been modeled that if we have a 20% levy on sugary drinks, this will raise over $600 million. And that can be used to drive health awareness initiatives that I mentioned before to raise awareness of the multitude of health dangers of sugar, not just obesity and type two diabetes, but also tooth decay. This is the leading cause of dental caries in our society. And the money can also be used to fund health inequalities.

Dr James Muecke (00:42:06):

You know, if you go up to Aboriginal communities, you'll see that sugary food and drinks in abundance and actually cheap and healthy and fresh foods are expensive. And the final A - advertising, one of the other things I've been calling for is to take ads for sugary food and drinks from the TV during those hours that our children are watching. So a levy or a tax on sugary drinks is just one of many strategies, and there are a number of other strategies we should be looking at our school canteens and see what they're selling. We can remove ads from the internet that are targeting our kids. So it's really, you know, people often say, Oh, this is all nannying, but actually raising awareness is not nannying. And when we're protecting our children who are now developing type two diabetes, when we're protecting the vulnerable in our society, you know, this in no way it can be considered nannying and public health initiatives and public health initiatives are absolutely critical. And if you look at all of the public health initiatives that have happened in recent years, for example, seatbelts have saved lives, helmets when riding motorbikes save lives, banning cigarette smoking from restaurants and pubs will help to save lives. I mean, there's so many examples of this that I would suggest no one these days would consider nannying. So when you have an epidemic of type two diabetes, which is now impacting in some regions of Australia, well, over 10% of the popular population, then it's really time to do something positive. And it's really time for governments to be accountable and do something positive to curb this serious threat to our health system and to our society.

Tracey McBeath (00:43:41):

That's interesting talking about the sugary businesses that rely heavily on that. One of the things I've heard a lot about, and you've talked about is the exercise is medicine campaign by Coca-Cola. So a lot of those companies are really vested in the everything in moderation. And they are still holding onto the eat less move more. Well you're overweight because you just don't exercise. So we know exercise in the scheme of health is important, but they, they slur is so it makes it really hard for people to understand the true cause of all this sort of stuff. That to me is underhanded, it's not upfront. So it does definitely make it harder for people to see through all that stuff.

Dr James Muecke (00:44:24):

Exactly. And if you look at the exercise as medicine movement, one of the founding partners was Coa Cola. So coca cola's vested interests is move more so you can drink more Coke. I even wrote an opinion piece for the Canberra times about a month ago. And a few days later Dick Telford, who is one of the founders of Australian Institute of Sport came out saying that we can't forget exercise as an important part of this process. But if you then look at Dick Telford's research, he has a long standing study that's been funded by Coca-Cola. So I think Dick Telford's conflict of interest here is that he's been funded by Coke. So he will be advocating for people to move more so that they can drink more soft drink and drink more Coca-Cola. So you'd have to really look at these conflicts of interest before we seriously placed too much emphasis on these opinions typically when they're not based on rigorous science.

Tracey McBeath (00:45:17):

Yeah, absolutely. Absolutely. I' was hoping I could read quickly just a message I got sent yesterday from one of my Instagram followers, because I want to ask you to explain a little bit about why weight isn't necessarily an indicator of health because, and you touched on in the beginning, you said something about refined carbohydrates are sugar in disguise. So I think there's a real misunderstanding out there. You know, I think, well, no one can really deny the effects of sugar, but when you talk about carbohydrates and refined carbohydrates, there's a little bit of a misunderstanding that people don't really understand that they do convert to sugar in the blood. And it's the same, whether it's a can of Coke or a bowl of rice, but I wanted to read you this because I posted a picture that said, "we believe that patients get type two diabetes because they're overweight. As a doctor, Dr. Brian Lenkous was talking about how he has a huge number of patients who are a nice lean weight, yet are type 2 diabetic. And this message I got was from this lady. "So this is my dad. He weighs under 70 kilos. He is 74 years old and has run 80 marathons, ultra marathons, and now cycles a hundred kilometers a week. He has type two diabetes and he's on statins from two heart attacks. And won't give up the carbs because my mum doesn't believe it's healthy. That says so much to me. That's not an uncommon story.

Dr James Muecke (00:46:41):

No, that's right, it's not an uncommon story. You mentioned about refined carbohydrates and particularly the refined carbohydrates, you know, white rice for example, is highly processed. It's had the husk, the grain, the germ removed from it. So all you're left with is basically a little bullet of pure starch. And starch is simply a long chain of glucose when it weakens the gut, it's broken down into a single molecule of glucose which is then absorbed to the blood stream, so pretty much when you're having refined carbohydrates, such as the foods made from white rice, white breads and pasta white potatoes, you're pretty much having a sugary treat. And interestingly, I look to the pack of the pasta the other day, and I had 3.5% sugar, and I thought, Oh, that's not too bad. But then the refined carbohydrate element was 67%. So this is nearly 70% sugar when you're having a packet of pasta.

Dr James Muecke (00:47:35):

So it's really important for people to be aware of this. And, and I know that your experience and that person that made a comment, I've had a similar conversation with a number of my patients and one of them I can remember quite clearly, it was quite recently. And he said, doc, and I'm doing everything. I've cut out all the sugar, even cut out all the refined carbohydrates. I'm not having soft drinks, et cetera, et cetera. We had this long conversation with him, and I thought oh well, he's doing all the right things. And I suspect that there's, you know, there is a genetic element here in some people and as he was leaving, he said, all doc when I come next time can I bring you a packet of dried fruit? My wife and I packaged dried fruit as a living. So bingo, there you go. There is the little sugar bullets in the dried fruit, which are heavily sugary treats.

Dr James Muecke (00:48:20):

And if I look back, I mentioned earlier, a man that I know he's not a patient actually, but I was filming a documentary in 2018 about the experience of blindness. So I was seeking people who are blind and what their experience was. And Neil Hansel he's name. He doesn't mind me using his name. He was actually on the stage at the Australia day ceremony. He was the guy that went to bed at the age of 50 and wake up blind the next morning at the age of 16, when he first started earning money through to the age of 26, when he developed type two diabetes, he drank four liters of Coca Cola, every single day. 4L of Coke. And if you actually calculate that out and then quote me on this, but I think really the bottles got about 52 grams of sugar.

Dr James Muecke (00:49:05):

So a four L bottle, it's got about 104 grams of sugar. And half of that is fructose. And fructose is the really dangerous component, because for a number of reasons, it's not recognized as a food stuff by the body. It doesn't trigger the release of insulin. It suppresses our appetite control. And when it hits the liver, 30% of it is converted immediately to fat, which is harmful and helps develop a fatty liver, which is central to this whole process. So 30% of the say the 52 grams of sugar is converted directly to fat. So whatever a third of the 52 grams is, is turned into fat. Every time you have a 40 liter bottle of Coke. So this poor guy, he was on the move, he exercises and yet he didn't realize at the time the danger, he wasn't aware of how dangerous what he was doing with his body.

Dr James Muecke (00:49:56):

And even when he developed type two diabetes at the age of 26, he didn't realize the myriad of life changing and life threatening complications. This is a disease an insidious that ravages the entire body? You have no idea that what he was doing was putting himself at serious risk of damage to his own body and to serious damage to his family. I mean, when someone has type two diabetes, it's not just themselves, they take along their partner and other family members for the ride. You know, he's a very strong advocate for this as well, because he is aware now. He wasn't aware back then. He wasn't aware how addictive that sugar was and that he was actually addicted. He realizes now, but he wasn't aware than that he was addicted. So again, this is where the conversations need to be: addiction alleviation, the dangers of all the added sugar, the fact that is causes type 2 diabetes, not always associated with obesity.

Dr James Muecke (00:50:56):

Obesity actually is the biggest risk factor for type two diabetes. A 20 to 35 kilogram gain in weight is associated with something like 11600% increase in type two diabetes. So this is a serious driver of type two diabetes, but you don't always have to be overweight. So, just the fact that you might be keeping a healthy weight doesn't mean you're not at risk. And certainly for me, you know, earlier in the year, I was a big fan of, you know, there's rarely a day where I didn't have ice cream after dinner and at work most days I would pretty much consume a packet of cream biscuits. I had a scan of my liver earlier in the year, and I had a fatty liver. So little did I realise that I was on the way to potentially type two diabetes.

Dr James Muecke (00:51:44):

So I immediately went into a sugar detox every day, or most days I have a time restricted eating or fasting. So from dinner through to lunch the next day, I always exercise. I'm not overweight. I had a little bit of a belly, but certainly I didn't feel like I was at risk at all. And actually on Thursday, I'm going to have my followup scan to see if I've managed to reverse my fatty liver. I've certainly dropped probably about 10 kilograms. So everyone whose seen me after the lockdown said, my goodness, how much weight that you've lost. So yeah, this is really, really critical for people to be aware of the dangers of not just sugar, but also the amount of added sugar, refined carbohydrates, all of these things, which are potentially doing us damage,

Tracey McBeath (00:52:25):

Um, and that we can't necessarily outrun it or exercise at of. I think that's really important for people to understand. I mean, I was a personal trainer for 12 years and I've been definitely guilty of telling people to carb load and restrict their fat and yeah, all that stuff that I now know is not correct. And I'm doing my utmost to make up for, for that. But so many people are still told by their doctor to just it's your fault or your glutinous, you're just eating too much, just go and stop eating less and go and move more. And I just think it is absolutely cruel to tell someone, to do that and not help them.

Dr James Muecke (00:53:03):

Exactly. And, and particularly also when sugar is so addictive and if people are not aware of it, and for me, my need for sugar was a physical dependency. So literally day one, when I went in to my sugar toxicity, I had withdrawal symptoms of headache, irritability, clouded thoughts and fatigue. And for me, it was really tough and it was actually much tougher than the coffee withdrawal and also experienced these cravings. And for three days it was so intense, but after day 3 I then started to come out of that. But, you know, quite simply when people are having that withdrawal, that mini withdrawal and that need for a sugar hit, that's really just your addiction talking to you. But I suspect there's also many, many people in particularly poorer parts of our society, where they're using sugar, to alleviate significant stress in their lives, and the addiction may actually be a much deeper psychological element to it.

Dr James Muecke (00:54:02):

And so I think we also need to look going forward with funding that hopefully would derive from a levy on sugary drinks and other heavily sugared products we could actually have in place support groups, and helplines, and also counseling, psychological counseling, like we've done for alcohol and also for nicotine. So, yeah, absolutely. I think this is, this is also very important for people to be aware of. And, and, and these weight loss, the fad diets have a 90, nearly a hundred percent failure rate, they just don't work. Because when, we drop our calories, we actually drop our metabolism. The really important thing is when we actually go into a fasting mode, you actually have significant metabolic changes. So when we fast have a sudden drop in insulin and insulin is the big driver of weight loss, people who are on insulin, realise that once they go on insulin, they actually increase their weight.

Dr James Muecke (00:54:52):

So insulin helps convert glucose in to fat. So if we can get off insulin, that's a really good thing. Also, when you fast, you have a rise in adrenaline and growth hormones. So when you fast, even for short periods, you have significant metabolic changes, which can actually drive weight loss and drive reversal of type two diabetes. So this is also very important part of the puzzle. And, but if anyone's listening and they do have type two diabetes or type one diabetes, if you're going to do any fasting, if you want, particularly if you're on medications, you need to do it in conjunction with your treating GP or physician. So fasting is a very important part of it, and exercise is also very important as well.

Dr James Muecke (00:55:31):

But exercise, I think one of the biggest health benefits of exercise is stimulating the reward centre in our brain. And that also leads to the release of dopamine. Anyone who's been for a vigorous exercise, they feel great as a result of it. So this is really good. And particularly in these times we're in lockdown, that's why despite the lockdown, we're still encouraged to get out and exercise because it makes us feel good. It makes us feel better. And it's actually a much better alternative than reaching for a two liter or four liter bottle of soft drink or reaching for another packet of cream biscuits or a block of chocolate and consuming the whole lot. And I think it's really important to see exercise in this respect, not use exercise so that you can eat more sugary treats.

Tracey McBeath (00:56:17):

Yes, that's right. And I think, you know, for people who actually metabolically unhealthy to tell them go and exercise can be actually hard. You know, their body is under stress and it's struggling seeing this is what I see happen with my clients who are reversing the insulin resistance and things like that. They feel so bad about themselves because they've got no energy. Okay. So that cycle, so I can't, I don't feel like exercising. My body is struggling to make enough energy to get me through the day, but I feel so bad. I know I should be doing it, but when they start to reverse things, it's amazing how the energy just comes. And they do then for the first time in their life, almost feel like moving and exercising. And it's so wonderful to watch. And, you know, talking what you were saying about the physical and the psychological addiction of sugar and carbohydrates.

Tracey McBeath (00:57:05):

It's most of my work. Now you think that the physical addiction, while it's painful for a few days is much easier than the habits and the psychological things and how we've linked certain foods to feeling good. And that is very, very difficult to break and absolutely agree with you. That's an area that needs more attention and people need a lot more support to do that. That's why, you know, I think most of my work is like that. I now have people that they know what low carb is. They really understand the science, they know what to eat because it's not complicated. It's, it's really, you know, it's just eat real food. And, you know, when you understand what food does, it's quite an easy decision, but they're very, very tied to the habits that they have around food and what their family do. And, and that's the, the stuff that they definitely need more support around.

Dr James Muecke (00:57:57):

Yeah. It needs to be a systemic change doesn't attend. And, you know, I mentioned to someone the other day that, that they didn't even realize that we had dietary guidelines. And I said, well, that's true because I'd actually didn't even realize we had dietary guidelines. But what you do realize what we've been told for so long is that that meat is bad for, meat causes cancer, saturated fats are bad for us, it causes heart attack, you know, that I mentioned before that breakfast is the most important meal of the day. None of these things have any evidence behind them. So this is all steeped in biased, opinion and biased literature. So really critical, really critical for people to be aware of this. And what you mentioned before about people who are overweight or obese quite simply, cutting out those heavily sugar products, being aware of the excess sugar in some of the foods that they're eating and also incorporating some fasting into their daily habit.

Dr James Muecke (00:58:46):

And then that will drive the weight loss. And then that will allow them then to start moving more freely. It will take the pressure off their joints. They'll be able to exercise more freely and go for long walks and go for more vigorous walk. So they can then build up on that. And it's, so it's so important. The one downside for me in the last three months, I've lost so much weight. None of my clothes fit anymore. None of my trousers fit anymore, but one of the other positive things actually is that my wife says I don't snore anymore. So that's a really positive thing of weight loss. And so, you know, there's so many, so many positive things that can come out of this as well as improving our health. And, you know there are a lot of strategies and there are a lot of books and apps that people can actually access to look more closely at fasting, and what foods to avoid and what foods we should be eating.

Dr James Muecke (00:59:35):

But also when you got to be careful about when you have a habit that's tied to enjoying a sugary treats. My wife and I would often sit down after dinner and get a block of chocolate and watch TV. So, you know, that was a habit. You know, often we go to the cinema and we have an ice cream or a big container of soft drinks. So if you actually start to look at those habits that are tied to a sugary treat, what if you go for a long run and come back and have your sugary treat, if you'd just be very critical and very aware of not tying those habits to a sugary treat, that's one very important mechanism to try and curb this drive to consume sugary treats.

Tracey McBeath (01:00:21):

Absolutely. And it's absolutely possible to do that. I think it's very uncomfortable to do that, but with awareness and time and support, and I've seen it, I've seen people do, they have disengaged from those habits and changed it so absolutely possible. And I'm very, very grateful to you, Dr James Muecke. I should definitely let you go. I've talked to you for so long. I'm hoping I could end on one question I'd love to know from you is who are your heroes? Who is, who is someone that has really inspired you to do what you're doing?

Dr James Muecke (01:00:53):

Sure. Well, I can just very briefly talk about a hero in my history and a hero at the moment. I believe, the hero, from my history was, was the director of the department of ophthalmology at the Royal Adelaide hospital Colin Moore back in 1988, when I was doing my internship and I was wanting to do surgery and considering ophthalmology at the time, but I was reaching out to a number of the surgical groups and the advice I was getting almost universally was, Oh, you know, if you leave the system, cause I was wanting to go to Africa and I explained to them of that just have a year off, go to Africa and have this experience. And everyone's saying, Oh, if you leave this system, you'll never get back in and you'll ruin your chances of getting into specialty training.

Dr James Muecke (01:01:32):

And I was hearing this time and time again, and I was getting a little bit despondent, but then I went and met with Colin Moore. And I said, I'm interested in doing ophthalmology, but I want to go to Africa and have a year and have this experience. And he was really supportive. In fact, he said, if you do this, and if you came back and there was someone else who was also going for the job, I would select you because you've broadened your horizon, you've gone out and done something, something different. So that gave me the freedom to go and have that experience. And that for me, was a life changing experience. As I mentioned before, that really has been instrumental in the life that I've led and the incredibly rewarding and satisfying life that I've lead. And, wow. You know, that piece of advice was, was brilliant. So, I've always been very encouraging of people to follow their passions, not trying to put people off, doing something that they really feel is an important element to their life.

Dr James Muecke (01:02:27):

So that was a great piece of advice that I got. So, and at the moment, there are a number of heroes across the country. Certainly there were a number of heroes during the Bush fire. Uh, we saw quite visibly, and there were a number of heroes during the pandemic that we're seeing at the moment. But there are also many other other heroes who are uncelebrated whose whose amazing work really never, never goes recognized that never goes rewarded or celebrated. And I'm sure many people will know, but certainly for me, someone who's been a hero to me at the moment is Nicola Spirea who's is the chief preventative health officer in South Australia with Wellbeing SA. And she's been our leader, guiding us through this pandemic very visibly and really has put South Australia in a fantastic position. So I think she said, and gets my vote as a fantastic hero, who's just been a rock during this difficult time that we're going through.

Tracey McBeath (01:03:25):

Wonderful. I can't thank you enough for joining me today and thank you for all that you're doing. You have a huge amount of support behind you, and as soon as we know how we can help and what we can do, there'll be a lot of people that will be very vocal in, in pushing for fantastic change with the dietary guidelines. So please, don't stop. Please keep going. And thank you so much for everything.

Dr James Muecke (01:03:50):

It's a pleasure, TracEy, and thank you so much for reaching out to me and really enjoyed the interview. And I look forward to chatting some more. So thank you so much.