By Marika Sboros
Australian ophthalmologist Dr James Muecke has clear vision. He wakes each day and sees in graphic, gory detail a threat hanging over the lives of fellow Australians.
It is not the COVID-19 pandemic.
It is that each day, 250 people will develop type 2 diabetes. They do so “unnecessarily”, Muecke says, because type 2 diabetes is a preventable disease. It also makes people “more susceptible to pandemics”, he says. That claim is controversial but evidence-based and many MDs and researchers internationally endorse it.
Muecke is more than halfway through his time as 2020 Australian of the Year. He won the award for three decades preventing and treating blindness in some of the world’s poorest countries. His focus now is fighting a leading cause of adult blindness worldwide: type 2 diabetes.
In Australia, over half of all those with diabetes are not having their regular, all-important, sight-saving eye checks, says Muecke. As a result, it’s now the leading cause of blindness amongst working-age adults, he says. It’s also the fastest-growing cause of blindness in Aboriginal people.
Muecke on ‘insidious disease’
But it’s not just blindness that potentially lies in the wake of a diabetes diagnosis. It’s also gangrene of the feet, amputation of lower limbs, impotence, kidney failure, heart attack and stroke and declining cognitive function, he says.
These are just some “life-changing or life-threatening complications that menace people with this insidious disease”.
Thus, in his public talks, interviews and most recently, in a hard-hitting opinion piece in the Canberra Times, Muecke goes for the jugular of those in positions to protect public health. He also puts the country’s diabetes epidemic into proper perspective:
In the first three months of the COVID-19 pandemic in Australia, 102 people died from the virus infection, he tells me via email. In the same period, over 5000 died from type 2 diabetes. Therefore, more than 20,000 Australians a year die “from an illness that is preventable”.
Click here to read: COVID-19: Biggest risk is ‘not the virus’!
Therein beats the heart of Muecke’s main mission as 2020 Australian of the Year. He wants to halt not just spiralling rates of type 2 diabetes but also obesity. Or “diabesity”, as doctors now call it, because of the common co-existence of both conditions in patients.
Directly in Muecke’s sights are Australia’s dietary guidelines and research showing their contribution to diabesity. Also in his line of vision are food, soft-drink and drug industries and businesses that influence the guidelines and make billions feeding off them. And guideline authors heavily conflicted with industry links.
Where blind obedience leads
Australians need to know that most of what the experts told them about diet for decades has proved false, Muecke says. They also need to know about all the vested interests and COIs (conflicts-of-interest) among those responsible for the guidelines.
“We’ve been told for years to eat less fat, especially saturated fat, and more carbohydrates. Yet we’ve never been fatter, our teeth more rotten and type 2 diabetes and its complications more prevalent.
“We have blindly and obediently followed this advice for 40 years and it is killing us – literally.”
Muecke wants to see a dedicated campaign warning Australians of “the multitude of health dangers of sugar and an overhaul of our flawed dietary advice mechanism”. He has devised the “5 A’s of toxic sugar” to synthesise for himself why sugar deserves to be called a public-health hazard:
- Addictive: sugar is as addictive as nicotine and other dangerous drugs;
- Alleviation: it makes us feel better and want more;
- Accessible: it is cheap and easily available everywhere
- Addition: around 75% of our food and drink has added sugar;
- Advertising: we are continually bombarded with advertising encouraging us to buy and eat sugar.
Muecke now adds two more A’s: awareness and accountability. Both are lacking among those in positions of power to stop sugar from harming people, he says.
Perils of challenging dietary dogma
That’s brave, fighting talk from a medical doctor. After all, there was a time not that long ago when dietitians would have reported Muecke to his regulatory body, the Australian Health Practitioners Regulatory Agency (AHPRA), for daring to stray into “their” territory.
Australian orthopaedic surgeon Dr Gary Fettke knows all about that. Dietitians from the Dietitians Association of Australia (DAA) reported him to AHPRA for his views on dietary sugar in 2014. AHPRA responded by investigating Fettke over more than four years, threatening his licence, even banning him from speaking about sugar, before backing off and vindicating him.
In 2018, AHPRA apologised privately in a letter and dropped all charges against Fettke. The DAA dietitians involved haven’t apologised or forgiven Fettke and other dietitians for following in his footsteps.
These days, there’s safety in numbers as many MDs and researchers globally now actively oppose official dietary guidelines. That opposition is particularly vocal in the US because the country’s dietary guidelines are hugely influential.
Most English-speaking countries, including Australia, followed the US guidelines closely when the “experts” first introduced them in the late 1970s. Most still follow them slavishly. That’s despite solid research showing that from the outset, the US guidelines lacked solid evidence from either randomised controlled trials (RCTs) – the gold standard of scientific research – or even weaker, epidemiological evidence.
US authorities review the guidelines every five years. The latest review leaves many wondering why the Dietary Guidelines Advisory Group (DGAG) bothered to invite submissions. The DGAG published its expert report on July 15. It instantly elicited controversy and vigorous opposition.
On the same day, the Nutrition Coalition (TNC) responded in a press release with a blistering critique. TNC is a US-based non-profit, non-partisan educational organization that was founded in 2015. Its primary goal is ensuring that US nutrition policy is based on rigorous scientific evidence. Teicholz is TNC founder and director.
She is among critics of the latest revisions who say that the guidelines are still based on weak science. They make “no progress at all on diet-related diseases devastating America”. The guidelines also continue demonisation of saturated fat and put the extensive industry links of DGAG members under scrutiny.
Teicholz is vocal on the issue of industry influence on US guidelines. In a recent tweet, she targeted the DGAG recommendation that people eat artificially fortified or enriched foods for iron and B vitamins rather than “real” food. She asked if this might have “something to do with” DGAG ties to multinational food corporations.
An article in the BMJ in April 2020 notes the “outsize role” that a “powerful, industry-funded group” played in steering the development of the guidelines. It is the International Life Sciences Institute (ILSI) that started life as a Coca-Cola front. The article notes a call by the pressure group, Corporate Accountability, to curb ILSI’s influence “to protect public health”.
ILSI members showed up significantly in the marathon, multimillion-rand trial of South African MD and scientist Prof Tim Noakes. That was after a Johannesburg dietitian who headed the Association for Dietetics in South Africa (ADSA) reported him to his regulatory body, the Health Professions Council of South Africa (HPCSA) in 2014 for his views on nutrition.
Just as APHRA did with DAA dietitians, the HPCSA enthusiastically went to war with Noakes on ADSA’s behalf. Unlike AHPRA, the HPCSA has still to apologise to Noakes even privately. That’s despite finding him innocent and vindicating him comprehensively twice, the last time on appeal in 2018, on all 10 aspects of a charge of unprofessional conduct.
Fettke and wife Belinda have done extensive research on the disturbing phenomenon of medical evangelism influencing dietary advice globally. Belinda has launched a Youtube channel with a groundbreaking video, Nutrition Science, How did we get here? It is well-worth watching – as riveting and shocking as it is well-researched.
Back on the Australian front, Muecke regularly targets those with COIs and “a lack of accountability, at several critical levels” in business, industry and government. In his sights are stores using “predatory marketing tactics” and TV that continues to advertise to children.
“If they won’t do the right thing, then surely it’s time for our government to step in?” he asks rhetorically.
Muecke’s opinions have mostly resonated in medical circles in Australia – on the surface, at least. I did, however, come across one prominent dissenting voice in defence of sugar. It is Canberra University emeritus professor of sports science Richard “Dick” Telford.
Conflicts of interest
Telford wrote a letter to the Canberra Times, responding to Muecke’s opinion piece. In it, he endorses Muecke’s message to avoid sugary products and processed foods as “eminently sensible” to reduce the risk of developing type 2 diabetes.
However, he disagrees that those responsible for official dietary advice got anything wrong. Telford rightly says that type 2 diabetes is multifactorial. And that excessive sugar intake is just one of “several modifiable lifestyle-related factors” that can increase the risk of developing it.
“Other risks are prolonged periods of physical inactivity, excessive stores of body fat, and psychological stress,” he says.
Telford, therefore, effectively argues for the CICO (calories-in, calories-out) model of obesity. It is that all people have to do to lose weight is to eat less and move more.
That message lies at the heart of Coca-Cola’s “exercise is medicine” marketing campaigns. It showed up in a New York Times exposé in 2016 of the lengths to which Coca-Cola went, funding scientists to shift blame for obesity away from bad diets, sugar and soft drinks to fat.
Telford enjoys a reputation as the “icon” of The Australian Sport’s Commission’s Australian Institute of Sport (AIS) that Coca-Cola, Nestle, PepsiCo and others have funded. He also worked with Kellogg’s to develop the Sustain breakfast cereal. Telford left the AIS in 2005.
‘Move more’ message
PepsiCo’s involvement caused controversy in 2007 when, according to one media report, the AIS promoted the sports drink Gatorade through its education programs. That was “despite warnings by nutritionists and dentists that the beverage rots children’s teeth and is contributing to the childhood obesity problem”.
Telford did not respond to emailed requests for clarification of his comments in the Canberra Times. And of whether his industry links and funding influenced or compromised his AIS research. He also did not respond to whether he has since severed those links.
In an email to me, Muecke expressed surprise to learn of Telford’s Coca-Cola conflicts in his long-running study.
“It certainly explains why (Telford) is pushing the ‘move more’ message,” he says.
Muecke has his own interpretation of that message: “Move more so that you can drink more Coke!”
That didn’t work out well for one young man who drank 4 litres of Coke a day from the age of 16 until he was diagnosed with type 2 diabetes 10 years later, says Muecke. At the time, the man “was busy and thin, didn’t realize that he was addicted. He is now blind in both eyes, has had a heart attack and nine amputations”.
Clearly, says Muecke, “exercise is not enough medicine”.
He now sees government as his “one last hope”. Government must “step in to protect the health of all Australians”, Muecke says. It needs to protect taxpayers who are funding the type 2 diabetes bill to the tune of $20 billion every year.
Many experts now see type 2 diabetes as “the real pandemic” and Public Health Enemy Number One.
As a doctor, Muecke simply wants to see government “put the health of its people above vested interests”.