Regenerative Health with Max Gulhane, MD
I speak with world leaders on circadian & quantum biology, metabolic medicine & regenerative farming in search of the most effective ways of optimising health and reversing chronic disease.
Regenerative Health with Max Gulhane, MD
88. Fighting To Reverse His Patients' Diabetes: Orthopaedic Surgeon Dr Gary Fettke on Nutrition & Medicine
In this conversation, Dr. Gary Fettke shares his journey from conventional orthopedic surgeon to a prominent advocate for dietary changes in managing diabetes and obesity. He discusses the challenges he faced from regulatory bodies and the food industry while promoting a low-carb, high-fat diet as a solution to the problem of diabetic foot ulcers and metabolic dysfunction more broadly.
See Dr Fettke speak live in person at Regenerate Melbourne Summit 2025
https://regenerateaus.com/
TIMESTAMPS
05:27 The Backlash Against Dietary Changes
08:27 The Role of Vested Interests in Medical Guidelines
11:34 The Importance of Nutritional Education
17:35 The Challenges of Medical Regulation
20:43 The Impact of the APRA Process
26:40 The Influence of Pharmaceutical Industry on Education
29:40 The Role of Red Light Therapy in Healing
39:13 Optimizing Metabolic Health
39:45 The Role of Mitochondria in Health
43:35 Real-World Success Stories in Diabetes Management
47:35 Individualized Patient Care vs. Guidelines
50:31 The Importance of Questioning in Medicine
53:31 Siloing in Medicine and Its Consequences
57:25 The Need for Holistic Approaches
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X - https://x.com/FructoseNo
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#diabetes #obesity #dietaryguidelines #lowcarb #redlighttherapy #nutrition
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In this episode of the podcast, I speak with Dr Gary Fetke. Gary is a retired Australian orthopedic surgeon whose selfless efforts to improve the metabolic health of his diabetic patients with species-appropriate nutrition was met with fierce and sustained attack over a number of years that almost resulted in the loss of his medical practice. In this episode we discuss Gary's story, his perspectives on healthcare and medicine today. A reminder that you can see Dr Fetke live in person at Regenerate Melbourne on March the 23rd at 75 Reed Street in North Fitzroy. For more information and to grab some tickets, follow the link in the description below. Enjoy this episode with Dr Gary Fetke. Gary. Thank you for joining me.
Speaker 2:Pleasure, max Good to catch up again.
Speaker 1:Now maybe you could explain for my audience the series of events that kind of brought you from you know, maybe euphemistically just a run-of-the-mill orthopedic surgeon, maybe euphemistically just a run-of-the-mill orthopedic surgeon practicing clinically, to becoming what I believe is definitely a celebrity doctor in some niche circles. So can you break that down for us?
Speaker 2:I've got a golden toilet brush over my shoulder there which explains my entire orthopedic career. My registrars gave it to me because I have it very proudly. I thought what on earth are they giving me a golden toilet brush for? But they'd actually said that, effectively, my practice was cleaning up everyone else's poo. So whenever the worst patients and the most complicated patients seem to come, you know, across my way and you've seen that thing where people say, oh, can someone volunteer to do that, all those who can help out step forward.
Speaker 2:And then I just found out for decades that my colleagues just kept stepping back and my colleagues just kept stepping back. So I had a practice of taking on the most difficult problems on a weekly basis and part of that was diabetic foot complications. So here in northern Tasmania, ultimately I said, okay, I'll see what we can do for them, because they're just like a leper colony scenario Don't touch them. Don't touch them whatever. I mean without being too crude. Right at the beginning there's a fungating smell of dead flesh. And you know, at your clinic there my clinics were called Fetke's FDAP, fructose-free, fungating Foot Folly Fridays. I never found out what the FDAP meant, but it was very much that I had. You know, if someone got a deep infection in a joint replacement, they often end up in my clinic or in my practice. I was doing a lot of salvage work salvage trauma, salvage infections and with that comes salvaging. I've tried to salvage diabetic foot complications and over the years I've always embraced somewhat new techniques and interesting techniques.
Speaker 2:But then what was originally just an occasional case of a diabetic foot complication amputation toes, amputation leg just literally became a tsunami and it was well and truly beyond my control to manage all of the complications. So, essentially, if you come up with, if you're overwhelmed with the complications, you come back to the root cause analysis. And if you can come back to the root cause analysis and I think, which is that you know I'll simplify it easily If we actually put the wrong fuel in our cars, the cars are going to run poorly. And if we put the wrong fuel in our bodies and we complicate it by the way we run our cars and run our bodies, then all of a sudden we find out that you get complications. So I'll state that diabetes and obesity are lifestyle-related conditions, primarily related to diet and other consequences which we can delve down, but primarily related to diet.
Speaker 2:So, essentially my crime in the system was that in 2012, 2013, so a fair while ago I came up with a nutritional model of modern disease just a hypothesis, where I looked at the basics of the biochemistry of the food we eat. And so that, in a nutshell, was that the combination of sugar, refined carbohydrate and polyunsaturated seed oils creates inflammation in every single corner of the body. Every single blood vessel, every single cell becomes angry and inflamed. We can add on to that other lifestyle things that have you know, cropped up over time, but the modern, standard Australian diet, the SAD diet, the modern diet, is in fact, an experimental diet which has only been with us for most particularly the last half of the 20th century. Maybe started being introduced at the beginning of the 1900s, but nonetheless it's been an experiment which has been an abject failure. So by simply doing the opposite of that cutting back on sugar, cutting back on refined carbohydrates, getting rid of the seed oils, putting protein back into the diet, complete protein, which is an animal-based protein I was able to turn around the health of these people's feet literally by prescribing in hospital eggs and cheese, you know, incredibly dangerous.
Speaker 2:And the further I went down that path, we realized we can actually reverse diabetes, put it into remission, and so I started talking about the perils of sugar. And then I can still remember Belinda, my wife, who's speaking in Sydney and she's well known in this field as well. She said, oh, you've got to get on this thing called social media. You've got to get on Facebook and start telling it. So I quickly developed a little website called nofructosecom.
Speaker 2:I ended up on this thing called Facebook and within 48 hours I was targeted by a representative of the Coca-Cola industry. He was targeting me and calling me all sorts of interesting things and, because I'm an orthopedic surgeon, one of the great things about being a surgeon is that you're stubborn and arrogant, I suppose, is the other thing. So when you actually that you're stubborn and arrogant, I suppose, is the other thing, so when you actually realize you're right, you're going to stick by it. Well, I did so the more I looked into this topic, which is now almost commonplace. But I can tell you, in 2010, 11, and 12, when I was starting to put this model together, it was well and truly on the outside of the spectrum of what people would be looking at, and certainly not in the realm of an orthopedic surgeon to be looking back at biochemistry. Anyway, I started talking about it publicly, started trying to actually look at hospital food and point out how bad it was, and the more I became notorious in that field for speaking out about it, the more I became targeted.
Speaker 2:And so, by 2014, and we've got all this on going back in time and getting hold of all sorts of internal data I was targeted by the breakfast cereal industry in Australia for my actions because their breakfast cereal sales were down in Australia and New Zealand and these seven people were to be targeted against them and I was the only doctor on that list and they were in a paid relationship with the Australian Diabetes Australian Dietitians Association and they had KPIs to promote the benefits of sugar and cereal to the Australian population.
Speaker 2:Bearing in mind, these are the people writing the dietary guidelines who are involved in them, and so it wasn't long before I was reported to APRA, the medical board, for being dangerous and working outside of my scope of practice. I ended up being reported three times. Each time we know it was a dietician. One of the times I got reported because I inappropriately reversed someone's type 2 diabetes on national TV. It's called the Saving Australia Diet on Channel 7 on the Sunday night program, the Sunday program. Anyway, we turned someone's diabetes around over a period of several weeks. It actually didn't take that long, but nonetheless the program ran over several weeks and so I got reported to the medical board for actually inappropriately being involved in managing someone's diabetes without drugs and with just purely a lifestyle intervention.
Speaker 1:I mean, it's a Kafkaesque charge, really, isn't it?
Speaker 2:It was, but the trouble is the medical board were taking it seriously. They ended up getting a nutritional expert one of the biggest leaders, know leaders in australia and the world to actually give evidence and he said it was outside of my scope of practice. He, however, failed to declare that he was actually working for the breakfast cereal industry at that point in time, which opened up a whole pandora's box, of which Belinda's, I'll say the world expert. On opening up that box and then, saying so, finding out who are the vested interests shaping our dietary guidelines, who are the vested interests shaping our nutritional guidelines, our diabetes guidelines? Most of the medical guidelines in the world, not surprisingly, have been manipulated and there are vested interests in it. And you can chase it back to big food and big pharma, sorry, pushing a plant-based agenda, pushing a pharmaceutical agenda to try and get us hooked on drugs for a lifetime, for a lifetime of profits for these companies, when the primary aim is to actually give them lifestyle-related management. And if we just so, essentially if you did the opposite of what I'm talking about, which is go back, get rid of this industrial diet that we've got, move back to an ancestral diet, a diet that we actually were meant to evolve on or which we did evolve on. Then, all of a sudden, it comes with this enormous amount of health and wellbeing. And the more I got into trouble, the more study I did. I virtually did a PhD involving nutritional biochemistry, which isn't taught to us in medical school, started looking at the physiology of healing, and all the time this is starting to grow in momentum to the fact that, yes, there's low-carb, healthy-fat keto diets. There's more and more research coming along showing the benefits of a lifestyle intervention, which are, in fact, far more powerful than the pharmaceutical ones.
Speaker 2:But, not surprisingly, you come up against more and more blockades. There was blocking of research. I couldn't get anything through an ethics committee. I couldn't work out why until I found out that the person on the ethics committee was blocking it was best friends with the head of dietitian at the hospital and just go. So I mean the story went that, essentially, I was reported three times to the medical board. I was threatened to have my license to operate taken away and ultimately they came out with a ruling saying that I wasn't allowed to talk about it, even though I was getting patients that were getting better and getting control and getting healthier, and blah, blah, blah, coming off medications, deprescribing. And so when that announcement came out it literally was just after I'd presented to a Senate inquiry about the failings of the medical board and the whole APRA process. I felt that I was intimidated and harassed. So I actually reported the medical board for harassment and they were actually found guilty of that. And then ultimately, through the National Ombudsman and five years of stress and pain and financial cost, that enormous amount of stress to the family, the National Ombudsman saw that my case needed to be reviewed. It was reviewed and it was tossed out in four weeks and then I was given an apology.
Speaker 2:But by this time the cat's out of the bag that if we have continued down this path of an ultra-processed food diet, then we've, not surprisingly brought upon our sickness and poor health. And so I've in fact gone up and down from that point of nutrition and in medicine and so I've got this keen interest slash, understanding right back to regenerative agriculture. And looking at you know, I don't know if you've heard you know, half quoting Roosevelt and extending it, but the health of the people depends on the health of the food. The health of the food depends on the health of the soil and it's linear. You know it's all involved until you actually accept that. So we ourselves live on some acreage and I've got the chooks out there and the sheep.
Speaker 2:And I went and got my gun licence in case of Armageddon because I need to have my animal-based proteins and fats. I need to have my animal-based proteins and fats. But at the other end we've looked into the vested interests and the guidelines, not just here in Australia but in New Zealand. We've been involved in trying to rewrite the dietary guidelines. In the United States I'm currently involved in trying to change things in diabetes management for the Nordic countries and we have been able to achieve now that low carb or therapeutic carbohydrate reduction is now in the National Diabetes Strategy. It's been adopted by the Australian Diabetes Society and Diabetes Australia as best practice. So it's taken 15 years for what was just flamingly obvious that you can reverse people's diabetes in a couple of days, get them to avoid most of the complications which they're told they're going to have.
Speaker 2:You know they're told they're going to have, and all it required was an animal-based complete protein, complete healthy fats, complete micronutrients, minerals and vitamins. And you know great surprise to me we actually don't need carbohydrate, despite all the myths of our dietary guidelines saying it should be 50%. You know, and all the advertising and literally the propaganda that's been shoved down our throats at a biochemical level because that's where you can't argue with any of this stuff, and I know you're doing the stuff at a biochemical, cellular level with the light therapy I'm talking about it from a nutritional aspect, at the cellular level. At the biochemical level, you can have an opinion as to whether or not you and I are right, but if you can't argue against us at a biochemical level, that's just the facts. Thanks for your opinion, but these are the facts and so over time I go through different points when I'm a bit more passive and a bit more aggressive. In some respects I'm almost over it. In that it's up to you.
Speaker 2:The information is there. You know we're in a Western world, we're in Australia. You've got access to good information, good science. You've got access to good food. You've got good access to good information, good science. You've got access to good food, you've got good access to local farmers, local suppliers, and we either do all of this and turn around our health tsunami, our sickness tsunami we embrace this or we're screwed, and so I don't feel as though this is. You know, I actually ask people when they say, oh, have you heard of low-carb, have you heard of keto? Oh, can you buy low-carb beer there? And I say yes and I say okay, so we're winning. The public are aware of it. Now we need to let the public know that it's actually best practice not to eat crap.
Speaker 2:Yeah, it's incredible, I mean that's a long answer to it, sorry.
Speaker 1:No, no, that's where I think that provides very good context for your story and for people to understand your perspective. I want to ask you about the process and specifically reflecting back on what I can imagine was an incredibly stressful and all-consuming process, especially the uncertainty of it. So, looking back on everything that you went through, it really seems like attacking you was some kind of hail Mary by these entities in the face of what seems to be an inevitable push towards a species-appropriate nutrition.
Speaker 2:I think I mean I'm not the first person to talk about carbs and processed food. I think what hit home to the industry that were coming after me is I wasn't a celebrity chef. I wasn't a celebrity chef. I wasn't a media personality. I was a surgeon that was actually just sick and tired of amputating bits of dead flesh and that had some resonance in the public, and part of my downfall was that I was on social media. But the saving grace for that is that it raised awareness of the situation. I'm indebted to all the people that helped myself and others raise this topic up, because it's actually people power that will actually have taken this forward.
Speaker 2:I'm yet to see. You know, like the College of GPs just came out with their latest guideline development guidelines for diabetes management and, despite therapeutic carbohydrate reduction being in the national strategy and adopted by the Diabetes Society and Diabetes Australia, they've got it way down. Age 100 or whatever. It's mentioned a couple of times sort of as some experimental thing. It's just complete BS. It's not experimental, it's unbelievably effective. I've got people who actually say they don't have diabetes when they're at home because they're following a low-carb diet and they've got diabetes when they go into hospital and they've got diabetes when they go into hospital. It's just, you know it's. And so our hospitals, which should be pillars, of example, will just abject failures on this, and this is one of the criticisms I kept on coming to the hospital.
Speaker 2:So show me the protein for breakfast. Just show me when is the protein. Oh, it's in the milk. So show me the protein for breakfast. Just show me when is the protein. Oh, it's in the milk. I said that's not protein, that's a tiny bit of you know less than a gram of protein that you're going to get. Someone probably needs 80 to 150 grams of protein per day. Where is the protein? Where is the protein at lunch? Where is the protein at dinner? Because it's not coming in the ice cream which you're recommending three times a day. It's not coming in the biscuits. It's not coming in the cake, not coming in the chocolate drinks. It's just not coming in the fruit juice. Where is the healthy food for people to get better? And if that's the example we set to people in society, when they come into hospital, they take that home.
Speaker 2:I got criticized. I used a slide once where I spoke to the whole national food industry, the national hospitality industry for hospitals, nursing homes, prisons. And my second slide was hospital food is unhealthy. It's killing my patients. Is hospital food is unhealthy, it's killing my patients. Anyway, I got reported to APRA for that one as well, because they then audited my practice at the hospital to find out how many people directly died from the hospital food. And I said it was a figure of speech if you set the example.
Speaker 2:But nonetheless, the system comes down on you quite hard, apra, in their wisdom act. I was asked to come back and speak again to the National Food Body as a plenary speech and a week before that, apra asked for a copy of my talk before I gave it. So I sent them an email I said just to clarify you want me to provide a copy of my talk before I give it Because they're investigating me. So I mean, where's free speech in Australia when it's starting to be actually overlooked by the regulators? So I think there are scary times.
Speaker 2:So as a result of all of that, you know I might be retired from my clinical practice. So I'm still not retired from medical practice. I'm still heavily involved in guideline reform. As I say, we're trying to help out the Nordic countries for changing the ways that we've actually been able to change things here in Australia. But I also do a lot of support for people who are actually getting caught up in the APRA process and if I have an argument, I don't know a lot. Most people don't know how big APRA is Australian Health Practitioners I've forgotten Regulatory Agency.
Speaker 2:Regulatory Agency I was about to say Reform Agency, but Regulatory Agency agency they have nearly 800,000 members doctors, nurses, physiotherapists, paramedics, ambulance officers and that's a sizable amount of the population who live in fear of the regulator, who are practicing very defensive medicine in all realms, who are fearful of getting reported to the regulator because the process is the punishment it's slow, it's tedious, it'll drive people down a very depressive line. A lot of doctors, nurses, over time have committed suicide as a result of the APRA process and that's why I've presented to Senate inquiries about their failings. But if and COVID was another period of time, I actually don't mind what your opinion was, but you should have been able to state what you thought was best for your patients. So I still do a lot of that where I'm helping people caught up in the APRA process for trying to discuss sound management. And we've got a regulator here in Australia which is, in fact, yeah, I think they're both incompetent and malignant.
Speaker 2:This is not a political statement, but the trouble is most people well, people need to realize that medicine as it's practiced here in Australia is very, very defensive, where people don't want to step outside of their boundaries or their perceived boundaries. They don't want to do things which are innovative because they're fearful that the guideline doesn't say that. And that was my naivety, because I was just coming back to basic biochemistry, instituting a simple lifestyle preventative intervention on my patients and seeing results. And the system came down on me well, in the most amazing fashion, and you go, well, I'm just trying to help my patients and it's working and it's not costing anything. So it's still a long road for all of us. So my job now, I think, is just to keep mentoring people and when they do get caught up in the system, to say actually this is a shortcut of how you get out of it.
Speaker 1:I guess the first thing that we sign up for when we become a doctor is to agreeing to a whole bunch of precepts which Hippocrates is said to have been the originator of that relate to ethical medical practice, and at the top of the list is not doing harm. And somewhere on the list is also either explicitly or implied that we are going to treat our patient with the best of our ability to the best of our ability. So I think for the lay people say listening to this podcast, it would feel or be a surprise surprise perhaps, maybe not after the past four years, but a surprise that they might be getting advice or care that is other than what the doctor might think is best and it's because of factors that are external to their doctor-patient relationship.
Speaker 2:Did you take the Hippocratic Oath?
Speaker 1:We did yeah, when we graduated.
Speaker 2:Which uni was that University of. Melbourne I went to New South and we didn't take the Hippocratic Oath. We do a pledge, but it wasn't the Hippocratic Oath. I mean, you've got to watch out for the Hippocratic Oath. It said thou shalt not bugger thou patience it was a one-nose version.
Speaker 2:Yeah, but it wasn't actually the Hippocratic Oath. So we took a pledge which had the sensible elements of the Hippocratic Oath in there. I'll come back to the. We can almost go down the path of education If you, we.
Speaker 2:I think it's unfortunate that we are educated in a system of read repeat reward. So you go to school, you go to, you know you follow whatever's in the textbook, whatever you're taught by the teacher up on the board, whatever, if you just read that, repeat it, you pass. And then you go to this place called university, which should be used to be a place of questioning and doubt and debate. And what's happened? And you've heard me talk, or I've talked, towards the issues of when we change the model of education, but now it's so entrenched, now this read repeat reward. So if you go to university and you question your lecturers, you get into trouble. They just follow the paradigm and that has flowed right. You get into trouble, they just follow the paradigm and that has flowed right down through into guidelines. So there's a guideline for antibiotic management, there's a guideline for this.
Speaker 2:There's a guideline for that there's dietary guidelines which are for to make for healthy people. I'll briefly mention that the guidelines Australian dietary guidelines are for healthy people and if we take some US data the last lot which is looking at metabolic health 93.2% of the US population are metabolically unwell. It's probably the same here in Australia, plus or minus a little bit, which means that the dietary guidelines are actually relevant for only less than 7% of people. So one of the things I've been pushing for the last several years is let's ignore the dietary guidelines. Let's come up with condition-specific guidelines for health and well-being, but with primarily a dietary intake and well-being, but with primarily a dietary intake. And guess what? Every single one of those interventions is the same. It's an ancestral diet.
Speaker 2:My mantra is eat fresh, local and seasonal whole food based on your culture and environment, avoiding added sugar and processed food. That's it. So that's the best management for diabetes. It's the best management for mental health problems. It's the best management as a primary, as an adjunct therapy in cancer. It's bowel disorders. Every single thing comes back to putting that in there. So forget the dietary guidelines, which have been written by the food industry. So if we have this model of read, repeat, reward, and you've gone through university repeating it. And then you come out into practice and the guidelines say do this, even if it's nonsensical and I'm happy to discuss all sorts of guidelines, whether or not it's cardiac ones or bowel ones or diabetic ones. When you realise that the people writing the dietary guidelines or the diabetic guidelines or the cancer guidelines or the cardiac ones or the cardiovascular disease, they've been written by people who have effectively funded completely by the pharmaceutical industry, I'm just going to call it out. It's just, you have such a financial conflict of interest.
Speaker 2:I was supposed to give some lectures at a university and I won't mention which state, but the Dean of Medicine blocked it after agreeing. And then, with a little bit of investigation, I wrote to him and said are you stopping me from giving these lectures to the medical students because of the $225,000 that you've been paid for in direct consultancy fees by Pfizer, and I think it was Nova Nordisk in direct consultancy fees by Pfizer, and I think it was Nova Nordisk. That was the end of our communication, because I'd called him out. I said you're stopping this because of that. So anyway, my slides were given to someone else and the lectures were given to the medical students, but with my name crossed out on it so you can get around it, but the fact is, wtf. What is the dean of medicine, the gatekeeper of medical student education, receiving hundreds of thousands of dollars in money from the pharmaceutical industry, not for research I've got problems with that but in direct consultancy fees?
Speaker 1:Yeah, it's so deep. It goes very, very deep to and again it comes back to this idea of the doctor and the patient and the reality is is there is in many, almost always there's a third party involved and that third party is not obvious but, as you've talked about, when, say, it's the renal guidelines or the guidelines for hypertension, there's a subtle conflict of interest in the honoraria that these professors of cardiology took and then they've gone on to dictate essentially practice for the whole of our profession. So I'm not sure too many people really understand the depth of that conflict of interest.
Speaker 2:Well, I talk about it also being a generational education, so you can actually track our dietary guidelines back to 1923 with the formation of the American Dietetics Association, and back to 1917 with the Flexner Report in the US, which was commissioned by Carnegie of Steel and Rockefeller of Oil, and they got rid of holistic medicine at that point in time in Canada and the United States and with that came the birth of the pharmaceutical industry. I'm putting a whole lot together very quickly. And then our medical education was conflicted because of that, because if you wanted to go to a university in the US, Rockefeller would say look, I'll build this building for you if you follow the modern model. And so we ended up being. Our textbooks have been written by vested interests. Our teachers have been taught by those with vested interests. They have their own vested interests.
Speaker 2:So at some point in time you've got to work out is it endemic or is it complicit or both? And for me it was just a complete awakening and I realised how much of my education had been corrupted, maybe inadvertently, but I've got a questioning mind and it just wasn't right and it just wasn't right. And so it's just you know, one of the things I found in all of my research on it is there is no single biochemical pathway in the body that requires you to ingest carbohydrate, glucose or fructose or any polymer of that. There is none, Just zero. Yet how come we've literally been told we have to have 50% of our diet as carbohydrate? Well, that comes from the processed food industry.
Speaker 1:Amazing it is, and I've done a couple of episodes. Obviously, I talked to your lovely wife, belinda, a year or two ago and also to a very interesting gentleman, matthew Lischak, who wrote a book called Fiat Food, and to me that I'm not sure if you've read it, but that gives the most complete or I guess you could use the word root cause analysis on the explosion of processed foods in the latter half of the 20th century, and it essentially came, and still does come, down to monetary debasement and the effect that had essentially on nutritional debasement, where high-quality animal-based proteins and fats were replaced with highly refined food products to mask inflation.
Speaker 2:Well, it's yes and, excuse me, I think the social experiment is an abject failure, whether or not we're looking at food, we're looking at pharmaceutical, we're looking at light. You know, we briefly talked beforehand that you can't get. I can't get red light in my house if I'm building something and there's almost a black market for an incandescent globe.
Speaker 1:I'd love to get your perspectives on that, because you mentioned that you've been using some red light therapy, some photobiomodulation, clinically as well. So what's your perspectives on this modality as it relates to your diabetic foot treatment?
Speaker 2:It works. So when you start recognising that sunlight is critical for our well-being, it's only a matter of time to work out which of the wavelengths are actually better for this or that, and that's where a lot of the research has gone. I often tell the story of the old heat lamps which were used in. You know I can still remember having a heat lamp with some sporting injuries as a teenager. A lot of people remember the heat lamps and it was probably not the heat that was beneficial, it was probably the wavelength. In retrospect I started, you know, fiddling around with it and, to be fair, the first definitely got something caught in. I've been mowing out in the paddock the. You know I had several, seven or eight patients with tendinitis and I sent them to a red light clinic and everyone should know that people work as compensation. Patients with tendonitis never get better. Anyway, I think seven out of the eight got better. I said hang on, this stuff can't happen. I mean, you don't want to operate, you don't want to make their problem worse, you want to let time let them heal. But the majority of them had some, you know, significant benefit. So I actually bought three red light units. They're called a baby bear, a mama bear and a bubba bear, just three different sized ones, near infrared and and um and uh and red. So 660, 840 nanometres, simple units, commercially available, easily available, not too expensive. And so I used it a bit on myself and then I loaned it to staff members when they came to me as patients and I said, look, you know me, I'm always thinking outside of the box. And then they all felt some benefit. So everyone I loaned a unit to bought one for themselves. So this is interesting. And so since then we now know it has a role in inflammation and pain management.
Speaker 2:So I started using red light therapy, particularly after knee replacements or slow to recover therapy. You know, musculoskeletal pains, and until you put it on you just don't know. And often the results are very quick. Often the results are over a long period of time. I've got good friends who have had a beautician business for 30 years. I was talking to them about it and they said oh, you're such a slow learner, fetke. We've been using red light phototherapy for facials for 25 years. I said have you, you know how come? And they took you know, I'm not, it's just we in the medical profession, because it's not in the guidelines. It's outside of traditional therapies. We've been behind the naturopaths on some topics like sugar for decades. I'm not saying everything in naturopathy or everything the beauticians do is good. I'm just sort of saying some of these practices have been working outside of the traditional medical fields. We just were a bit immune to knowing about it.
Speaker 1:Yeah and look. The first data that emerged in the field of red light therapy was some researchers, essentially using a ruby laser, finding that the fur was growing back and the wound was healing quicker. On a mouse that had I believe it was an excision they were doing some kind of cancer tumor research, and so I mean wound healing is probably the oldest of the indications and perhaps has the strongest evidence base for healing that cancer.
Speaker 2:One is where they shaved the rats for the procedure. It wasn't actually the wound healing, it was where they shaved the rats. The hair grew back very quickly in that red light therapy. I mean it's an accidental find, but again, if you've got something which is cheap, potentially effective, with no major side effects, then it should be instituted as to be considered in a management plan, particularly when you've got the cohort of patients that seem to be coming at me. So all I was doing in my clinical practice is let's see what we can optimize. This is what I can do. What can you do to make you better metabolic health, better healing potential, better clinical outcomes? And the important stuff about it all is it can be turned around within days and certainly weeks.
Speaker 1:Yeah.
Speaker 2:And that's a blow away.
Speaker 1:Yeah, and it all does come back to the mitochondria and you know I've done lots of lectures and podcast interviews on it and really you mentioned about the fuel substrate and really putting animal fat and into burning animal fat as the energy substrate in the mitochondria, as opposed to whatever the contents of refined, ultra-processed foods are, and then, additionally, doing these other lifestyle things which we mentioned red light therapy, obviously. Lifestyle things which we mentioned. Red light therapy, obviously, fasting, cold exposure all can play a certain role depending on the patient and, as you say, gary, the condition of which diabetes, in my opinion, is one incarnation of mitochondrial dysfunction. It disappears and you just have to get the ingredients and the inputs right. That's at least how I think about it.
Speaker 2:There was. I'll need to come across it for you. Have you seen that Chinese paper showing circulating mitochondria?
Speaker 1:Cell-free mitochondria.
Speaker 2:Yeah, the cell-free mitochondria. Yeah yeah, I'm fascinated by that because I'm wondering why some of the we get a generalized benefit.
Speaker 1:Yeah, from local. The ascorbyl effect, which seems to underlie a systemic benefit of localized red light therapy.
Speaker 2:yeah, but I'm wondering whether or not that's actually via the circulating mitochondria.
Speaker 1:Yeah, I think it is. I think that's one key mechanism, absolutely.
Speaker 2:Again, I think we're on the cusp of it opening up as a whole topic but it's not mainstream for the reasons that it doesn't fit into someone's block of guidelines. You know there's work you'll be aware of, showing reversal of macular degeneration. You know improvement in that aspect. I was actually having new glasses the other day and went down and had to check them. Was having a chat to the optometrist and he said, yeah, they're using red light therapy and so they're just using different spectral light therapies. Getting into the clinical practice Amazing, it's exciting times.
Speaker 2:James Mookie's written a paper about macular reversal of macular degeneration, a series of case studies with a therapeutic carbohydrate reduction, low carb, all happening within several weeks. He's had a practice for decades of where you'll look down and see a patient who's come along with macular degeneration problem with the eye. Nothing's changed for years and years and years. He puts them on a low-carb diet and all of a sudden the things improve. We're not talking about cure, we're talking about improvements, dramatic improvements, and I've seen all the pictures or not all the pictures he's shown me a lot of them about.
Speaker 1:Wow, this is just diet, lifestyle, optimal light therapy tick, it's, it, it is, and that was Dr Glenn Jeffery's work at UCL. He showed that the retinal cells, their mitochondria, which they have massive amounts of, were absorbing the light and was helping prevent death of those cells. So absolutely huge. I want to ask you about, I guess, the protocol now in the area of your practice, and are people still able to follow or choose a lifestyle-based approach for their diabetes in in that area that you, that you were working in, or what's the status of of that um for that patient group?
Speaker 2:I've got some here left. Feel free to tear it out now in front of the. Here's a situation which is current guy in his 40s, out of control, type 2 diabetes, carrying too much weight on half a dozen medications. He works in a pharmacy who are on board with what I'm talking about. His own wife is a pharmacist at the hospital and the pharmacist he works with said you should have a chat to Gary, his wife, who works at the hospital. I am a nutcase. I'm just out on the spectrum not to be considered, even though this is part of the national strategy and best practice for Australian Diabetes Society. It's huge to be able to say that, but they have adopted it once it became their idea. But anyway, it's another whole story. So he's gone against his wife's wishes. He's lost 8 kilos, his diabetes is under control. So are we winning? Yes, some pharmacists are on board with it, some doctors are on board with it and they're supportive, but yet we've still got an establishment that thinks that I'm this crazy guy, but I'm now the crazy guy quoting the guidelines.
Speaker 2:Now, who's crazy? Is it the establishment that isn't embracing the guidelines? Because that's essentially what I've been trying to do, if we can get this into the guidelines and one of our agendas has always been people say what's your end point? We say our end point was achieved last year, which was we would like to see low-carb therapeutic carbohydrate reduction be seen as best practice, or at least a practice in the management of type 2 diabetes which should be offered to patients and they should be supported if they wish to do it. It's pretty simple. We've gotten to that point, yet the establishment still says it's crazy.
Speaker 2:Now there's a whole lot of other politics and names and all sorts of things which I'm not going to air. My dirty laundry about, how many barriers we've had to come up against, how many clashes. I gave you one little clash example with the Dean of Medicine, but it's just been an ongoing assault. So once I cleared my name, that literally opened the floodgates for me. I said I can talk about this now and we can take it further, and it also means you can talk about it and others can talk about it. You are not going to get reported to the medical board, or you might get reported, but you will not get into any trouble for talking about a well-structured, complete diet for yourself, your patients and that's all it needs. To come back to the Medical Board here in Australia and South Africa and Sweden. Those are three test cases. I was one of those. They're not going to go back there because we've got them on the science, we've got them on the politics, we've got them on the vested interest. It's the best thing for people.
Speaker 1:Can you talk a little bit about that point where there is a, I guess, difference in guidelines or what's accepted practice compared to where, if they say what you were discussing and using effectively, which was therapeutic carbohydrate restriction, and can you speak to that discrepancy and does a doctor have to go through the process, this drawn-out, protracted regulatory process, to fight that battle essentially, or is there going to be a time and a place where that is no longer going to be so tedious?
Speaker 2:I think with what we're talking about, there's no battleground anymore. It's finished.
Speaker 1:I mean dietary-wise yes, but say in other areas ground anymore.
Speaker 2:It's finished. I mean dietary wise, yes, but say in other areas I think here's I've got lots of comments to make about that guidelines are guidelines, but what we've done is we've allowed guidelines to become rule books. There's a statement itself, and so we've got a problem with and I keep saying it's a guideline, it doesn't matter what it is, it's a statement itself, and so we've got a problem with that and I keep saying it's a guideline. It doesn't matter what it is, it's a guideline. And guidelines are there for the population the average to median population and maybe two standard deviations. Well, it just happens to be that all of my patients are more than two standard deviations away from the mean. So if you give individualized patient care and you have some metrics that you work with whether or not it's the appropriate blood investigations or imaging investigations and you're individualizing patient care that's why I love glucose monitors. There's CGMs that you can put on there. I don't care if I'm outside of the gonads For this person. Their blood glucose is best controlled by. So if you're giving individualized care, informed consent and appropriate care and follow-up, that means you're involved and you're actually caring for them, rather than group practice sort of things. Oh, here's your script and off you go and see someone else next time. Then I just there's enough. We've created in the last 10 years. There's enough shaky enough of a body of opinion to shake the guidelines, whether or not it's the cardiac ones.
Speaker 2:You know there's people speaking up about cholesterol and statins and the perils of putting people on statins long-term when it's ill-advised. So one of the things I talk about. With people who've got high cholesterol I say okay, go along and get a lipid subfraction analysis and a coronary artery calcium score and then find out what you really need to be managed with. One of the cardiologists here in town said he had a go at me one day. He's a friend, but he said would you stop doing those lipid subfraction analyses? And people ask you why am I an orthopedic surgeon? I can vaguely get around it saying I'm doing that because the patient came to me with musculoskeletal pain and they're on a statin. Therefore I want to find out why they're on a statin and I want to try and advise their GP to look into it further. Long answer, but that's how I get around it. I could do a coronary artery calcium score for the same argument, because you put people on these drugs which are coming to me and complaining about musculoskeletal pains. But anyway, the long and short of it. He said would you stop doing these lipid subfraction analysis? Because on the standard cholesterol profile he wanted to put them on a statin. They came back with the lipid subfraction analysis and it said hmm, actually they don't need it. So I said well, look, all they're doing is reducing their carbs and processed food. I said why don't you try it yourself anyway? I didn't see him for a while and then I saw him again he'd lost 12 kilos.
Speaker 2:Wow, whether or not you're talking about diabetes or mental health, mental health is being broken open now, not just for mental health, but also neurodegenerative disorders, parkinson's in particular, dementia that there's a role there for diet in the equation. The same thing in cancer management, I think. I mean you've gotten emails from me. You'll see that my byline at the end of it is science evolves by being challenged, not by being followed. And if we stop challenging, that is the scientific method, that is evolution. That is just the way all science evolves. The moment we stop challenging or we persecute people for challenging, then that is the end of our scientific pathway.
Speaker 2:Acquiring yeah, that's the end of society. If we just stop questioning, then everything that we're faced with on the planet, right? This second is perfect? Of course it's not. Yeah, and so that that's so. But the trouble is the system set up to not lay the question two, two points on that.
Speaker 1:The point you made about guidelines and individualized care they, it seems almost like a paradox of being able to give fully individualized care if we're following population-based or guideline-based medicine, because by the fact of their existence they're unable to account for all the unique characteristics of the patient sitting in front of you. So that was to me the original genesis of evidence-based medicine was supposed to blend the best available, was supposed to shape clinical practice based on the best available evidence used in conjunction with clinician discretion. But, as you say, it's become so far towards rule-based medicine instead of really allowing that clinician discretion. The other point I wanted to make is and maybe this comes back to your kind of regulatory battle, which was the definition of scope of practice, because someone might say to you okay, dr Gary, but if you're nota cardiologist and you're playing with pharmacotherapy and heart failure, why is it? You're potentially out of your scope of practice, and just to use that as an example. So how do we take that into account when perhaps challenging paradigms or exploring better treatment options for our patients?
Speaker 2:I'll come back to the first part of your statement and I'll come back to the segment, just by way of example, with guidelines. Most people aren't aware that most drugs that have ever been brought onto the market were tested on 70 kilo males. They weren't tested on women. They weren't tested on women. They weren't tested on children. They weren't tested on pregnant people. They weren't tested on elderly. Most people were about 25 to 30-year-old, healthy, 70 kilo males. Now you try and find for me a population of healthy, 25 to 30-year-old 70 kilo males. Those don't exist anymore. Of healthy 25 to 30-year-olds, 70 kilo-miles those don't exist anymore. So all of our drug therapies have been tested in isolation. We don't know what happens when you mix two medications together and the number of people on polypharmacy with multiple drugs. It's just an experiment. That's out there. So when people say, oh, that's the guideline for putting on, well, okay, you've said that there's a guideline there for this drug, but where's the guideline and the evidence that it works in conjunction with this drug and this drug and this drug? And so many people go to the doctor with side effects of one drug and get given another drug to try and treat the side effects when maybe they should come off the drug to start with. So I mean, that's one of the problems with guidelines they're just isolationist and they're looking at a problem with just diabetes. Well, okay, the person's got a mental health problem, they've got a cardiac problem, they've got a renal problem.
Speaker 2:This siloing of medicine has been a tragedy. How do I? The simple argument to that second part of the thing is how do I manage it? How can I determine my scope of practice? It's really simple. You and I have got the same letters after our name MBBS, bachelor of Medicine, bachelor of Surgery, with a basis in science, biochemistry, anatomy and physiology. And you know, the shoulder bone is connected to the elbow bone, which is connected to the wrist bone. So if someone comes along to me, we've got, as I said, 93% of the population are metabolically unwell. We've got to stop this siloing of medicine. We've got to be brave enough to walk outside of our silo. I'm very proudly published in the Journal of Gynecology as an orthopedic surgeon.
Speaker 2:Some guys were gynecologists, were named a visiting professor of gynecology at the hospital and they were doing a new, trying to work out a new technique for women's incontinence and trying to tighten everything up in the pelvic floor and they said how can we actually anchor it? I said, look, I can put some shoulder anchors in there for you, which minimized the complications of that procedure dramatically. And so it was a defining moment for women's incontinence management using shoulder anchors. They've refined them, changed them now, but I can still remember the nursing staff saying I was operating in one theatre. I said to my registrar look, I'll be back in half an hour, scrubbed into a gynecological procedure and we developed a world-leading technique. That is because we were not working in silos. The guys I was chatting to we thought have you got anything up your sleeve for doing that? I went, actually we do.
Speaker 2:So the siloing of medicine is a major concern. But if I keep coming back to the fact that if we come back to basic biochemistry, basic metabolic health, basic physiology, they're all interrelated. So I had patients come along with an arthritic hip, but they probably also had a lung condition, they probably also had some mild cardiovascular disease, and so my primary degree you come back to whichever interpretation of the Hippocratic Oath is first, do no harm and treat the patient as a whole. Do not treat them as a hip replacement or as a cardiac, which is what happens in medicine. Oh, that's outside of my scope of practice. No, it is not outside your scope of practice to have an opinion in that, and a well-informed doctor has an opinion. That's what a general practitioner does. They are supposed to have an opinion on every single bit of thing they may identify that needs some silo treatment there or there.
Speaker 2:So I think we've gotten caught up in our own regulatory authorities which have told us to be compartmentalized, told us to be siloed, authorities which have told us to be compartmentalised, told us to be siloed, and the trouble is the moment you look outside of your silo. In fact, that was that Netflix series Silo. I don't know if you ever saw it. People just I'm waiting for the second season of it, but nonetheless people think they're completely caught in a silo for 100 years. When one of them escapes and find out there's silos everywhere and it's just.
Speaker 2:I think we're at a crossroads in medicine. Maybe we've been at a crossroads for medicine since Hippocrates himself, but it's a constantly evolving situation and unless you embrace a questioning mind, a questioning approach, then you're going to stagnate. I practiced as an orthopedic surgeon for 35 years and I was doing things. I was constantly tweaking to make it better. That's what we've got to keep doing, and sometimes we have to. You know, ultimately, if you're driving up the highway and there's this sign saying stop, turn around, you're going the wrong way sooner or later. If you don't do it, you're going to have a crash, and I think we've got so many signposts in society at this point in time saying you're going the wrong way.
Speaker 1:Yeah.
Speaker 2:And what are we talking about? Going back to a recommendation of what we did for a couple of hundred thousand years? Yeah, it's such a no-brainer.
Speaker 1:Yeah, and on the point, two points two of the most clinicians that I respect, who I've listened to, interviewed on this show, or. One of them was Professor Richard Weller, now he's a dermatologist, but his research has shown the systemic benefit of sunlight on all-cause mortality and cardiovascular mortality and spoken at hypertension meetings. And the other one was Peli Lindquist, who's a Swedish gynecologist exactly, and he has done research again showing the same thing. He did melanoma research and showed that the women with the highest sun exposure had the less the lowest all-cause mortality.
Speaker 1:So, just like you putting shoulder anchors into the female pelvis, for you know urogyne indications, it's this cross-disciplinary perspective is what gets patients good outcomes and pushes medicine forward. And then, on that point I mean, there's mitochondria in every organ of the body. So the fact that and mitochondrial dysfunction or different flavors of it, is what's underlying that 94% of chronic disease that you referenced. So again, it's just different ways of answering my own question about the scope of practice and the siloing of medicine is really we do have a perspective, because if we're treating the body as a whole, then we're going to be crossing these different specialist boundaries.
Speaker 2:We're supposed to, because it's about the patient first. At the moment I know some surgeons, particularly in Melbourne and Sydney, have just become specialised in the shoulder or the elbow or the knee or the hip, in the shoulder or the elbow or the knee or the hip. And I worked for a surgeon in Melbourne many years ago who was a world-renowned knee surgeon, unbelievably good on knees. But one of his old patients wanted to have a hip replacement and I watched him do it and it was terrible. I went whoa, you do not know how to do a hip replacement. I'm totally siloed. I'm very. I've done a lot of foreign aid work and you can't go over there and be the right hip surgeon or the left knee surgeon or whatever. You have to do a jack of all trades. But I still remember it ties in all with I did quite a few years or going back to Vanuatu for many years Beautiful people.
Speaker 2:But when the sun goes down, the people go inside their houses, go to bed. Sun goes up out, they come again. And I was just thinking, you know they were generally pretty healthy, except that they were introducing Western food. And wherever you introduce Western food you start developing Western diseases and you know we could talk for another hour about that from a historical point of view. But yeah, look, we're just going up the highway the wrong way. Turn around, get back. As I say, eat fresh, local, seasonal, whole food based on your culture and environment, avoiding added sugar and processed food, and get some exercise, which is life relevant, and that can mean any sort of thing, but it means getting outside and get appropriate sunlight, and I love Paul Mason's take on light, uv light that if your shadow is longer than your height, that's predominantly UVA, if it's shorter, uvb. So if your shadow is longer than your height, you know, get the sun onto your skin.
Speaker 1:Yeah, and even if it's shorter, then you really just have to titrate your exposure to your skin type and the ambient conditions, because you do need UVB as well. Maybe we can end on a topic, and it really, I think, ties into everything we've talked about and really why you went through however many seven years of regulatory purgatory or forward, as you've described. Then there's such an asymmetry of knowledge between the patient and the doctor. Maybe that's changing with AI and these large language models, but historically there's been such an asymmetry in knowledge that people had no idea whether they were getting best practice care or not. So I think that's really the why of continuing to ask questions, which is because that's what our patients deserve and that's what they're implicitly asking of us.
Speaker 2:You've made me think. I've thought about this topic of AI in health a lot recently. I think we're in a situation where if you go onto the internet you can get a whole variety of opinion and some are good, some are bad, and I actually preferred my patients to be investigating their problems and then I'd have to debrief them and guide them, and I think that's good. With the advent of AI, I'm concerned. You've heard of the black swan.
Speaker 1:A black swan event.
Speaker 2:No, just the concept of a black swan event, and so it wasn't damp here but a predecessor by about 15 years, a Dutch seafarer came to Western Australia and found black swans, and up until that time all swans in the world were white, and that single event meant that it had to change the entire genus and the nomenclature of that. Swans were not always white, they were black or could be black, and so that one black swan, that single event, changes the entire narrative. That's why it's called a black swan. That single event changes the entire narrative. That's why it's called a black swan event. When people talk about it in economic terms, are we worried about a black swan? It's the unforeseen event that happens, which just changes everything.
Speaker 2:Well, the trouble with AI. So let's say, you've got 1,000. Literature, science, knowledge says that there's a thousand white swans and then there's one black one. Well, if AI got hold of that at that point in time, it says actually, there's, the vast majority of information tells us that swans are white. The AI then generates another 10,000 comments for that. So now we're up to 10,999 assessments that swans are white and one black.
Speaker 2:The next generation of AI will say well, all swans are white and that was maybe just an error in someone's eyesight.
Speaker 2:So if we want to get the summation of opinion, which is really just based on the summation of opinion and the averaging out of that, we're going to get rid of black swans.
Speaker 2:And so when you try and challenge that because at point in time we've done it in our low carb groups around the world you put into chat, gpt or whatever what you think is going on, tell us about cholesterol, tell us about this or whatever, and low carb is still dangerous because the vast majority of information says that it is. So I'm worried about our next generation of doctors who are very much dependent on, let's say, whatever the latest AI generating information software is, and then if that is incorporated into the guidelines, then our ability to question that is becoming potentially a thing of the past. So I think lots of reasons we're at a crossroads. But I think our information technology is brilliant at this point in time because it's allowing you and me to have a conversation and it's allowing us to get an alternative thought pattern out there. It has allowed us to actually get this to become best practice. But I'm worried by the forces around us, the powers that be, that maybe, maybe we're going to lose the ability to keep questioning.
Speaker 1:Yeah, it's a legitimate concern and that is just the resultant from the way these models get trained, which is essentially just inputting on existing data, which is the consensus. More of the web pages talk about consensus management. Then it's going to spit that back out, so it remains to be seen how that's going to play out into the future. But I guess my point was to emphasize that people might be more informed than historically they have been about illness, for better or for worse. But it doesn't change the need and it emphasizes the need in my mind that we as doctors need to always be asking the question of how can I best treat my patient. I think that's the point I was getting at.
Speaker 2:I agree with that. Now, I don't want people to think that I'm pessimistic or depressed about the future. I suffer from a condition called hyperpragmatism, so you actually assess everything and that's my surgeon in me. Okay, this is the situation that's in front of us. These are our options. With all the knowledge that I have, I think we should do this. So I think it's about positioning yourself into the future, and I'd like to think that our children have got questioning minds, and certainly my grandchildren. You know they're seven and four and you're tricking. You're tricks to them, but I say, no, I'm making you question what I'm saying, and so I'm trying to instill that, and the family always think it's funny when I'm trying to, you know, play psychological warfare with my grandchildren. But again, we've got to create a questioning mind.
Speaker 1:That's it.
Speaker 2:And unless we do that well, you know, brave new world 1984,. Here we come. Our thoughts will be controlled for us. And again, it's just I see it happening. I've been part of the cancel culture. I get it, but there's still enough of us around who are questioning.
Speaker 1:Yeah, you know it's wise advice. So, gary, we're very much looking forward to having you speak in Melbourne on the 23rd of March. So I'll just remind everyone who's listening that if you want to come and see Dr Gary Fecke speaking and sharing his insights on, I'm sure, all these topics and more, then, yeah, please come along to that event and it should be a fantastic day out in Melbourne. So, gary, any final comments or thoughts or parting wisdom for the audience?
Speaker 2:I can talk underwater, so I'll be kind to all of your listeners and let you all escape.
Speaker 1:Okay, well, I really appreciate your time, gary. Thank you for sharing your insights and, yeah, your journey. I think it's been very interesting and instructive. So thanks again, and we'll see you on the 23rd of March.
Speaker 2:See you soon. Thanks for having me. Bye-bye.
