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Pioneering Preventative Medicine with Dr Gary Fettke

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Pioneering Preventative Medicine with Dr Gary Fettke

It was Einstein who said; "Great spirits have always encountered violent opposition from mediocre minds."

This quote resonates with the story of today's guest, pioneering orthopaedic surgeon, Dr Gary Fettke. Tune in to discover why Dr Fettke describes himself as a committed sardine ,and why he was targeted by his professional peers for daring to question the status quo. Dr Fettke shares his awakening to the limitations of current, medically-accepted food guidelines and the challenges he has faced in bringing forth research to apply pressure for change. Dr Fettke is committed to raising awareness to the many flaws in our hospital system and, furthermore, to our agricultural and food supply chains, which is perpetuating the cycle of chronic disease in society. 

Covered in this episode

[00:43] Introducing Dr Gary Fettke
[01:58] The journey to becoming a real food nutrition advocate
[05:41] Becoming aware of the flaws in the system
[10:11] Thin on the inside, fat on the outside - TOFI
[14:10] The deeper agricultural issues of our food supply
[17:48] Champions are not always celebrated
[22:14] Why a lot of nutritional research is flawed
[28:54] Food production needs to focus on quality, not quantity
[37:13] Committed sardines: the way forward
[47:12] Education is the key

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining me on the line today, all the way from sunny Launceston in Tasmania, I say that with a wry smile, is Dr. Gary Fettke. Who's a Tasmanian orthopedic surgeon with a long-standing interest in the preventative aspects of health outcomes and particularly before surgery. He's always and always has been a loud advocate for public health and prevention. 

As a cancer survivor, he saw the benefits of reducing sugar and processed carbohydrates in his own health and started to share the information in broad principles with his patients. His open nutritional advice on healthy eating has come under investigation by AHPRA after anonymous vexatious notifications by dietitians. His case became public last year, and partly after his involvement in the Senate inquiry into the medical complaints process in Australia that highlighted the AHPRA process.

Welcome to FX Medicine. Dr. Gary Fettke, how are you?

Gary: Good morning, Andrew. And it is quite sunny down here.

Andrew: Well, it's not in Sydney.

Gary: Well now, I think it's because we can actually see the climate out here rather than having to look through the fog.

Andrew: The smog. Yeah.

Gary: Well, I'm being kind.

Andrew: Now, Gary, I've first got to go back. You've had a long-standing interest in health. So tell me where your interest in medicine began? Because sometimes medicine and health aren't always walking hand in hand. And I guess, I say that from a cynical perspective. But tell me about your beginnings?

Gary: Really probably goes back to when I was 16 when my mother died from cancer. So I had a pretty raw finish to high school, and she died of an unknown cancer. She was a smoker. And I was a fat kid. So the combination of that and my struggle with my own weight, I was on diets from the age of eight, meant that I ended up going down that path of medicine. I was doing a lot of sport, so I could lose that weight as a teenager. And the combination of sport and medicine ended up traveling the path of orthopedic surgery. So I've been an orthopedic surgeon now for 26 years.

Andrew: Yep. 

Gary: And a major component of that has been let's look at the prevention aspect, rather than actually just treating the outcomes. The return on investment, once you start treating patients, particularly in the hospital environment, is effectively zero. And you may get a few dollars in return in research, but you'll get the biggest return on investment for prevention. 

Andrew: Right. 

Gary: So 25 years ago, I was one of the first surgeons in Australia to not operate on patients if they were smoking.

Andrew: Oh, really?

Gary: And, basically, the paper called "Where there's smoke, there's fire." And literally, once you start looking for the research, and looking for that evidence that smoking was bad for you. And quite clearly it's on every cigarette packet nowadays. And the science is quite clearly, in that situation, that smoking is bad for you. And if you look back, it was there 30 years ago. 

So the same thing goes with obesity. So it would be 15, 17 years ago I stopped, or significantly avoided, doing joint replacement on patients that were too heavy. And for the same reason, the results of joint replacement are not as good if you are too heavy. It's blatantly obvious that patients don't recover as well. They have more complications in the procedures. The interventions aren't going to last long. And I got challenged on that one as well, and as well as the smoking issue. And I presented papers, again, all related to that. 

But if you tell people to stop smoking, and tell them to lose weight, the big problem in the medical profession is we just tell them. And there's a big difference between telling a patient, and then or providing them with the tools to actually give them that advice. 

So the flow on from that is that I've effectively been in research on the obesity aspect for, you know, 40 years. And, ultimately, this is my journey where I came across the problems of eating by the food pyramid. I sort of say that I tried to do that. I had a healthy eating lifestyle, if you go by that food pyramid, for many years. And sure, snacking a bit of chocolate, because a little bit won't hurt. But I had major weight issues for a long time. And also I had diabetes or pre-diabetes, high blood pressure, and then I had a cancer 17 years ago.

Andrew: Wow.

Gary: And it made me obviously rethink all of that and go, "Hang on. I think I'm supposed to be doing the right thing, and yet I'm getting sicker?" And the flow on, as time went on, is I started looking at the perils of sugar. And then as I realised it's not just sugar. It's become the whole eating process. If we start doing the opposite of that, which is eating real food rather than processed food, you end up with a definition of...I think that's a tragedy we actually have to call real food, real food. It should actually just be food.

So if you actually eat food that by definition is low in sugar, low in refined carbohydrate, and has a higher amount of healthy fat. It’s just eating fresh local and seasonal food. And when you define it, it doesn't come in a package. It doesn't come in a truck. Doesn't have long food miles. And I like Caryn Zinn, a comment from her, a quote from... she's a dietician in New Zealand..."Empty pantry full fridge." 

Andrew: Right. 

Gary: So... when you look at that definition of real food, and you start eating towards nutritional value rather than calories, surprise, surprise, your health improves. 

And I was my own N=1 experiment. Extrapolate that across family, and then my surgical team. And we started seeing amazing results in everyone's health. And I don't apologise to my surgical team, because I've actually well improved in their health.

Andrew: Do they want an apology?

Gary: Oh, yeah. They occasionally do remind me that I started them on that journey. 

Andrew: Yeah. 

Gary: But we are a good team. And it's been a, you know, the flow on from that is, several years ago, I started explaining to my patients that sugar, in the amount that we're having, is... dare say the word "toxic." 

And that's when my problems, I suppose, started when I started creating waves in the hospital system of the hospital food. And I'll say it, and I think as a concept hospital food is crap, and it's killing my patients. And I'll say that because the example of food that we give to patients in hospital is less than optimal. And sure it doesn't kill them hospital, or not that I'm aware of. But over a long period of time, it sets a poor example. And the major example I use here is that if you've got diabetes, the current hospital guidelines are that you're supposed to have two desserts per day. 

Andrew: Yeah. 

Gary: And that's a New South Wales Hospital food guideline policy which has being duplicated around Australia and particularly in Tasmania. 

Andrew: Wow. So who...? 

Gary: If you think about it...

Andrew:...who set's that?

Gary: No, no. That's the hospital food guidelines for patients. And you're supposed to have recommendations of two desserts per day, plus biscuits for morning tea and afternoon tea. And one to two energy foods which include muffins, potato chips, and energy bars.

Andrew: Wow. 

Gary: So I've pointed this out to the hospital system. The hospital food industry. And all that I do is take the data and take the information from their guidelines. And quite clearly, if you've got an inability to handle sugar in your diet, which is what diabetes is, we shouldn't be encouraging patients in a hospital to have significant amounts of it. We just push their blood glucose control way up and creates problems. 

So I've... Unfortunately, I point out this blatantly obvious flaws in the system, and that's created waves. And in my situation, the hospital dietitians started reporting me to the medical board.

Andrew: But I can't believe that any dietitian would support those sort of guidelines. Indeed, I would have thought they would have been throwing their hands up in the air and tearing their hair out of those. I mean... I'm sorry. I'm bamboozled by the acceptance of those. 

I do want to ask a question though about if you... Going back to your childhood, how did you lose the weight? Was it purely exercise?

Gary: Oh yeah, I had a shocking diet as a teenager. You know, I had my four liters of ice cream per week. I was raiding everyone's fridges. I was completely carb loaded. And I had that growth spurt. I was exercising literally till the cows came home. 

Andrew: Right. 

Gary: And I was probably what they called the TOFI towards the end of my teenage years. Thin on the outside, fat on the inside

Andrew: Right. 

Gary: Quite clearly I was metabolically inflamed. My wife, who still loves me, knew me back then. 

Andrew: Oh really? 

Gary: And I had this beetroot face all the time. I was plethoric and running around… but that was, in some respect, somewhat crazy and uncontrolled days. Any listeners who had a parent dies, when you're a child or a teenager, you go through a fairly angry phase. 

So part of that was my nutrition wasn't great, and my partying wasn't good either. But I was still a medical student. I've got to thank Belinda for getting me back on the straight and narrow when I was 18. 

Andrew: Right. 

Gary: So, not that I was...but they were just angry days. But along the way, you set up your eating habits for life in that timeframe.

Andrew: And this is I guess what's happening, we can see it in Australia now with the kids coming through 20%... What is it, 20% obese?

Gary: And increasing. Yeah. That's...

Andrew: 50% overweight.

Gary: ...certainly, 40% to 50% now overweight. I mean, as a population, we've now got two-thirds of the population that are overweight or obese. So therefore if you're normal weight, you're actually a minority group now. 

Andrew: Wow. 

Gary: And that's interesting the way to start thinking about it. So if you hear normal weight people are almost getting discriminated against. Because I hear about that, in the schoolyards now, that the normal weight child is copping a bit of flak for being too skinny. 

Andrew: Oh, really? Wow.

Gary: Yeah. Really. And it's...I've got colleague's kids that have copped a bit of flack there for that whole situation. 

Andrew: Yeah. 

Gary: And that's what happens in minority groups cop a bit more discrimination. It just happens to be with normal weight kids are copping a bit more than the average child in the schoolyard. I think these are interesting times.

Andrew: Oh, interesting is a word. So when you're talking about your prediabetes and hypertension, what era was this? How old were you then? 

Gary: Late 30s.

Andrew: Late 30s. So the dietary indiscretions throughout your younger years had set you up for this over a period of time? What about familial aspects?

Gary: Well, no. My father’s skinny as a rake, and there wasn't any major health issue apart from my mum, dying from cancer. 

Andrew: Yeah. 

Gary: So the problem I sort of see here is that if our guidelines are flawed right at the beginning, then you have people who are actually trying to do the right thing, and yet they are going to struggle with their weight. 

I come back to the smoking issue. There's so much information out there nowadays about smoking and the perils of it, that if you want to smoke now, then you've made a conscious decision to do so. If you want to eat well, then there's so much confusion out there that you can't...you're going to struggle to make that decision. 

I mean, there's no question that putting the right fuel in the car is going to make the car run more efficiently. The question is which fuel is it? And that's where all of this information, and I actually call it misinformation and at times disinformation. Is creating problems for the community. 

And even if you go down the path, and this is part of an area I'm exploring at the moment. If you want to go down the path of eating well and getting good quality fresh produce into you, I’m actually looking at the nutrition of our soil, which is interesting. Because we've lost 30% of the organic matter in our topsoil over the last 10 years and 80% in the last 100 years. And that's where our nutrients come from out of the soil.

So if nutrition of our soil is then reflected in the nutrition of our food, and then that's reflected in the nutrition in our health. And I think this is a major environmental disaster in the making. That we’re actually losing the nutrients and mineral out of our soil. So we’re adding fertiliser to the soil to our agricultural land. Which is making things grow faster, but without the minerals in them. 

Andrew: Yeah. 

Gary: Whole new area of exploration that we need to be considering if we’re looking at longevity of our health. We’ve got a whole agricultural sector which is producing quantity of food. But not actually looking as much at quality. And certainly not getting remunerated as much for it. 

Andrew: Yeah, well, that’s right. I was just exploring in another podcast recently that, I think it’s weird, that it is accepted by every, let’s call them authorities, but it’s accepted by all the authorities that to improve the yield of animals you need to feed them a certain supplementation program, if you like. For instance, dairy cows, they’ve got it fine-tuned. It’s going to cost you between $9-$11 per day, per cow to actually give them this nutritional supplementation for an optimum yield of milk. 

We’re talking about agricultural land for plants and then, it’s very well accepted for instance, that avocados need certain minerals to fruit… Australian being a very old continent… Where the disparity comes in is, it is not accepted that to get the maximum yield out of us, for our productivity in 21st century, it is not accepted that we have the right foods, and even, judicial supplementation, when required, to keep us on the straight and narrow. There’s this, as you say, it’s not just misinformation, it’s actually disinformation. Which is a really interesting point. 

So who’s running that? Is that industry? Is that our sweet spot that’s such a researched area now, to take advantage of? As Steven Fry so eloquently put about his almost sexual interaction with, what was it? The cake mix that his mother used to make. And him licking the bowl. 

Gary: We are starting to pay the price for our manipulation of our agricultural practices. I think that’s the summary of that. As to where it stems from and where it goes? I’m fascinated as to why we’ve gotten ourselves into the predicament, certainly of our health practices and where and why it’s being defended as such. 

So, I’ve given that some thought. Because clearly I keep coming up against obstructions when I try and talk about the current science and the current outcomes. And trying to work out why it’s being defended so strongly. And it’s sort of a layered effect. 

The first is, is that if you have generational education, then people come to believe things. So if you’re being taught by your educators and their educators have been taught by educators before that and they’re all taught the one thing, then all of a sudden you believe it. 

Andrew: Yep. 

Gary: And so, we talk about the low carb, high fat concept. That’s been around for 40-50 years. That’s been the educational paradigm. And once you’ve educated in that, it’s really hard to get out of it. It becomes a doctrine, it becomes a religious belief in some respects. And then, when that’s challenged, you will defend that paradigm, almost to the death. If you then challenge that, then that becomes a matter of major inconvenience. And as a society, you know, as individuals we like convenience. You know, changing things is inconvenient. And we’re educators along the pathway, like I call, “Read, repeat, reward.” So if you read something, then you repeat it, then you’re going to reward it. It’s not much trouble. So that’s where a lot of our dietary guidelines have sort of been, just sort of, keep on keeping on. 

If you challenge that, then that becomes an inconvenient process. So if I read something and then I challenge it, then I create consternation from those that I’ve challenged. And most people are, if you’ve got a belief, and you develop that paradigm and someone challenges it, the very first thing you’re going to do is defend it. 

I throw into that then, we’ve got a layer of bureaucracy. I don’t know if you’ve heard of The Peter Principle? But The Peter Principle in, lets say in society and particularly bureaucracy, people rise to their level of incompetence. 

Andrew: Right. 

Gary: And you can’t get promoted beyond that. And I know this is a bit of a harsh comment but, as a society, we might have well-meaning people that move up there, in these bureaucratic channels. But I honestly think it gets to a point where they get challenged and you know, they’ll defend the paradigm. And they’re working at a level which is, you know, at their capacity. 

And I’m quite forgiving about all of this. Otherwise you just get angry. And I sort of, well, “Hang on, why are you defending this situation? When I’m trying to be constructive and give you, you know, current evidence.” And this isn’t just at a dietary aspect, it’s also, in my situation, I think, at a medical board level, they can only act upon information they’re given. And that information, if it’s come from bias and vested interests, then they’ll act upon it. Without actually… because it’s more convenient to act upon the evidence that’s given to you.

Andrew: Oh absolutely. 

Gary: Rather than it is to say “Well ok, the evidence given to me, may in fact, be wrong.” To digress, that’s what’s happened, I think, in the medical board situation. I tried pointing out to them that the information being supplied to them, whether or not it’s from dieticians, or from members of the food industry, it’s completely biased. And it should be accepted as biased and as a result, pretty well, thrown out. 

That’s largely fallen on deaf ears within the medical board. But the senate enquiry has seen that there’s been problems in the evidence submitted. I didn’t mean to become a test case for looking into this jurisdiction in Australia. But as a result, my case was used because it’s almost Monty Python-esque. 

Andrew: Yeah. 

Gary: You know, here’s a surgeon trying to advise his patients to lose weight and eat healthy. And yet, it’s not quite in line with the dietary guidelines and certainly not the hospital food guidelines, which as I stated earlier, are crazy. And yet, I’ve ended up in that situation of supposedly being silenced. But talking about things in general terms today, you know, is clearly not giving individual nutritional advice. So that’s why we’re talking in generalisations. 

Andrew: But when we’re seeing the undoing of these guidelines even from very well run research, like the Sydney Diet Heart Study. Showing us that there was really no benefit from these polyunsaturated, or high intake of polyunsaturated oils from plant sources. 

When you’re getting this sort of research coming through. And it’s research. And even, when it’s home turf stuff. And we know that our dietary guidelines are failing us. Surely it’s kind of like, if you know that your car is not stopping, you need to check the brakes. 

Why is there this resistance to saying “Hey guys, we need to go back and look at something. Because something’s gone wrong, something’s broken”

Gary: Well, there’s people and institutions that have based their careers on this. And it’s a big, big ask to admit that you’re wrong. And you know, I think there, and I’ll say there’s a bit of personal ego and institutional ego in that scenario…

Andrew: Right. 

Gary: There’s, you know, massive dollars in this, at a research level. When you admit that you’re wrong, it costs you something in the process. 

I used to be the cake judge at the hospital, to put tings in perspective. I’ll admit, I made a mistake. Sorry guys. Sorry everyone. And I was also involved in a knee replacement recall. A knee replacement had a very long history and there was a bad batch of that, for about 18months. No surgeon in the world knew about it. And yet, admitting that a bad batch had gone in, cost my knee practice for a couple of years. Not that I did anything wrong. So when you admit that there’s a mistake….

Andrew: Wow. 

Gary: I never stopped operating. But I knew that my knee replacement patients dropped off for a couple of years. It’s back to normal now. 

Andrew: Yep. 

Gary: But there is a price to pay for admitting that you’re wrong. And it’s perceived. But here, this would involve a major back down from The Dieticians Association of Australia, from The Heart Foundation, Diabetes Australia.. to actually admit that they’ve not been giving the ideal advice. Now that also involves The Cancer Council, Menzies Institute. These are major institutions in our society that would actually have to admit that they’ve actually been giving the wrong advice. But that’s my criticism of them. That, you know, man up, say that there are other options and choices available for people. And saying that they are dangerous is, I think, now, negligent. So that’s the part where I get myself into trouble, is pointing out to these institutions, that they can do better. By providing up-to-date and appropriate advice. 

And low carb, healthy fat in diabetes, clearly has the role to improve outcome. And the complications of diabetes are completely avoidable. Preventable and avoidable. With a lower carbohydrate lifestyle. And to say otherwise from institutions is just frankly, wrong. And I think, as time goes on, they’re exposing themselves to a potential class action. 

LCHF gets called a fad diet. I’ve got to completely agree, it is a fad diet. Lets do it against diabetes. Anyway, that’s just to throw them straight back at the situation. And, as you said, The Sydney Heart Study, that is research which has been reviewed, the original data, and then seen to be flawed in the follow up. 

I have major concerns with nutritional ‘research’. Because I think it’s been completely prone to bias for decades. Which really means a bit of an unravelling of the scientific method I think. You know the scientific method? Which is...

Andrew: Testing…

Gary: Which is, well, you come up with an observation, well, you make an observation and you come up with a hypothesis. You test is, you retest it and if you think there’s an outcome there, you’ll then implement it. But every single layer of science and research, and nutrition is prone to bias. 

Andrew: Absolutely.

Gary: There’s the bias of the initial investigator. You know, you come along with the concept, so you want to try and… you know, you’ve made an observation that is biased by your environment, in the first place. Then there’s design bias, in the way you set the trial up. There’s funding bias, of who’s effectively funding that process. Then there’s observer bias, where the people involved in the trial, it’s very hard to double-blind the situation. Particularly in nutrition, it’s pretty hard to convince patients that they’re actually eating something, when they’re not. 

And then you end up with editorial bias, once the paper’s presented to different journals. Because one journal will accept it, and there’s many journals in the nutrition field that are funded by the food industry themselves. And therefore they will publish articles which are obviously pro their situation. And I’ll open up that story down the track. Because that’s a whole new story we’re about to release some information on. 

Andrew: Right. 

Gary: And then you’ve got readership bias. Because if I’m not interested in that topic I’m not going to read it. 

Andrew: Ahh, yes, yes. 

Gary: Therefore if I’m researching some other topic, I’ll probably ignore LCHF if it’s not in my radar field. So as a result of nutritional science and research, I’m just you know, looking back, I struggle to make any interpretation of it. And therefore, most of the work that I’ve been doing is looking at it from a biochemical aspect. You know, going back to a cellular level. Going back to the chemistry of glucose and fructose and the polyunsaturated oils. Because what we ate 10, 20, 30 years ago is just prone to error. And yet, our guidelines are just driven by this sort of, information which has been collated in a biased fashion with lobby groups having a major input into it. 

Andrew: Is one of the great problems with our current dietary guidelines, would you agree that one of them is that they don’t incorporate our level of convenience in our current lifestyle? That everything must be convenient. I won’t ride to the shop, or walk to the shop, or run to the shop, I’ll take the car, even though it’s 500, 800 metres away. You know I’ll do ‘the shop’ at the supermarket, but I’ll park as close as I can so I can walk the trolley there. You know, and it’s the great challenge, is to try and get the closest carpark. It’s our mindset.

Everything is based on convenience. We have computers running our lives now so our virtual world is within a box that we’re looking at. The other thing where I want to go though is, part of it, even if we do want to try and eat healthy, even if we want to eat, let say, more salmon. I’d love to find a salmon 50, 80 years ago that ate soy. 

So are we sort of, our own enemy in that we want to do these things that are supposedly good for us. The intake of fish, the intake of fish oil, even supplements. And then we actually create a strain on the natural resource that provides that. So is it really that man’s the problem, I guess? Yeah, like, how do you address this sort of stuff?

Gary: You could move to Tasmania, but we don’t want too many of you down here. But, quite seriously, on that note, I’m completely with you. I mean, we used to live in Sydney. I actually say people exist on the mainland and we live in Tasmania. There’s Tassie pride now. 

I actually think that we have gone over the edge of the cliff as lemmings. And I think that what I’m talking about and encouraging people to consider, as a choice, is to adopt a healthier eating lifestyle. And it’s not just how you eat, it’s how you live, and exercise and move and interact. But I think it’s really hard, even if you think you want to eat really healthy, to actually find that food. 

There’s a great Pixar movie called WALL-E…

Andrew: Yes!

Gary: Which I’ve watched again as an adult. 

Andrew: Love it, yes.

Gary: And realised that..

Andrew: That’s right, it’s a serious message. 

Gary: We’ve gone over the edge. And what I’d like to think is that my children and grandchildren are going to be armed with the information to make the choices they want. 

I just gave a talk to one of the political parties recently about the role of where Tasmania can fit into that equation. I do think that in Tasmania we have a potential oasis here on the plant. With a couple of minor tweaks we can be fossil fuel free for our electricity production. We have arable land. We have temperate climate, even though it’s a bit cooler than Sydney. And we have the ability to become self sufficient. And part of that is looking after our farm land, our top soil. 

I, actually am a great believer in cows actually restoring organic matter to our top soil. The fact that cows are being accused of methane gases and causing global warming is a nonsense. It’s another one of those myths. 

Andrew: Compared to other things yeah. 

Gary: Oh, even on the number crunch. Sheep produce more methane per kilo than a cow.

Andrew: Oh really?

Gary:  And there’s about the same number of ruminants, cow’s, sheep, goats, bison, buffalo on the planet as there was 100 years ago. Those numbers haven’t really changed, it’s the way they’ve been farmed and grazed that probably has. 

I’ve got to admit I think it’s crazy that in the U.S that they… a lot of their cereal and grain production is actually for feeding cattle and cows in the feedlots. But if we can actually restore our cattle back onto pastures and the grasslands, they eat that grass, which is actually dragging carbon dioxide out of the atmosphere. And they convert that into organic matter. 

I actually just took a little video on the weekend, it maybe seems strange. I’ve actually turned over a cow pattie just to look underneath at all the worms that were coming out of it. 

Andrew: Yeah. 

Gary: Purely because of this argument. That we can restore organic matter to our topsoil. And it’s not done by killing and ploughing the soil or adding fertilisers. It’s actually by using ruminants. And putting that material back .So I think we need to re-look at that. And I think Tasmania would do that. That’s getting nutrients back into the soil. How we do that across the agricultural lands of Australia, which, as you’ve said, have been ancient lands which actually don’t have a lot of mineral content anyway. So that’s a big, tricky matter. 

So, where are we heading? I think, unless we have a dramatic turnaround in our food production. And the quality of it, not the quantity. As a society we’re going to struggle with modern disease. Or a term I’ve heard recently I quite like it, is that we now have food disease on the planet. And that’s a product of convenience. But then, we all prefer to do that. Rather than grow vegetables in our backyard. And there is the opportunity to turn our backyards into vegetable plots, our streetscapes can change. With major changes in council and decisions. And there are some small streets around Australia that are, you know, instead of putting dry grass down the side there, you turn them into little vegetable plots, community areas. And that’s a very big, holistic comment, but it requires everyone to get off their… I almost said that other word, off their backsides and start making a difference and contributing back into the community. So it’s actually not just convenience, it’s also selfish. 

Andrew: Yeah, but it’s not that hard. We actually do it. My father in law just thought, “Oh hang it,” and he won an award for doing so. It was really cool. And then what we’ve got, it’s not huge, it’s just sort of a little plot out the front. But it’s a community garden and he get’s joy out of it. And our neighbours reap the rewards of these beautiful, beautiful tomatoes. Way too many chillies. Like, organic soil, so we really look after it. I guess, the only thing we can’t control is that it is on the nature strip. And so therefore any car that goes past, thankfully we’re on a cul-de-sac, but any car that goes past, of course, there’s always those issues of fuel things. But hey, what do you do? 

Gary: Well the majority of us aren’t living on the main road. 

Andrew: Well that’s true. And we’re breathing them anyway so, it’s sort of like, well…

Gary: And again, it’s, apart from being healthy for us, it’s healthy for the soul. And there is… one of the most common features of people who live over eighty, is that they garden. 

Andrew: Yeah. The Blue Zones. 

Gary: Blue zones is another whole topic. In that, it’s not, you know, I talk about the blue zones not being about what they eat, it’s what they don’t eat most blue zones. 

Andrew: Yeah, yeah. 

Gary: You know, avoid sugar. Processed carbohydrates and the polyunsaturated oils. But, as importantly they have a deep spiritual connection as well. A community spirit. 

Andrew: Yeah, and they move. They don’t necessarily exercise. But they move. 

Gary: Yeah, regularly. 

Andrew: So gardening is just this, you know, “I’ll go down and get some spinach, I’ll go down and get some spring onions,” or you know, whatever. Just that movement. Just that tending of the garden, tends the soul as well. 

Gary, I do want to go back to, it was something you mentioned before, about this status quo. And, I think, I’m pretty sure it was Einstein who actually said it? But there’s this quote; “Great spirits have always encountered violent opposition from mediocre minds.” 

Now every great surgeon, you know, the Charlie Teo’s of the world. They get lambasted. Semmelweis, lambasted. And yet eventually it becomes, “Oh yeah, that’s common practice.” Folic acid. Lambasted. It took a generation of orthodox GP’s to lobby the government with regards to lead levels in mines, like Mt. Isa. And they were, you know, basically thrown out for a whole generation, until it happened. And then it was like, “Oh yes, we know about that.” 

Where’s the tipping point of acceptance?

Gary: Um, there’s a deep sigh at the begining of… before I started this answer. I, as we talked about research, I struggle with the findings of nutritional research because of where it, I’ll say funding bias and funding interpretations and implementation. 

What we’ve done is we’ve gone to the public. You know, the public are not stupid. They know that walking down the street, you can observe around you that those current food guidelines don’t work. With the advice we’re doing as a society, doesn’t work. 

So, rather than waiting for governments to change their decisions and advice because they’re under the influence of lobbyists. I’m openly cynic about that. Cynical. And rather than waiting for the health education to change. Because again, textbooks have been largely written by food industry. And the ongoing education of doctors is largely from the pharmaceutical industry. But again, with major dollars involved in that. 

I think the answer to this equation is in the public. And social media plays a major role in that. In that, you know, on social media, like my Aunty went low carb, healthy fat and she lost a heap of weight, felt better and came off all these medications and reversed her diabetes. That’s a far more powerful message within a small, you know, in that family unit, than people talking about what happened in some double-blind, poorly controlled study funded by industry. 

Andrew: Yeah. 

Gary: So if we talk about that, I actually think the answer going forward is actually the public. Because the multiple N=1 studies are out there if this person does that and they improve and they improve and they improve. 

Now, there’s a thing called, and you talked about what the tipping point is, and there’s an ecological term called ‘committed sardines,’ I don’t know if you’ve heard about that. 

Andrew: No. 

Gary: A school of fish, we talk about sardines here, can turn with a blink. Turn 180 degrees. 

Andrew: Yes, right. 

Gary: But a school of sardines, if you compare it to the size of a sperm whale. A sperm whale to turn 180 degrees takes about 3-4 minutes, so it’s cant do it quickly. Whereas a school of sardines can turn on, you know, the blink of an eyelid. And the number that are required to turn that school of sardines has been researched and it’s about 3%

Andrew: Oh.

Gary: It’s not 30%, it’s not 40%, it’s not 50%. It’s not a majority. 

Andrew: It’s an idea.

Gary: That 3% can turn the concept around. Because at any point of time in a school of sardines there’s some fish on the outside that are swimming in the opposite direction, a bit more alert to danger. And once you’ve alerted a certain number then you can turn the whole lot. And I think that myself, others, you guys, you know, we’re all part of that group of committed sardines. Earlier doctors. And as a result of that making a difference because of multiple N=1 studies. 

I know a couple of guys who are podcasting. And their aim is for each person to raise the awareness with two others. And if you keep doing that the multiplication effect of that is… that’s the way forward. 

Andrew: Yep. 

Gary: I’ve got to digress for a second. I’ve just got two kangroos just outside my study window here at the moment. 

Andrew: How cool is that?

Gary: It’s very cool. Grazing on the non-vegetable portion of the garden so that’s ok. 

Andrew: So Gary, with regards to things like change. And convenience. As, you know, if I’m thinking here about this cold, windy, wet Sydney morning. And yet there’s a necessity to move and yet I’m sitting here on my backside and I need to move. And yet it’s so warm and cosy. And when you’re talking about the learned convenience and the learned behaviours, physical behaviours, not let alone dietary of obese people and diabetics. How do you institute change? How do you get them to move? 

Gary: I think it’s Nutrition: 1. Movement: 2. I think this is a flow on from the 1977 “Life Be In It” campaign. That we’ve started convincing ourselves everyone who’s overweight, you know, the Norm, get up and move campaign, it’s primarily a movement issue. Food drives behaviour far more than we think. What I've come to learn is that the chemistry of food, particularly fructose, actually drives behaviour to make us hungry, eat more. Fructose in nature comes in fruit. And possums will strip a fruit-tree bare at the end of summer, beginning autumn so they can deliberately turn that into fat for winter hibernation. So very primitive, but most important...

Andrew: Which we don't do?

Gary: ...reflex. No. It looks like we have the ability to get fat or store fat for winter hibernation every day. But when we're exposed to fructose, it will actually drive a certain amount of behaviour. Again, that survival instinct just as much as we need water.

And then you're actually distracted by the market. And the marketing of food is such that it's full of bright colours, and it's telling you terms like, "Natural," and, "It's good for you," and "Healthy." When in fact, anything in the packet probably isn't. So you're distracted by the market. And then you've got the cultural issues. And we talk about going to a party or going to a celebration, or we've got morning tea and afternoon tea. It's not some sense of break. It's actually always associated with food.

So it's very, very hard for people to actually change all of that when you've got so many discretions around it. Where does movement come in that? Well, I think that's number two. And that requires this thing called motivation. And a lot of my patients who have arthritis, and can't actually move as much as they'd like to. So I focus on what they can do, which is focus on what they're putting in their mouth. Start making conscious decisions. I'm a bit more of a...I'm moved away from the 30 minutes a day of aerobic exercise, to core exercises and high-intensity work.

Andrew: Yeah, yep. 

Gary: But that may be my own personal bias because I haven't got a lot of time in my lifestlye. Do that for a few minutes a day rather than being able to find the time to get half an hour or...

Andrew: So this is the HIIT training, high intensity...?

Gary: Yeah, yeah. Yes, yes. Yeah. I do that. But again, that's not for everyone. But again, it's a matter of keeping moving as much as you can. And it does require motivation. 

So to try and do all of this by yourself is very hard. Belinda came up with a term that most people require ‘S.A.M’ when they’re addressing all of this lifestyle stuff. And the S.A.M stands for support, accountability and motivation. So when you actually try to embark on a change in health, change in weight, getting diabetes under control, it's very hard to try and do it by yourself, because of the distracting things around you that help to drive behaviour in the environment and the market.

So one of the things we encourage people is to not do it alone. Drag the rest of your family in. And you do it as a family. Do it with the support of friends. And that comes back to the community. And it's much easier to do low carb, healthy fat now than it was five years ago, or even when I started talking about sugar several years ago. Everyone thought I'd lost the plot. But now if you sort of say, "Look, I've cut back on sugar," you're not ostracized.

Andrew: No, that’s right. 

Gary: So again, the only way that occurs is actually because of community message, social media. Because you don't really see governments spending a lot of money saying, "Give up sugar," or leading by introducing a sugar tax. Because again, that's... it's bad dollars for government to be discouraging the sugar industry. 

So I think it comes back to support, accountability, motivation. And as a community, we're doing that now better than we were before. And there's a growing awareness of...that we're doing something wrong, and that we can do better. In fact, I use the #wecandobetter, and #wecan'twait. 

Andrew: One last question. When we're talking about low carb, healthy fat diets, we're talking about changing our types of nutritional intakes. Can you still have too much of a good thing? Like, you talk about fructose being the driver of hunger, but once hunger is set in, it's a hard thing to change. So even when you try to start eating salads, they're not eating a little bowl. They're eating a massive bowl. And then they're saying, "I still need more. So I'm going to eat not one chicken leg or something, I'm going to eat the chicken." 

So what do you find are the best ways to change the volume of intake?

Gary: Education. Number one, I use a fist size as an example. I say to people, you’ve got a fist size amount on your plate of nutrient dense food, that's all you need. 

It's hard early on to actually make those changes. I'm moving towards this concept of eating nutrient for nutrient value rather than quantity. 

Andrew: Right. 

Gary: And if you find the nutrients, then you'll, in fact, find the satiety. You'll feel full.

Andrew: Right. 

Gary: I think one of our big problems, in society at the moment, is when you eat one pizza, you have a truckload of calories but you don't have any nutrients. So your body says, "Actually I better go and eat a second pizza now."

And so I think part of our volume on a plate is driven by habits. Part of it is driven by the fact that it's actually nutrient poor. I think it's often described this whole concept of healthy eating. Low carb healthy...a bit like playing chess. The moves in chess are actually very simple, you know, how each piece moves. But once you start delving into it, it just gets more and more complex. 

Andrew: Yep. 

Gary: And so it's actually okay to tell people, "You don't have to get it sorted out in one day." I certainly didn't. I've learned this over several years. And I'm still learning. I mean, I'm just this morning reading some other stuff, "Oh. That's interesting. I hadn't thought about that." And if I go to meetings, and I'm catching up with people who are world leaders on this, I learn from them every time. 

I got accused at a meeting recently. He’s the ‘laid back low carber.’ And the reason being is that some people were saying, "Well, how much carbohydrate do you have? How much fat do you have? How much protein?" Said actually, I've got no idea. I just know that what I do is very low in sugar, there's virtually no processed carbohydrate in there. And I'm eating to satiety what my body tells me. I'll go wake up and think actually I'm going to need a bit of protein here. So I'll have some eggs and leftover meat from last night. And some days, I'll go, "Actually, I think I better get more fat here, so I’ll have a bit more nuts, and cheese, and some dairy in there."

So I think we need to...because people think about it as a diets. And I think they get really hardcore about it, which is fine. And I think you need to do that sometimes to really develop an interest in how much you're having. But once you relaxed into it, in fact, it’s just a lifestyle and just kind of stop eating so much process food. And having the strength and the willpower when you're in a community, in a group, when they say, "Have a bit of cake or so..." Well, my life is easy at the moment. Nobody offers me cake apart from to tease me. So I literally walk into a room at the hospitals now, and people hide their cakes and junk food. And I think, "Oh. It's good. I'm winning. I don't have to say anything anymore." 

For want of being a little bit controversial, we talk about them as treats. And I actually think they're moments of substance abuse. And that we...because we're driven to it. And the moment that you understand how you're driven towards that sugar and that behaviour, then you start being able to be having some control. And it's a bit like tobacco. Once you have the information, then you can start making personal decisions. So I still have some chocolate, it’ll be 90%, and I understand that I like the taste of it. But I'm actually enjoying that it's very low in sugar, and we're not having truckloads of it. So it's okay to let your sweet buds have a hit from time to time. But just understand that it is that, rather than having for nutritional value.

There are essential proteins that our body requires. There's essential fats that our body requires. But there is not a single biochemical pathway in the body that requires ingested glucose or fructose. 

Andrew: We make it, yeah. 

Gary: We don't have to have carbohydrate in our diet. So it's there in nature in surplus to allow us to get fat for winter hibernation. It's there as an extra fuel source. A carbohydrate in your diet is a luxury item. And sure, we've got a convenient staple food supply based on cereals, grains, sugar, soy that make our life easier. And we can crop and take nutrients out of our soil for that. But we need to understand that, as a society, we're starting to pay the price for it.

Andrew: Yeah. Gary, one last question. Just some quick resources. If people want change, where do they go get it?

Gary: I have a website that we're running still called nofructose.com. That has overview stuff. It's certainly got... my lectures that I give. 

Belinda, because of the politics of medical boards, has taken over my Facebook page. And so it's called Belinda Fettke No Fructose. But I'm still tweeting away on Gary Fettke @fructoseno. And I'm still staying loud on this topic because I have to. And once you see the results of low carb, healthy fat living for yourself and for others, and particularly in diabetes management, once you see the results, you can't unsee them. And it's too important. 

Andrew: It is too. 

Gary: And the sooner we get to the 3% of the committed sardines out there, we're going to make it, for instance, for those that choose it. And I understand it's going to be difficult to actually eat well for everyone on the planet. But if you actually understand that you got a choice, and there's an option, then you can start making those decisions. And it's not going to be for everyone. But I think not letting people know about it, that's the thing I can't forgive. It's just important.

Andrew: Words well said, and I've got to say hardly fought for. So, Dr. Gary Fettke, thank you so much for joining us on FX Medicine today and sharing your passion, and your knowledge, and indeed I would say, your care for your patients. Even though they might not like it in the short term, it's their ultimate care that you're thinking of in the long term. 

So thanks very much for sharing your expertise with us today. And good luck for the future.

Gary: Thanks, Andrew. It's been great chatting. 

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Dr Gary Fettke
AHPRA: Australian Health Practitioner Regulation Agency
Caryn Zinn
Book: The Blue Zones
Book: The Peter Principle
Dieticians Association of Australia
The Heart Foundation
Diabetes Australia
The Cancer Council 
Griffith University: Menzies Health Institute
Dr Charlie Teo
Ignaz Semmelweis
Find Gary Fettke on Twitter: @fructoseno

Research Explored in this episode

Ramsden C, Zamora D, Faurot K et al. The Sydney Diet Heart Study: a randomised controlled trial of linoleic acid for secondary prevention of coronary heart disease and death. FASEB J 2013 April; 27(Suppl 127.4)


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