Sport and exercise medicine physician, Australian cricket team doctor, professor of sports medicine at La Trobe University
The past few weeks have been interesting for medicine in Australia.
Monday 14 November was World Diabetes Day, which was marked by the release of a report from Diabetes Australia. The report stated that there are now over a million Australians diagnosed with Type 2 diabetes. The total number of Australians with diabetes could be up to 1.7 million people, as the number of Australians currently with undiagnosed, "silent" Type 2 diabetes is unknown.
In addition, the number of people with pre-diabetes and at high risk of developing Type 2 diabetes is also unknown, but estimated to be around 2 million. Complications of diabetes are a major health issue with 4,400 amputations of toes, feet or limbs and 3,500 people with diabetes needing kidney dialysis in the past 12 months alone.
We saw the release of a report commissioned by the Medical Board which showed that doctors, along with nurses and pharmacists, are the most trusted professions in Australia.The report stated that 90 percent of the community trust doctors and nurses and 85 percent trust pharmacists (and 7 percent trust politicians!).
The third, related medical item of interest was the revelation that a Tasmanian orthopaedic surgeon has been banned by the Australian Health Practitioner Regulation Authority (AHPRA) from giving nutrition advice to his patients. Dr Gary Fettke's concern about the increasing number of amputations that he was required to perform as a result of complications of diabetes led him to the realisation that by the time these patients saw him it was too late.
Dr Fettke has adopted a preventive approach by discussing in broad principles the health benefits of reducing sugar and processed foods with his patients to gain better control of their blood glucose levels. He cofounded Nutrition for Life in 2014 to provide a team of health professionals to counsel diabetic patients about lifestyle issues, in particular diet.
Viewers of Channel Seven's Sunday Night program will have seen a recent series where Dr Fettke and chef Pete Evans mentored a former Tasmanian cricketer Tony Benneworth, who had developed Type 2 diabetes, with a diet low in sugar and processed carbohydrates. The results were very impressive with dramatic loss of weight (15kg) and a total reversal of Tony's Type 2 diabetes, including coming off all diabetes medications under the supervision of his GP, and individualised nutrition support from the team at Nutrition for Life including Accredited Practising Dietitians and a diabetes educator.
According to Dr Fettke, his AHPRA experience began in 2014 with an anonymous notification by a hospital dietitian in regard to encouraging people to reduce their sugar intake. A further 2016 notification, again by an anonymous dietitian, included a complaint of "inappropriately reversing a patient's Type 2 diabetes".
According to Dr Fettke's wife, nutrition has been deemed by AHPRA to be "outside the scope of practice" of an orthopaedic surgeon, even though the majority of Dr Fettke's patients have weight-related joint issues and/or diabetes.
Dr Fettke advises patients to limit their intake of added sugar to the levels recommended by both the World Health Organisation (WHO) and our own CSIRO. WHO recommends that no more than 10 percent and ideally no more than 5 percent of daily energy intake should come from free sugars. This is the equivalent of 12 and ideally six teaspoons of added sugar per day. The average intake by Australians is approximately 14 teaspoons a day with teenagers consuming considerably more. Research has shown an association between sugar intake and the modern day health epidemics of obesity, Type 2 diabetes and cardiovascular disease.
After a two year investigation, AHPRA informed Dr Fettke recently that he was "not suitably trained or educated as a medical practitioner to be providing advice or recommendations on this topic as a medical practitioner". This 'caution' that AHPRA has handed down suggests that he is also restricted from participating in any 'nutrition' research projects to improve the health outcomes of his patients. Dr Fettke has been informed that there is no right of appeal against the decision, although a subsequent media release from AHPRA suggests that an appeal to the Supreme Court is possible (albeit prohibitively expensive).
It is also unclear from AHPRA's decision which doctors are allowed to give nutrition advice and which are not. All doctors receive equal amount of nutrition training (admittedly very little) during their medical degrees. A number of practitioners such as Dr Fettke then go on to explore the science behind nutrition more fully.
The field of nutrition is going though a very interesting time with some long-held beliefs being widely challenged. In addition there are numerous unqualified "gurus" giving advice about what we should and should not be eating. Surely it is preferable to have a doctor giving nutrition advice rather than unqualified individuals, many of whom have a product or program to sell.
I have actually heard Dr Fettke speak at conferences on the topic of nutrition and have been hugely impressed by the depth of his scientific knowledge and his passion to make a difference to his patients.
Surely we should be encouraging, not discouraging, doctors to be giving lifestyle advice in an attempt to reduce the rapidly increasing numbers of Australians suffering from obesity and Type 2 diabetes. The decision by AHPRA needs to be urgently reviewed.