Healthcare Starts with Better Conversations

Episode #88 is LIVE | Healthcare Starts with Better Conversations 

Medicine is built on the noble intention of helping people heal.

So why are so many patients leaving consultations feeling unheard, unsupported and simply handed another prescription?

This week on Metabolic Wellbeing without the BS, I had the privilege of sitting down with the wonderful Dr Liz Fraser from Canberra, Australia—a recently retired GP who spent decades working within the medical system while courageously questioning many of its assumptions.

This isn't a conversation about blaming doctors.

It's a conversation about understanding the pressures they face.

🎙️ Together we explore:
 ✅ The emotional toll of being a junior doctor.
 ✅ The culture of medical training and why Dr Fraser jokingly refers to the MBBS as the "Mind Boggling BS" qualification.
✅ Why 15-minute GP consultations often make genuine preventative healthcare almost impossible.
✅ The burnout, pressures and emotional burden carried by healthcare professionals.
✅ Why doctors need emotional support just as much as their patients.
✅ The growing evidence around nutrition and metabolic health that many clinicians acknowledge privately but feel unable to discuss publicly.
✅ How fear of "rocking the boat" can prevent meaningful change.

One message stood out above all else...

Healthcare isn't just about prescriptions. It's about relationships, curiosity, humility and having the courage to keep asking better questions.

The evidence supporting real food, metabolic health and lifestyle medicine continues to grow.

Yet changing decades of entrenched thinking takes courage.

For clinicians.

For patients.

For all of us.

As Liz reminds us, listening may be one of the most powerful interventions in medicine.

And perhaps the most important takeaway?

👉 Your health is ultimately your responsibility.

No guideline, medication or healthcare professional can care more about your wellbeing than you do.

The time to start isn't tomorrow.

It starts today.

🎧 Episode #88 of Metabolic Wellbeing without the BS is now available on all major podcast platforms.

If this conversation resonates with you, please like, share and leave a review. Every conversation helps challenge outdated thinking and empowers more people to become the CEO (Chief Energy Officer) of their own health.

Transcript

SPEAKER_02 0:02

Hi, I'm Martin Gillespie and welcome to another edition of Metabolic Wellbeing Without the BS. We are going to Australia's capital city. For those who do not know, the capital is not Sydney, it's not Melbourne, but it's Canberra, and we have Dr. Liz um here today. So Liz, welcome to the show. Who is Liz?

SPEAKER_00 0:26

Well, I'm a very recently retired GP, and you might say that I'm an anti-GP. I worked in the mainstream medical system for nearly 30 years. I've long had reservations about medical practice, and there isn't a critique of Western medicine that I don't agree with at some level. I am also a human being who loves walking the dog and gardening and getting my hands dirty and very much enjoying not being responsible for everybody else at the moment. I burnt out as a junior doctor in three years and I left medical practice in a state of high dudgeon and I was never going back, but I maintained my registration. I went off and I washed dishes and then I ran a vegetarian cafe for a couple of years. I worked in a women's refuge. I studied health education at Cambridge University and I got a master's degree and read a lot of the philosophy and sociology about health. And in that time I did a lot of growing up. So after 11 years, I went back to medical practice and I trained as a GP. I figured that after 11 years it wasn't safe to be let loose on the unsuspecting public. But interestingly, what I brought with me was a broader view of what constitutes health. So I guess as a result of the study that I'd done, I was very interested in the psychosocial part of the biopsychosocial model of medicine. And I've really fell out of love with prescribing over the past 26 years. And through my own health journey, I I found a way into the rich medical research literature and started looking at biochemistry and cell biology. And dabbled in, I guess, CAM, complementary alternative medicine, did some courses through the Australian College of Nutritional, Nutritional and Environmental Medicine. And then in 2018 I stumbled into the low carb space. I found low carb done under while I was looking around about looking up information about ketosis for a patient with Parkinson's disease. And what really amazes me is how much of this information is out there, but it's hidden from view, like it doesn't translate into clinical practice. Mainstream medicine has a very narrow definition of what constitutes knowledge and what's acceptable in medical practice, but there's all this information out there in the research literature, and I was shown how to read the reas find the research literature, I guess, and um started bringing that into my clinical practice, and uh the low-carb Down Under uh conference in Sydney in 2018 changed my both my personal life and professional life. So, what else would you like to know?

SPEAKER_02 3:48

Wow, so I have a question for you, and in fact, I've got quite a few.

SPEAKER_00 3:54

Good.

SPEAKER_02 3:58

If you could go back to your medical training, what would you change?

SPEAKER_00 4:06

My medical training was such a long time ago. Um, I started in the late 70s and finished in 1984. Um gosh, you've caught me a bit off guard there, Martin. Um I think I I I actually had a uh background, I did fairly uh boring straightforward undergraduate degree um uh in medicine and MBBS, mind-boggling BS. Um and that included lots of basic physiology and biochemistry. So when I started reading the literature again um about 10 or 15 years ago, I actually was familiar with a lot of the concepts. Of course, things have moved on a lot since then, but I do think all that biochemical stuff is really important and understanding what's going on in the inner body. Um so my undergraduate medic medical degree was six years, three years preclinical, and then three years clinical. I guess one of the things I would like to see changed is the culture of um bullying um junior doctors, uh, the long hours and the um kind of sink or swim approach, because uh that's what uh that's some of what defeated me back then. Also, I think uh junior doctors or medical student students and junior uh doc doctors in training and junior doctors need um a lot of emotional support because this is a emotionally tough job and I wasn't prepared when I was a uh young adult. Um, you know, I graduated at the age of 23 or 24. Um, I wasn't emotionally prepared for the uh the the practice I was thrown in the deep end as um junior doctors are. So there's some of the things that I would want to take questions.

SPEAKER_02 6:19

Les one key thing that you've said, and I know we spoke about this off camera. There is this culture type A personality at school, you become a lawyer or a doctor.

SPEAKER_00 6:31

Yeah.

SPEAKER_02 6:32

Now you take an 11-year hiatus, and we'll come back to some of the the wonderful things that you did. But don't you think there should be a bit of a reality check and go take the foot off the gas, you're 18, 19, take some time out.

SPEAKER_00 6:54

Um that certainly wasn't an option back when I was that age. And I think a lot of uh young people do that now, and they go out and they have that gap here, and they go traveling and they see the world and they do a bit of growing up and um uh come face to face with reality. I I did things the the other way around. I went straight into um undergraduate medicine and then practiced as a junior hospital doctor for three years and burnt out and ended up um washing dishes and going into hospitality where I burnt out in two years. Um so uh you know, we all we're all on a different life journey, a different life path. Um there's different ways of doing it, but I think that's perhaps um one of the reasons why um medical training now uh is postgraduate, a lot of it is postgraduate training. They young people go to university. Well, people of any age really can go if they can meet the entry criteria. Uh, there are people going back in middle age to university and doing postgraduate medicine. Um, so there's many different ways, and those people make very good doctors because they have the life experience.

SPEAKER_02 8:13

There's two there's two doctors as you um speak about it. There's two doctor two Australian doctors that I know of personally who have got non-medical first undergraduate degrees, and that's Dr. Olivia Lesler and um a neurosurgeon in Sydney, Dr. Benetta Simmons. They've done degrees in uh international relationships.

SPEAKER_00 8:34

Yeah.

SPEAKER_02 8:36

So they didn't go back, they didn't start their medical journey until they were about 27, 28, and that really reflects quite a bit of what you said there. You were 23 and you're dealing with life of other of others.

SPEAKER_00 8:52

Yep.

SPEAKER_02 8:53

But you don't have enough life experience to sort of I was going to say have those um emotional controls of your of yourself.

SPEAKER_00 9:03

Yes, and be able to respond to people who are um when people are having health crises, they're not having a good time. And um I guess doctors tend to certainly when I was uh a young doctor, there was, and there still is to some extent, this idea that the doctor is the font of all knowledge and wisdom and knows everything. And really uh what I learned in general practice is that uh patients are in patients, the people I don't like using the term my patients, I think it's um a bit affected. Um, but the people who came to see me are by and large intelligent people, they've been doing some reading, they've got their own thoughts and ideas. It's a negotiation, and I'm there to provide my expert knowledge, but I had to acknowledge that the patient is actually the expert in their own health. Um and listening to them, one of the gifts of retirement was that I had people that I'd been seeing, some for as long as two or more decades, um, come to me and thank me and give me feedback. They appreciated that I listened, that I didn't reach for the prescribing, uh, you know, I wasn't automatically prescribing. Um, I offered them information and I wasn't bullying or threatening about, you know, you must do this or you're going to die next week or next month, which is uh a lever that doctors often pull, uh, which is based on that authoritarian position that we're supposed to occupy. And that's, I think it's the old model. Uh I was definitely in a patient-centered model where uh the patient is an expert in their health, and I'm there to help support them make the best decisions that they can for them.

SPEAKER_02 10:59

Now, one of the things that you mentioned in your gap time between your undergraduate and then going back into becoming a medic was that you ran a vegan. Was it vegan or vegetarian?

SPEAKER_00 11:12

Well, vegetarian.

SPEAKER_02 11:13

Vegetarian.

SPEAKER_00 11:14

Yeah, I wasn't strictly vegan, but like I did like the tofu topping on the pizza.

SPEAKER_02 11:20

I mean, we're talking, let's let's give some context here, right? We're talking sort of the 90s, 80s, 90s.

SPEAKER_00 11:27

Yes, yes, the uh there's a vibrancy of change.

SPEAKER_02 11:31

There's a vibrancy that food was and always will be a communication tool. You know, there's trends that happen in catering. You were just on that on that wave. And to be honest, in the last 10-15 years, there are there have probably been more sort of trends of food, etc. Where would you rate that now though? Would you say that that a sort of vegetarian lifestyle is one that you would endorse?

SPEAKER_00 12:06

Absolutely not. Having lived through it and survived, um, I think we were all slightly mad. Now, maybe that's partly a function of being uh young. Um, but also I think um a vegetarian diet is an incomplete diet and doesn't provide um particular brain nutrients. And I look back at that time, and even though I went back to eating meat uh after some years, I always spent uh I was still convinced that plants were better, and I spent a lot of time trying to eat less meat and consume lots of legumes. And that I think contributed to my personal health crisis of about 15 years ago. Now at the age of 65, I'm in a lot better shape than I was at the age of 50 when I was very focused on grains and legumes and meat as the uh little bit of stuff that I was trying to cut down. You know, instead of having a whole chicken thigh have half a chicken thigh, you just don't get the nutrients that you need. And for me, um my turnaround came when I started taking a handful of supplements in B6, magnesium, and vitamin C, followed by things like iodine, selenium, and methylated B vitamins, and my brain switched on and I was able to think again, and that's when I embraced looking at uh the literature about nutrition, and um I it's been a really long journey, it's taken many, many years for me to undo all that unhelpful thinking and prejudices that I had, and I think there's a lot of um uh pressure, a lot of propaganda out there extolling the virtues of uh plant-based or plant-forward diets. And personally, I think it's wrong for a population. There might be some people, and I've had people who tell me that you know they're thriving on a vegan or vegetarian diet. Well, good luck to them, but I didn't, and I have seen plenty of people who haven't either. So I think it's it's a life choice that might be embedded in particular values, but I don't believe that it's good for the uh person or good for the planet.

SPEAKER_02 14:36

Now you open a hornet's nest there.

SPEAKER_00 14:40

Yes, I certainly have.

SPEAKER_02 14:42

If you walk into any now any aged care facility, meat is probably the lowest part of what they're feeding elderly people. Schools are now going more plant-based. There's this dogma of plant-based, you know, here in the UK, five vegetables in Australia, it's you know, five a day as well, isn't it? I think it is.

SPEAKER_00 15:12

Um Yeah. And Zoe Harcomb has um exposed uh that for what it is. It's propaganda. There's no evidence based for any evidence based for any of that. When I hear the term balanced diet, I kind of go, you know, I want to punch that person. Um I think what's more important is a nutritious diet, a nutritionally complete diet. And there are some nutrients which you just don't get from plants and which are found in uh eggs and animal food. And um, me personally, at the age of 65, I'm in far better health than I was at the age of 50 when I took time off work, and at that point I didn't know whether I'd ever work again, I was so unwell. And um, in the end it was four months. But the things that got me better were the nutrients, which showed that my diet was incomplete. And the interesting thing was that six months before I developed an autoimmune condition, I'd been to see a dietitian because for various reasons, because of food sensitivities and intolerances, I was on a restricted diet and eating vast quantities of legumes and lots of plant matter. Uh, and she said, Oh, it's pretty good, like I was actually doing a pretty good job, and I still got really sick. And at the end of the year, when uh I completed the antithyroid medication, like I had hyper hyperthyroidism Graves disease, um, the numbers were normal, but I was a complete mess. And um I've progressively changed my diet over you know a decade and a half, and I now base my meals around meat, eggs, and cheese, and the green stuff is there to make the plate look pretty, and you know, I enjoy it. I grow my own vegetables and I really enjoy eating them. Um, but I focus on real food, and uh, meat, eggs, and cheese provide the nutritional foundation that enable me to be physically active, to go walking uh with my dog to do regular resistance training, um, to spend all day in the garden and not feel completely um messed up afterwards. Um what I'm aiming for personally is to is uh kick ass uh aging. And you mentioned aged care facilities. Um my understanding is that the budget for food for people in aged care facilities is minuscule. Um so I'm not surprised that they barely get any meat. And the contrasting, I guess the counter example is Hal Cranmer in the United States who runs some boutique care homes, and he gets people in who can't, you know, they don't go there because they're having a good day, they go there because they can't do anything for themselves, so they're often obese, have chronic metabolic disease, and he uses a variety of strategies, including animal-based diets, exercise, sauna, uh resistance training, etc. etc. Some of those people end up going home. They regain uh independence, and isn't that phenomenal? And shouldn't we be doing that kind of thing for people before they need uh care facilities in the long term?

SPEAKER_02 18:50

I couldn't agree more. One piece of um wisdom I would like from you, though, is when people start making these changes, and you mentioned that you were ill for about four or five months. People want a quick fix now. You know, you must have seen this in surgery and your practice for many, many years. Doctor, just give me a pill, I'll feel better. What caution would you give around the time it takes for people to really change and see change happening?

SPEAKER_00 19:25

Oh it's everyone's on an individual journey, but I think I often say to people, you've got to have a long view on this. Um and it's not just the physical changes, physical changes can occur quite quickly, um, but it's also mindset change, uh, and that can take time. And I know that it took me a long time to unlearn all that fat phobia that I had, that it's okay to have the fat on the chop, and it's okay to have the chicken skin. In fact, it's the best bit, like the pork crackley. Um, a lot of people are really, really afraid of animal fat. We've had, you know, is it since the 1950s or 60s, so six or seven decades of propaganda against saturated saturated fat, animal fats.

SPEAKER_02 20:24

It's so one of the I like your point, Mare, around it's a personalized journey. And I think that that's where unfortunately I can see medicine, and if you want to call it the health journey, it's a personalized approach, which you need a my call out is people are listening to this and want to know where to get started, it is so vital to have a team around you to help you. And a a GP, give some credit to GPs, they do have some knowledge if they're open enough to learn.

SPEAKER_00 21:01

If they're not knowledge resistant, if they haven't been um bought the guidelines for Klein and Sinkra. And a lot of uh GPs believe that um you've got to follow the guidelines or something terrible will happen, that you'll be medico-legally exposed. And the point about guidelines is that uh medicine um medical practice should not be slavish rule following. Um, and I'm a big fan of uh a paper by David Sackett et al. from the BMJ in 1999, evidence-based medicine, what it is and what it isn't. And Sackett talks about the evidence based medicine triad, the best available evidence, and often it's not very good if the studies haven't been done because there are no financial incentives to do them. Your clinical judgment and experience, like as a doctor, 20 something years of clinical experience is worth is a useful resource, but also. Patient preferences and values? Like what does the person want? And the person may distrust Western medicine. I I used to attract the people who had bad experiences with other doctors, and they would come to me because I would listen and I would respect what they had to say. And you you mentioned the support team, and that can be very wide, and I think in a patient-centered approach, the person is the patient is the center of that team. And it might include helpful people, but it can also include unhelpful people, family, friends, loved ones, co-workers who are all saying, but this crazy diet, this crazy keto or low-carb diet is going to kill you, all that fat. And people, and also allied health providers and other doctors and specialists. Whereas, in fact, many people benefit by not having those things. So being able to be think flexibly and having a team which are aligned in how they see things.

SPEAKER_02 24:04

One other little bit where I don't think there is enough credit given. Those patients with real lived experience are a vital cog. And I think that that goes under the radar too much.

SPEAKER_00 24:19

Absolutely, yes. So um one of the things that um I've been involved in is Low Carb Canberra on Facebook. It's a private group, and there are many low carb groups around the world, and we provide uh support um to you know, peer support to people who want to know more about low carb. You know, it's it's like other uh support groups, we share our experience, strength, and hope. And at times that the difficult stuff.

SPEAKER_02 24:55

You mentioned a wonderful energy there. There is always hope. And I think that that's one key thing where, regardless of what you've been diagnosed with, you've got to have hope. And at times you do need different modalities to help you through that. You mentioned a terrific thing there about team alignment. A key factor is that you also mentioned that the patient is in control, you can't say no to that certain person on your team. Building your own boundaries is vital.

SPEAKER_00 25:38

Absolutely, yes. And so many people I think struggle with um the doctor is an authority and um feel compelled to do what uh the doctor says they must do. And I think there is absolutely no place for bullying. And one of the things that I've heard a lot of is uh people tell me their stories, their experiences in this flawed medical system with doctors who think they have the monopoly on knowledge.

SPEAKER_01 26:12

So, a question for you. What's Liz doing next week? What's the future for Liz?

SPEAKER_00 26:22

Oh well, more of the same. Walking the dog. Hopefully, there'll be some sunshine and uh gardening and doing my workouts, and I'm going to Melbourne.

SPEAKER_02 26:31

It's 28 degrees where I am right now. So, you know, get over it, Princess. The sun is coming out.

SPEAKER_00 26:38

It's been 15 or 16 degrees here today, and it's been glorious. And I was out in a t-shirt. Um, and next week I'm going to Melbourne for a couple of days and um giving a very short talk as part of the Australasian Metabolic Health Society Foundation's great bunch of people there. Yep. So I'm I'm still using my brain and uh still writing articles uh for uh about metabolic health for wherever I can get them published. I'm working on something on type 2 diabetes remission, which we're aiming at Australian Doctor, which potentially reaches thousands of doctors around Australia on how to do get people into remission in general in the context of primary care.

SPEAKER_02 27:30

I think that's super, super exciting. And um the one negative, having lived in Australia for a long time, the general public still have their head in the sand or other parts of their anatomy around type 2 diabetes and obesity. And it's so sad if you look at Australia as you know, this pinnacle of healthy, thriving, the climate is fantastic, etc. But the obesity rates have gone through the roof.

SPEAKER_00 28:04

We're not too fine, uh too far behind the United States in terms of uh poor metabolic health. And um the advent of the new classes of wonder drugs, uh the GLP1 agonists and the SGLT2 inhibitors, for some they have their role, they're a useful tool. I'm not against prescribing those things, but I think that it needs to come with um strong advice regarding lifestyle, that drugs are useful, but they come at a cost, and that's not just the financial cost. There are always potential adverse effects, and quite frankly, doctors tend to overestimate the benefits of our clever interventions and we underestimate the adverse effects. That's just um medical practices, uh tunnel vision and blind spots. We don't see the um the adverse effects, and we focus, we're we're very focused, tunnel vision on the benefits.

SPEAKER_02 29:15

It's funny that GLP ones, Liz, when I moved to Scotland, I thought We Golvy was a Scottish pharmaceutical because of the name, and we Scots use the terminology we all the time. So I thought this is great. Scotland have put on the map health um sort of weight loss drugs. But to your point, and I think that this is a one that I want to drive home with your help, GLP1s do have a place in conjunction with metabolic therapies.

SPEAKER_00 29:47

Absolutely, and you're better off implementing that uh the metabolic lifestyle, the uh therapeutic carbohydrate reduction, the resistance training, the circadian health stuff, and optimizing that and keeping the dose low. Having a GLP1 prescription doesn't give you license to just eat whatever you like. In fact, it's a recipe for disaster in the long term because so many, and you probably know this, so many people don't tolerate these drugs. Many people, about a third of them, end up stopping it due to the adverse effects within about three months. And at some point, um people get sick of paying the enormous cost, and it doesn't work for everyone. And then even if it does work and you stop taking them, if you haven't made the life, the long-term sustainable lifestyle change, you will regain the weight, and the weight you regain will be at a post tissue rather rather than lean mass, you won't gain regain bone and you won't regain muscle. So I think it's a they're a double-edged sword, and um I was always big on counseling people about lifestyle, and the sad thing is that the system is so flawed. It's um I in Australia it's based around 15-minute consultations. You can't have these conversations in 15 minutes, it takes a lot of work to help people see uh what the importance is. You you mentioned people want quick fixes. The drugs look like they're a quick fix, but there ain't no quick fixes in in real life.

SPEAKER_02 31:36

So Liz, that's the beauty of this podcast. We've been able to go around quite a quite a lot of good things, and also you opening your your I was gonna say kimono, I don't mean it that way, opening your heart up to some of your your journey, which has been fabulous. You mentioned you've got some great things coming out. Where can we find these things about what you're doing on type 2 diabetes?

SPEAKER_00 31:59

Well, um the article on type 2 diabetes remission will be an Australian doctor, but it probably won't be until um sometime next year. Um and Australian Doctor can only be accessed uh by people with an uh Australian health professionals registration number, so it's not for the general public. Um I'm one of the uh conveners of Low Carb Canberra. Now there's two low carb Canberras on Facebook, one is a private group and the other is the public page. I'm involved in both of those and I manage the public page. Um and what I'm trying to do is can be one of the voices, one of the many voices in the metabolic health space, and uh provide, I guess, information and inspiration to people who want uh who want it.

SPEAKER_02 33:00

Liz, you've been an absolute inspiration. I know your work for many, many years. I've been lucky enough to follow you and um watch some of your um performances, so to speak. You are an icon for a young, sprightly 65-year-old going, I'm taking control of my health. And thank you for spending your wisdom with me this morning or this evening in your part of the world. I'm looking forward to getting this out because you're out there with some other fabulous trailblazers. I love your definition of MBBS. I'm going to steal that because I think it's the first I've heard. Um, it was brilliant. Liz, thank you so much for your time. I'm going to hold a recording then, but stay on the line.

SPEAKER_00 33:47

Okay, we'll do it. Thank you very much for um allowing me to talk, Martin.

SPEAKER_02 33:52

Liza.