Indigenous health expert

Nutrition scientist and public health researcher Professor Kerin O’Dea discusses a career dedicated to researching diet and chronic disease in Indigenous Australians.

Australian Life Scientist: What drew you into studying science?

Kerin O’Dea: I wanted to study science from really quite a young age - when I was about 12. I was absolutely fascinated by reading about drug discovery and learning, for example, about curare, a powerful muscle relaxant used by the Indigenous people of South America in their ‘poison arrows’ to hunt and disable game - that that was then widely applied in surgery.

That got me interested in drugs and pharmacology and I ended up doing pharmacology at Melbourne University. I did the equivalent of an honours year in pharmacology but then switched fields to do a PhD in biochemistry.

ALS: How did you become involved in nutrition research?

KO: I was working in a very specialised area of physical biochemistry and I couldn’t see the direct application of it and it wasn’t something I could discuss easily with people who weren’t experts in the field so I went back to pharmacology. I spent the first two years of my postdoc in the early 1970s working for Bayer in its research division.

That was in the days when the pharmaceutical industry was doing really good research. Bayer had very big research division and I ended up looking at alpha-glucosidase inhibitors. These were eventually turned into drugs and used not all that successfully in diabetes treatment, but the principle was fascinating.

And that was what got me interested in nutrition generally. I was fascinated to see that you could greatly improve the metabolic profile of a rat that was insulin resistant by simply slowing down the digestion and absorption of complex carbohydrates. I realised it was like unrefining refined carbohydrate and felt it obviously had application in conditions like diabetes.

I did some of the early work on the glycaemic index - looking in particular at the rate of digestion and absorption of unprocessed foods, like brown rice, and then showing that if you ground it up you would get much faster digestion and absorption, and correspondingly higher glucose and insulin responses. So that’s really how I got interested in diet diabetes - and that remains a major research interest.

ALS: Did working in Indigenous health bring you back to Australia?

KO: I first got interested in diabetes in Germany. Then I was offered a job at the Cleveland Clinic in the US as a project scientist, and held that position for two years.

I was able to organise my own research program and I continued on with the work that I’d started at Bayer, looking at different feeding patterns in rats. Rats normally nibble on food throughout the night, but when you expose them to large amounts of food just twice a day they learn to gorge during those feeding periods. Even though they don’t eat more food, they actually put on more fat and develop insulin resistance. It was very interesting work.

This led to research on glucose and insulin metabolism in animal models of diabetes.

When I returned to Australia in 1977, I was working as a research scientist at the Royal Children’s Hospital in Melbourne. The Professor of Paediatrics at the time, Don Cheek, was working with Aboriginal communities looking at child health and undernutrition. I was interested in the opposite really - adult health and overnutrition.

Professor Cheek worked with clinicians in the Kimberley and Central Australia, and pointed out to me that Aboriginal people were starting to get type 2 diabetes. He also told me that groups of Aboriginal people in the Kimberley were going back to the bush in the dry season and living off the land. I thought that would be a fascinating natural experiment - to see how their health changed as a result of going back to live off the land. And that was the first study in Indigenous health that I was involved with.

ALS: You’ve conducted some pivotal studies in Indigenous health in Australia, can you discuss some of these?

KO: I conducted several studies in the late 1970s and early 1980s where Aboriginal people actually did go out and live off the land completely. The most famous one was where we went out with a group of people with type 2 diabetes and showed a huge improvement in their health in the space of just seven weeks. All of the metabolic abnormalities of diabetes were reversed or greatly ameliorated.

The Aboriginal participants were not surprised - they knew their traditional lifestyle was very healthy. Clinicians were more surprised because they didn’t think you could reverse diabetes so quickly.

For me that was the most important study I’ve done because it put me on the path for the rest of my career. I was fascinated by the traditional hunter gatherer diet and lifestyle and understanding the foods, looking at food quality and how different it is from our diet and lifestyle now. Agriculture has made food more palatable but it’s probably not nearly as healthy as the ‘wild’ foods that these people ate - wild animals are very high quality.

Aboriginal people - and hunter gatherers everywhere - ate everything from a carcass that was edible. They value things that are nutritionally very healthy, which we value less. For example, they absolutely valued the brain, which is a fantastic source of long-chain omega-3 fatty acids, particularly DHA (docosahexaenoic acid), which we now know is probably very important for mental health - it’s certainly important for brain and nervous tissue development.

They also value the liver, which, interestingly, is a good source of vitamin C, and a wonderful source of folate, zinc, iron and numerous vitamins. You wouldn’t want to live on it, but the way Indigenous people ate it, which was small amounts shared among many people, was very healthy. They also valued bone marrow. Another highly valued food was honey.

While they got most of their energy most of the year from bulky foods with low energy density, their favourite and most highly valued foods were the fatty or sweet components of their diet. It is as if humans are programmed to know that these preferences were very important.

ALS: Do these results translate to other populations?

KO: Our genome has changed very little since we were all hunter gatherers.

There are a few differences. For example, most people in Western societies can drink milk and tolerate lactose well into older age, but that is not the case in many populations around the world where people develop lactose intolerance after infancy.

However, a hunter-gatherer diet is not practical for people living in big cities. We’re not hunting ourselves and we’re not eating the food really fresh.

I would never tell people to live entirely off animal food. The animals that we’ve bred for food, until recently, we’ve bred to be fat. From a hunter-gatherer perspective this was probably quite sensible, but for us, we are sedentary and consume too much.

I definitely use the hunter-gatherer diet as a model. The principles are excellent - minimally processed whole foods - lean meat, from wild animals ideally. I am also an advocate of eating offal - but not from intensively reared animals because you just don’t know what might be in them.

ALS: In your work in the Kimberley region, was there a two-way exchange of knowledge in your work with Indigenous communities?

KO: I did a lot of that work from a Melbourne base, but I’d go up to visit for a couple of months at a time.

The locals were fascinated with my interest in all this and were wonderful teachers. Their knowledge was extraordinary - of animal behaviour, animal life cycles, plants, the knowledge of their environment. These were people who were no longer living as hunter gatherers but they had spent time in their early life as hunter gatherers and their parents had been hunter gatherers. They were very proud of that knowledge and it was most impressive.

I used to wonder how people could survive in the desert - and the people from the desert said they didn’t know how anybody survived anywhere else!

And all of a sudden I could see. Because there are grasses and grass seeds in the desert regions, emus and bush turkey as they are called - the Australian bustard - and goanna are actually quite fat because they have a good diet eating seeds. I was fascinated when people would go out and within half an hour they would have caught a few goanna, they might have ambushed (or in these days shot) a turkey, and they’d have a really good feed.

As Westerners we have a huge amount to learn from the study of the hunter-gatherer diet and lifestyle.

I really wanted to talk to Aboriginal people about how they could adapt the principles of the hunter-gatherer diet and lifestyle to their Western diet and lifestyle - to use the traditional diet and lifestyle as a benchmark. Even if they couldn’t go out hunting to choose store foods that are more like bush foods.

ALS: You are one of the directors of Outback Stores, is this one of the possible solutions to people accessing better quality food in remote areas?

KO: Working on the quality of the diet is certainly is one of the briefs of organisations like Outback Stores.

There’s another very good store organisation in the Northern Territory called ALPA. It was originally called the Arnhem Land Progress Association and is run by the elders of a number of Arnhem Land communities. They’ve had a healthy nutrition policy for years and try to minimise the cost of fresh fruit and vegetables. Outback Stores has the same goals.

Many people would say that the store in an outback community should be seen like the school and the clinic - that is as a service provider. But at the moment the store is a small business and so it has to make a profit.

I would love it if there could be links made with the major supermarket chains so that people could get the same sort of low prices that are available in cities. That’s the aim but we’re not there yet.

ALS: Is the government providing support for this?

KO: In principle they are, but I think there’s a real reluctance in Australia to provide food to people.

We give billions of dollars of support to industry in remote parts of Australia, such as providing the diesel fuel rebate, yet there’s a reluctance to provide food for children, for example.

I think in the long term we are going to have to make the economic arguments to set up some programs to improve the nutritional quality of food. Subsidising the whole food supply would be very expensive, but we could provide very cost effective healthy breakfasts and lunches for children and it would have huge beneficial outcomes.

Other countries are doing some interesting things. Canada has a program called Nutrition North where, as I understand it, communities can get subsidised hampers of food delivered in very remote areas. We spend so much on people once they get sick, yet we spend so little on keeping people healthy. The economic arguments will have to prevail eventually.

The health promotion approach we have assumes that if people have the knowledge they’ll change their behaviour. The campaigns about health barely make a dint in the very clever marketing campaigns for unhealthy food. The most heavily advertised foods and drinks are mostly the ones we should avoid.

I’m not against government health promotion programs but they need to be integrated into action.

One of the issues with the food supply is that the processed food and beverage industry is very powerful and these transnational companies have huge influence over government.

ALS: What about taxing junk food?

KO: Yes, there is a good argument for that and using the money raised to promote healthy food or using it in a way to make healthy food cheaper - for example, to support meals for children in day care, kindergarten and primary school.

It will take a courageous government to do it.

The real issue that we have to face is that obesity and type 2 diabetes are increasing at an alarming rate. People are getting type 2 diabetes at a younger age and this actually starts a terrible intergenerational cycle. When women have diabetes in pregnancy, particularly type 2 diabetes in pregnancy, which used to be very rare, their offspring are at much greater risk of developing early onset obesity and type 2 diabetes.

We need to break that cycle because we are all paying for it. So, although we are reluctant to tax some of the causes of obesity, we all carry the costs. And the healthcare costs are just getting higher and higher. I think these are some of the important discussions we are going to have to have.

ALS: What do you think is the main challenge to overcome to turn this around and start reducing the rates of these diseases?

KO: Translating the results of research is a big challenge. It will require major changes in the food supply and in the way we live. Physical activity needs to be built into daily routines. Urban planning to encourage walking and cycling, and an excellent public transport system are important components of a healthy society of the future.

People who are poorly educated and socially and economically disadvantaged are much more likely to be overweight, obese, have diabetes, etcetera. How do we minimise the impact of social disadvantage?

Education is fundamental to this and a lot of Aboriginal leaders have recognised that and are really pushing that children get the opportunities so that they can lead full lives in the future.

We used to be a society that was much more egalitarian in the middle of the 20th century. But we’ve become less unequal over time and I think the health problems we are seeing are, in part, a consequence of this.

Working on interventions that can improve diet quality and lifestyle should be seen as an investment in our future, rather than seen as welfare. I think any country has to be judged on how it treats its most disadvantaged people, and I don’t think Australia is doing very well at the moment.

ALS: You were director of the Menzies School of Health Research in Darwin and the Sansom Institute of Health Research at the University of South Australia. How did your career path come to this?

KO: I have to say probably I wouldn’t have thought of doing anything like that until after I’d been at Deakin University. I had been a professor and head of a research institute there, and then I became the first Dean of Health and Behavioural Sciences in the newly merged larger institution.

That was a terrific experience and where I was supported to build a research culture in an organisation that previously didn’t have a very strong one.

I was Pro Vice-Chancellor of Research at Deakin for a couple of years as well. Through that work I became very familiar with the whole research management system in Australia. Those were two very good learning experiences that enabled me to then move in and be reasonably comfortable directing an institute like the Menzies School of Health Research. Also, it was an area I was passionate about. So becoming director of an independent health and medical research institute focusing on Indigenous and international health in northern and central Australia fitted with that passion.

The Sansom Institute for Health Research is a different kind of model. It is more of a vehicle with which to build the research culture in a university. The University of South Australia had patches of very strong health research but there were areas that weren’t strong as they could be.

ALS: And finally, what are your plans for the future?

KO: I stepped down [from being director of Sansom] because I have an NHMRC Program Grant - I say it will be the last big grant that I get - and I really needed more time to devote to that. I’m halfway through it now.

The project is looking at preventable chronic disease in Indigenous populations and really looking at the food supply, people with diabetes, how to get early interventions, that type of thing, what’s practical.

My longer term plan is to mentor younger people coming through because that is the future. It’s very important that they become advocates and lead research that is focused on solutions rather than just problem definition.