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Joy of consulting and low-carb prescribing - Watch out for ‘pings’ says award-winning GP
Joy of consulting and low-carb prescribing - Watch out for ‘pings’ says award-winning GP
![Glen Davies at the NZPHA](/sites/default/files/styles/cropped_image_16_7_/public/2021-06/Glen%20Davies%20Awards%20Night.jpg?itok=PdnP2-xy)
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This article was first published in the 23 June edition
PRIMARY STARS
Medtech GP of the Year Glen Davies talks to Fiona Cassie about his low-carb mission, the consultation, and being too accessible
Medtech GP of the Year Glen Davies hates the word patient.
“I don’t encourage any of my patients to be patient: I think every single one of them should be a pain in the arse, basically,” Dr Davies says.
“They should be insistent they get what they want.”
It was a challenge from an impatient patient that turned the Taupō Medical Centre GP into an advocate for low-carbohydrate diets as a health intervention for type 2 diabetes.
His “passion for eradicating a major disease”, by encouraging a low-carb diet to reverse type 2 diabetes, was noted by the judges of this year’s MedTech GP of the Year Award, presented at last month’s New Zealand Primary Healthcare Awards | He Tohu Mauri Ora.
The citation notes the “great impact and outcome” of the Reverse Type 2 Diabetes Taupo (RT2DT) group, which he helped establish. Its Facebook following is close to 3000 people.
Fellow finalist GP Lily Fraser is also a passionate advocate of low-carb eating, and Dr Davies regards the two of them as joint winners.
A GP for 25 years, he says medicine initially wasn’t on the cards.
“I had preferential entry into dentistry, so I figured, that’s easy,” he recollects with a laugh.
It was after a young psychiatry registrar visited his grandmother that he changed direction. The young doctor had a lovely bedside manner, wore a paisley shirt, and drove a Mini with a Union Jack on the roof: “He was just the coolest dude.”
After graduating in 1989 from the University of Otago, Dr Davies spent two-and-a-half years at Tauranga Hospital, before taking an obstetrics and gynaecology role at a Papua New Guinean mission hospital.
In his two years there, he had to “do whatever you needed to do”, including 80 caesareans, 80 breech births and 80 twin deliveries. He also managed to do 80 scuba dives.
“I always vowed that I would do more scuba dives than caesareans,” he laughs.
On his return, he was a GP locum for a year, including in Taupō. He bought into Taupō Medical Centre a year later, on April Fool’s Day 1997.
In the early days, he was busy balancing 10-minute appointments and delivering babies – often finding a large group of patients waiting when he returned from attending a birth.
He loved delivering babies and, with the expertise gained in Papua New Guinea, was reluctant to let go of obstetrics. He continued with obstetrics work well into the early 2000s.
For Dr Davies, the joy of general practice, and its strength over other specialities, is the art of the consultation. “I compare it to a party, where you just sit down and talk to one person and move on, and have a rewarding conversation with the next person.
“It’s the one thing that can never be tampered with, as it happens in your room, with your client, behind a closed door,” he says.
But GPs are easily accessible these days to any patient savvy with technology, including texts, Facebook and messenger apps.
“That’s my struggle at the moment… the fact that, while you are with someone, you can hear all those ‘ping, ping, pings’, and you are aware each ping is something that requires action.
“To me, that’s where we’ve gone off track in general practice, and that’s what we’ve got to dial back.”
He made it worse for himself by sharing his phone number with many patients – because he is so keen to support them in reversing diabetes.
“And when you’ve been in general practice for a small town for a long period of time, you just end up with 3000 friends,” he says.
Treating hypertension just with drugs is like putting a sticking plaster over a warning light on your car’s dashboard, says Glen Davies.
It does nothing to find or fix the underlying cause, says this year’s Medtech GP of the Year.
“About 70 per cent of the consultations we do are for non-communicable diseases (NCDs), and the majority of those are some manifestation of metabolic syndrome.
“And that all comes down to insulin resistance, which all comes down to eating processed foods, sugar and refined carbohydrates.”
Dr Davies, a co-owner of Taupō Medical Centre, is on a mission to encourage GPs to tackle insulin resistance with diet, not drugs.
It is about three years since a “road to Damascus” moment led to his advocacy of a low-carbohydrate, nutrient-rich, wholefood diet to reverse type 2 diabetes.
He doesn’t know how his patients – and others in the wider Reverse Type 2 Diabetes Taupo (RT2DT) group he helped to set up – have fared in trying to stick long term to the diet recommended to them.
But a total of 103 of his patients have reversed their type 2 diabetes (42 patients) or pre-diabetes (61). After two years, 75 per cent of the former remained in reversal, and 81 per cent of the latter did so.
Dr Davies acknowledges other interventions successfully deal with insulin resistance. He points to the 2017 DiRECT trial in Scottish general practices, in which patients took a dietary supplement then reintroduced food.1
But advocating low-carb diets to treat insulin resistance and metabolic syndrome is his passion, and international evidence is growing that it can result in type 2 diabetes remission.2
“Medicine will be so different when doctors learn all of this – when they start prescribing low-carbohydrate and ketogenic diets rather than medications,” Dr Davies says.
Hyperinsulinaemia and insulin resistance are behind not only diabetes and obesity, but also conditions like hypertension, gout, Alzheimer disease, non-alcoholic fatty liver disease and some cancers, he says.
Ninety per cent of prescriptions for NCDs could be replaced by dietary changes, he estimates. Poor diet, inactivity, stress and lack of sleep are all contributors, but it is poor diet that concerns him most.
“To me, it’s a no-brainer that we absolutely should be taxing sugar and refined carbohydrates.”
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1. Lean MEJ, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet 2018;391, 10120:541–51.
tinyurl.com/DirectDiabetes
2. Goldenberg JZ, Day A, Brinkworth GD, et al. Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data. BMJ 2021;372:m4743.
tinyurl.com/LowCarbBMJReview