Why GPs need to get off the drugs: I'm a doctor who de-prescribes

Fortunately, the doctor has a pill for every ill. Well, almost. Doctors are trained to prescribe. We make a diagnosis and, voila, here's your prescription.

Except the pills are not the cure. At best they are mitigation, a bandaid that slows the inevitable progression of the indignities of age. What's worse, the pills have a habit of multiplying. Too many meds is called polypharmacy. We all know an older person taking handfuls of pills, and they don't seem to get better, just slowly worse.

But what if you could age healthier? Maybe the afflictions described above are not inevitable? What if they are preventable? Or reversible? What if, through the power of diet and lifestyle, the prescriptions become redundant and can be de-prescribed?

Many of the diseases of ageing can be linked to metabolic syndrome, a cluster of five conditions that tend to travel together: abdominal obesity (a fat belly); high glucose levels (not quite diabetes); high blood pressure; high blood triglycerides; low HDL cholesterol.

As a doctor, once you see one of these conditions you look for the others. But metabolic syndrome is so much more: it also clusters with other diseases such as fatty liver, depression, osteoarthritis, stroke, Alzheimer's, cancer. The list goes on, and more of these diagnoses typically leads to more medication, unless you see that these conditions are not simply due to age, but share underlying causes, such as poor diet and lifestyle.

Then you stop seeing them as separate conditions that need another prescription and start seeing the underlying metabolic derangement. Metabolic syndrome is important because it points toward increased risk of cardiovascular disease, it's driven by excess dietary carbohydrates and it is reversible.

Diet and lifestyle are key. By "diet", I don't mean calorie restriction and living on a lettuce leaf a day. Nor do I mean tubs of porridge and bananas, so beloved of dietitians. Or more bloody legumes, or crackers with a scrape of margarine. Because, let's face it, the low-fat, high-carb dietary guidelines that Aussies have laboured under for decades are a big part of the problem.

The remarkable thing is, when you correct the metabolic problems with the right dietary approach, the metabolic syndrome and its related conditions get better. And you need much less medication. These conditions are, in the memorable words of US paediatric endocrinologist Dr Robert Lustig, "food-able, not drug-able".

What Lustig means is that the right foods can reverse the diseases of the metabolic syndrome, while the drugs are only drugging.

The dietary approach is simple: you decrease sugars, carbohydrates and processed junk foods. You focus on whole, real foods. You eat meat, poultry, fish, eggs, full-fat dairy, nuts and non-starchy vegetables. In short, you ignore the dietary guidelines that say "consume lean meat, limit red meat, choose low-fat dairy and eat lots of grains".

The guidelines recommend 45 to 65 per cent of daily energy be consumed as carbohydrates. That's about 250 grams of carbs daily - the metabolic equivalent of about 60 teaspoons of sugar. Every day. That's insanity. Instead, lower-carb diets (less than 26 per cent or 130 grams of carbohydrate daily) or low-carb diets (0 to 50 grams of carbs daily) have been consistently shown to correct all the parameters of metabolic syndrome, as well as the associated conditions.

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Many of the diseases of ageing mysteriously disappear when people eat low carb. OK, it's not mysterious. It's physiology. You lower your glucose intake, reduce your body's need to produce high levels of insulin, lower metabolic stress and inflammation, your grumpy gut improves, your waistline shrinks, blood pressure comes down, your joints ache less, and you feel better. With any luck, your doctor recognises your achievement and de-prescribes some of those pills.

It sounds like magic. But it works. As a GP, I've seen my patients do it. The right diet is powerful medicine.

At age 58, Jane was ready to lie down and die. With a multitude of diagnoses, including morbid obesity (BMI of 43), pre-diabetes, high blood pressures, depression, chronic back pain and an arthritic knee, Jane's days were punctuated by painkillers, anti-depressants and other psychotropic medications.

The icing on the cake was the diagnosis of fatty liver. Jane's GP used the term "metabolic syndrome," pointing out that much of her misery could be improved with the right diet.

Jane was already working out at the gym with a personal trainer. What she did next was gradually remove the carbs from her diet. Bread was the last of the starchy carbs to go.

Over two years, Jane reversed the markers of metabolic syndrome, including insulin resistance. Her liver returned to normal. In this time, she lost 28 kilograms - 26 per cent of her previous body weight.

She's kept it off for four years. Even COVID didn't derail her. She wasn't superstrict. She enjoyed a faceplant into a birthday cake for her 60th. And she pays for the occasional indulgence with a flare of once familiar aches and pains.

Still, the changes she's made are enough to keep her off the orthopaedic surgeon's wait list and reduce the number of pills. And she can see how much better off she is than many of her peers, the ones for whom dietary and lifestyle change seem too hard.