How to implement a total carbohydrate reduction diet for a patient with metabolic dysfunction - RACGP

By completing this course, health professionals will be able to:

Define insulin resistance and its central role in metabolic disease, recognising its strong association with chronic conditions such as obesity, type 2 diabetes, hypertension, cardiovascular disease and certain cancers.
Explain the mechanisms underpinning insulin resistance, including impaired insulin receptor function at the cellular level, the role of excess carbohydrate and fructose intake and the impact of lipid raft disruption in cell membranes.
Interpret clinical markers of insulin resistance and metabolic dysfunction, such as elevated fasting insulin, glucose intolerance and patterns of fat distribution.
Evaluate current evidence on dietary interventions for metabolic health, including the superiority of low carbohydrate diets over low-fat approaches in randomised controlled trials for weight loss, glycaemic control and energy expenditure.
Discuss the impacts of specific dietary components—notably carbohydrates, sugars, and seed oils—on metabolic pathways, de novo lipogenesis, and the formation of harmful lipids such as ceramides.
Critically assess common dietary myths, including claims relating to the “necessity” of dietary carbohydrate for brain function and the role of saturated fat in insulin resistance.
Summarise evidence relating to seed oils and health, including their documented effects on risk of cardiovascular disease and diabetes and the mechanism by which phytosterols may contribute to insulin resistance.
Identify the interconnectedness of metabolic disease and other pathologies, including immune dysfunction, mental health disorders and thyroid disturbances.
Apply practical advice for dietary change, including the benefits of restricting ultra-processed foods, refined carbohydrates, and seed oils to improve metabolic outcomes.
Reflect on historical and contemporary research, including studies involving dietary change in different populations, to inform current best practice in the prevention and management of metabolic dysfunction and type 2 diabetes.

These outcomes are designed to equip health professionals with critical understanding and practical strategies to address metabolic dysfunction through evidence-based dietary interventions and informed clinical decision-making.

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About Dr Penny Figtree

Dr Penny Figtree is an experienced Australian general practitioner based in Port Macquarie, New South Wales, with a distinguished medical career spanning over two decades. Graduating with first class honours from the University of Sydney in 1993, Dr Figtree has become a recognised leader in metabolic health, weight management, and therapeutic carbohydrate reduction (TCR).

Originally practising conventional general medicine, Dr Figtree grew increasingly concerned about the prevalence of obesity, type 2 diabetes, and chronic disease among her patients. Over time, she became an advocate for low carbohydrate and real food diets after witnessing exceptional patient outcomes—such as significant weight loss, diabetes remission, and successful medication deprescribing—through dietary change. Her medically supervised approach emphasises TCR and ketogenic strategies for a diverse range of metabolic issues, including type 2 diabetes, fatty liver disease, polycystic ovarian syndrome, and mental health conditions linked to metabolic dysfunction.

Dr Figtree combines lived clinical experience with evidence-based education, offering in-depth dietary guidance and patient-centred support. She leads both one-on-one consultations and practical education programs, equipping patients and health professionals with the tools to improve metabolic health, reduce reliance on medication, and achieve sustainable lifestyle changes. Dr Figtree’s outspoken advocacy for TCR, and her collaboration with peer experts, continue to advance the understanding and practical application of carbohydrate reduction in Australian primary care.

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