Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health

What if instead of managing diabetes with drugs, we focused on reversing it? In this episode of The Dr. Hyman Show, I sit down with Sami Inkinen, CEO and co-founder of Virta Health, and Dr. Greeshma Shetty, a board-certified endocrinologist, to discuss an approach that’s transforming how we treat metabolic disease. They share groundbreaking research and real-world results that prove type 2 diabetes isn’t a lifelong sentence—it can be reversed with the right nutritional and care model. In this conversation, you’ll learn: Why mainstream medicine still treats type 2 diabetes as a progressive disease—even though science shows it’s reversible. How Virta Health is using a combination of nutritional therapy and continuous remote care to achieve Ozempic-level results, without the drugs. The critical role of personalized dietary interventions in reversing metabolic dysfunction. How a high-touch, tech-driven approach to patient care is leading to long-term success. The real cost of diabetes—not just for individuals, but for the entire healthcare system—and why prevention and reversal should be the priority. If you or someone you love is dealing with type 2 diabetes, this is a must-listen episode. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal This episode is brought to you by Big Bold Health, Timeline Nutrition, BonCharge, and Paleovalley. Try Big Bold Health’s HTB Rejuvenate and get 25% off by going to bigboldhealth.com and use code DRMARK25 at checkout. Support essential mitochondrial health and save 10% on Mitopure. Visit timeline.com/drhyman to get 10% off today. Order BON CHARGE’s Max Red Light Therapy device today and get 15% off. Visit boncharge.com and use code DRMARK for 15% off. Get nutrient-dense, whole foods. Head to paleovalley.com/hyman for 15% off your first purchase.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mark Hyman?

  Coming up on this episode of the Dr. Hyman Show.

• 0:02Speaker 01

  Yeah, there's, there's a lot of societal debate like, how do we get insulin price lower and lower and lower? And I always say, guess what's better than a lower insulin price? It's eliminating the need for insulin in, in type 2 diabetes context. Obviously, type 1 is a different disease.

• 0:22Dr. Mark Hyman?

  Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real time lab insights. And if you're in need of deepening your knowledge around your health journey, well, check out my membership community, Dr. Hyman Plus. And if you're looking for curated trusted supplements and health products for your health journey, visit my website, drhyman.com for my website store and a summary of my favorite and thoroughly tested products.

• 1:02Dr. Mark Hyman?

  So, welcome Sammy and welcome Dr. Shadya Greshma. It's so great to have you on the Dr. Harman's podcast. The topic we're going to dive into today is one that is, I think, existential for humanity, which is this crisis of metabolic dysfunction that affects a huge swath of the population, especially in America where 1 in 2 Americans is prediabetic or has type 2 diabetes. 90% don't even know it. We have 93% of Americans who are metabolically unhealthy, meaning they're already starting on that trajectory. And it's driving so many of the costs according to healthcare system. It's driving so many of the chronic diseases like not just diabetes, but Alzheimer's, cancer, heart disease,

• 1:47Dr. Mark Hyman?

  mental health issues, all driven by metabolic dysfunction. And in medical school, it was something that I really never learned much about. And Greshma, I'm sure you didn't either. And we, we really sort of struggle to treat this problem, which seems to be getting worse and worse and worse. We're getting more and more medication, more and more drugs, more and more treatments, but the problem keeps getting worse. And what you have done in this extraordinary company, Virta Health, which we'll dive into, is to find a way through the mess of medicine to the root cause of why we're having this metabolic dysfunction and, and help reverse it. Now, when I went to medical school, I don't know, Rachel,

• 2:29Dr. Mark Hyman?

  if you went to medical school, this was the, the, the party line, but the party line was, if you get type two diabetes, it's a progressive disease that is not reversible. But this is actually not true. And for those people listening with type two diabetes, and make sure you, make sure you understand, I'm not talking about type one, which is an autoimmune disease. That's very different. It's not easily reversible. But type two diabetes, based on the science and, and a lot of the work that you've done at Virta Health and the science you published, actually is reversible. And it's not something that you hear when you go to the doctor's office. If you go see your physician and you have type two diabetes, they're not going to tell you this is a reversible condition. They'll say, I'll help you manage it. I'll give you medications. You want, maybe want to improve

• 3:14Dr. Mark Hyman?

  your diet and lifestyle, but you've got to accept that this is a lifelong, progressive, irreversible condition. Can you explain, you know, first, uh, start with Sammy, how, how you kind of got into this field? Because you're kind of a unusual character that was an entrepreneur, but an athlete, and you kind of discovered that what you were doing to fuel your athletic performance was, was not really getting you the health that you wanted. And I, I think, and then we'll sort of go into sort of really answering the underlying issue is, you know, why do we have this epidemic? Why are we failing at treating it? And why is there actually a new approach that may be the answer to solving so much of our, our extreme metabolic crisis that we're having today?

• 3:59Speaker 01

  Yeah. Well, first of all, Mark, thank you so much for, for having us here. And I, I feel, um, not completely Like what to to answer the question because I'm the only non M D on this call. So Dr. Shetty, Chris Mahir and you, but let me try. Well, first I would say.

• 4:18Dr. Mark Hyman?

  Mostly it's also for your experience too. Like I want to hear like, how do you get into this stuff?

• 4:22Speaker 01

  Yeah, so and I wanted to say that just to kind of contrast that I actually I do come outside of healthcare. I'm a physicist by training, started my career in a nuclear power plant. So that's my only claim to fame for science, for scientific thinking. But indeed, I was I was outside of healthcare and the very dire picture that you so eloquently painted, Mark, about the massive numbers of type two diabetes and obesity and metabolic disease. Effectively, you know, ten to twenty percent of people, minority in America, adults are what you might call metabolically healthy. So almost everyone is is metabolically unhealthy. So so the diet picture that you painted, that's kind of how I saw the world as well.

• 5:07Speaker 01

  If you had come to me about a decade ago and if you had come to me and say, hey, let's go and solve diabetes and obesity. This is solvable. Again, about ten years ago, I would have rolled my eyes and laughed you out of the room.

• 5:19Dr. Mark Hyman?

  That's right.

• 5:20Speaker 01

  I literally would have rolled my eyes and laughed you out of the room. And the reason is, you know, I was a pretty high performing endurance athlete. And while I was building my previous company, which was a tech company called Trulia, you know, I did a lot of triathlons and even got to a point where I won the world championships in triathlon in my age group. And I always thought, well, I am, you know, I'm a healthy guy. I don't have to worry about the things that people in the middle of America have to worry about. And let's face it, blame yourself. You eat too much. You can control what you eat. And if you eat too much, probably develop type two diabetes and obesity. So how do you solve that? You bottle willpower. Like, I can't help with that.

• 6:03Speaker 01

  So this was my thinking, and I'm embarrassed to say, I'm honestly, truly embarrassed to say this. This was my thinking more than a decade ago.

• 6:10Dr. Mark Hyman?

  Well, you shouldn't be because it's basically the thinking of almost everybody, including most physicians and nutritionists in the healthcare system. You're not alone there, Sammy.

• 6:18Speaker 01

  Exactly. So, so finally, like, you know, how did I become a co-founder and now CEO of Virta Health here now, almost a decade later? Well, it turns out, despite my, you know, winning and running triathlons and staying lean, I discovered that I was on my way to type 2 diabetes myself, and I already had prediabetes. And so this was around 2011. And I honestly, I was pissed. I was surprised, pissed and frustrated. I said, what the heck? I'm not one of those people. Like, I'm not one of those people. What's, what's going on with?

• 6:51Dr. Mark Hyman?

  You're winning triathlons and you're prediabetic, right? How did that happen?

• 6:54Speaker 01

  Yeah. And I, I, I should say fortunately, you know, I, I got very curious. I was like, what the heck's going on here? And I got lucky that through reading and reaching out to a lot of people, I, I met, you know, a number of scientists, but particularly Dr. Stephen Finney and Dr. Jeff Vollek, who had done research over, you know, three decades about metabolism and how the body metabolizes carbohydrates and fat and so forth. And, and met these gentlemen, scientists, and basically learned two things, and very briefly. One, I was obviously completely wrong. Diabetes and obesity, they, it's a metabolic disease. It's not a personal choice that you wake up one Monday and say, hey, I'm just gonna eat too much to develop type 2 diabetes.

• 7:37Speaker 01

  So that was one, I was wrong. And then the second thing was kind of what you, Mark, said earlier, which is that these conditions, despite the conventional wisdom, are reversible nutritionally.

• 7:51Dr. Mark Hyman?

  Yeah.

• 7:52Speaker 01

  Type 2 diabetes, obesity are systematically reversible nutritionally if you know how to manipulate nutrition. And I, I became convinced, both through personal experience and reading all this published research, that it indeed is possible. And so, and I'm not gonna go too much longer, but this was 2014, and I said, hey, this is incredible. If you can use nutrition in that way. Maybe I can help with my tech and entrepreneurial background and figure out a care delivery mechanism, how we can get this into the hands of millions and millions of people. And yeah, we started Virta Health now, it's almost ten years ago and we have this a little bit of a crazy mission, reverse type two diabetes and obesity in one billion people.

• 8:34Dr. Mark Hyman?

  Hmm.

• 8:35Speaker 01

  Reverse type two diabetes and obesity in in one billion people. And um yeah, here we are ten years later. We can go into details, how's it going? But uh yeah, that's how I became an accidental healthcare entrepreneur. And honestly, it's been the most rewarding uh journey in in my professional career. So.

• 8:53Dr. Mark Hyman?

  Yeah, it's it's kind of a miracle when you, you know, as a doctor, when you see things that you were taught were not possible. So, you know, Greshma, you're you're a board certified endocrinologist. You're you're directed the fellowship in diabetes, the Jocelyn Diabetes Center, which is iconic Harvard diabetes treatment uh facility. It actually started out with Dr. Jocelyn, who was the preeminent physician in diabetes care at the turn of the last century in the teens and twenties. And and the treatments they had back then were just very little, except nutrition, mod- sort of modifying what people ate and

• 9:34Dr. Mark Hyman?

  changing their diets. And in back then, before they had insulin, they used a ketogenic diet as one of the treatments for type two diabetes or type even type one diabetes, which was killing people. And it was very effective uh and and it kept these people alive. It was it was not perfect, but it was really quite um an interesting origin story. And now, you know, the American Diabetes Association doesn't quite recognize that diabetes is a carbohydrate excess problem, it's a carbohydrate intolerance problem. And they and they're recommending all sorts of things that actually don't. I think reflect the latest scientific understanding of how the body becomes pre-diabetic

• 10:17Dr. Mark Hyman?

  and type 2 diabetic. And so can you share with us your kind of awakening going from a sort of a traditionally trained endocrinologist, working at Harvard, leading the training of other leading physicians in this space, to kind of almost come back to the origin story of the Johnson Diabetes Center, which is to use a diet as the mainstay therapy for diabetes, rather than a whole cocktail of drugs, which can cost you huge amounts of money every year.

• 10:42Speaker 02

  You know, it's funny that it is full circle, that our knowledge, what we were doing before we had a therapeutic, and you know, insulin was an incredible discovery and saved the lives of many, many people with type 1 diabetes and poorly controlled type 2 diabetes. But I think somewhere along the line, we lost the sort of nutritional component of controlling metabolic health, and it was easier to write a prescription. And you know, we live in an obesogenic world now with toxic food environment, inadequate sleep, inadequate activity. And even with the way we deliver care, you know, patients are frustrated, they don't have enough time with their clinicians, they're paying more, they're having worse outcomes. And frankly, clinicians are also frustrated, you know, they're on this hamster

• 11:27Speaker 02

  wheel of, you know, metrics that aren't around quality, but you know, how many widgets are patients you see in an hour, which are called RVUs. So the specialties that deal with prevention and metabolic health are not valued appropriately. So I mean, the whole system sets it up for high cost, poor outcomes. And so part of the reason why I was super excited when I found VERDA is, one, the nutritional intervention really does flip that mantra of continuous progressive chronic disease of type 2 diabetes, like a one-way trolley track, right? Like you add metformin when you start, then by two to three years, you add a second agent, and by eight to 10 years, everyone's on insulin.

• 12:10Speaker 02

  So we flipped that at VERDA, and we have great data from our IUH trials that we can sustain remission and weight loss and de-prescription of medications over two years. I see this every day in my practice at Virta. The second piece is the model of delivery, the care model we have at Virta. So in my old practice, which is a traditional Burke and Mortar clinic, I was there for, um, after finishing fellowship, I was there for about 12 years. And, you know, my patients, they were lucky if they could even see me every six months because my panel was full. So talk about access. They come in, then they they're rushed through that appointment because you've only got 30 minutes to download their glucometer, their CGM, update their med list, you know, get the labs, the pre-check labs.

• 12:53Speaker 02

  And then they get to the room with you and you've literally got 15 minutes to solve all their metabolic health issues. Yeah. Unrealistic. So the way we do it at Virta is we've got this continuous remote platform where patients are able to log their biomarkers, so their glucose, their weight, their ketones, their blood pressure. And so the there's this ability, our algorithm will generate what we call an attention score, uh, which gets the right signal to noise, um, so that sweet spot of where the clinician can actually swoop in and take care of the patients who need help. So i.e. if they're doing badly and we need to intervene more on nutrition or meds, or if they're actually really moving in the right direction because they're doing the things you're helping them, coaching them towards.

• 13:38Speaker 02

  You can reinforce that virtuous cycle by de-prescribing medications, um, and move it forward. And the third piece, I just want to add because I don't think it's just pharmacology and technology. There's a strong component of the human touch. So we have a patient-centric way of giving care. We have a team of coaches and a team of clinicians. And these people are so passionate about metabolic health. And I will say, like, when my patients start at Virta, especially early on when they're making nutritional changes, they will interact with their coaches multiple times in a day. And often they're clinicians, they're metabolic clinicians, uh, probably daily, uh, because we're de-prescribing medications, answering questions, keeping them safe.

• 14:20Speaker 02

  So it's a very white glove, um, high-touch experience for our patients. So I think those are the three things that really drives the results we have. And just to make it really real, like today's Monday, so I did a bunch of lab reviews that came in over the weekend, which I've ne- I never thought I would say this, but my lab reviews are actually kind of very joyous at Virta. So this morning, I'll just say, Mr. W. He's a gentleman from Mississippi. He's been with us for nine hundred days. His weight is down eighty pounds. He came to us with an A1C at nine. It's now five point two. He's off three medications, diabetes medications, one including insulin. His sleep apnea is resolved.

• 15:02Speaker 02

  He's off his CPAP. He's only on one antihypertensive medication and he's just so much healthier and so happy. I'll just give you one other patient. It's another gentleman from Texas. He's South Asian, forty-five. He's only been with us for a hundred and sixty days. He's dropped seventeen pounds and his A1C has gone from eight point eight to seven point five. And he's only on one Metformin now. Like, this is incredible. And this is not unusual.

• 15:29Dr. Mark Hyman?

  And these are changes you just don't actually even see with medication. Like, you can't achieve those results using drugs unless you use massive doses of insulin, which are problematic.

• 15:39Speaker 01

  By the way, I'll add here, at the increase I mentioned, the IUH trials, so Indiana University Health and data, which is that when we started Virta, obviously, you know, we use telemedicine and nutrition to achieve these results. And when you use telemedicine and nutrition, you don't need FDA approval. It's not a new molecule that we are developing a new drug. But we made this, what at the time, this was two thousand and fifteen, seem like a crazy risky bet. That is, we started a five-year prospective clinical trial with practically no funding for the company. And most of my investors were sort of from the tech world and they were rolling their eyes and

• 16:22Speaker 01

  saying, are you crazy? You're gonna spend five years doing a clinical trial. Now with hindsight, it is one of the best things that we've ever done. And obviously, we keep publishing data and we have other trials in the works. But the reason it has been a, was such a good move at the time is, one, obviously, we've attracted people like Grisma to join the company who say, hey, I want to know if this actually works. Is this safe? What's the sustainability? And I don't want to hear white papers and marketing materials and be like, show me the hard data. Is it peer reviewed and I can go through? So that's kind of the one reason. But then the second reason is, which I didn't appreciate coming from outside of healthcare.

• 17:04Speaker 01

  Paradigms even in um in in light of new data change very slowly. Very, very slowly. Like you, Mark, men says, oh, diabetes is reversible. Well, guess what? If we go and poll thousand average or or random providers, you know, Harvard train, Stanford train, you name it. I don't know what percentage would still say, yeah, no, no, type two diabetes. It's it's chronic progressive. You can't reverse it. So even in light of data, it's honestly test taken and still have to work very hard to change the conventional wisdom that many of these, most of the metabolic diseases are reversible. And using our data, that's

• 17:46Speaker 01

  the language of most scientists and clinicians. But even with the data, you know, it it's hard work.

• 17:52Dr. Mark Hyman?

  Don't confuse me with the facts. My mind's made up, right?

• 17:55Speaker 01

  Exactly.

• 17:57Dr. Mark Hyman?

  Yeah. Well, you know, it's interesting. When I was in your group, the the the two things that I'm really hearing is you're using a different drug and a different delivery system. And and in you're finding the right medicine and the right way to give that medicine to the patient. Because in traditional medicine, we do what we do, not because it's the best way to do things, right? We know that lifestyle diet work better. We know that that that we can actually have those be effective. And yet we don't have a system that actually allows us to deploy that effectively. And so the drug here is a very specific diet. It's not just a healthy diet or whole foods diet or Mediterranean diet. It's a very specific therapeutic case. If food is medicine, then it's not all the same. What is the drug?

• 18:41Dr. Mark Hyman?

  What is the dose? What is the frequency? How is it? How is it prescribed? That really matters. And the second piece is the delivery system that that the episodic care you're talking about, where you go see the doctor every six months for eight minutes, you know, and don't have, you know, real feedback about what's going on, except being able to prescribe more medication and in order for live test. It's not, it's not the the right delivery mechanism. So in other words, if you're taking Ozempic, you can't just swallow it. You've got to inject it, right? You want to actually change people's lifestyle, you can't have an appointment every six months. And so that's continuous care model, which is high touch, which is digital,

• 19:24Dr. Mark Hyman?

  has allowed you to actually deploy this model in a way that's been more effective and more, people are adhering to more than you can ever imagine. Because the problem with lifestyle change is people just don't sustain it. They might do it for a week or a month or three months, but then they fall back. So, so can you tell us more one about the actual drug that you're using? In other words, the medicine you're using, the food that you're using to achieve these incredible results? And I, I think, you know, I think just to sort of talk about the data that I know, you can correct me if I'm wrong, but you know, in, in about 60% of the cases of the people you serve, you reverse the type of diabetes, put it in remission. You get almost all the people off of the main medications and most off insulin are dramatically reducing their insulin.

• 20:09Dr. Mark Hyman?

  You see dramatic weight loss, which is far more than you see from most other interventions, like 12% body weight, which is a lot. And you see, you know, there's this incredible data of improvement in cardiovascular biomarkers, which you think would make sense if eating a ketogenic or high fat diet. So can you talk about, you know, how this medicine works? Why it's effective? Why our old paradigm doesn't work? Why with the ADA and why with your average doctor saying and endocrinologist saying is actually not the right approach to treating that type 2 diabetes?

• 20:53Speaker 01

  Maybe I'll jump Chris first, give the non-MD, non-medical doctor view, now that I've observed 100,000 plus patients and, and 10 year journey. And maybe the listeners who are less clinically minded can, can get a few data points there and then I'll hand it over to you. Well, first Mark, indeed, the results that we deliver, I sort of jokingly, although this holds true, these days say that Virta nutritionally delivers Ozempic-like results without the drug. Like those are the outcomes that we deliver. And as you mentioned, twelve percent average body weight loss, and not just for six months, twelve percent at one year, sustain at two years, and we follow patients out to five years. So the results are very strong. And

• 21:38Speaker 01

  as you mentioned, in type two diabetes context, insulin is usually thought as sort of the last hope drug, hypoglycemic agent for type two diabetes. Well, at two years, from start to two years, eighty percent of all insulin inverter care is eliminated, which again is kind of unheard of because usually the dose goes up ten, twelve percent year over year. So.

• 21:59Dr. Mark Hyman?

  So eighty percent of people get off insulin. That's remarkable.

• 22:02Speaker 01

  It's, it's, this is eighty percent of the total dose at start is eliminated on a population level, which is insane. And I think the percentage of people who are completely off is somewhere in the same ballpark. I actually don't remember that number on top of my head, but it is, is very high. And as you said, sixty percent, what we call diabetes reversal rate at one year, which does mean that you are completely off of diabetes specific medications and your blood sugar is in a normal range. And yeah, there's, there's a lot of sort of societal debate, like, how do we get the insulin price lower and lower and lower? And I always say, guess what's better than a lower insulin price? It's eliminating the need for insulin in, in type two diabetes context. Obviously,

• 22:46Speaker 01

  type one is a different, different disease. But back to the, the treatment. So I'll give you the layman's verse first. Well, I, first I should say, nutrition is freaking hard. It is freaking hard. Obviously, we've had diet and exercise programs for the last three, four decades, and practically all of them have failed to deliver sustained results. And sometimes I say, you know, my background in physics, that getting nutrition right is harder or can be harder than nuclear physics, or at least in light of the last three, four decade. But here's a couple of cornerstones, why verti works. So number one, you have

• 23:27Speaker 01

  to be able to use nutrition to eliminate unnecessary hunger and cravings. So eliminate unnecessary hunger and cravings. Because if the nutrition program is based on sort of willpower and hunger, willpower always runs out, usually latest at the wedding photo. Like it just runs up, it runs up. And so, so that's one cornerstone of what Virta does. When we use nutrition, we help our patients or counsel them to eat to satiety and as much sort of real food as possible.

• 24:03Dr. Mark Hyman?

  That means eat until you're full. Like, don't, don't calorie restrict. Because, because

• 24:06Speaker 01

  Exactly.

• 24:07Dr. Mark Hyman?

  What, what most physicians say is in order to lose weight, you have to restrict your calories. And you have to eat less and exercise more. What you're saying is something different here.

• 24:15Speaker 01

  Exactly. And obviously mathematically that can hold. But again, if it's a mathematical exercise. When a little power runs out, which it does again at the wedding photo, whatever the milestone is, then weight, weight recains. So that's another nutritional side. And I'll also say one more thing around nutrition, which is. We have to, and this is what we do, we individualize more or less to the N equals one. And I'll give you a silly example, but. Often this is lost in translation in diet programs. So. If you're a vegetarian coming to Virta by identity or religion or that, that is your thing. And we tell you to eat bacon and extra breakfast. Guess what? We lose you immediately.

• 24:55Speaker 01

  Also, the other way around, like we work with one large Fortune 500 company. We work with US Foods. There's a lot of truck drivers. And these are mostly men. And so they're used to like burgers and meat and stuff. If we tell them. And obviously this is stereotypical, but if we tell them, okay, it's steamed spinach for the rest of your life. Guess what? Again, we lose you immediately. So we have to do a lot of individualization. And, and so that's on a nutrition side. And Chris, we can go into more details, but that, those are some of the cornerstones. And then. On a care delivery, I'll just mention that as, as you said, Mark. You know, even with the best protocol, best nutrition, best nutrition science, if it's here's what to do, see you in three months, guess what?

• 25:39Speaker 01

  It's like telling to a driver on a car, okay, just hold on to your steering wheel and keep going. Guess what? First corner and you're gonna drive to the forest off the road. So it's the same thing with nutrition. So the care delivery model that we have, it's basically daily monitoring, daily interaction. So when you hit the first corner, which could be, I don't know, kid's birthday party, or maybe there's like a death in family, or you lose a job, something emotionally really hard to overcome. We're there to help you and guide you. And so that wasn't possible without telemedicine. And now, obviously, with telemedicine, it's, you know, chronic disease is 24/7. Care better be and support better be 24/7 too.

• 26:24Speaker 01

  So that's kind of a little bit of, on a high level, the nutrition piece, and then combining with this 24/7, more or less 24/7 support that we can deliver, that has allowed us to deliver those results. But maybe Grisma, you can add a little bit nuance to the kind of nutrition piece and how that's different from.

• 26:41Dr. Mark Hyman?

  Neil, let's dive into the sort of diet part, because I think this is really an interesting conversation, because it's not something that most people understand, how this is a kind of a carbohydrate intolerant disease. When you have diabetes, you become carbohydrate intolerant. That doesn't mean all of us are born that way, but we come that way because we live in a sort of a soup of sugar and starch that's washing over us for decades. And that leads to the development of this metabolic dysfunction. And the solution is to kind of reverse that trend by restricting carbohydrates and increasing fats. And tell us sort of how that works and why we kind of got so far away from it,

• 27:22Dr. Mark Hyman?

  because it was the treatment, you know, 100 years ago, and now we're coming back to it as the treatment. And explain the biology behind the science of ketogenic diets as a diabetes reversal treatment.

• 27:33Speaker 02

  So you know, for in the trial, our patients were on a well-formulated ketogenic diet, which is very low carb, so 30 grams. But practically, in our clinical workflows, we do a lot of low carb, and not everybody's in well-formulated ketogenic diet. So we really try to sort of meet patients where they need to be. And there's a lot of heterogeneity in type 2 diabetes, right? We've in genome-wide association studies, we now know there's hundreds of different like types of type 2 diabetes. But sort of like, the end result or the goal is to preserve beta cell functional mass, right? And the beta cells are those cells that make insulin. And so anything we can do to de-stress that beta cell and keep its insulin production

• 28:18Speaker 02

  up is critical. And when we eat high carb diets, we add to cytokine release, inflammation, glucotoxicity, all of these things stress out the beta cell. And so that sort of accelerates the destruction of beta cell function and mass over time. And that's when you start seeing the one-way trolley for type 2 diabetes. So if you can reset that and change that pathway, you can definitely improve insulin secretion and also decrease while you're losing weight, decrease the insulin resistance at other target organs, like in your liver and your muscles. So you you also spare the beta cell from having to produce more insulin to do the same job.

• 29:03Speaker 02

  So multiple layers of de-stressing the beta cell through the nutritional intervention, directly, but also indirectly by affecting other parts of metabolism. I mean, energy homeostasis is so complex. I have so much humility. You know, I started my fellowship training studying adipokines. I was in a lab where I was studying leptin and adiponectin. And like, there are so many other cascades, and they all interact with the gut, the microbiome, the brain, your satiety centers, your pancreas. So there's so much complexity. So really, thinking about it simplistically, though, is really preserving and de-stressing that beta cell.

• 29:42Dr. Mark Hyman?

  And the way you do that is by basically restricting carbohydrates and adding a lot of fat. Now, it's not the bacon and, you know, uh, kind of cheeseburger diet, right? There's a healthy way to do this. It doesn't mean you have to be eating a lot of food that may not be great for you. And so I think people are often thinking, oh, fat is bad, you know, fat makes me fat. In fact, you know, if we eat fat, you get fat. And there's this whole mythology we had about that. And in fact, that was the sort of the prevailing theory for so long. And now it's shifted and we understand that actually for these metabolicly dysfunctional people, which is most of America, that we're eating way too many refined starches and sugars.

• 30:27Dr. Mark Hyman?

  I mean, carbohydrates are also vegetables, so there's no harm in eating vegetables, but the starch and sugar and the refined carbohydrates are the ones that are driving this problem. And so the solution is restricting those. And you're saying you don't always have to be fully ketogenic. You can be very low carb. But I've seen this too. I mean, a patient at Cleveland Clinic who was type 2 diabetic on insulin for 10 years, you know, had heart failure, had kidneys starting to fail, fatty liver hypertension, had multiple stents put in for cardiac disease. And was on 20,000 of copium medications. Her body mass index was 43, which is huge percent. And her A1C blood sugar average was 11.2. And, and, and we just didn't put on a keto diet, but since she took off, you know, grains and beans, sugar, processed food,

• 31:12Dr. Mark Hyman?

  put her on lots of good fats, olive oil, avocado, some nuts and seeds, healthy protein, lots of veggies, fiber. And it was about 50% fat, not 75 or 85% fat, which is what most keto diets are. And within three days, she was off her insulin and three months she was off her medications. Her A1C went from 11.2 to 5.5, which is normal. Her ejection fraction went to normal. Her kidneys got better. Fatty liver got better. Her blood pressure got better. In a year, she lost like 116 pounds. So without Ozempic, without a gastric bypass, simply by getting the group support, which we did, and, and by using kind of a very kind of low carbohydrate diet that was a very anti-inflammatory diet. So. What I'm hearing you say is it doesn't have to be always ketogenic,

• 31:54Dr. Mark Hyman?

  but it has to sort of be matched to that person's state of metabolic dysfunction. The more sick you are, the probably the higher dose of drug you need in a sense, right?

• 32:03Speaker 01

  I I would also add that we haven't published this. Actually, we published some, but we actually have very interesting dose response data. So pharmaceutical companies usually do a what they have to do like a dose response study. So here's the molecule. You add more of that molecule and then see what happens in terms of safety and in terms of outcomes. And you obviously you can then tease out the correlation and causation like, oh, more of this cetaminophen, less you have pain and whatnot. We actually have very interesting dose response data to carbohydrate restriction and seeing what happens to weight, glycemic control and getting getting off the meds. And I guess the punchline is the the more insulin resistant you are,

• 32:46Speaker 01

  the more of that dose, the better is is basically without sharing all of our secrets. But it's fascinating because we've we literally have dose response curves and and it kind of tells tells the story. The other thing I wanted to add, Mark, when I listened to you and I was thinking those patient outcomes and what you had seen, if I wasn't, if if I did not have the 10 year history of building Virta and seeing exactly the same results now with 100,000 plus Americans, I would still be like, oh, I'm I'm sure nutrition can work, but come on, like, these are the like the grandfather who was 100 pounds overweight and then ran a marathon. Like, we always hear these stories like, oh, it's a one anomaly, one out of million.

• 33:30Speaker 01

  But I think really what the world needs to hear, this is individuals, business decision makers, policy decision makers, scientists, is that these results are systematically possible, absolutely systematically possible. And this idea that we have 200 million sick American adults metabolically unhealthy and the best we can do is Manage symptoms with medications is ridiculous. It is so ridiculous. And so we really have to get the message across that there is a way nutritionally. You don't have to be a superman or superwoman.

• 34:11Speaker 01

  Ordinary person, there's a systematic way to achieve those results. Obviously, there's a distribution. Some are hugely successful, some are moderately successful. But that message hasn't broken through yet and it has to. And that's why I'm grateful to be on this podcast too, because it's ridiculous.

• 34:29Dr. Mark Hyman?

  Yeah.

• 34:29Speaker 01

  There's no other way out of this metabolic health mess. GLB-1's in tap water is not going to solve this mess.

• 34:36Dr. Mark Hyman?

  No, no, and again, it's interesting when you're talking about how you you're sort of able to execute on things in the sense that you learned in your research around these hormones and molecules that regulate appetite, like adiponectin and leptin and the inflammatory molecules that are produced by your fat cells. And that was sort of where your research was. And what we're learning is that the application of the right nutritional approach in metabolic dysfunction actually automatically regulates those hormones. Rather than having to take Ozempic, which artificially does this, your body can naturally change the levels of the appetite and fullness hormones

• 35:18Dr. Mark Hyman?

  that that are driving this overeating behavior that is driven by the carbohydrates. So like when you eat more sugar and starch, you want more sugar and starch. When you eat that, I mean, I would say nobody can, you know, eat, you know, 12 avocados, but anybody can eat, you know, a whole bag of Chips Ahoy cookies, right? So it's just like no limit on that. And I think the body has this natural ability. When you feed it in a way that it's designed to work, it actually resets. And it's not willpower, it's just science. So can you explain how that works?

• 35:48Speaker 02

  Yeah, so when folks increase their fat intake and certainly when people achieve nutritional ketosis with higher ketone levels, the hormones that drive appetite are naturally suppressed and the hormones that signal satiety go up. So endogenous GLP-1, CCK, go up and then, you know, things like ghrelin go down. So again, so exactly like harnessing nutrition to appropriately do that positive feed loop that's towards improving health and decreasing hunger. It drives with just the nutritional changes.

• 36:30Dr. Mark Hyman?

  So what's interesting is that, is that you just said something that I want to sort of highlight and double click on, which is that when you eat in the right way, you naturally increase your GLP-1 peptides, which are regulating your appetite and that you don't have to take Ozempic. And what you also said, Amy, earlier was that you're achieving Ozempic-like results without taking the drug, without all the side effects and without all the costs. And, and so can you kind of explain what, and we talked about this when we were hanging out in person in Aspen, you know, the, the data that shows that, you know, out there, the pharmaceutical companies are funding billions of dollars of research on these GLP-1 agonists and other

• 37:15Dr. Mark Hyman?

  related peptides around a whole spectrum of diseases from depression to autoimmune disease to neurodegenerative diseases to longevity to obviously weight loss and diabetes to cardiovascular disease. And they're trying to get all these studies done to get indications for these other applications of these drugs. But what you're, what you're saying when I heard you say was that using this nutritional approach, you can actually achieve all the same types of outcomes. And it's not the drug itself, it's actually the change in your metabolic health. It's, it's, can you explain more about that, maybe Grishman, how that, how that works?

• 37:53Speaker 01

  Yeah, absolutely. And, and first, upfront, I want to say that this may sound like, oh, this guy is so anti-pharmaceutical. No, I'm a physicist by training, I believe in science, I believe in Western medicine. And also these GLP-1 drugs, you know, first one was, I think, in America approved for treating type 2 diabetes 2005. And it's a tool in a toolkit, it's a tool in a toolkit for type 2 diabetes and in some cases for obesity. So I just want to be very clear, and obviously, Virta, our providers practice evidence-based medicine. So anything I say next isn't going to be like, oh, you know, drugs are bad in all cases. No, that is not the case. But to, to answer your question specifically, um, and this is all data that's published in period.

• 38:35Speaker 01

  So if anyone wants to sort of double check, you can go to verdahealth.com and slash research and find our published period results. But indeed, so what we've been able to show is that as we run our nutrition program, among our patients, the following things either improve or get reversed. Obviously, type 2 diabetes, so that's glycemic control, so blood sugar comes down. Hypertension, so blood pressure comes down. Inflammation comes down, so this is CRP, C reactive protein, and white blood cell count. And we also have an unpublished paper looking at 16 inflammation protein, proteins of which almost all improve, which is unheard of, better than, better than HUMIRA, that's unpublished, so that's a caveat.

• 39:19Speaker 01

  Depressive symptoms improve, sleep apnea improves, so gets reversed. Knee pain goes down, cardiovascular disease risk markers and 12-year cardiovascular risk goes down. Kidney and liver function improved, so we looked at EGFR. And we can't really say that we can, it would be a little bit overeating to say we reverse kidney disease. But we have shown that we improve kidney function and same with, with liver function. So when you look at these broad spectrum metabolic health improvements,

• 40:01Speaker 01

  it's basically the same list that the GLP-1 manufacturers are now showing.

• 40:07Speaker 01

  That we the improve or reverse and we've already published this data. So what can we conclude? Again, I'm not the medical doctor here, so maybe Chris can kind of cover me up here.

• 40:16Dr. Mark Hyman?

  Yeah.

• 40:16Speaker 01

  But basically, what we we can show is it is possible to achieve the same broad metabolic health improvements as GLP-1s may or may not nutritionally, one hundred percent nutritionally. Therefore, it is not the exogenous molecule that is achieving these results alone. Because it's possible to achieve the same results nutritionally. Now, we can still debate the mechanism. Is it all about the weight loss or are there other things in play? And our hypothesis is there are other things in play. But again, such as information, reduced information. But we can achieve the same things nutritionally. Uh, which I think again is a very important message to be heard.

• 41:01Speaker 01

  Because in the next year and two, there's going to be headlines. Oh, GLP-1s now improve the eighth new thing. And the answer is, guess what? Nutrition improves all those things. And then finally, I will say, again, there's a place for these drugs. GLP-1 is a tool in a toolkit. But I think this statement holds true, which is we don't know the short, the midterm and long term side effects of exogenous drugs. But we know the side effects of healthy food. Guess what? Happier, better, longer life.

• 41:35Dr. Mark Hyman?

  That's right.

• 41:35Speaker 01

  Like healthy food. It's tough to say like, what's bad about that? Not much.

• 41:40Dr. Mark Hyman?

  That's right. Yeah, no, I think I think you're right. I think, um, and I'd love to hear your perspective as an endocrinologist, Kritishma, about the GLP-1s. And, you know, the utility, but also the risks. And I sort of whether or not they're really necessary. If we actually got our nutrition right and we got the delivery system right, which is this continuous care model to support people and behavior change. Because that's the biggest thing. And I, you know, I sure this sort of conversation you just mentioned, Sammy, reminded me of a study I read that looked at gastric bypass. And they they did a controlled study where they took a group of obese patients. Half of them got bypass and half of them didn't. But the diet that the bypass patients got. After their surgery was the same diet that the non bypass patients got. And they both reversed their diabetes within a couple of weeks.

• 42:23Dr. Mark Hyman?

  It wasn't the diet, it wasn't the surgery, it was the food. And I hear you saying the same thing about this GLP-1. So I'd love, Vishwan, you to share from an endocrinologist's perspective, you know, what what you're thinking is about this, you know, you know, where they play a role. And and and actually, is this approach of, you know, very aggressive nutritional intervention with the continuous care model of lifestyle support and behavioral change, you know, actually better? And and how do we think about that?

• 42:51Speaker 02

  Yeah, no, I think that's a great question. And it kind of hits on something we spoke about earlier during this call with insulin and how we sort of, I think we missed an opportunity of marrying some of the nutritional sciences to patients who were able to receive insulin. And when you think of like even type 1 diabetes, of course, insulin was life saving. But because we didn't really invest in figuring out the right nutritional. Now, we have a lot of folks with type 1 diabetes who we say they have double diabetes.

• 43:21Dr. Mark Hyman?

  Yes.

• 43:22Speaker 02

  Which is type 1 with insulin resistance. Because we've, we've just let people eat whatever they want, even if it doesn't work for their body. So I like that, like to think of that as an analogy for GLP-1s. You just can't eat whatever you want just because there's a new medication. Because guess what? Again, the energy homeostasis is super complex. There's no silver bullet, like you actually have to eat right for your body. And there's so many, like I said, the genome wide studies have shown that there's a lot of different types of type 2 diabetes. And if we can get to the root cause, we can help a lot of folks and not look at one target molecule that we're using today, which is, you know, the GLP-1 therapy and that.

• 44:04Speaker 02

  So I think really thinking more holistically about our patients that these are not magic bullets. Look, they're great medications for patients with diabetes and other non glycemic indications, like reasons outside of blood sugar control, such as heart disease, heart failure, kidney disease. There's mortality and there's outcomes data to support their use. But what about? Like the millions of people who have not yet developed those complications who have diabetes and the folks who have pre-diabetes and obesity and this is, you know, diabetes is the tip of the iceberg, right? We have a whole society below that where we need to drive impact because we can't just medicate everybody in the country.

• 44:45Speaker 02

  So really thinking about the root cause and finding the right nutrition for the individual patient. And this is, this is part of precision medicine, right? Personalizing your diet to what works for you. And it's hard work. I mean, what our coaches and clinicians do at VERTA, it's, it's a daily, again, like a white glove experience where we're getting that data. We're doing that positive feedback to make those changes, to learn and course correct when things aren't going well, um, to celebrate when we get those lab reviews. Um, so really, you know, it has to be a very patient centric holistic approach. But so I think there is a role for these medications, but I think we need a better solution for, as a population.

• 45:25Dr. Mark Hyman?

  But is your belief that, that if people were able to adhere to a diet that was right for them, that these drugs are redundant?

• 45:34Speaker 02

  I think so. I think if you could prevent, I mean, I'm, I'm of the mindset prevention is always better. Less is more. So if you can teach people to eat well and keep them healthy, um, that's better for everyone. They feel better. They have all the other non, forget about just the metabolic risk. Think about neurocognitive risk, cancer risk. There's so many downstream things that just by eating right, we can fix. Um, and then I'll just really quickly say like even sort of transgenerational, like when young adults who are in their prime reproductive years, when they're metabolically unhealthy, we know there's all this epigenetic changes that drives the next couple of generations to have metabolic dysfunction.

• 46:19Speaker 02

  So there's, there's real implications for populations when you teach them how to eat correctly. Um, and the last thing I'll add is diabetes disproportionately affects minority populations and those with less socioeconomic means. Imagine if we could, if we could improve that without costly medications and prevent it and close some of the complication gaps and the death gaps that we have in the United States.

• 46:42Dr. Mark Hyman?

  Yeah, I know. Absolutely. I mean, the health disparities are huge and, and you know, the, the, there's a whole food inequity issue and nutrition security issue. And there's all the ways in which.

• 46:54Speaker 02

  And equity around getting medications.

• 46:55Dr. Mark Hyman?

  Yeah.

• 46:56Speaker 02

  Accessing expensive medications and accessing expensive technology like CGM. Like there's, there's all kinds of equity issues. So what, what if we went to the root cause and just help people be healthier from day one?

• 47:08Dr. Mark Hyman?

  And, and, and you know, it failed miserably, right? Because if you look at the, the, the national approach to addressing diet and lifestyle, our recommendations, our guidelines, our best efforts to help people eat better just have failed miserably and, and they failed, in my opinion, because we are not understanding the nature of behavior change. And we're not understanding the nature of how people need to shift and how people need to actually understand what it takes to, to actually make a lifelong change in their, in their behavior. And I, I think, you know, I, I discovered this after working with Paul Farmer in Haiti during the earthquake. That was in 2010, I got to know him and his work.

• 47:49Dr. Mark Hyman?

  And, you know, he was able to cure TB and AIDS in the most destitute places on the planet. In Haiti, where the public health community had given up because it was multi-drug resistant tuberculosis, you know, the drug regimens were complicated. You know, the, the, you had to be on dose on schedule and people didn't have watches. They didn't have clean water, like, so they just kind of gave up. And Paul Farmer realized that it wasn't a medical problem. It was a, a social problem, a structural problem. And, and he basically trained thousands of community health workers, neighbors, helping neighbors to change their behavior and to support their, their life. And, and I, and I applied that in a model at a big church in California

• 48:30Dr. Mark Hyman?

  called Saddleback Church, where we got 15,000 people to work in small groups to change their lifestyle together because of that high touch and, and that cultural shift that, that sort of led them actually to be able to do the things that actually work. And so I think that's what's unique about VERTA. It's not just understanding the science of metabolism, the science of metabolic dysfunction, the science of how we apply nutrition as medicine or ketogenic diets as, as a key therapy. But it's this other piece that, that has been completely neglected in healthcare, which is the, the way in which we need to deliver healthcare, which is through a high-touch, connected, supportive environment, whether it's coaches and doctors and nutritionists supporting patients, or whether it's eat people, it's helping people.

• 49:15Dr. Mark Hyman?

  The, the science behind this is quite good, but it's been ignored because it's not reimbursed. But what's exciting about VERTA is that You're showing not only does it work, but that you're actually saving approximately $6,000 per patient, you know, and I, and just in Medicare, for example, just because I was testifying in Congress last week, you know, sharing with the congressman how, you know, we have such an enormous cost of diabetes and we're able to actually address that by, by, by actually doing the right thing and using this model to actually help reverse diabetes.

• 49:52Speaker 01

  Yeah, I would add there, Mark, that the nutrition science and the care delivery model, and the third piece that I think has been behind Virta's, what I might call early success and impact, is the business model. And it may sound like MBA talk, but this is a very, very important thing, because if you don't have the right business model, you can't get anywhere in US healthcare. And it's, so our business model is very, very rare in, in US healthcare, in that it is a true win, win, win. So what we do is Virta Care is 100% free, and no, I'm not joking, 100% free for the individual patient. So

• 50:37Speaker 01

  that's a win for the patient. But then the payer that we work with, which is either self-insured employers, like Fortune 500 companies, like UPS or United Airlines, or US Foods, like we work with nearly 500 large employers, and then health plans like, for example, California, Hyman, and some government entities. So the payer pays for the treatment. But here's the best part, like you said, they save a lot of money, so they pay less than they save. So that's the second win. So it's very rare in US healthcare. Usually it's like, oh, this is a beautiful new molecule, big molecule, large molecule, or like a

• 51:17Speaker 01

  specific cancer treatment, say. And then it's million dollar treatment, or $100,000 treatment. And then there's this trade-off, okay, that's clearly it's going to improve, save human lives, but can we afford to cover? But in a case of reversing chronic disease like type 2 diabetes, we literally go to a large employer, again, like US Foods, which has been applying for a long time, and we say, guess what? We can reverse diabetes, make your employees happy and more productive. And you make money in the process. And this is safe. Here's the evidence published period. What is there not to like? You make money and you save lives and families and improve lives for your employees. Like high five, and I'm not saying it's been easy. We work with, I think, five hundred thirty customers so far.

• 52:02Speaker 01

  Um, it's still hard, but uh, so anyways, I just wanted to highlight that if people listen like, oh, it's intensive care model. And this must be some concierge thing that's gonna cost fifty thousand a year. No, it's free for you.

• 52:14Dr. Mark Hyman?

  Yeah.

• 52:15Speaker 01

  And so, so when you combine those things, the outcomes through nutrition and care delivery. And then a business model that honestly, to me, feels like a win, win, win. That has allowed us to scale pretty fast. And I, I always say this very openly because I want others to copy this. We need more innovation in healthcare like this. That isn't, oh, here's the million dollar miracle cure for this thing. And then everyone's fighting, who's gonna cover it?

• 52:40Dr. Mark Hyman?

  It's crazy. I mean, I, I mean, when I was in Congress, I was testifying, you know, the, the, the United States government, federal government spends about a billion dollars a day on diabetes care. Direct diabetes care. And the Medicare population, eight, eighteen million uh, are diabetic. If this was applied across that population, you know, and everybody did it. It would be over a ninety billion dollar savings for the federal government a year. And that's just this one issue. And I think it, it also cuts across all these other health conditions. So I think the economics makes sense, the science makes sense, the delivery model makes sense. You know, but the barriers are really that, that, that the traditional academic perspective is that this is not the, the treatment.

• 53:23Dr. Mark Hyman?

  And it's not really uh, sort of taken up by the American Diabetes Association, American Heart Association, by Medicare reimbursement, which we're trying to change. I'm, I advocated actually as part of my testimony for a national diabetes reversal pilot program. Where we can actually demonstrate this within the Medicare population and show that this actually works better, that it's a triple win, as you said. And that, that then actually maybe the entire health insurance industry would, would cover this. And I, I think it would be a, a, a good thing in many ways because it, it provides the, the right drug with the right delivery. Mechanism to actually create the most effective outcomes and to reduce costs the most. And that's what we're missing in American healthcare is a delivery model and a treatment

• 54:08Dr. Mark Hyman?

  model that actually works better. And I think, you know, for people listening out there, you know, people struggle with weight, they struggle with how to regulate their appetite, they struggle with knowing what to eat, they struggle with how to change their behavior. But, you know, what we're talking about today is, is a lot of both clinical evidence, research evidence, and this, this sort of science behind how we can actually do this at a population level. It's not one-on-one, like you said, with a concierge doctor and, you know, like if everybody wants to see me, I can help people lose a hundred pounds, a hundred fifty pounds, but they're working with me closely in my team and it's one-on-one and it's, you know, it's intensive. You've learned how to build something that's scalable to the entire country and maybe even a billion people.

• 54:51Speaker 01

  Yeah, absolutely. And you mentioned there, people struggle with metabolic disease and nutrition, 100%. And I guess, you know, I mentioned I'm a triathlete and entrepreneur, this and that. So I just want to say, I hear you, I see you, I can empathize with you. And I say this because 100% of the patients that come to Virta, which again now is more than 100,000 Americans, they have tried somewhere between three and 15 different diet programs or different times, and they failed every single time. So if somebody's listening and say like, well, I've tried everything and I've failed, I just want to say, I see you,

• 55:34Speaker 01

  I hear you, you're not alone. That is the story of practically every single American struggling with metabolic disease. You haven't failed. I think the right message is the program or the diet failed you. The program or the diet failed you. And I say this with high degree of conviction, because that is the case. And there is a way to help you succeed. When you have the right support and the right nutrition science, you can succeed. But this is the story of everyone. I've tried five things. I failed. I'm a loser. I'm a failure. You are not a failure. The program has failed you. You haven't failed.

• 56:11Dr. Mark Hyman?

  And Grisham, why, why do you think medicines are resistant to this? I mean, you, you, you come from the center of, you know, the sort of the heartbeat of, uh, traditional medicine at Harvard and Justin Diabetes Center. You know, why do you think there's such a resistance to accepting this as a, as an effective model?

• 56:28Speaker 02

  Well, I think part of it is that we all sort of have our belief systems that we grow up in and were mentored in. And, you know, even with research, when, when a trial is negative, it's very unlikely to get published, right? So we, we sort of perpetuate biases in, in medicine. And so there's, there's sort of like this bias built into the science. But I think slowly we're going to see that change. And I think now that we're in the age of more data and big data, like I think the outcomes speak for themselves. And I think what we've just been saying, like the, what the triple, the triple aim

• 57:08Speaker 02

  of better outcomes, better patient experience at lower cost, that, that is going to drive things forward. And I think Sammy's point of saying like, the business model is really important. And I don't think I would have said this four years ago, but after working at Virta, because no, I mean, I practiced in a model with, where I was in that fee for service, even though I was an academic clinician, I was in that fee for service model. And so even if I provided excellent care, I needed to spin my wheels and race through my clinic and try to get everybody through as fast as I could so I could stay on schedule. And then, you know, do my pajama charts late at night because I don't have time to do any of my documentation, which is excessive. It's, it's, it's burning out clinicians.

• 57:51Speaker 02

  So I think until, until we fix the way we reimburse, um, folks who take care of preventable diseases, um, it's going to be hard to change. So I think the business piece of it is really important.

• 58:04Dr. Mark Hyman?

  But what you're talking about is not just prevention, Grisham. You're talking about reversal and treatment. So I think people think of

• 58:09Speaker 02

  Right.

• 58:10Dr. Mark Hyman?

  diet and lifestyle is, it's great prevention. Okay, can prevent diabetes. I can prevent heart disease. I can prevent these diseases if I exercise and eat well. But no, no, no. What you're showing very clearly is that that lifestyle is a more effective treatment. And I think, you know, as physicians, our oath is to help our patients. And if there was a drug that worked better than diet, you and I would both use it. What we're hearing really from the science here is that we're not using the most effective drug. And it's because we're not paying for it and not paying for the service of actually delivering this sort of supportive, continuous care model with the right education, with the right support, with the right knowledge.

• 58:52Dr. Mark Hyman?

  And I think, I think it's sort of what you're showing also that, that, that people are, you know, like nobody wakes up and goes, hey, I want to be diabetic, right? They're, I want to be overweight. The, the people want to do the right thing. They're trying to eat better. They, like you said, they try to these diets. They've taken all these medications. The doctors are doing their best to actually help manage the disease. But they're barking up the wrong tree because they're, they're not actually using the right tool and they're not using the right delivery model. And that's really what Bert, I think, has pioneered. And I think, you know, for me, to me, it's one of the most exciting things in healthcare to see what you're doing because you're, you're outside of healthcare. You're disrupting it from the outside. It's getting certain attention from, from certain payers like private insurers of a Medicare Advantage. And I think, you know, has the potential to really revolutionize how we both think

• 59:37Dr. Mark Hyman?

  about using the right treatment for each patient and also the delivery, which has got to be through behavior change models that work. And I'm curious how you came to that behavior change model. Cause yes, ketogenic diet is great. It works, but tell someone to do it. Good luck there, you know, they're on their own. They're not going to be able to figure it out.

• 59:55Speaker 02

  I think one thing to add on that is because we're this continuous model where we have sort of the luxury of a two-tiered rounded system of coaching and clinical team. We're really able to give robust education and resources. And I mean, I think that's one thing Sarah Hallberg, who ran the IUH trial. She had just finished reading her book recently. And one thing she said is that we often in medicine underestimate. Patient's ability to understand physiology and their own health.

• 1:00:30Dr. Mark Hyman?

  That's right.

• 1:00:30Speaker 02

  And when you actually educate them and show respect and share that knowledge with them, it's very powerful.

• 1:00:38Dr. Mark Hyman?

  Yeah.

• 1:00:38Speaker 02

  So I think, you know, old school paternalistic medicine, I tell you to take this, you take this, don't question me, is what we've done in medicine. We've done that for a long time. And this is much more of a shared decision making. Let me explain to you your physiology, why we're doing this. We make the changes. Guess what? You're logging it into this app on your cell phone. Your doctor and your coach are seeing it. We're adjusting your meds in real time. It really makes that knowledge actionable. So really sort of respecting patients' intelligence and, you know, sharing what their physiology is doing and sort of on real time, you know, making, driving that forward. It's a real positive feedback loop.

• 1:01:20Dr. Mark Hyman?

  I think that's right.

• 1:01:20Speaker 02

  That's a big piece of it.

• 1:01:21Dr. Mark Hyman?

  I agree. I mean, I always as a physician, that's my experience too, that, you know, I think I was biased. I had the assumption that people knew, understood, just didn't do it because they were lazy or they were gluttons or they whatever. There's all these judgments about, about obesity and diabetes that, you know, the people just didn't care. And, and I realized how flawed my own thinking was and how it wasn't their fault that they were living a sea of misinformation around nutrition. It was not accidental. It was propagated by a food industry desire. It was desiring to get more stomach share and that, that the scientific community was corrupt as well because it's highly funded by these

• 1:02:04Dr. Mark Hyman?

  big food companies that the NIH, you know, spends, I think, point zero zero two percent of their budget on nutrition science, most of which isn't even the right stuff anyway. And, and so we've had this sort of system that is completely sort of neglected the, the individual patient's ability to take control of their health because they're not getting the right information. They're not getting the right education. And when they are and when they do, people are willing to shift. And I've seen this over and over over three years of practice. When you sit with someone, you look at their data with them, you explain their biology, you say, this is what's going on, whether you're carbohydrate intolerant or your guts unhealthy and you need to eat this or do that.

• 1:02:43Dr. Mark Hyman?

  People are willing to do it because they don't want to feel sick and they're trying to do their best, but they're they're kind of following a path that we set on medicine that's completely flawed. And I, and I think I'm very enthusiastic about seeing how this becomes adopted across healthcare. Because like you said, if you are showing the data now, you have a hundred thousand patients. There's this opportunity for for sort of the tipping point to happen where this becomes more widely adopted. And it becomes actually standard care, not just, not just for diabetes care. But but the concept of continuous care model of support and coaching and, you know, constant interaction, dynamic ways of working with people with telemedicine, with coaching, with digital apps,

• 1:03:26Dr. Mark Hyman?

  with biosensors that, you know, upload into the cloud that you can read. I mean, it's a really different era of medicine. And and I think we're seeing this convergence that it's going to shift us from, you know, being being sort of burdened with this chronic disease epidemic to starting to shift it. If if we're actually able to kind of get the kind of payers to start to realize that this is a win for them too.

• 1:03:47Speaker 01

  And I I should just, I'm very optimistic and not just speaking my own book. Given the growth that we've seen from, you know, twenty payer clients early twenty twenty and now five hundred twenty plus. This message of we can save lives, improve lives, and you make money in the process. Even if you don't care about the humans, you just want to make money, you should cover pay for vertal-like treatments. I'm actually very optimistic that the the growth and positive impact on human lives will continue. On the product and and behavior change side, I'll just add one more thing in addition to what Chris mentioned, just trusting the patient. And internally, we use this term that at best we are co-pilots.

• 1:04:32Dr. Mark Hyman?

  Yeah.

• 1:04:32Speaker 01

  On your journey towards better health, we are co-pilots. We're not the captain. We're not the boss telling you. We are co-pilots. So just trusting the patient is so important. The second thing I wanted to mention, obviously, everything we do is telemedicine. In we use AI, it's like software and tech DNAs is at the core as much as sort of patient safety and clinical and nutrition science. But the way we use software is to empower our clinicians, so providers and coaches, so that they have more time for what we call powerful care moments. To drive results, this human connection, real human connection between the patient and our clinicians

• 1:05:17Speaker 01

  is very, very important. And like, there's a reason why I, as a CEO, you know, you know, we have so close to thousand employees, but I write handwritten notes, not to everyone, every day, but to many people. I will never have AI write those. It's not my assistant who writes those. Guess why? Because I care. But because the whole point of the thing is that I personally write the note and the address on the envelope and send it to you as as a note of appreciation. It's the same thing in our care. Yes, we can use AI. Yes, we can use software to sort of automate the simple logistical things to provide you support. But there's a point in time where this human

• 1:05:57Speaker 01

  connection makes all the difference, 100% difference. And we don't want to lose that, even if AI technically could deliver all the bits and messages and pictures and whatnot.

• 1:06:10Dr. Mark Hyman?

  Yeah, it's incredible. Well, I applaud you both for what you're doing. I look forward to more and more science and data coming out to supporting you to help make this the model of care for for care in general in America. And I think for those listening, I think we're going to link to vertahealth.com, which is the website. You can read about the program. I mean, everybody in America is either touched by diabetes or touched by someone who has it or has it or has prediabetes. I mean, and not, like I said, 90% of people don't even know they have it. At Function Health, you know, company I co-founded, we allow, you know, extensive testing of metabolic health, and we're seeing just such a degree of metabolic dysfunction that nearly everybody could learn how to sort of improve their health. And there's also an incredible amount of research you've published. It's all on your website and as well as how to engage with the

• 1:06:54Dr. Mark Hyman?

  Program. So we're going to link to all that. And I appreciate both of you so much, so much for what you've done to actually advance healthcare and medicine and and kind of wake people up to the possibility that these chronic diseases are not a one way street. And that is what we need to teach America that these chronic diseases don't have to be chronic. I don't want to manage them. I want to get rid of them. And I think you do too. And thank you both for all you've done to sort of make that happen and continue. The work that you know, Sarah started with you and Sammy and the research you're doing now is really inspiring. So thank you both being on the podcast and I think you all for listening.

• 1:07:28Speaker 01

  Thank you, Mark.

• 1:07:29Speaker 02

  Thank you.

• 1:07:30Dr. Mark Hyman?

  If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. And this podcast is separate from my clinical practice at the Ultra Wellness Center and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.

• 1:08:14Dr. Mark Hyman?

  This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit ifm.org and search their Find a Practitioner database. It's important to have someone in your corner who is a trained licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.

• 1:08:49Dr. Mark Hyman?

  When it comes to supplements, you only want the best for your body, the kind with the highest quality, cleanest, and most potent ingredients you can get. That's exactly what you'll find at my supplement store, where I've hand-selected each and every product to meet the most rigorous standards for safety, purity, and effectiveness. These are the only supplements I recommend to my patients, and they're also what I use myself. Whether you want to optimize longevity, or reduce your disease risk, or you're looking to improve your sleep, blood sugar, metabolism, gut health, you name it, drhyman.com has the world's best selection of top-quality, premium supplements, all backed by science and expertly vetted by me, Dr. Mark Hyman. So check out drhyman.com, because when it comes to your health, nothing less than the very best will do. That's drhyman.com, D-R-H-Y-M-A-N dot com.