The Dr. Hyman Show - Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health

Episode Date: February 12, 2025

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 https://admin.shopify.com/store/dr-hyman-store/content/articles/633451511939 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.

Coming up on this episode of the Dr. Hyman show. Yeah, 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 type 2 diabetes context. Obviously type 1 is a different disease. One of the most important tools when it comes to living a long healthy life is improving the quality of our food. But why? Research shows that a group of molecules called polyphenols may be a key.

Polyphenols are made naturally in plants. When we consume them, they may target key metabolic and immune pathways within our cells to promote health span. A food that's uniquely loaded with these polyphenols is Himalayan Tartary Buckwheat, or HTB, an ancient gluten-free seed prize for its medicinal benefits for thousands of years. My friends at Big Bold Health are HTB experts and have published incredible research linking HTB to cell pathways involved in aging. Right now you can try Big Bold Health's flagship product, HTB Rejuvenate, with a special discount code. Each capsule of HTB Rejuvenate is packed with quercetin, rutin, and other

polyphenols from HTB, so this product is an outstanding choice for on-the-go polyphenol support. I take this product every day and it's a key part of my supplement stack. Head to BigBoldHealth.com and use code DRMARK25 to try this amazing product today. I really want to talk to you today about why you should care about urolithin A, a powerful compound that I believe is a breakthrough for healthy aging. As we age, the mitochondria in our cells naturally become less efficient. Think of them like little batteries. When they're drained, we feel it. Sluggish muscles, slower recovery, less energy. But here's where Urolithin A comes in.

Research shows that Urolithin A supports mitophagy, or the renewal of these batteries, which keeps our cells energized and functioning optimally. And that's why I take Timeline Nutrition's Mitopure, which delivers Urolithin A in a form that's bioavailable and backed by real science. Since adding it to my routine, I've felt a noticeable difference in how quickly I recover and how strong I feel even during intense activities. So if you want to support your body at the cellular level and keep up with everything you love, give it a try. Visit timeline.com slash D dash R dash Hyman for 10% off.

Trust me, your body will feel the difference. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone via 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.

So welcome, Sammy, and welcome Dr. Shaddi Grishma. It's so great to have you on the Dr. Sauraswati 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 one in two Americans is pre-diabetic 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 our healthcare system, it's driving so many of the chronic diseases like not just diabetes but Alzheimer's, cancer, heart disease, mental health issues, all driven by metabolic dysfunction.

And in medical school, it was something that I really never learned much about, and I'm sure you didn't either. And we really sort of struggled to treat this, 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. 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 help reverse it. Now, when I went to medical school, I don't know, Rich, if you went to medical school, this was the party line, but the party line was, if you get type 2 diabetes, it's a progressive disease that is not reversible. 2 diabetes, it's a progressive disease that is not reversible. But this is actually not true. And for those people listening with type 2 diabetes, and make sure you understand, I'm not talking about type 1, which is an autoimmune disease. That's very different. It's not easily reversible.

But type 2 diabetes, based on the science and a lot of the work that you've done in 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 2 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 may want to improve your diet and lifestyle, but you've got to accept that this is a lifelong,

progressive, irreversible condition. Can you explain, you know, first, start with Sammy, how you kinda got into this field? Because you're kind of a unusual character that was an entrepreneur, but an athlete, and you kinda discovered that what you were doing to fuel your athletic performance was not really getting you the help that you wanted.

And then we'll sort of go into really answering the underlying issue is, why do we have this epidemic? Why are we failing at treating it? And why is there actually a new approach that maybe the answer to solving so much of our extreme metabolic crisis that we're having today. Yeah. Well, first of all, Mark, thank you so much for having us here. And I feel not completely adequate to answer the question because I'm the only non-MD on this call. So Dr. Shetty, Chris Mahir and you, but let me try. Well, first I would say- Mostly it's also for your experience too. Like I wanna hear like, how do you get into this stuff?

Yeah, so, and I wanted to say that just to kind of contrast that I actually, I do come outside of healthcare. So I'm a physicist by training, started my career in a nuclear power plant. So that's my only claim to fame for scientific thinking, but indeed I was outside of healthcare. And the very dire picture that you so eloquently painted, Mark, about the massive numbers of type 2 diabetes and

obesity and metabolic disease. Effectively, you know, 10 to 20% 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, 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 10 years ago, I would have rolled my eyes and laughed you out of the room.

I literally would have rolled my eyes and laughed you out of the room. That's right. 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 the 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. 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. Well, you shouldn't be because it's basically the thinking of almost everybody, including most physicians and nutritionists in the healthcare system.

So you're not alone there, Sammy. Exactly. So, so finally, like, you know, how did I become a co-founder and now CEO of Verta 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 pre-diabetes 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 me here? And your pre-diabetic, right? How did that happen? Yeah. And, uh, I, I should say, fortunately, you know, 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 met a number of scientists, but particularly Dr. Steven Finney and Dr. Jeff Volek, who had done research over three decades about metabolism and how the body metabolizes carbohydrates and fat and so forth and met these gentlemen scientists and basically learned two things and very briefly. One, I was obviously completely wrong. Diabetes and obesity, it's a metabolic disease. It's not a personal choice that you wake up one Monday and say, hey, I'm just going to eat too much to develop type 2 diabetes. 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. Type 2 diabetes obesity are systematically reversible nutritionally, if you

know how to manipulate nutrition. And I became convinced both through personal experience and reading all this published research that it indeed is possible. And so I'm not going to 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 a 10 years ago and we have this a little bit of a crazy mission, reverse type two diabetes and obesity in 1 billion people, reverse type two diabetes and obesity in 1 billion people. And yeah, here we are 10 years later and we can go into details. How's it going? But yeah, that's how I became an accidental healthcare entrepreneur. And honestly, it's been the most rewarding journey in my professional career. So, yeah, 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, Grishma, you're a board certified endocrinologist. You're directed the Fellowship in Diabetes, the Jocelyn Diabetes Center, which is iconic Harvard diabetes treatment 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. The treatments they had back then were just very little except nutrition, modifying what people ate and changing their diets.

Back then, before they had insulin, they used a ketogenic diet as one of the treatments for type 2 diabetes or even type 1 diabetes, which was killing people. It was very effective and it kept these people alive. It was not perfect, but it was really quite an interesting origin story. Now, the American Diabetes Association doesn't quite recognize that diabetes is a carbohydrate excess problem. It's a carbohydrate intolerance problem.

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 and 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 Jocelyn Diabetes Center,

which is to use a diet as the main state therapy for diabetes rather than a whole cocktail of drugs, which can cost huge amounts of money every year. It's funny that it is full circle that our knowledge, what we were doing before we had a therapeutic and insulin was an incredible discovery and saved the lives of many, many people with type one diabetes and poorly controlled type two 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 we live in an obesogenic world now with toxic food environment, inadequate sleep, inadequate activity. And even with the way we deliver care, 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 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 Virta 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. So we flip that at Virta and we have great data from our IUH trials that we can sustain remission and weight loss and deprescription 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 my old practice, which is a traditional Burke and Mortar clinic, I was there for, 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 Glycometer their CGM update their med list, you know Get the labs the pre-check labs and then they get to the room with you and you've literally got 15 minutes to solve all their metabolic Health issues. Like that's 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 this ability, our algorithm, will generate what we call an attention score, which gets the right signal to noise.

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, you can reinforce that virtuous cycle by de-prescribing medications 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, probably daily because we're deep prescribing medications, answering questions, keeping them safe. So it's a very white glove, 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 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 900 days. His weight is down 80 pounds.

He came to us with an A1C at nine. It's now 5.2. He's off three diabetes medications, one including insulin. His sleep apnea is resolved. He's off three diabetes medications, one including insulin. His sleep apnea is resolved. He's off his CPAP. He's only on one anti-hypertensive 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, 45. He's only been with us for 160 days. He's dropped 17 pounds and his A1C has gone from 8.8 to 7.5. He's only on one metformin now. This is incredible. This is not unusual. I think there are changes you don't actually even see with medication.

You can't achieve those results using drugs unless you use massive dose of insulin, which are problematic. By the way, I'll add here, I think Chris mentioned the IUH trials, so Indiana University Health and data, which is that when we started Virta, obviously, we use telemedicine and nutrition to achieve these results. 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 2015, seemed 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 saying, are you crazy? You're going to 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 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, paradigms even in light of new data change very slowly, very, very slowly. Like you, Mark, mentioned, oh, diabetes is reversible. But guess what? If we go and poll a thousand average or random providers, you know, Harvard trained Stanford trained, you name it. I don't know what percentage would still say, yeah, no, 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 it's has 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 the language of most scientists and clinicians. But even with the data, you know, it's hard work. Don't confuse me with the facts. My mind's made up, right? Exactly. Yeah. Well, you know, it's interesting when I was seeing you, Ghrishma, the two things that I'm really hearing is you're using a

different drug and a different delivery system. And 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 and diet work better. We know 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 a whole foods diet or a Mediterranean diet. It's a very specific therapeutic issue. Food is medicine, then it's not all the same. What is the drug? What is the dose?

What is the frequency? How is it prescribed? That really matters. And the second piece is the delivery system. The episodic care you're talking about where you go see the doctor every six months for eight minutes and don't have real feedback about what's going on except being able to prescribe more medication and order a few lab tests. It's not 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? If you want to actually change people's lifestyle, you can't have an appointment every six months. So this continuous care model, which is high touch, which is digital, has allowed you to actually deploy this model in a way that's been more effective and people are adhering to more than you can ever imagine. 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 can you tell us more 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 think just to sort of talk about the data that I know, you can correct me if I'm wrong, but in about 60% of the cases of the people you serve, you reverse the type of diabetes, put in remission. You get almost all the people off of the main medications and most off insulin or dramatically reducing their insulin. 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 this incredible data of improvement in cardiovascular biomarkers which you think wouldn't 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 an endocrinologist saying is actually not the right approach to treating that type 2 diabetes. Let's talk about red light therapy.

After my recent back surgeries, recovery and managing back pain became a top priority. That's where Bond Charge has made a world of difference. Bond Charge is all about making science-backed wellness tools accessible, and their red light therapy collection has become a game changer in my recovery. Whether you're looking to reduce muscle soreness, boost your energy, or simply unwind, BondCharge's red light devices are designed to fit into your life seamlessly.

Just a few minutes each day and you're reaping the benefits of improved circulation, reduced inflammation and even better skin. For me, it's been a huge help with muscle tension, especially in my back post-surgery. The infrared heat combined with the latest in light therapy penetrates deep to support my recovery. I can use it after workouts, before bed, or even while I meditate. Plus, I've noticed I'm falling asleep faster and waking up more refreshed without the usual aches.

BondCharge truly thought of everything from easy setup to worldwide shipping plus a 1-year warranty. If you're ready to step up your wellness routine, go to bondcharge.com and use code DRMARK to save 15%. That's B-O-N-C-H-A-R-G-E.com. Code DRMark for 15% off. As a doctor focused on longevity, I often remind my patients that aging isn't just about how we look. It's about how well our bodies function. One key player in this process? Collagen. Collagen supports your joints, bones, gut health, and metabolism, but as

we age, our natural collagen production declines. The solution? Bone broth, a time-tested source of collagen and amino acids essential for healthy aging. That's why I recommend Paleo Valley's unflavored 100% grass-fed bone broth protein. It's made exclusively from grass-fed, grass-finished beef bones, slow simmered to preserve the pure, nutrient-rich collagen your body needs, without high heat, chemicals, or glyphosate. It's flavorless, odorless, and dissolves instantly, so you can easily add it to coffee, smoothies, or soups. It's the simplest way to get the restorative benefits of bone broth in seconds.

Head to paleovalet.com slash hymen to get 15% off and try 100% grass-fed bone broth protein today. Supporting your body as you age has never been easier. Maybe I'll jump Chrisma first, give the non-AMD, non-medical doctor view now that I've observed 100,000 plus patients and 10 year journey and maybe the listeners who are less clinically minded 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 the drug. Those are the outcomes that we deliver. And as you mentioned, 12% average body weight loss, and not just for six months, 12% at one year, sustained at two years, and we'd follow patients out to five years. So the results are very strong. And as you mentioned in type 2 diabetes context, insulin is usually thought as sort of the last hope drug, hypoglycemic agent for type 2 diabetes. While at two years, from start to two years, 80% of all insulin in verticaria is eliminated, which again is kind of unheard of because usually the dose goes up 10, 12% year over year. So 80% of people get off insulin. That's remarkable. It's, it's, this is, um, 80% 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, it's very high. And as you said, 60%, 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 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 type 2 diabetes context.

Obviously type 1 is a different disease. But back to the treatment, so I'll give you the layman's version first. Well, 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, uh, 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 the couple of cornerstones why Virta works. But here's the couple of cornerstones, why Virta works. So number one, you have 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. based on sort of willpower and hunger. Willpower always runs out. Usually latest at the wedding photo.

Like he just runs up and it runs out. 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 satire and as much sort of real food as possible. That means eating to your full. Like don't, don't calorie restrict. Because Exactly. 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. Exactly. And obviously mathematically that can hold. But again,

if it's a mathematical exercise, when the willpower runs out, which it does again at the wedding photo, whatever the milestone is, then weight retains. So that's an nutritional sign. 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 eggs for breakfast, guess what?

We lose you immediately. 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 so that's on a nutrition side. And Krisman can go into details, but that those are some of the cornerstones.

And then on a care delivery, I'll just mention that 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? 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 going to 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, kids 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 seven, care better be and support better be 24 seven too. So that's kind of a little bit of on a high level the nutrition piece and then combining with this 24 seven more or less 24 seven 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. Yeah 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. They're not, as I 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 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. So, you know, 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 diets. 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? In genome-wide association studies, we now know there's hundreds of different 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 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 two 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 also spare the beta cell from having to produce more insulin to do the same job. 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. I started my fellowship training studying adipokines. I was in a lab where I was studying leptin and adiponectin. And 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. And the way you do that is by basically restricting carbohydrates and adding a lot of fat. Now, it's not the bacon and 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, fat makes me fat. you know, if we eat fat, you get fat. And there's this whole mythology we had about that. And in fact, that was sort of the prevailing theory for so long. And now it's shifted. And we understand that actually, for these metabolic dysfunctional people, which is most of America, that we were eating way too many refined starches and sugars. 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, I had a patient at Cleveland Clinic who was type 2 diabetic on insulin for 10 years, had heart failure, had kidney starting to fail, fatty liver, hypertension, had multiple stents put in for cardiac disease. It 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. We just didn't put on a keto diet but since she just took off grains and beans, sugar, processed food, put her on lots of good fats, olive oil, avocado, 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 diet diets are. And within three days, she was off for insulin and three months, she was off for medications or 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 a ZempBic, without a gastric bypass, simply by getting the group support, which we did, 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, 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? 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 obviously you can then tease out the correlation and causation like, oh, more of this acetaminophen, unless 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 off the meds. And I guess the punchline is the more insulin resistant you are, the more of that dose, the better is basically without sharing all of our secrets. But it's fascinating because we literally have a dose response curves and it kind of

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 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 sure nutrition can work, but come on, like these are the, like the grandfather who was a hundred pounds overweight and then ran a marathon. We always hear these stories, like, oh, it's a one anomaly, one out of million. But I think really what the world needs to hear, there's these 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, 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. There's no other way out of this metabolic health mess. GLP once in tap water is not gonna solve this mess. No, and it's interesting when you're talking about how you're 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 reach 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 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, I mean, I would say nobody can eat 12 avocados, but anybody can eat a whole bag of chips, a whole 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? 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 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. So what's interesting is that you said something that I want to 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, Sammy, earlier was that you're achieving Ozempic-like results

without taking the drug, without all the side effects and without all the costs. And so, can you kind of explain what, and we talked about this when we were hanging out in person and asked, but you know, 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 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. They're trying to get all these studies done to get indications for these other applications of these drugs. But 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

Grisham and how that how that works? Yeah, absolutely. 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 two diabetes 2005, and it's a tool in a toolkit. It is a tool in a toolkit for type two 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 answer your question specifically, and this is all data that's published in peer reviews. So if anyone wants to sort of double check, you can go to VirtaHealth.com and slash research and find out published in peer review 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, a 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, but better than humira. That's unpublished.

So that's a caveat. 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 improves, so we looked at EGFR and we can't really say that we can, it would be a little bit overreaching to say we reverse kidney disease, but we have shown that we improve kidney function and same with liver function. So when you look at these broad spectrum metabolic health improvements, it's basically the same list that the GLP-1 manufacturers are now showing

that we need to 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. But basically what we can show is it is possible to achieve the same broad metabolic health improvements as GLB once may or may not, nutritionally, 100% 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, reduce information. But we can achieve the same things nutritionally,

which I think again is a very important message to be heard 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 of those things. And then finally, I will say, again, there's a place for these drugs, GLP-1s are a tool in a toolkit. But I think this statement holds true, which is, we don't know But I think this statement holds true, which is we don't know the short, the midterm and longterm side effects of exogenous drugs, but we know the side effects of healthy food. Guess what? They're all good.

Happier, better, longer life. That's right. Like healthy food. It's tough to say like, what's bad about that? Not much. 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 anachronologist

or a screen-shamer about the GLP-1s and their utility, but also their risks. 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. This conversation you just mentioned, Sammy, reminded me of a study I read that looked at gastric bypass and they did a controlled study where they took a group of obese patients. Half of them got bypassed 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. It wasn't the surgery, it was the food. And I hear you saying the same thing about the GLP-1. So I'd love, Rishabh, you sort of share from an endocrinologist perspective, what your thinking is about this, where they play a role.

And actually, is this approach of very aggressive nutritional intervention with the continuous care model of lifestyle support and behavioral change actually better? And how do we think about that? 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 one 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 one diabetes who we say they have double diabetes, which is type one with insulin resistance, we've we've just let people eat Whatever they want even if it doesn't work for their body So I like that pair like to think of that as an analogy for GLP ones You just can't what eat whatever you want just because there's a new medication because guess what again the energy homeostasis 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 the GLP-1 therapy and that. 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. 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 Virta it's it's a daily again like a white glove experience where we're getting that data we're doing that data, we're doing that positive feedback to make those changes, to learn and course correct when things aren't going well, to celebrate when we get those lab reviews.

So really, it has to be a very patient-centric, holistic approach. So I think there is a role for these medications, but I think we need a better solution as a population. But is your belief that if people were able to adhere to a diet that was right for them, that these drugs are redundant? I think so. I think if you could prevent, I mean, 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, 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. 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. So there's real implications for populations when you teach them how to eat correctly. And the last thing I'll add is diabetes disproportionately affects minority populations and those with less socioeconomic means. Imagine 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. Yeah, I know.

Absolutely. gaps and the death gaps that we have in the United States. Yeah, I know, absolutely. I mean, the health disparities are huge and, you know, there's a whole food inequity issue and nutrition security issue and there's all the ways in which, you know... And equity around getting medications. Yeah. Accessing expensive medications and accessing expensive technology like CGM. There's all kinds of equity issues. So what if we went to the root cause and just help people be healthier from day one? And, you know, it failed miserably, right?

Because if you look at 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 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 actually make a lifelong change in their behavior. And 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. 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, the drug regiments were complicated, you know, that you had to be on those on schedule and people didn't have watches, they didn't have clean water.

So they just kind of gave up. And Paul Farmer realized that it wasn't a medical problem, it was a social problem, a structural problem. And he basically trained thousands of community health workers, neighbors helping neighbors to change their behavior and to support their life. And I applied that in a model at a big church in California called Saddleback Church where we got 15,000 people to work in small groups to change your lifestyle together because of that high touch and that cultural shift 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 BERT. 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 a key therapy, but it's this other piece that has been completely neglected in healthcare, which is 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 people's helping people.

The science behind this is quite good, but it's been ignored because it's not reimbursed. But what's exciting about Virta is that you're showing not only does it work, but that you're actually saving approximately $6,000 per patient. And just in Medicare, for example, just because I was testifying in Congress last week, sharing with the congressman how we have such an enormous cost of diabetes

and we're able to actually address that by by actually doing the right thing and using this model to actually help reverse diabetes. Yeah, I would add there Mark that the nutrition science and the care delivery model and a 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 NBA 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 so our business model is very, very rare in US healthcare in that if you say true win, win, win. So what we do is Virta Care is 100% free. No, I'm not joking. 100% free for the individual patient. So 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, United Airlines, or US Foods, we work with nearly 500 large employers, and

then health plans like Prosciutto California, Humana, and some government entities. 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. That's right. So that's the second win. So it's, it's very rare in U S healthcare. Usually it's like, Oh, this is a beautiful new molecule, big molecule, large molecule, or like a specific cancer treatment, say, um, and then

it's million dollar treatment or a hundred thousand dollar treatment. And then there's this trade off. Okay, that's clearly it's going to improve safe 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 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. 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, 530 customers so far. It's still hard, but 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 50,000 a year. No, it's free for you. And 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 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 going to cover it. It's crazy.

I mean, when I was in Congress, I was testifying. The United States government, federal government, spends about a billion dollars a day on diabetes care direct diabetes care and the Medicare population 18 million are Diabetic if this was applied across that population No, and everybody did it It would be over a 90 billion dollar savings for the federal government a year And that's just just one issue.

I think 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. But the barriers are really that the traditional academic perspective is that this is not the treatment and it's not really sort of taken up by the American Diabetes Association, American Heart Association, by Medicare reimbursement, which we're trying to change. 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 then actually maybe the entire insurance industry would cover this. And I think it would be a good thing in many ways because it provides the right drug with the right delivery mechanism to actually create the most effective outcomes and to reduce costs the most. That's what we're missing in American healthcare is a delivery model and a treatment model that actually works better.

I think for people listening out there, 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. What we're talking about today is a lot of both clinical evidence, research evidence, and the 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 like if everybody wants to see me, I can help people who's 100 pounds, 150 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. 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 a hundred thousand 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 failed. I just want to say, I see you. 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. And Grishma, why do you think medicines are resistant to this? I mean, you come from the center of, sort of the heartbeat of traditional medicine at Harvard and Johnson Diabetes Center.

Why do you think there's such a resistance to accepting this as an effective model? Well, I think part of it is that we all sort of have our belief systems that we grow up in and we're mentored in. Even with research, when a trial is negative, it's very unlikely to get published, right? So we sort of perpetuate biases in medicine. And so 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, I think the outcomes speak for themselves. And I think what we've just been saying, the triple aim of better outcomes, better patient experience at lower cost, that is going to drive things forward. And I think Sami's point of saying 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 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 do my pajama charts late at night because I don't have time to do any of my documentation, which is excessive. It's burning out clinicians. So I think until we fix the way we reimburse folks who take care of preventable diseases, it's going to be hard to change. So I think the business piece of it is really important. What you're talking about is not just prevention, which when you're talking about reversal and treatment. it's going to be hard to change. So I think the business piece of it is really important. But what you're talking about is not just prevention,

which when you're talking about reversal and treatment. So I think people think of diet and lifestyle as it's great prevention. Okay, I 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 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. But 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. And I think it's sort of what you're showing also that people are, you know, like nobody

wakes up and goes, hey, I want to be diabetic, right? I want to be overweight. People want to do the right thing. They're trying to eat better. Like you said, they've tried all 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 not actually using the right tool and they're not using

the right delivery model. That's really what Virta, I think, has pioneered. I think, to me, it's one of the most exciting things in healthcare to see what you're doing because you're outside of healthcare. you're disrupting it from the outside. It's getting certain attention from certain payers like private insurers, even Medicare Advantage. And I think, you know, has the potential really revolutionized how we both think 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 because yes, ketogenic diet is great, it works, but tell someone to do it, good luck. They're on their own, they're not going to be able to figure it out. 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 a patient's ability to understand physiology and their own health. And when you actually educate them and show respect and share that knowledge with them, it's very powerful. So I think 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 patient's intelligence and sharing what their physiology is doing and sort of on real time driving that forward. It's a real positive feedback loop. I think that's a big piece of it.

I agree. I mean, I always say as a physician, that's my experience too, that 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 whatever. There's all these judgments about obesity and diabetes that people just didn't care. 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 that was desiring to get more stomach share and that the scientific community was corrupt as well because it's highly funded by these big food companies that the NIH spends, I think, 0.002% of their budget on nutrition science, most of which isn't even the right stuff anyway. And so we've had this sort of system that has completely neglected 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 gut's unhealthy and you need to eat this or do that. 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 kind of following a path that we set on medicine that's completely

flawed. 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 100,000 patients, there's this opportunity for sort of the tipping point to happen where this becomes more widely adopted and it becomes actually a standard of care, not just for diabetes care, but the concept of continuous care model of support and coaching and constant interaction, dynamic ways of working with people with telemedicine, with coaching, with digital apps, with biosensors that upload into the cloud that you can read. It's a really different era of medicine.

And I think we're seeing these convergence that it's going to shift us from being burdened with this chronic disease epidemic to starting to shift it if we're actually able to get the payers to start to realize that this is a win for them too. And I should just, I'm very optimistic and not just speaking my own book, given the growth that we've seen from, you know, 20 pay your clients early 2020 and now 520 plus, this message of when 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 Virta-like treatments. I'm actually very optimistic that the growth and positive impact on human lives will continue. On the product and behavior change side, I'll just add one more thing in addition to what Chris mentioned, just trusting the patient. Internally we use this term that at best we are co-pilots 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. 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 is very, very important.

And like there's a reason why I as a CEO, you know, we have close to thousand employees, but I've write hand why I, as a CEO, you know, we have close to a thousand employees, but I've 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

and the envelope and send it to you as a note of appreciation. It's the same thing in our care. Yes, we can use AI. Yes, we can use software to automate the simple logistical things to provide you support. But there's a point in time where this human 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. 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 care in general in America. And I think for those listening, I think we're gonna 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 pre-diabetes. I mean, and not like I said, 90% of people don't even know they have it.

At Function Health, we know, company I co-founded, we allow extensive testing of metabolic health, and we're seeing just such a degree of metabolic dysfunction that nearly everybody could learn how to improve your health. There's also an incredible amount of research you've published. It's all on your website as well as how to engage with the program. We're going to link to all that. I appreciate both of you so much, so much of what you've done to actually advance healthcare

and medicine and 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 make that happen and continue the work that you know Sarah started with you and Sandy and I appreciate you're doing now. It's really inspiring so thank you both for being on the podcast and thank you all for listening. Thank you, Mark. Thank you.

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 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. 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. 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 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. Do you have a question about my favorite books, supplements, or recipes? Then sign up for my free Mark's Picks newsletter at

drheimann.com slash Mark's Picks, where I'll share all of this information with you and so much more. You'll get emails from me every Friday with recommendations on things that have helped me on my health journey, and I hope they can help you too. Thank you so much again for tuning in. We'll