Dr. Greeshma Shetty
Appearances
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
So, you know, for in the trial, our patients were on a well-formulated ketogenic diet, which is very low carb. So 30 grams, um, 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 two diabetes, right?
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
We've in genome wide association studies, we now know there's hundreds of different like types of type two 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,
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
So really thinking about it simplistically, though, is really preserving and de-stressing that beta cell.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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, which is type 1 with insulin resistance. Because we've just let people eat whatever they want, even if it doesn't work for their body. So I like to think of that as an analogy for GLP-1s.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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 Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
the millions of people who have not yet developed those complications who have diabetes and the folks who have prediabetes 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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
So really thinking about the root cause and finding the right nutrition for the individual patient. And this is part of precision medicine, right? Personalizing your diet to what works for you. And it's hard work. I mean,
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
What our coaches and clinicians do at Virta, 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, to celebrate when we get those lab reviews. So really, it has to be a very patient-centric, holistic approach.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
So I think there is a role for these medications, but I think we need a better solution as a population.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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 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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
And there's all the ways in which- And equity around getting medications.
The Dr. Hyman Show
Reversing Diabetes Naturally: The Science Big Medicine Ignored
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?