Dr. Shadia Grishma
Appearances
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
He's off three medications, diabetes medications, one including insulin. His sleep apnea is resolved. 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, 45. He's only been with us for 160 days. He's dropped 17 pounds.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
And his A1C has gone from 8.8 to 7.5. And he's only on one metformin now. Like, this is incredible. And this is not unusual.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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 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?
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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 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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
So really thinking about it simplistically, though, is really preserving and de-stressing that beta cell.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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. 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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
And there's all the ways in which... And equity around getting medications.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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 helped people be healthier from day one?
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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. And 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
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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 uh of better outcomes better patient experience at lower cost that that is going to drive things forward and i think sami'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
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
And one thing she said is that we often in medicine underestimate 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, 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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
So really sort of respecting patients' intelligence and sharing what their physiology is doing and sort of on real time data. driving that forward. It's a real positive feedback loop. I think that's a big piece of it.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
diabetes rather than a whole cocktail of drugs which can cost huge amounts of money every year you know it's funny that it is full circle that our knowledge we 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
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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 two 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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
So we flipped 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 brick and mortar clinic, I was there for, um,
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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'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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
And then they get to the room with you and you've literally got 15 minutes to solve all their metabolic health issues. It'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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
And so there's 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 is. can actually swoop in and take care of the patients who need help.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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 deprescribing medications and move it forward. And the third piece I just want to add, because I don't think it's just
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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,
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
They will interact with their coaches multiple times in a day. And often their clinicians, their metabolic clinicians, probably daily because we're deprescribing 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.
The Dr. Hyman Show
Blood Sugar Chaos: How to Take Back Control & Reverse Diabetes | Virta Health
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. 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.