Reversing Diabetes Instead Of Managing Symptoms | with Steve Hastings

This video provides an in-depth exploration of reversing type 2 diabetes and obesity through nutrition-based interventions, featuring Steve Hastings, Leader of Health Plans at Virta Health. The discussion challenges the conventional approach of merely managing chronic conditions, advocating for a paradigm shift towards achieving sustained reversal. Hastings emphasizes the profound impact of food as medicine and details Virta Health's comprehensive strategy, which combines individualized nutrition protocols with a continuous virtual care model to empower patients and drive significant health outcomes.

The core of Virta Health's methodology revolves around personalized nutrition, moving away from generic dietary advice. The program focuses on reducing processed foods, excess carbohydrates, and sugars, while integrating healthy fats, which can clinically be described as a well-formulated ketogenic diet, though the term "keto" is deliberately avoided due to its commercialized stigma. This protocol is meticulously tailored to each member, considering their medical history, allergies, intolerances, cultural preferences, food environment, budget, and social determinants. This highly individualized approach, coupled with daily virtual interactions with a dedicated care team (health coach and provider), allows for real-time adjustments based on objective biomarker readings and subjective data points like hunger, cravings, and depressive symptoms.

A significant portion of the conversation addresses the role of GLP-1 medications in weight loss and diabetes management. While acknowledging their effectiveness for some, Hastings cautions against viewing GLP-1s as a standalone "magic pill," emphasizing that they are prescribed as an adjunct to diet and exercise. Virta's program demonstrates comparable weight loss outcomes (13% average) without GLP-1s, and critically, provides a strategy for sustained weight loss (85% success rate) for patients who deprescribe GLP-1s. The company's success is backed by peer-reviewed published papers, showing 60% diabetes reversal (A1C below 6.5% and off all diabetes-specific medications) within the first year, with sustained results over two, three-and-a-half, and five years. This evidence-based approach highlights the potential for true behavior change and long-term metabolic health improvement.

The video also delves into the broader implications of diabetes and obesity, noting that three-quarters of the US population is overweight or obese, with type 2 diabetes costing approximately $16,000 per patient annually. Beyond physical health, the program has shown improvements in mental health, specifically depressive symptoms, and creates a "halo effect" where family members also adopt healthier eating habits and experience positive health changes. Hastings discusses the scalability of Virta's "provider and vendor" model, which partners with health plans, PBMs, and employers to deliver this reversal benefit, often fully covered for members. He anticipates the GLP-1 "crisis" will continue to dominate healthcare discussions but expresses hope that "food as medicine" will gain greater recognition and be valued as a primary tool for optimizing health outcomes, challenging the skepticism that patients "won't do this."

Key Takeaways:

• Diabetes and Obesity Reversal is a Proven Reality: Virta Health has clinically demonstrated that type 2 diabetes can be reversed, defined as achieving sub-diabetic A1C levels (below 6.5%) while eliminating the need for diabetes-specific medications. Their trials show a 60% reversal rate in the first year, with sustained outcomes over five years.
• "Food as Medicine" is a Powerful, Quantifiable Tool: The concept of food as medicine is not just a buzzword but a practical tool that impacts biochemistry. By reducing processed foods, excess carbohydrates, and sugars, and introducing healthy fats, individuals can achieve significant metabolic health improvements.
• Individualized Nutrition is Essential for Success: A one-size-fits-all approach to diet is ineffective. Virta tailors nutrition protocols based on a patient's medical history, allergies, intolerances, cultural preferences, food environment, budget, and social determinants, ensuring adherence and efficacy.
• Virtual Care Models Drive Continuous Support and Behavior Change: Virta's continuous remote care platform facilitates daily interaction with a dedicated care team (health coach and provider), allowing for real-time monitoring of biomarkers and subjective data, crucial for sustained behavior modification.
• Deprescription of Medications is a Key Outcome: A primary goal of the program is to safely deprescribe diabetes-specific medications as patients' blood sugar normalizes, reducing reliance on drugs and associated costs.
• GLP-1s are Adjuncts, Not Sole Solutions: While GLP-1 drugs are effective for weight loss, they are most impactful when combined with diet and exercise. Virta's program offers a non-drug alternative with comparable weight loss (13%) and provides critical support for sustaining weight loss after GLP-1 deprescription (85% success rate).
• The GLP-1 Cost Crisis Demands Comprehensive Solutions: The rising cost and utilization of GLP-1s pose a significant financial challenge for employers and health plans. Solutions that focus on root cause reversal and sustained behavior change are necessary to manage this trend.
• Broad Health Improvements Extend Beyond Weight and A1C: Patients experience a range of benefits, including improved sleep, reduced cardiovascular risk factors, and significant improvements in depressive symptoms, highlighting the holistic impact of metabolic health.
• "Halo Effect" Promotes Family-Wide Health: Individual health improvements often lead to positive changes within the family unit, as spouses and children adopt healthier eating and activity patterns, amplifying the program's impact.
• Scalability Through a Provider-Vendor Model: Virta's dual role as a clinical provider and a vendor (managing communications, enrollment, and reporting) enables the delivery of reversal benefits at scale across diverse populations and demographics (commercial, Medicare, Medicaid, veterans).
• Challenging the "Patients Won't Do This" Mindset: Virta's Health Equity Report demonstrates successful A1C reduction across all socioeconomic cohorts, proving that even the most disadvantaged patients can achieve diabetes reversal, refuting the common physician skepticism about patient adherence.
• Satiety is a Critical Mechanism for Adherence: The nutrition protocol focuses on making patients feel full and satiated, which naturally reduces cravings and supports long-term adherence, mirroring a key mechanism of GLP-1 drugs.
• Employer and Health Plan Engagement is Crucial: Employers and carriers play a vital role in promoting health by offering solutions that go beyond traditional drug management, empowering members with options for chronic disease reversal.

Key Concepts:

• Diabetes Reversal: Achieving sub-diabetic A1C levels (below 6.5%) while simultaneously eliminating the need for diabetes-specific medications.
• Food as Medicine: The concept that dietary choices have a direct and profound impact on an individual's biochemistry and overall health, serving as a primary tool for disease prevention and reversal.
• Deprescription: The process of safely reducing or discontinuing medications, particularly when a patient's underlying condition has improved through lifestyle interventions.
• Virtual Care Model: A healthcare delivery system that utilizes remote technologies (e.g., apps, video calls, remote monitoring) to provide continuous patient support, coaching, and clinical oversight.
• Halo Effect: The positive ripple effect of an individual's health improvements on their immediate family members, who often adopt similar healthy behaviors.
• Area Deprivation Index (ADI): A measure of socioeconomic disadvantage used to assess health equity and the impact of interventions across different demographic groups.

Examples/Case Studies:

• Virta Health's Clinical Trials: The video frequently references Virta's peer-reviewed published clinical trials, which demonstrate 60% diabetes reversal in the first year and sustained results over five years.
• GLP-1 Deprescription Data: Virta has published data showing that 85% of patients who deprescribe GLP-1s are able to sustain their weight loss through the Virta protocol.
• Health Equity Report: Virta's report using the Area Deprivation Index illustrates that A1C reduction is achievable across all socioeconomic cohorts, including the most disadvantaged populations.