Chronic metabolic disease is rapidly becoming a national crisis. The Centers for Disease Control (CDC) states that almost 50% of the adult population in the United States are affected, with 11.3% suffering from type 2 diabetes and 38.0% with prediabetes. Almost half of United States adults, 48.1%, suffer from hypertension. Obesity affects almost as many, as the CDC has stated that 41.9% of adults in the United States are obese, according to the National Health and Nutrition Examination Survey.
Metabolic conditions we treat
Type 2 Diabetes
Revero can help safely reduce diabetes medications under a clinician’s supervision and lower blood sugar to healthy levels.
Prediabetes
Revero can help lower blood sugar levels to below the prediabetic range and achieve significant clinical weight loss.
Primary Hypertension
Revero can help return blood pressure to normal range for primary hypertension and achieve safe medication reduction.
Obesity BMI > 30
Revero can help achieve significant weight loss for patients who are struggling with obesity and have a BMI > 30.
Prediabetes
Prediabetes is a precursor to type 2 diabetes, characterized by slightly elevated blood glucose levels, impacting nearly 40% of the US population. It’s a manifestation of progressive insulin resistance, but it's typically asymptomatic and may go unnoticed without regular testing. If untreated, prediabetes can evolve into type 2 diabetes.
Prediabetes occurs when the cells of the body become less responsive to insulin signaling. This makes it more difficult to move blood glucose out of the bloodstream and into cells. The pancreas compensates by increasing its release of insulin. During prediabetes, blood sugar is not elevated enough to cause strong short-term symptoms. The elevations in insulin can, however, result in weight gain, as well as a skin condition known as acanthosis nigricans. This sign consists of darkened skin in the armpits and back of the neck, and is often accompanied by skin tags.
For prediabetes, fasting blood sugar between 100-125 mg/dL or Hemoglobin A1C between 5.7 and 6.4% are typical markers. Over time, as cells become increasingly resistant to the effects of insulin, blood sugar levels continue rising until type 2 diabetes develops.
What is A1c?
A1c represents the average levels of blood glucose over the previous three months. A diagnosis of type 2 diabetes is made when the A1c level is at or above 6.5%.
Role of diet in treating prediabetes
There are three macronutrients in food: protein, fats, and carbohydrates. When we eat, we typically consume a combination of these macronutrients in varying proportions, which affect blood sugar levels differently. It's uncommon to consume just one macronutrient unless it's pure oil or sugar. Understanding this is crucial, especially in managing prediabetes or type 2 diabetes through dietary strategies.
Carbohydrates break down into simple sugars, mainly glucose, during digestion, causing the most substantial spike in blood glucose levels. In healthy individuals, blood glucose levels return to normal relatively quickly. However, for individuals with prediabetes or type 2 diabetes, it takes longer to regulate blood glucose levels after a carbohydrate-rich meal. Proteins have a smaller and slower effect on blood glucose levels, while fats do not cause a rise in blood glucose levels. Recognizing this is pivotal in formulating a scientifically sound diet to manage type 2 diabetes.
For instance, a meal featuring fatty meat and non-starchy vegetables differs significantly in macronutrient composition from a meal including bread, pasta, rice, and sweets. The former is primarily protein, fat, and fiber, with low digestible carbohydrates. Conversely, the latter contains high amounts of digestible carbohydrates but is lower in fat and protein. Consequently, the impact on blood glucose levels between these two meals is vastly different.
Treatments options for prediabetes
Medical providers typically treat prediabetes with Metformin. Patients who fail to make dietary changes and are likely to progress to diabetes are treated this way. Often, recommendations to lose weight or “eat better” are made, but these do not directly address the root cause, which is eating carbohydrates over one’s personal carb tolerance threshold.
A root-cause approach for treating prediabetes
Prediabetes can be treated with a low-carb diet to counter insulin resistance. Low-carb diets can effectively lower blood glucose and insulin levels. By reducing carbohydrate intake below an individual's tolerance level, blood sugar levels return to normal. Reverting to the initial high-carb diet often leads to a recurrence of elevated glucose and insulin levels. Sustaining a low-carb diet may be necessary to prevent a relapse into metabolic issues.
A low-carbohydrate diet helps lower blood glucose load and decrease insulin requirement and production, resulting in normalized fasting blood glucose levels and HbA1C. Carbohydrates prompt the strongest insulin response, while proteins have a mild effect, and fats require no insulin response. Food choices significantly influence insulin production, impacting energy storage and blood sugar levels. Seemingly healthy foods like brown rice contain a large amount of carbohydrates that can lead to significant blood sugar spikes, particularly for individuals with insulin resistance. Carbohydrate tolerance varies among individuals, with insulin-sensitive individuals needing less insulin to process carbs, while those with low carbohydrate tolerance experience heightened insulin levels, exacerbating insulin resistance and potentially progressing to diabetes.
Type 2 diabetes
Type 2 diabetes is characterized by more elevated blood sugar and insulin levels, as the body struggles to control blood glucose levels effectively. Diagnosis usually involves blood tests, with fasting blood sugar levels of 126 mg/dL or higher or Hemoglobin A1C of 6.5% or greater indicating type 2 diabetes.
The root cause of type 2 diabetes is primarily insulin resistance, where the body's cells become less responsive to insulin. Insulin is a hormone produced by the pancreas that helps regulate blood sugar (glucose) levels by allowing glucose to enter cells to be used as energy. When cells become resistant to insulin, glucose cannot enter effectively, resulting in elevated blood sugar levels. To compensate, the pancreas produces more insulin, but over time, the pancreas may not be able to keep up with the increased demand for insulin production. This leads to a buildup of glucose in the bloodstream, causing type 2 diabetes.
Common symptoms of type 2 diabetes include fatigue, increased thirst, frequent urination, blurred vision, persistent hunger, and weight gain. If the condition is not properly treated, it can lead to severe complications, including peripheral neuropathy with risks of infections and limb amputation, cardiovascular diseases like heart attacks and stroke, and kidney diseases requiring dialysis or transplant. Other complications include eye problems (diabetic retinopathy, cataracts, glaucoma), dental and gum diseases, sexual dysfunction, cognitive decline, and autonomic neuropathy affecting various organ systems.
• Several factors contribute to the development of insulin resistance and type 2 diabetes, including:
• Genetics: Family history and certain genetic factors can increase the risk of developing insulin resistance and type 2 diabetes.
• Diet: Consuming a diet high in processed foods, sugars, excessive carbohydrates, and unhealthy fats can contribute to insulin resistance and weight gain.
• Physical Inactivity: Lack of regular physical activity can impair insulin sensitivity
• Obesity: Being overweight or obese, especially excess fat around the abdomen, increases the risk of developing insulin resistance and type 2 diabetes.
• Metabolic Syndrome: A cluster of conditions including high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat, often precedes or accompanies insulin resistance and type 2 diabetes.
• Age: The risk of type 2 diabetes increases with age, especially after the age of 45.
• Medical Conditions: Certain medical conditions like polycystic ovary syndrome (PCOS), prediabetes, and sleep disorders can increase the risk of type 2 diabetes.
• Medications: Certain medications can potentially contribute to the development or exacerbation of insulin resistance and type 2 diabetes in certain people. Examples include corticosteroids like prednisone, antipsychotic medications such as Olanzapine and Risperidone, certain HIV medications, immunosuppressant drugs such as cyclosporine and tacrolimus and less frequents common medications like thiazide diuretics, beta blockers and statins.
Role of diet in type 2 diabetes
Diet is the main factor affecting blood sugar levels, primarily influenced by carbohydrates turning into glucose during digestion. Protein intake can slightly affect glucose levels. Apart from dietary factors, elevated cortisol levels due to stress, poor sleep, specific medical conditions, or certain medications can also play a role.
Carbohydrates exist in starchy foods like bread and potatoes, as well as in fruits, sugary beverages, vegetables, and candy. All carbohydrates are broken down by digestion and absorbed as sugar molecules, which raises blood glucose levels. Whether the food is a bowl of rice, a slice of bread, a potato, or a sugar-sweetened soda, it all becomes sugar (glucose) once the body digests and absorbs it into the bloodstream.
Fructose is a carbohydrate, a sugar molecule, that is used in many sugary beverages, energy drinks, and fruit juices. One example is “high fructose corn syrup” which is an extremely common sweetener. Fructose promotes fatty liver disease, worsens insulin resistance, and can accelerate the development of type 2 diabetes.
Everyone has a limit to how much carbohydrate their body can process over time before the system is overwhelmed and insulin resistance develops. This is known as a personal carbohydrate tolerance level. Exceeding that level, i.e. eating more carbohydrates than the body can process correctly, results in an increasing need for insulin and the development of insulin resistance. Eating starchy or sweet foods provides such a high carbohydrate intake that the carbohydrate tolerance level is easily exceeded.
It is important to emphasize that all carbohydrates, whether sugars, starches, or digestible fiber, are absorbed as sugar and contribute to exceeding the carbohydrate tolerance level. This is the reason that low-carbohydrate diets like the Revero nutrition therapy are a logical treatment for insulin resistance or type 2 diabetes. Revero’s low-carbohydrate diet targets this root cause of metabolic disease by reducing carbohydrate intake to below the personal threshold.
Insulin resistance is the driving issue underlying type 2 diabetes and is linked to other conditions like metabolic syndrome, polycystic ovarian syndrome (PCOS), erectile dysfunction (ED), and heart disease. It may also be a factor in triggering inflammatory and autoimmune diseases.
The typical treatment for type 2 diabetes involves lifestyle changes and medications to lower blood sugar levels. However, these treatments mainly address the symptoms and not the underlying causes, which are insulin resistance and inflammation.
Type 2 Diabetes and Inflammation
Type 2 diabetes is often seen in conjunction with inflammation and autoimmunity, two interconnected phenomena that can have significant impacts on human health. A silent destroyer of health, chronic inflammation often goes unnoticed but plays a significant role in the development of both type 2 diabetes and autoimmune disease.
A research study examining health records of over three-quarters of a million people found that type 2 diabetes increased the chances of developing autoimmune disease, and autoimmune disease also increased the odds of developing type 2 diabetes.
Consuming high levels of carbohydrates and sugars not only promotes elevated levels of insulin and glucose which can lead to insulin resistance and type 2 diabetes, but also creates inflammation which increases the risk of developing an inflammatory or autoimmune disease as explained above.
Treatments options for type 2 diabetes
Three primary treatments have proven effective in treating type 2 diabetes:
Bariatric surgery
While bariatric surgery does promote weight loss, a study has shown that between 37%-76% of patients regain significant weight within a six-year period.
Very low calorie diets
Reducing calories to near-starvation levels induces ketosis, which helps improve insulin sensitivity. However, this approach is definitely not sustainable, so it isn’t appropriate as a long-term treatment for type 2 diabetes.
GLP-1 medications
GLP-1s can be effective in certain cases, but they come with serious side effects like nausea, vomiting, and diarrhea. Additionally, these medications are costly and still require lifestyle changes for full effectiveness.
Very low carbohydrate diets
Type 2 diabetes can be treated naturally through diet and lifestyle changes, with carbohydrate restriction being extensively studied as an effective method for reducing A1c levels and medication dependence.
A root-cause approach for treating type 2 diabetes
Recent research has validated that type 2 diabetes can be treated with a low-carb diet, resulting in reduced weight, HbA1c, blood pressure, and improved blood lipid profiles. The study also showed that the dependence on medications could be greatly reduced through a low-carbohydrate diet.
Nutritional ketosis, a natural metabolic state where the body and brain burn fat and ketones instead of carbohydrates as their primary fuel source, is another valuable tool in sustainably treating type 2 diabetes and has been shown to be effective in research. Nutritional ketosis can occur in low-carbohydrate diets if there is sufficient fat in the diet in combination with low enough carbohydrate intake.
Revero’s low-carbohydrate diet is designed to treat the cause of metabolic disease, with the goal of lowering blood sugar levels, reducing dependence on medications, and promoting weight loss. Reducing carbohydrate intake to below the personal carb threshold helps the body to become “fat-adapted,” burning fat for fuel instead of carbohydrates. In some cases, nutritional ketosis may also occur. Shifting away from carbohydrates as a primary fuel allows cells to recover their insulin sensitivity, so that insulin levels can subside toward normal levels and the patient can begin losing weight. The Revero plan is designed to be more sustainable as a long-term intervention.
The importance of medical supervision for treating type 2 diabetes
It is crucial when treating type 2 diabetes with low-carb or ketogenic diets to provide medical supervision for safety. Diabetes medications may need to be reduced or eliminated as normal blood sugar levels are achieved. The combination of a low-carbohydrate or ketogenic diet and these medications can result in blood sugar levels dropping to dangerously low levels.
While type 2 diabetes has long been thought of as a chronic condition, research has shown that many people with the disease have the potential to reduce or eliminate their dependence on medication. With the right treatment and medical support, type 2 diabetes can be treated without the need for surgery or medication. As the prevalence of type 2 diabetes continues to rise, preventing, treating, or managing this condition is very important for public health.
Revero’s innovative model is designed to provide this type of treatment, and offers a remote care model, providing patients with continuous support from health coaches and medical providers. They monitor patient biomarkers like weight and blood sugar and make ongoing recommendations for medication reduction.
Type 2 diabetes medication options
This popular diabetes drug functions by reducing the absorption of glucose in the intestines, while reducing gluconeogenesis (glucose production) in the liver and improving insulin sensitivity. While this is one of the better tolerated diabetes medications, side effects do occur and include muscle pain, difficulty staying warm, dizziness or weakness, vomiting, slowed heart rate, nausea or diarrhea. Hypoglycemia is not commonly seen.
This class of drugs causes the pancreas to release more insulin, helping to lower blood sugar. Examples: Glipizide, glyburide, glimepiride. The primary side effects are all related to hypoglycemic episodes, while over time weight gain, fluid retention, and dangerous cardiovascular events are also possible.
Also stimulate the pancreas to release insulin, by closing potassium channels in pancreatic beta cells, allowing calcium to enter and stimulate insulin secretion. Example: Repaglinide. Side effects include diarrhea, nausea, vomiting, stomach upset, muscle pain, headaches, and weakness or lethargy. In rare cases, hypoglycemia, tremors, joint pain, and respiratory tract infections can occur.
Function by slowing the degradation of GLP-1, causing slowed absorption from the gut. They also stimulate insulin secretion while slowing gastric function and emptying, reducing glucagon and reducing appetite. Examples: Sitagliptin, saxagliptin. Side effects include debilitating and severe joint pain. This led to an FDA warning about this class of drugs.
Function by binding to a receptor in fat cells to force them to store more circulating fat. This results in an improvement in insulin sensitivity. Example: Pioglitazone. The side effects include fluid retention, weight gain, congestive heart failure, bone fractures, bladder cancer, hepatotoxicity, macular edema, and abnormal ovulation combined with increased risk of birth defects.
SGLT-2 inhibitors work by inhibiting the reabsorption of glucose in the kidneys, making patients urinate out extra glucose. This has the effect of lowering blood glucose levels, although not as effectively as some other drugs. Examples: Sitagliptin, saxagliptin. Side effects include urinary tract infections, genital yeast infections, upper respiratory tract infections, frequent urination, hypercholesterolemia, joint pain, thirst, back pain, flu-like symptoms, and constipation.
GLP-1 receptor agonists function by promoting the GLP-1 receptor, which slows stomach emptying, stimulates insulin release from the pancreas, and reduces glucagon production to slow gluconeogenesis from the liver. GLP-1 agonists also stimulate satiety, making your brain feel like you’ve eaten enough-before you actually have. Examples: Semaglutide, liraglutide, exenatide. The side effects include poor appetite, nausea, vomiting, diarrhea, dizziness, tachycardia, headaches, and indigestion.
Insulin: short and long acting. Injectable insulin functions just like the insulin produced by the pancreas. It causes glucose to move out of the bloodstream and into cells, while blocking the release of energy from fat cells. Side effects are a worsening of insulin resistance, weight gain, hypoglycemia, headaches, lipodystrophy (pitted or swollen fat), fluid retention causing peripheral edema and elevated blood pressure.
Diabetes FAQ
Type 1 diabetes results from insulin deficiency due to pancreas damage from an autoimmune condition that destroys insulin-producing cells in the pancreas. On the other hand, type 2 diabetes stems from insulin resistance, where the body produces insulin but becomes less responsive to it over time. Insulin signals the body to store food energy, shuttling it into cells.
Type 1 diabetes necessitates lifelong insulin injections due to the pancreas's inability to produce insulin. In contrast, in type 2 diabetes, increasing insulin levels become necessary to store glucose until the body can no longer manage it, causing elevated glucose levels.
An effective approach to treating type 2 diabetes is reducing carbohydrate intake below a personalized threshold.
DKA is a serious medical emergency, mainly affecting those with type 1 diabetes. It results from excess ketone production due to insufficient insulin while having high blood glucose. Triggers in patients with type 1 diabetes include missed meals, skipping insulin, or fighting infections.
Without insulin, glucose cannot enter cells and be used for fuel, forcing the body to break down fats rapidly. The excessive rise in ketone bodies as byproducts, causes acid buildup in the blood, and can lead to organ failure, coma, or even death.
While rare in type 2 diabetes, DKA can occur due to medication issues, sudden insulin discontinuation or the pancreas’s failure over time to produce enough insulin.
Metformin, a trusted medication that has been around for decades, primarily reduces liver glucose production and enhances insulin sensitivity. Though its exact mechanism isn't fully understood, it's widely used as the initial treatment for type 2 diabetes. It is not expensive, safe with minimal side effects or long-term risks. Metformin does not cause low blood sugar and is deemed safe with a low-carb diet. Moreover, Metformin has also been shown to help prevent type 2 diabetes and is utilized off-label for other insulin resistance conditions like prediabetes and PCOS, and can aid in weight loss.
Typical symptoms associated with diabetes, such as excessive thirst, blurred vision, frequent urination, and tingling extremities, are actually signs of the condition itself rather than the initial insulin resistance that precedes it.
Early warning signs of insulin resistance can start months and years before type 2 diabetes develops or traditional blood sugar or HbA1c tests are elevated. Early signs can include: fatigue, weight gain, elevated blood pressure, new skin tags, darkened skin patches (Acanthosis Nigricans), and paradoxically, signs of low blood sugar.
Symptoms of low blood sugar happens when a person hasn't eaten for an extended period, leading to a sensation of being “hangry” (hungry and irritable). This situation hints at high insulin levels due to insulin resistance, causing delayed glucose storage followed by an excessive drop in blood sugar levels.
The 2022 guidelines from the American Diabetes Association (ADA) recommend all adults age 35 or older be screened at least once every 3 years for diabetes. ADA also recommends all adults at any age who are overweight or obese to be screened.
• There are a few tests that are used to diagnose type 2 diabetes that you doctor can order:
• A fasting glucose level 126 mg/dL or greater
• Hemoglobin A1C 6.5% or over
• If an oral glucose tolerance test shows elevated glucose
• If your blood sugar ever tests over 200 mg/dl
There are specific symptoms and observations that also could make you suspect type 2 diabetes that should prompt you to see your doctor (see next section).
Symptoms of type 2 diabetes can vary in severity and may develop slowly and seem unrelated, making them easy to overlook or attribute to other causes. If you feel you have some of these symptoms, get a medical evaluation.
Common signs and symptoms of type 2 diabetes include:
• Increased thirst and dry mouth (polydipsia).
• Frequent urination (polyuria), especially at night.
• Excessive hunger (polyphagia), even after eating.
• Unexplained weight loss despite an increase in hunger and food intake.
• Persistent tiredness, lack of energy, and a feeling of being physically or mentally drained.
• Blurred or hazy vision or seeing floaters or spots.
• Slow healing of wounds and infections: Cuts and sores taking longer to heal, and frequent infections or sores that are slow to heal.
• Tingling or numbness: Feeling “pins and needles”, numbness, or pain, especially in the hands, feet, or legs.
• Darkened skin patches (Acanthosis Nigricans): Velvety, dark patches of skin, usually on the neck, armpits, or groin.
• Impaired wound healing: Cuts, bruises, or sores that take a longer time than usual to heal.
• Irritability: Feeling easily irritable or having mood swings.
• Frequent vaginal yeast infections or urinary tract infections (women).
• Erectile dysfunction (men).
It's important to note that not everyone with type 2 diabetes will experience noticeable symptoms, especially in the early stages. Regular screenings and check-ups with a healthcare professional are essential, especially if you have risk factors like obesity, Polycystic Ovarian Syndrome (PCOS), prior gestational diabetes, a sedentary lifestyle, family history of diabetes, or high blood pressure. Early detection and appropriate management of type 2 diabetes are crucial for preventing complications and maintaining overall health. If you suspect you may have diabetes or are experiencing symptoms, seek medical attention for proper evaluation and diagnosis.
Yes, type 2 diabetes is largely preventable, and lifestyle modifications play a significant role in prevention. One essential step in prevention is to have a primary care provider for personalized guidance and support in diabetes prevention and screening.
Here are key strategies to reduce the risk of developing type 2 diabetes:
• Healthy diet: Focus on a whole food diet rich in protein, healthy fats and vegetables. Avoid processed food, sugary beverages, excessive carbohydrates or sugary snacks.
• Regular physical activity: Just 150 minutes a week of aerobic exercise or weight lifting can aid in prevention
• Weight management: A robust connection exists between obesity and the onset of type 2 diabetes. Losing excess weight, especially around the abdomen with a nutritious diet and exercise, can significantly reduce the risk of type 2 diabetes.
• Limit alcohol consumption
• Stop smoking
• Regular Check-ups for early detection and monitoring
• Manage stress
• Adequate sleep
• Knowledge and education
Scientific evidence indicates that specific foods, such as refined grains and sugary beverages, are linked to a higher likelihood of developing type 2 diabetes mellitus. Trans fats or hydrogenated fats have also been shown in research to be associated with higher chances of type 2 diabetes.
Here are types of foods that can increase the risk of type 2 diabetes:
• Sugary foods and beverages: Foods high in added sugars, such as sugary drinks, candies, pastries, cakes, cookies, and sweetened cereals, can cause rapid spikes in blood sugar levels.
• Processed Carbohydrates: Refined grains and processed carbohydrates like white bread, white rice, sugary cereals, and pasta can lead to rapid increases in blood sugar.
• Highly Processed Foods: They often contain added sugars, unhealthy fats, and refined carbohydrates, all of which can contribute to insulin resistance and promote type 2 diabetes.
• Trans Fats: Foods high in trans fats, such as fried foods and processed snacks can contribute to insulin resistance and increase the risk of diabetes.
• Fruit Juices: Fruit juices may contain natural sugars, but they lack fiber, which slows down sugar absorption. Drinking fruit juices can cause rapid increases in blood sugar levels.
• Alcohol: Excessive alcohol consumption can affect blood sugar levels and lead to weight gain, which can increase the risk of insulin resistance and type 2 diabetes.
For a diet to result in sustained long-term benefit, it must fit a person’s budget, taste preferences, values, and of course health.
Research has shown that ketogenic diets are helpful for controlling type 2 diabetes. By restricting carbohydrates, you are reducing the load of sugar on the body and reducing the body’s need to produce more insulin, which in effect reduces insulin resistance, the primary root cause of type 2 diabetes.
Mediterranean diets have been shown to help prevent type 2 diabetes.
Reputable organizations like the American Diabetes Association and the European Association for the Study of Diabetes have issued reports affirming the benefits of low-carbohydrate diets for those with type 2 diabetes.
Revero’s low carbohydrate diet and clinical protocols are designed to treat the root cause of metabolic diseases like type 2 diabetes.
The most important single step to helping prevent type 2 diabetes is talking with your PCP about what your options are, and deciding what will be best suited to your needs.
Several supplements, including cinnamon, zinc, chromium, Alpha-Lipoic Acid (ALA), Ginseng, Fenugreek, green tea and others have been evaluated for diabetes treatment. The results haven’t been conclusive to make any recommendations.
Research suggests that Berberine, derived from several plants, has shown potential in reducing blood sugar levels by affecting various metabolic pathways. It may have a similar effect to some diabetes medications like Metformin and might be useful as part of diabetes management, but don’t take it without consulting with a healthcare provider.
It's crucial to consult with a healthcare provider before adding any supplements to your diabetes management plan. Some supplements may interact with medications or have side effects, and proper dosages need to be determined based on individual health conditions and needs.
It is Revero’s recommendation that people with type 2 diabetes should only change their diets with medical supervision. Changing your diet, particularly to Revero’s low-carbohydrate diet, can be very effective at lowering blood sugar and will require monitoring and medication adjustment as it can lead to a rapid drop in blood glucose or blood pressure to dangerous levels. You should NOT attempt to adjust medications on your own as you will risk serious complications.
Most medical clinics are not set up to provide continuous monitoring of biomarkers, but that is part of how we designed the Revero protocol. We are able to adjust medications as needed, more than once a day if needed. We sometimes even lower medications ahead of time to prevent unsafe low blood sugar levels.
Cardiovascular disease (CVD) is a broad term that encompasses a range of conditions affecting the heart and blood vessels. These conditions can lead to various health problems, including heart attacks, strokes, angina (chest pain or discomfort), heart failure, arrhythmias (irregular heartbeats), and peripheral artery disease. Here are some key components and types of cardiovascular disease:
• Coronary Artery Disease (CAD): This is the most common type of heart disease and occurs when the blood vessels (coronary arteries) that supply blood to the heart muscle become narrowed or blocked due to a buildup of plaque (atherosclerosis). It can lead to chest pain (angina) or a heart attack (myocardial infarction). Myocardial infarction is the #1 cause of death in patients with type 2 diabetes.
• Stroke: Patients with type 2 diabetes have a greatly increased risk of ischemic stroke, and also about a 25% lower chance of a good outcome. This is thought to be the result of damage to the lining of arteries, causing inflammation and stiffness as well as thickening. Ischemic stroke occurs when a blood clot blocks or narrows an artery supplying blood to the brain.
• Peripheral Artery Disease (PAD): PAD occurs when there is a narrowing or occlusion of the arteries in the legs and other parts of the body, limiting blood flow. This condition is a major cause of diabetic foot ulcers, amputation of feet or legs, and death. The occurrence of peripheral arterial disease is estimated to be 2-7 times higher in people with type 2 diabetes than in those without the condition.
Diabetic nephropathy is a serious kidney condition that can develop in people with diabetes, particularly if the diabetes is poorly controlled. Up to 40% of diabetics develop diabetic nephropathy.
Diabetic nephropathy results from prolonged damage to the small blood vessels in the kidneys caused by high levels of blood glucose (sugar). Over time, this damage affects the kidneys' ability to filter waste products and excess fluids from the blood. It can also lead to end-stage kidney diseases requiring dialysis or kidney transplant.
Chronic kidney disease and end-stage kidney disease are most frequently caused by type 2 diabetes.
38% of patients with type 2 diabetes develop protein in their urine (albuminuria) and 29% experience impaired kidney function within 2 years.
Chronic kidney disease progresses to end-stage kidney disease requiring dialysis in as little as two years. This has been found to occur in 10-17% of type 2 diabetic patients.
Diabetic neuropathy is a type of nerve damage that can occur in individuals with diabetes, particularly those who have had diabetes for a significant period. Elevated levels of glucose in the blood over an extended period can damage the nerves throughout the body.
The symptoms of diabetic neuropathy can vary depending on the type of nerves affected. The most common types of neuropathy are:
• Peripheral neuropathy: Affects the peripheral nerves usually in the legs and feet, causing pain, numbness, and tingling. It can also cause sensory loss or altered sensation, making it difficult to perceive temperature or pain. Muscle weakness and difficulty coordinating movements can also happen.
• Autonomic neuropathy: Affects the nerves controlling involuntary bodily functions like bladder problems, gastrointestinal issues (gastroparesis), sexual dysfunction, and changes in heart rate (arrhythmia) and blood pressure.
Diabetic retinopathy occurs in patients with type 2 diabetes who have elevated blood glucose levels. The risk of diabetic retinopathy increases with the amount of time you have type 2 diabetes. High glucose levels cause damage to the circulation of the retina.
Diabetic retinopathy may be either proliferative or nonproliferative.
Nonproliferative retinopathy occurs when high blood glucose levels lead to a breakdown of the structural walls of blood vessels in the retina.
Proliferative diabetic retinopathy is when the blood vessels no longer function, and the body grows new blood vessels to replace them. The new ones are also not normal and develop leaks. As new blood vessels grow, the retina can detach from the back of the eye, causing loss of vision. Glaucoma can also result from the growth of new blood vessels.
Diabetic retinopathy can cause different symptoms, such as loss of color vision or blurry vision. Those symptoms are slow to develop though, and anyone who has diabetes should have regular eye exams to detect retinopathy early.
Diabetic retinopathy does not occur in everyone with type 2 diabetes. If you have type 2 diabetes, controlling your blood glucose level could help prevent severe vision loss or delay the worsening of retinopathy.
There are treatments for advanced diabetic retinopathy. The choice of treatments depends on the state of a person’s retina.
There is no good published peer-reviewed research that shows objective improvement of these conditions in type 2 diabetes following a low carb diet. However, there are many anecdotes of people improving these conditions over time with a low carb or ketogenic diet.
When you have diabetes, your feet can develop many different complications. These problems are the result of nerve damage, blood vessel problems, and delayed healing
Diabetic neuropathy occurs when the nerves are damaged by diabetes, causing loss of the sensations of pain, cold, or heat in the feet. This results in changes to the foot and toes known as a “Charcot foot”. If you have diabetic neuropathy, the nerve damage can make you unaware of injuries to your feet. You can sustain wounds, cuts, blisters, scrapes, or ulcers and not feel it. Because of the delayed healing, getting these to heal properly without infections is challenging.
Diabetes can also result in damaged blood vessels, reducing circulation and contributing to delayed healing and resultant infections. Even antibiotics become less effective, because the bloodstream is normally how the antibiotic gets to the site of the infection in the feet or toes. These types of wounds can take weeks or months to heal.
Fungal infections, corns, and calluses can also develop from diabetes, and hair loss on the lower legs or feet and toes is often noticeable as well.
The best strategy is prevention, by examining your feet every day and preventing foot injuries. Controlling blood sugar, blood pressure, and blood lipids can also slow the underlying causes of diabetic foot issues by preventing or slowing blood vessel and nerve damage.
Warning signs are swelling, redness, blisters, ulcers, or calluses and should be reason to immediately contact your medical provider. Doing this will help to make sure that small wounds or infections get attention before becoming worse. Antibiotics are often used for infections. Dressings and medications are used on wounds, to help the foot heal.
These types of diabetic foot problems can sometimes result in wounds that don’t heal or become very infected, and this can necessitate surgery or even amputation. Prevention is by far the better path, so get evaluated by your medical provider immediately when lesions are noticed.
Uncontrolled high blood sugar can lead to various complications affecting different parts of the body. Common serious complications of type 2 diabetes include:
• Cardiovascular complications: heart disease, stroke and peripheral vascular diseases
• Type 2 diabetics have a risk of fatal myocardial infarction equal to individuals who have had a previous myocardial infarction
• Chronic kidney disease (Nephropathy)
• Nerve damage (Neuropathy), which can be peripheral or autonomic
• Eye disease (Retinopathy)
• Foot complications (Diabetic foot ulcers)
• Complications related to poor wound healing
• Cognitive function decline such as dementia
• Complications during pregnancy
It's crucial for individuals with type 2 diabetes to work closely with their healthcare team to manage their blood sugar levels, blood pressure, and overall health effectively to reduce the risk of these complications and improve their quality of life. Regular monitoring, a healthy lifestyle, and adherence to prescribed medications are key components of managing type 2 diabetes.
Hypertension
Hypertension is a severe health issue with potentially dire consequences. Often symptomless, it's referred to as a 'silent killer.' Recognizing hypertension risk is crucial, ensuring proper monitoring and treatment when necessary.
The heart propels blood through arteries, generating pressure to sustain fluid circulation. Consistently elevated blood force against arterial walls is called hypertension, or elevated blood pressure. Blood pressure naturally varies during the day, influenced by factors like sitting, walking, eating, or strenuous exercise.
Hypertension is categorized into primary and secondary forms. Primary hypertension refers to cases where high blood pressure is observed without an identifiable underlying cause. In contrast, individuals with secondary hypertension have underlying conditions like thyroid and adrenal disorders, congenital heart anomalies, or kidney diseases. Additionally, factors such as smoking, stress, certain medications (both over-the-counter and prescription) can raise blood pressure.
Long-term hypertension can lead to severe health issues due to the damage it causes to arteries. Sustained high blood pressure can damage the endothelial lining of arteries, leading to reduced blood flow to various body parts. It can cause aortic aneurysms, potentially fatal bulges or ruptures in the aorta, and can constrict coronary arteries, resulting in chest pain, arrhythmias, or heart attacks. This condition also forces the heart to pump harder, causing enlargement and reduced pumping efficiency, leading to heart failure. Hypertension can affect the brain, causing transient ischemic attacks or strokes, and may lead to vascular dementia. It also damages the kidneys, leading to failure, and harms the retina, causing vision loss. Moreover, hypertension disrupts overall blood circulation, affecting various bodily functions including sexual health.
Blood pressure values
Elevated blood pressure is defined as systolic ≥130 mm Hg and diastolic ≥80 mm Hg. Blood pressure, measured in millimeters of mercury (Hg), comprises systolic (arterial pressure during heartbeats) and diastolic (arterial pressure between heartbeats) values.
Role of diet in hypertension
Elevated insulin inhibits sodium excretion at the kidneys, by making the kidneys reabsorb sodium. This results in a compensatory retention of water as well. The increased water retention causes an overall increase in blood volume, raising blood pressure. Eating too many carbohydrates results in a worsening of insulin resistance and elevated insulin levels. This can progressively make these problems worse over time if carbohydrate consumption continues.
Insulin normally causes a relaxation of arterial muscle walls, mediated by nitric oxide and resulting in a lowering of blood pressure after eating. However, researchers have identified that insulin resistance changes this state of function, causing insulin to instead reduce the effect of nitric oxide, resulting in increased vascular constriction and blood pressure.
Other studies also suggest a potential association between dietary carbohydrate consumption and hypertension. A 2020 meta-analysis published in the Public Library of Science Journal discovered that "diets with high levels of carbohydrates, especially refined or high glycemic index carbohydrates... appear to be associated with hypertension." This analysis, based on randomized controlled trials with at least a 3-month follow-up post-diet commencement, found that individuals adhering to a low carbohydrate diet experienced a reduction in both systolic and diastolic blood pressure measurements.
Research indicates a possible connection between insulin resistance and hypertension. In a 2019 study, 154 participants, including 89 with type 2 diabetes, were instructed to follow a low carbohydrate diet. Data collection occurred from March 2013 to November 2018, with regular follow-up assessments of blood sugar, insulin levels, and blood pressure.
Throughout this study period, researchers observed that as blood sugar and insulin levels decreased, indicating reduced insulin resistance, participants' blood pressure also improved. While the researchers plan to conduct additional follow-up trials, they posit that the substantial effect on blood pressure results was, in part, due to a decrease in insulin levels and enhanced insulin sensitivity.
Treatment options for hypertension
Hypertension is routinely treated with:
• A low-sodium diet: Sodium causes water retention at the kidneys, so a low-sodium diet can lower blood pressure by causing systemic dehydration. However, the increased sodium retention is often the result of a high-carbohydrate diet. When researchers compared low-sodium diets with very low-carbohydrate diets, they found that low-carb diets reduced blood pressure more effectively, and also resulted in better glycemic control and body composition.
• Medications
Type 2 diabetes medication options
Calcium channel blockers reduce how easily calcium enters the muscle cells of your heart and arteries. This prevents arteries from constricting. Examples include amlodipine, nifedipine, diltiazem, and verapamil. Side effects include constipation, dizziness, fatigue, headaches, flushing, and swelling of ankles and legs (peripheral edema).
Angiotensin II receptor blockers (ARBs) function in a similar way to ACE inhibitors, but using a different cell receptor. Common examples include losartan, valsartan, and irbesartan. The side effects are similar to ACE inhibitors, but the risk of cough or angioedema are lower.
which function by relaxing blood vessels and reduce the production of angiotensin II, a hormone that constricts blood vessels. Common examples include lisinopril, enalapril, and ramipril. Side effects include cough, low blood pressure, dizziness, elevated blood potassium level, kidney dysfunction, and angioedema (a rare by serious swelling of the deep skin layers).
Diuretics, often called “water pills,” cause a functional dehydration by causing your kidneys to release sodium and water. Common diuretics include thiazide diuretics (hydrochlorothiazide, loop diuretics (furosemide), and potassium-sparing diuretics (spironolactone). Side effects include frequent urination, dehydration, low potassium level, dizziness and muscle cramps.
Beta blockers reduce blood pressure by blocking the effects of the hormone adrenaline (epinephrine) on the heart and blood vessels, which can slow heart rate and decrease the force of heart contractions. Examples include metoprolol, atenolol, and propranolol. Common side effects include fatigue, cold extremities, slow heart rate, impotence, insomnia and depression.
Alpha blockers function by relaxing the muscle tone in the walls of arteries to reduce the resistance to flow. Examples include doxazosin and prazosin. Side effects include dizziness, fatigue, low blood pressure, impotence and slow heart rate.
Alpha-2 receptor agonists These medications work in the brain to reduce nerve signals that increase heart rate and constrict blood vessels. Examples include clonidine and methyldopa. Side effects include drowsiness, dry mouth, constipation, dizziness, low blood pressure, and fatigue
Combined alpha and beta blockers block both alpha and beta receptors, which can reduce heart rate and relax blood vessels. Examples include carvedilol and labetalol. Sides effects include dizziness, fatigue, low blood pressure, impotence and slow heart rate.
Vasodilators directly relax and widen blood vessels, reducing blood pressure. Examples include Hydralazine and minoxidil. Common side effects include headache, fluid retention, rapid heartbeat (tachycardia), dizziness and flushing.
A root-cause approach for treating hypertension
Revero targets the root cause of hypertension by using a low-carbohydrate diet to treat insulin resistance. Consuming less carbohydrates reduces insulin levels, helping to restore insulin sensitivity. Because elevated insulin levels cause the kidneys to retain sodium and water, treating insulin resistance and restoring insulin sensitivity results in release of this retained fluid, lowering blood pressure. This approach can help the body to reduce high blood pressure sustainably without incurring the side effects that come with medications.
The importance of medical supervision for treating hypertension
Restoring insulin sensitivity can result in insulin levels dropping in a matter of days. This has a powerful effect on lowering blood pressure. If a patient is also taking prescription medication to lower their blood pressure, the result can be dangerously low blood pressure that increases the risk of loss of consciousness or falling.
For these reasons, it is critically important that these powerful dietary interventions be implemented with medical supervision. Tracking blood pressure and related symptoms such as a light-headed feeling can allow a supervising medical provider to be aware of the need for medication adjustments. This can prevent episodes of low blood pressure and keep patients safe.
Revero’s innovative model offers continuous remote care, providing patients with continuous support from health coaches and medical providers. They monitor patient’s biomarkers like weight and blood pressure and make ongoing recommendations for medication reduction.
Obesity
These statistics include some information that might run counter to what many people believe about weight gain. The people eating the most calories, for example, were not the most obese. In addition, during a several-year period when obesity rates continued to climb, the average caloric intake was actually falling. This indicates that the obesity rate increase is not due to an increased consumption of calories, but instead due to other measured factors such as an increase in the proportion of the calories that were provided by carbohydrates.
Obesity is an abnormal increase in body fat, and is often defined by a body mass index (BMI) over 30. From needing larger clothes to noticing physical changes to body proportions, obesity is easily identified. Symptoms are secondary to the physical changes that obesity causes, and could include low energy, reduced range of motion or agility, and joint pain from weight bearing.
Role of diet in hypertension
Eating carbohydrates over an individual’s personal carbohydrate threshold results in elevated blood glucose levels. These are countered by the pancreas releasing more insulin to cause the glucose to be stored away in cells. This cycle repeats, as insulin sensitivity is progressively reduced and the need for more insulin rises. Because insulin causes the body to store blood glucose as body fat, high insulin levels result in weight gain. Inflammation also results, further complicating the functional picture and resulting in reduced satiety. This increases appetite, even though the body is having difficulty storing the extra fuel. Increased intake of calories results, driving further increase in weight as the cycle continues. Insulin resistance and a loss of appropriate satiety signaling is at the root cause of obesity.
Treatments options for obesity
Common treatment options for obesity include:
• Bariatric surgery: Bariatric surgery has a variable success rate, with failures usually defined as either a failure to lose enough weight, or failure due to symptoms secondary to the procedure. One study found an overall success rate of 58% for surgical bypass or gastric banding, while another study noted that 44% of patients experienced intolerable symptoms after gastric banding bariatric surgery.
• Medication: This strategy became famous due to the use of fenfluramine/phentermine, or “fen-phen”, which did help some people lose weight. However, it was basically amphetamine stimulants, with serious and dangerous side effects.
• GLP-1 medications: Newer medications such as glucagon-like peptide-1 agonists (GLP-1 Agonists) instead function by stimulating insulin secretion, while stimulating the proliferation of pancreatic beta cells. Examples of these drugs are Ozempic and Wegovy. GLP-1 agonists increase glucose uptake into muscles, while decreasing gluconeogenesis in the liver. They also act directly on the hypothalamus to stimulate satiety. Pancreatitis is a known side effect, as are kidney, skin, liver, immune, endocrine, blood, neurological and cardiovascular side effects.
• Diet: Often consisting of calorie-counting/low-calorie consumption, diets alone have proven to be very challenging as a primary therapy for obesity. Low-carbohydrate diets have been shown to help with metabolic disease in general, and obesity quite specifically.
• Exercise: Some research opinions state that exercise is much more effective for preventing obesity or maintaining weight loss than it is for treating obesity. Exercise can help, however, and there is evidence that interval-type exercise is more effective than a continuous-effort type of exercise.
How Revero treats obesity
Revero’s combination of low-carbohydrate diet, medical supervision, and clinical protocols are designed to target the root cause of obesity. Restoring insulin sensitivity, reducing insulin levels, and rebuilding normal hunger and satiety signaling are the goals of the Revero program. When patients eat carbohydrates well below their personal carbohydrate threshold, large quantities of insulin are no longer needed to move glucose from the bloodstream into cells. Being fat-adapted means that the body can oxidize body fat for fuel instead of being fully dependent on carbohydrates. This powerful combination of effects targets the cause of obesity, making it possible to consistently lose weight without persistent hunger.
A root-cause approach for treating metabolic conditions
Revero offers root-cause treatments for type 2 diabetes, prediabetes, primary hypertension, and obesity. Our virtual clinic provides ongoing support through clinicians and coaches, and enables safe medication management, as well as a personalized nutrition therapy is designed to reduce blood sugar and insulin resistance and restore health in an effective and sustainable way.
