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.
What about all of the other conditions that result from insulin resistance and metabolic disease? Let’s take a look at these problems, starting with the basics.
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.
Prediabetes
Prediabetes is a precursor to type 2 diabetes. It is characterized by slightly elevated blood glucose levels, impacting nearly 40% of the US population. It’s a manifestation of insulin resistance, but is typically asymptomatic, going 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. Cells become increasingly resistant to the effects of insulin and 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 for managing prediabetes or type 2 diabetes through dietary strategies.
Carbohydrates break down into simple sugars such as glucose during digestion. This causes the most substantial spike in blood glucose levels. In healthy individuals, blood glucose levels return to normal relatively quickly. 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. These facts are the basis for a scientifically sound diet to manage type 2 diabetes.
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. These two meals affect blood glucose levels very differently.
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. This comes with risks of infections and limb amputation. Cardiovascular diseases like heart attacks and stroke, and kidney diseases requiring dialysis or transplant can also result from metabolic disease.
Other complications include eye problems (diabetic retinopathy, cataracts, glaucoma), dental and gum diseases, sexual problems like erectile dysfunction, cognitive decline, and autonomic neuropathy that can affect various organ systems.
Several factors contribute to the development of insulin resistance and type 2 diabetes. These include having a family history of metabolic disease. Certain genetic factors can increase the risk of developing insulin resistance and type 2 diabetes.
Consuming a diet high in processed foods, sugars, excessive carbohydrates, and unhealthy fats can contribute to insulin resistance and weight gain.
Lack of regular physical activity can also impair insulin sensitivity. Muscle is metabolically active, so having low muscle mass (known as being sarcopenic) can also promote metabolic disease.
Being overweight or obese, especially with excess abdominal fat, increases the risk of developing insulin resistance and type 2 diabetes.
Metabolic Syndrome is a cluster of conditions that include high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat (which often precedes or accompanies insulin resistance and type 2 diabetes.)
The risk of type 2 diabetes increases with age, especially after the age of 45. In addition, certain medical conditions like polycystic ovary syndrome (PCOS), prediabetes, and sleep disorders can increase the risk of type 2 diabetes.
Some medications can contribute to the development or exacerbation of insulin resistance and type 2 diabetes. Examples include corticosteroids like prednisone, antipsychotic medications such as Olanzapine and Risperidone, certain HIV medications, immunosuppressant drugs such as cyclosporine and tacrolimus, and less frequently, some 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. The problem is that carbohydrates turn into glucose during digestion. The added glucose enters the bloodstream, and requires insulin to move it out of the blood and into the cells. Protein intake can slightly affect glucose levels.
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, raising 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 low-carb ketogenic levels.
Insulin resistance is the root cause of type 2 diabetes and related 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
Four primary treatments have proven effective in treating type 2 diabetes. These are bariatric surgery, very low-calorie diets, GLP-1 weight loss medication, and very low-carbohydrate diets.
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.
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-1s can be effective in certain cases, but they come with serious side effects like loss of appetite, nausea, vomiting, and diarrhea. Additionally, these medications are costly and still require lifestyle changes for full effectiveness.
Type 2 diabetes can be treated naturally through diet and lifestyle changes. Carbohydrate restriction has been extensively studied as an effective method for reducing A1c levels and medication dependence.
Treatments options for type 2 diabetes
Four primary treatments have proven effective in treating type 2 diabetes. These are bariatric surgery, very low-calorie diets, GLP-1 weight loss medication, and very low-carbohydrate diets.
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 loss of appetite, 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. Carbohydrate restriction has been 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. This results, resulting in reduced weight, HbA1c, blood pressure, and improved blood lipid profiles. The study also showed that a low-carbohydrate greatly reduces the dependence on medications.
Nutritional ketosis is a natural metabolic state where the body and brain burn fat and ketones instead of carbohydrates as their primary fuel source. It is a proven tool in sustainably treating type 2 diabetes. Low-carbohydrate diets can trigger nutritional ketosis if there is sufficient fat in the diet in combination with low 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 low-carb ketogenic levels helps the body to become “fat-adapted,” and burn 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
Medical supervision is crucial when treating type 2 diabetes with low-carb or ketogenic diets to ensure 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.
Research has shown that many people with type 2 diabetes have the potential to reduce or eliminate their dependence on medication. Type 2 diabetes can be treated without the need for surgery or medication using the right treatment and medical support. Preventing, treating, or managing this condition is very important for public health.
Revero’s innovative model is designed to provide this type of treatment, offering a remote care model while providing patients with continuous support from health coaches and medical providers. They monitor patient biomarkers like weight and blood sugar, making ongoing recommendations for medication reduction.
Type 2 diabetes medication options
Metformin: 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. This is one of the better tolerated diabetes medications, but side effects do occur. These include:
• Muscle pain
• Difficulty staying warm
• Dizziness or weakness
• Vomiting
• Slowed heart rate
• Nausea
• 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. Over time weight gain, fluid retention, and dangerous cardiovascular events are also possible.
These stimulate the pancreas to release insulin, by closing potassium channels in pancreatic beta cells. This allows calcium to enter and stimulate insulin secretion. Example: Repaglinide. Side effects include:
• Diarrhea
• Nausea
• Vomiting
• Stomach upset
• Muscle pain
• Headaches
Weakness or lethargy
• In rare cases, hypoglycemia, tremors, joint pain, and respiratory tract infections can also occur
These function by slowing the degradation of GLP-1, slowing 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
These 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 (liver toxicity)
• Macular edema
• 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
• Constipation
GLP-1 receptor agonists function by promoting the GLP-1 receptor, slowing stomach emptying, stimulating insulin release from the pancreas, and reducing 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
• Indigestion
Is available in both 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. It also blocks the release of energy from fat cells. Side effects are:
• Worsening of insulin resistance
• Weight gain
• Hypoglycemia
• Headaches
• Lipodystrophy (pitted or swollen fat)
• Fluid retention causing peripheral edema and elevated blood pressure
Revero’s root-cause approach
Revero offers root-cause treatments for type 2 diabetes and prediabetes. Our virtual clinic provides ongoing support through clinicians and coaches, and enables safe medication management, as well as a personalized nutrition therapy designed to reduce blood sugar and insulin resistance and restore health in an effective and sustainable way.
