Chronic metabolic disease is rapidly becoming a national crisis. 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. 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.
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.
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.
