EP 542 What If Chronic Disease Was Optional? - with Brett Smith

Employers are spending billions treating obesity, diabetes, and metabolic disease symptoms. What would happen if we finally started fixing the root causes instead? We'll find out on this episode of ShiftShapers. Change either energizes or paralyzes.

The choice is yours. This is the ShiftShapers Podcast, bringing the employee benefits industry interviews with individuals and companies who are shaping the industry's shifts. And now, here's your host, David Saltzman. And to help us answer that question, we have invited my old friend Brett Smith, who is Vice President of Business Development at Toward Health, which is a physician-led metabolic health practice focused on reversing chronic disease through lifestyle medicine.

Welcome, Brett. Hey, David, great to see you. It's always a pleasure. Great to great to chat.

Let's let's start with the big picture and then we can kind of drill down a little bit because the scale of the metabolic health crisis is something that a lot of employers and advisors still underestimate. So, how did metabolic syndrome, things like obesity, insulin resistance, and hypertension, how'd that become such a big driver of employer health care costs? It became basically the whole driver of employer health care costs, if based on how you kind of filter this. But it it's simply because we changed as a society.

We got sold a bill of goods that the foods that we were eating were healthy, and if nothing else, they at least weren't unhealthy for us. And we fell for the trap. We made a lot of profit, I'm saying, as a society, selling a lot of crap, and we removed all of the nutrition and we demonized the things that are actually some of the healthiest things that the body requires. And let me just expand on that for 10 seconds.

And everything that we're gonna talk about is like if you were well, anybody over the last 30 years is gonna say, like, that's blasphemy, Brett. You know, uh, of course we're gonna go low fat. Of course we're not gonna do these different types of things. I believe we have created our whole mental health crisis that we're experiencing in this world for fear of eating animal and animal fat.

That saturated fat is actually one of the healthiest things you can put in your body. Now, I can get into the whole biochemistry of this, but um because I've freaked out enough on all of this that I've gone down all the rabbit holes and um with all of that. But the thing is, is that all the building blocks from our body, food is either food is only two things. It is an energy source to be used as either glucose or fatty acids and ketones in the electron transport chain of our mitochondria in our cell to create ATP.

Um, so it's either energy or it's a building block. And you know, most of our building blocks or most of our body cells are made out of fat and cholesterol. And our, you know, you start depriving the body of what it needs, you're now not building proper neurons. You're doing what we'll get into in a little bit, uh, the state of insulin resistance.

And when you went uh in Europe, it's very widely called that Alzheimer's is called type 3 diabetes. We don't use that language here. Um and uh, but yeah, if you have an insulin-resistant liver and muscles, you start becoming diabetic. If you have an insulin-resistant brain, you start getting Alzheimer's and other different things.

And the amount of awakening that happens just by going back and eating the historic foods that we ate for millennia and millennia and our whole time on this planet as Homo sapiens, it's just like a whole rebirth. And there's almost nothing that a doctor prescribes in most office visits that somebody can't get off of just by focusing on eating real food. So I'll I'll start with that as an opening place, if you think that answers the questions, or we can dive a little deeper. No, I think it does.

And and you know, lots more to come, obviously. We'll get into more of this as we go along, but many companies invest heavily in what they call wellness programs. And it's interesting because the underlying health problems just keep getting worse. So, what is fundamentally broken beyond what we've already talked about about the traditional wellness model that a lot of employers flock to?

Well, uh, you know, when when we b we kind of both left Humana at the same time, because for those that don't know, my whole career has been in the health insurance world. I jumped in selling for Cigna in 1987 as a field rep. I was a broker for 10 years. I went back and got with Humana when you and I were there, and then I spent the bulk of the remaining time outside of a short stint in pharma.

I uh was mainly in population health management, both the corporate wellness and disease management sides of things. We were selling both of those kinds of programs. And the thing is, is that there's a couple of reasons that wellness doesn't work. And one of them is grounded in the standpoint of we're we're not doing the screenings that we do when people came in and had blood tests and things like that, we're not looking at the actual data that is actionable and that you can help somebody head off things with.

It takes 10, 15 years of you heard me use the word insulin be insulin resistant before it starts showing up as an elevated glucose level. So instead of testing a fasting glucose, if you test a fasting insulin instead, and you see that, oh my God, your insulin's really chronically elevated, that's what creates and drives the insulin resistance. So, one, we're testing the wrong things. Two, all of the guidelines that um that are being followed, that we're coaching people on walk another mile, eat another apple, less calories, more movement, both of those things make you more hungry.

And the we told people stop eating meat, fish, and eggs when they're actually the cornerstone of everything you need to build a healthy body and maintain a healthy body with, and they're incredibly satiating. And when you remove them out of the digestive tract, now you understand and you follow the evolution of that. Here's why you now, you know, they naturally trigger all of your own GLP1 hormone creation. And when you're now eating 60, 70, 80% of your processed food that doesn't do anything but make you hungrier, and it's designed to make you hungrier and keep eating it to never trigger your GLP1.

So it just takes weeks of eating more, you can call it historically accurate, how we all used to eat. And suddenly people start creating their own GLP1 again. But the thing is, is that there's a um my my brain got broken on all this in 2018. There's a there's this book right over my shoulder, Dr.

Sarah Hallberg, H-A-L-L-B-E-R-G. And I came across a TED talk she did in 2014 that you can find on YouTube, pull it up, 20 million, 30 million views. And she did a talk about um, in order to reverse diabetes and obesity, you have to ignore the guidelines. At first, it kind of roped me in because I was used to selling the guidelines.

If you're selling disease management programs, you're selling standards of care, how doctors treat and make sure you're taking all your pills at the right time. And so I'm like, well, what's this crazy woman talking about? So I was paying attention to this, or I watched this and she broke my brain and helped me realize we should not have disease management industries. They shouldn't exist.

Um, we should have disease reversal. And she, you know, and it was because I was searching, thinking that ketosis and keto was a dangerous thing because as I started looking into it, because my brother had some success with it, and I used to be 115 pounds heavier than I am at this moment, and I lost that in nine months in 2019. But in 2018, I went to try to jump into PubMed and look at the published research and everything to find the definitive studies to teach my brother that you're doing something dangerous doing this keto thing.

And then I found that TED talk, and she showed, oh my God, you know, it's not that the um that keto's dangerous or anything, it's just that the our guidelines are dangerous. And many of the things that when you look at who actually funded the people on the committees for the different guidelines, um, that it's all pharma driven and so it's all profit-driven. And what she kind of taught me is that doctors are not taught in medical school or any other biology class before getting to medical school about the state of ketosis.

And in under 30 seconds, every baby born in the mother, well, every baby in the mother's womb is in the state of nutritional ketosis, born is in ketosis. Uh, mother's breast milk, which until just the modern era, we went to formula, is loaded with fat, you know, healthy saturated fats. 60% of it is fats. And um they stay in ketosis.

And I would argue that all of humanity used to live in ketosis until we Coca-Cola, Crackerjack, Twinkied, and everything else, ice creamed our way out of it. But all of those things didn't used to be a normal part of what people ate. We ate locally raised food that came from a farm a couple hundred miles or dozens of miles away. We ate meat, fish, and eggs, and we had a very small amount of the population that had weight problems.

And, you know, we used to call type 2 diabetes adult onset diabetes, and nobody got it until they were in almost 60, 70 years old. And it was from years and decades of not having allowing more things into our diet than we ever used to, because it was almost an unknown thing for hundreds of years. But when it was treated, it was treated with a very low-carb ketogenic diet. And we kids that are born with epilepsy can, you know, instead of having seizures all the time, Mayo and uh John Hopkins brought this ketogenic diet that was also for 200 years used on diabetics until we had insulin, used it.

And about 70, 80% of kids that are put on a ketogenic diet, their seizures go away, and after five years, they're now no longer having that issue, and they can even go to a standard diet and be just fine. So there's a long, long history of all of this, but our med school doctors are only taught about one aspect of ketosis, which is called diabetic ketoacid acidosis, DKA for short. And yes, if your pancreas beta cells are not generating insulin, you eventually will die. Your body's gonna go into a state of toxicity, and the end stage of that is part of it is called diabetic ketoacidosis.

Your ketones go way off of the charts because you're so metabolically broken that your body can't regulate anything. And there is not a person in the world that doesn't recognize, including people in my space, the low-carb space, the disease reversal space, that it's a problem. But it's but that's all that people ever have been exposed in medical school to the word ketosis. They don't realize what I said.

Every baby, uh, you know, we all were born in it. It's a natural state. It's probably the native metabolism that we have. And um so it was very easy to keep kind of that tapped down because anybody comes to their doctor and talks about keto, they're told, no, it's like a vampire with garlic, stay away, um, you know, because they're thinking diabetic keto acidosis.

So we have when I sold my first program for Cygna in 1987, it was a $30 single premium and a $130 full family premium. Not the employee share of the premium, the whole fully insured premium. And um, the only thing that changed from 87 till now is the metabolic health of the whole population. So let's let's let's let's ask a question then as you're as you're moving towards this.

This isn't just an individual health issue, it's a systemic cost problem for employers, right? What what's the financial impact of all this stuff in in terms of healthcare claims, productivity loss, disability? How how does how does this affect an employer or or a self-funded plan? Well, if you go to the CDC, they will say that your average obese type 2 diabetic costs your plu your company $20,000 in claims, maybe some absenteeism, presentedism, but you kind of put a a thing on or a label on the whole thing, a cost on that individual.

And that's now, you know, getting close to uh anywhere from a third to two-thirds of any given population out there. Well, what what we do by understanding the holes that are in, because I the way I say your average doctor is practicing medicine with their hands handcuffed behind their back. If you don't understand how the body operates in our native metabolism, and even understand that there is a native metabolism, that there's a fat adapted and a sugar burning one, um it's almost impossible.

You're going to be stuck chasing symptoms with pills. What we do is we go to the what you said in the opening, we go to the root cause of what's why is this person diabetic? Why is this person hypertensive? Why is this person got chronic kidney disease?

All of these, you know, all of these things, the root causes are the same root cause on all of this. Just like I said, type 3 diabetes on Alzheimer's. Almost everything that doctors are treating, because we're not checking insulin levels early on, we're checking glucose where the the horse is out of the barn by this point in time. Um, you know, and now we have people that have kind of serious sugar addictions, and why they think they need to have their bread, why they can't think of not having pasta, why um they have to have their bagel with their coffee in the morning, all of these things.

And, you know, the average American never ate a bagel, you know, before 1930, unless, you know, they were a certain religion. So it's just not part of our real true past. But the thing is, is that that $30,000 claimant can be turned in under six months to a $500 annual physical person a year. So if we remove 30,000 of claims, presented and absenteeism, right on one person and now give me 10 of those people, and we are toward health.

We are a metabolic health medical practice. We understand and we filled the gaps that exist in the standards of care. And so it's not a matter of bringing clinics on site, it's not a matter of just having direct primary care virtual because the average doctor doesn't know how to do all of this. They are they've been taught that all of these conditions are idiopathic, of unknown origin.

And so that's why they only focus on symptoms. Once you understand what the root of all of these things are and you attack that, suddenly the biggest thing that you have to be aware of, the body heals so fast that if you're not tracking glucose and know what's going on, that's why our people will wear CGMs. If you have blood pressure issues, if you don't have a blood pressure checked, you're gonna heal so fast that the medications that you're on right now can actually become dangerous because they can make you hypotensive and you could stand up, stand up out of your chair and pass out because your blood pressure's too low.

So you have to be titrated off of things, but that's the secret. Go ahead. You got a question. Now we're up to our prescription pads in GLP1 drugs.

What happens to an employer health plan financially when those medications become widely used across an entire workforce? They're already widely used. One in eight people in our country are on a GLP one at this moment. So um, and more would like to be uh most employers will only allow it if you're a diabetic, not just for weight loss.

Um it's out of your own pocket if it's for weight loss. But um one of the strengths of our program, like I just said, is we're titrating people off of all of these medications. But you know, some of these medications have $1,000 a month price tags to them. And uh so what happens is as though we wind, because we have what's called the GLP1 off-ramp program.

Once you teach people how to resolve the root cause of all the other issues, and most people coming to us also have weight issues like I used to. Uh, I had a, you know, I was I had a 44 to 46 waist, depending upon which pair of pants I was wearing at a given time. I came back down to 34 waists in nine months. And um so when you put the real food in the body and get the processed crap out of the body, suddenly within weeks, that whole GLP1 issue goes away.

It's just a non-thing. Um, however, I do want to quick say GLP1s can be a very useful tool as you're taking that four to six weeks of adapting the person back to what real food will do for their body because it it taps down on a lot of the sugar cravings and everything. And as I mentioned earlier, a great deal, a high percentage of our population now has some form of sugar addiction or either other eating disorders. I was also a stress eater and I used to have to fill out a lot of RFPs, which required me to work all night.

And uh, so I ate a lot of garbage with a RFPs are are evil for your diet. Yes, you you use the exact right word. But anyhow, so you know there's lots of different reasons why people can use boo or use food as like almost a drug or or uh something to numb themselves with, come home, sit in front of the TV, and now we're gonna eat a whole bag of cookies or potato chips or both while being in front of the TV after having a whole meal that never satisfied us. Once you go back to eating this way, snacks just never it's it's just a habit reflex, but no longer a blood sugar roller coaster reflex.

Go ahead. At the end of the day, employers want to know whether these programs actually deliver measurable results. Now, I know you guys have research that shows participants lose about 15.5% of body weight after 52 weeks, which is roughly comparable to being on a semiglutide.

What surprised you most when you about these outcomes when you first started noticing them? Well, um, like I said, when Dr. Sarah broke my brain and she kind of laid it all out with this big famous study she did in Indiana, being part of the, she was at Purdue University, a part of IU Health, the statewide system-based uh health system. And then she wound up getting brought in as the chief medical officer to Verta Health.

And this is kind of a big point. So I know you've got a big benefits office or audience. And one of my biggest challenges, and I'm answering your question indirectly, um, because my biggest shock when I got to Toward Health here, because I found Verta Health because she that next year, 2015, became the chief medical officer of Verta. And I and they're out selling programs to employers with a guarantee.

Here, we're going to reverse your diabetics. And they have, but they only work for the most part, not hard line, but 5,000 employee in up marketplace. So all of the mercers of the world, all of the people who work with the jumbos, the Fortune 500 type companies, many, many, many of those companies, well, 550 currently is what they have on their website of those companies use Verta Health. But nobody has ever talked to 95% of the brokers who work in the under 5,000 employee range.

So nobody's ever called on them until I got here and I started now with Tort Health. We're working with the mid-market. And they don't even know what that that the jumbo market has already adopted this. And Verda currently has 200,000 patients that are working with their doctors and coaches in this model, and they've already reversed tens of thousands of diabetics and all of these things over the last 10 years, and they're still living in the 10 year ago thing that keto will hurt you type of a m mindset.

They've seen people around them lose weight and do things with it. But the biggest shock to me with all of this is not that we're able to achieve these great things, that we can within a year to two kind of take somebody who was the way I was and make me look like I was when I came out of college again to a degree. Um, but uh it's just not known. And every in nobody understands that the average doctor understands nothing about all of this.

Disease reversal, they were taught this is idiopathic, you can't do these things, these are chronic lifetime or diseases of modernity, but something must have changed in modernity that gave everybody these conditions that no, that humanity never used to have before. So it becomes very evident and obvious, and I've helped change five, six different doctors' views on a lot of these things, people that are close to me. It was tough when they were watching it happen to me, uh, that they, you know, and then I start explaining and you start filling the gaps in their knowledge of what they're not taught, but say all of this science and all this research is there.

It's just being kept out of the um synth meta-analysis that are put together to create guidelines. Um nothing more than, you know, we just had a huge change where we used to call the food pyramid like this, where meats were up at the very top and the grains were at the bottom. And the new FDA and um AJS just came out with an inverted pyramid where now meat, you know, meats and healthy fats, and that's the thing. You have to retrain the brain because we've been taught stay away from fats, stay away from fats.

Well, yes, there are some fats you should stay away from, and they're all the ones that are in the processed foods to make things shelf stable and live for five to ten years on a shelf without going bad. Um, the real fats won't do that. And that's why we moved away from them. So beyond weight loss, what kind of clinical improvements are you guys seeing in things like A1C, blood pressure, cardiovascular risk?

Absolutely. Well, we we have a guarantee for employers. If you give us one of these chronically ill people, they we will drop their A1C in six months by one point, which could be enough to take them clear from being a type two to not even being pre-diabetic anymore. Um, we will drop their, if they have blood pressure issues, their millimeters of mercury by 15 points on their on the blood pressure.

And um we we guarantee that within six months, and we will guarantee five percent of base weight reduction again in six months. And if we don't do that, we we have a money-back guarantee and we refund money. So strong. Well, we we know it, we believe in it, and uh Verda has similar types of get guarantees with some of those things as well.

Um, but it's just it's documented. We know it. It's just that you got to get the general population to understand, and it's gonna come from the Verda 200,000 patient, a couple thousand of our patients, where we're gonna get to 100,000 patients through time. Uh, they can get there quicker when you're bringing in 10 and 20 and 30,000 employee groups than I will at 2 and 3 and 4,000 or 200 employee groups.

Yes. But David, it's not just diabetes and hypertension, because remember where I said earlier the root cause of most of these conditions that doctors are prescribing 80 different conditions for, come out of the same one, two, three root causes, which all wind up resolving. So while we're not outselling that we're a mental health company and we're gonna help somebody no longer have bipolar schizophrenia, that can some many times become the long-term result because of the body heals.

And when you stop doing a lot of the stuff that's causing the anxiety and the depression, which much of it is the what we're putting in and changing the physiologic state that the body's living in, you go back to the native state and give it the right raw materials to build neurons, to have um healthy, consistent energy. And most of the body runs, even preferably off of fatty acids and ketones. Your heart prefers it. Most of your brain also runs perfectly well off of ketones.

You're now solving so much of what's going on. So, yeah, so we have guarantees and we mark it as chronic disease. Let's focus on the diabetes, hypertension, and obesity. Because when you get that swatch of people, that's now half to two-thirds of the population at the employer.

Um, so we have guarantees around those things, but we wind up resolving so many other things. You've been on the website, you're you've seen the list. So here's the big question: what kind of an ROI can an employer reasonably expect from reduced medication spend to fewer claims to healthier employees with absenteeism, presenteism, and all of those HR type things? Well, you know, just using that one example of your obese type 2 diabetic, you know, we're gonna save you, you know, the $30,000 that they're costing the plan right now.

Um, give me 10 of those or or five of those, and here's $100,000 back. Um, we we we have another guarantee around deprescribing. We don't de-prescribe to get people cheaper health plans. We de-prescribe because the people as they're healing need to come off of these medications or the medications are no longer beneficial for them.

Um, but the savings in the prescriptions, on average, depending upon how sick of a cohort of a group we're bringing on at any one time, average between kind of $1,500 and $4,000 per person in just drug medication savings alone, which more than pays for our whole program. And um, so it's all predicated on how sick the population is that they're giving us. And we do have also an app in which this can go out across the whole population, because, like I said, when you start testing and if they did a mass screening and find out just what percentage of their population has an insulin problem, which also means they probably have an insulin resistance problem, which means if they're not type 2 diabetic now, give it another 10 to 12 years and they'll be type 2 diabetic then.

So we can work with the whole population and we even offer, you know, if somebody's doing our intense program, the non-intense people can be using our app and even doing free group coaching that we offer, and they can kind of do this kind of on their own. So, and beyond that, we offer virtual uh primary care, virtual urgent care, and and things like this. So we address many of the medical spend things. Yeah, I think we can take the medical trend and by getting the sickest people into our program, cut it at least in half in the first year, uh, just with what we're doing there.

And then, you know, but most of this, again for those self-funded geeks out there, because you know, that average claim that by taking that diabetic and now they're no longer diabetic, which means their GFR of their kidney disease is now starting to improve and come back up again. And now we're taking a future dialysis person no longer on the path towards dialysis, but the heart risk reduces by 50%. So while the $30 of savings drops all right to the employer, the stop loss carriers and vendors start carrying.

If you're reducing the heart risk of these people by 50%, and there are um these are all called metabolic therapies, and there's a number of them beyond um therapeutic carbohydrate restriction, but these are used in cancer treatments across the world, and they're also cancer prevention things. So we've been able to, using the heart risk calculators, document about a four a 50% decrease in uh heart risk just by being in our program and fixing the person's metabolic syndrome. So if employers want to move from just managing chronic disease to actually reversing it, what's the first thing they should be thinking about?

Well, the the first thing is just realizing that, you know, because I everybody realizes what we've been doing the last 40 years, none of it's worked. Nothing that we did at Humana with the large deductible plans and all of these things, the smart suite kind of stuff. And just all we've done is move more burden onto the employee, and the employee can't take anymore, but the employer can't take anymore. So the first thing they have to realize is that, hey, we can actually fix the health.

We've put false hope in wellness and it never delivered because it was based on the same guidelines that got us into this situation. When you start working with people and medical practices that understand how to fix things, changing the health changes everything. Uh, some of our best, actually, a lot of our early corporate clients came to us because we we also do a direct-to-consumer and they found Dr. Tro.

There's a podcast called the Low Carb MD Podcast. And he he does this with another physician. Uh Tro's out of New York, another one, Brian, out of Phoenix. And they have 450 episodes over the last eight, nine years.

And so people who own companies found this, just like with what I did with myself, losing 115 pounds in nine months, reversed heart disease. I had, I, I, I stopped the heart progression of and I reversed all the soft plaque out of my body, some of the calcified plaque out of my body. But so when we do the do that for people who own companies, suddenly it doesn't go to the broker and it doesn't go to the HR. The owner of the company says, if you can do this for me, can you please do this for my employees too?

And so, yeah, we got a 4,000 employee employer that way. And they were already doing on-site medical clinics, on-site pharmacy, on-site fitness with trainers. Never had success with any of this because it's a broken model. The old standards of care, the the calories should never be even thought of.

And um, we get brought in there and suddenly things start changing dramatically. It's a whole new world. Even, even um, I mean, we're recording this on the 18th of March, and it was just yesterday or the day before that HHS came to an agreement with some of the biggest medical schools that they're now going to include 40 hours of nutritional training for physicians, which where they've had zero. Now, maybe 40 is not enough, but it's way the heck better than zero, depending on what they're taught.

You just hit the you just hit the nail on the head. We first have to fix nutrition training because that's why they flip the pyramid, right? Well, yes, but you have to also teach and you know, because 95% of dietitians and the American Diabetes Association doesn't follow these guidelines, but they're heavily funded by the food and you know, Coca-Cola and everything else out there, and all the pharma. So, but you you first have to fix the medical education and take the handcuffs off of the doctors and start teaching them in med school the physiological reality of all of this and the different metabolisms the body can live in.

And if you just get back to your native one again and stop abusing yourself, it all resolves. So, yes, we need to have that happen, but we need to have them taught the prop, the real, not what has been taught over the last 50 years. I think, you know, educating um individuals about this is probably the best way that it's going to happen. It's gonna be a grassroots thing.

I had one of my very first clients when I was practicing down in Miami before you and I met at Humana and we're changed forever, um, was a guy named Eduardo Gomez. And Eddie said to me once, he said, you know what, doctors will get off their pedestals when patients get off their knees. So I think the best hope for this is to be patient-driven and to get a lot of education out there to the populace. But Brett, what a fascinating conversation.

Thanks for spending some time with us. Brett is vice president of business development at Toward Health, T-O-W-A-R-D. Brett, if people want to reach out to you, what's the easiest way to get in touch? Well, absolutely.

Call my cell phone, 262-255-9545. Uh, I'm Brett at Toward.health, not.com.

It's there's a new extension in the internet these days. So Toward, as in Brett is walking toward you, T-O-W-A-R-D.health. And that will get an email to me.

We can spend some time. And uh if you're a broker, love to show you. I mean, let me end on just this one last sentence. If you're a broker, when's the last time that you were able to go in and feel confident about telling an employer, we're gonna take all of your chronically ill people and teach them how not to be chronically ill, and we're gonna cut your medical inflation in half and start impacting your stop loss, and we're gonna save you hundreds of thousands of dollars in the next two years.

No, nobody has ever been able to walk in and confidently say that without thinking that somebody's gonna offer them a straitjacket. We deliver on that. We have money-back guarantees on this. It happens, and it's not little old toward out there.

Verta Health has thousands of employees doing this with the largest employers, most of the Fortune 500. Marsh McClennan, they have, you know, they're doing it for their own employees. This is a thing, and it's the future of healthcare. Become a part of it.

Help your help your clients. Thanks a million for all the great information. Appreciate your time, David. The ShiftShapers Podcast is a production of Shift Shaper strategies and may not be reproduced or quoted in whole or in part without our express written permission.

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