The Reverse Mullet Healthcare Podcast

Gebre Nida - Transforming How We Treat Type 2 Diabetes with Lifestyle Medicine

• BP2 Health

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Meet the medical unicorn who's reversing type 2 diabetes with lifestyle. Dr. Gebre Nida, an endocrinologist who grew up in Ethiopia where diabetes was rare, found himself overwhelmed treating the condition when he began practicing in the United States. Despite excellent training in diagnosis and medication management, he lacked tools to actually reverse the disease—until he discovered lifestyle medicine.

What happened next is extraordinary. By creating simple educational packets and dedicating extra time to selected patients, Dr. Abraha documented remarkable outcomes: average A1C reductions of 3.4 points, LDL cholesterol drops of 61 points, and weight loss averaging 26 pounds—all between just two visits approximately three months apart. These weren't temporary improvements; follow-up data showed sustained benefits at one year. Perhaps most impressive, ten patients who arrived with double-digit A1C levels now require no diabetes medications whatsoever.

The economic implications are profound. With NIH data showing that each one-point A1C reduction saves 13% in diabetes-related costs, the financial case for lifestyle medicine is compelling. Yet our healthcare system remains structurally misaligned with these incentives, treating lifestyle interventions as expenses rather than investments. Dr. Nida's most powerful insight might be his observation that "type 2 diabetes doesn't happen in the clinic—it develops in the kitchen, where people live, where people work." His success demonstrates that by addressing disease at its source, we can achieve outcomes that medications alone cannot match. Ready to transform your approach to chronic disease? Listen now and discover how the simplest interventions often yield the most powerful results.

Justin Politti:

Welcome to the Reverse Mullet Healthcare Podcast from BP2 Health. We are live at the ACLM Conference in Orlando, florida 2024. I'm your host, justin Politti. I'm Dave Pavlik.

Ellen Brown:

And I'm Ellen Brown.

Gebre Nida:

I'm Gabriela Ciannida.

Ellen Brown:

Tell us about.

Gebre Nida:

Thank you for joining us. Yes.

Ellen Brown:

And so on our journey with outcomes-based payment transformation and the linkage with lifestyle medicine, you were the probably one of three or four people that just immediately popped up as legends in success and in tracking clinical outcomes, and just your program is just the perfect example of the power of lifestyle medicine economically right, and I mean also for your patients, but so yeah tell us about so a unicorn, and I was trying to find our unicorn. I don't know where our unicorn were. You are the absolute. He is an absolute unicorn.

Justin Politti:

Yeah, so I needed the. It's gone, that's all right. We had a unicorn. I think somebody lifted it.

Ellen Brown:

Yeah, so tell us, tell us about your program and your successes. And yeah, I so tell us, tell us about your program and your successes.

Gebre Nida:

I was born and raised in Ethiopia, about 9,000 miles away Before I came. Diabetes was a rare thing in Ethiopia because you have to afford the extra calories that lead to type 2 diabetes. We would see rare type 1 diabetes and there is this rare kind of famine-associated diabetes. And then I had a chance to come to the US with MD degree specialized in internal medicine and endocrinology and joined the US Medical Force in 2009. In Greensboro area, I'm the only endocrinologist in one county and then, as soon as the shop was open, flat gate of type 2 diabetes. Not to mention that I didn't have experience during residency and fellowship. I saw, you know, lots of patients with type 2 diabetes in Detroit, but I did not expect myself to spend 75 or 80% of my time spending treating type 2 diabetes. You know the training was not very good about reversing diabetes, but it was very good in diagnosing and treating it.

Ellen Brown:

Exactly.

Gebre Nida:

Pathology and pharmacology. So you know, for the first 10 years I thought I was doing a good job, following guidelines, you know, prescribing this, prescribing that for my patients. And then, by sheer accident, three years ago, I knew about the existence of Lifetime Medicine and American College of Lifetime Medicine Long story. But right after I knew about it, I downloaded some resources from the SLM and created a package and started to give it to some of my patients. And then, sure enough, patients were actually ready for an option. They were ready to accept treatment alternative instead of expensive medication like insulin, because by the time they hit my door it means that the A1C is through the roof. They have been dealing with diabetes for 10, 15 years and they have no other choice other than getting on insulin or some expensive elaborate regimen. So when I start to give this package to these patients, some of them would come back in a couple of weeks with a remarkable result.

Gebre Nida:

And after I missed the first few, I started to document some tally patients coming with A1C of three point drop from 10 to 7 and LDL dropping by 50 points. They're losing 20 pounds between two visits three months apart. And then I wrote an abstract on my first 45 patients and I presented the poster ASLM conference. That's what you saw, probably. So after that it caught the attention of my system. They tend to support me. I have a steering committee, a charter. A eventual plan is to roll out this lifetime medicine to a larger number of patients for the outcomes. I have 200 plus patients now with similar results and I'm excited. I feel like I found the call.

Ellen Brown:

So tell us the results, some of those results from that research poster, because it's insane.

Gebre Nida:

Yeah, so an average drop of A1C of 3.4. 3.4.

Ellen Brown:

In what period of time?

Gebre Nida:

Between two visits, like three to four months Average drop in LDL of 61 points from 133 average to 72 without further addition of medications no insulin, no statins, nothing further addition of medications, no insulin, no statins, nothing. And then average weight loss of 26 pounds between two visits for the first cohort and then I expanded that over a year and still maintain that change average once you close to three weight loss of close to 20 pounds ldl about 45 points in a year. Before that I would see a yo-yo. You know patients control some time and they lose it back. Now that's a durable change because patients adapted, behavior change. So that's remarkable.

Justin Politti:

Why isn't this on the front page of the New York Times, the Washington Post, like every? Media outlet like name, whatever right. And why aren't we storming?

Ellen Brown:

like I know, to get this in every. That's why casey.

Justin Politti:

So that is why casey means is making such a difference, because she's at least preaching this in a way that people understand it I mean, when you hear outcomes like that, it's like why in the world are we doing things the way that we're doing it when we have such good results? Yeah, like I don't know. To me it's. I know I'm ranting, but'm ranting.

Ellen Brown:

but what other resources are you giving those patients or tools, aside from you know? You said you give them packets and send them home, but what's.

Gebre Nida:

So to go back to his question, I can give you a list of reasons, but we needed people like you to take it to the public. So the resources I give to my patients, the papers and time 10 to 15 minutes of time. Unfortunately, I cannot give it to every single patient because I have to see 20 plus patients every day. I select some patients like the last patient the morning shift, the last patient the evening shift. I sacrifice my exercise time, my lunch time just to see, and then I didn't have to prove the concept of lifetime medicine. But in fact I'm not even equipped to deliver the six pillars of lifetime medicine. My strength is diet, probably some talk and exercise. I don't have a mental health, I don't have sleep study, but can you imagine if you have a team ready to deploy the six pillars? These outcomes would be multiple. Four like many four.

Ellen Brown:

So what are your barriers for being able to deploy all six Time?

Gebre Nida:

Time.

Ellen Brown:

Time and also we talked about this last night. It's health system.

Justin Politti:

Yeah, the resources right.

Ellen Brown:

No, the health system doesn't see the economic value from it.

Justin Politti:

That's what I'm saying, correct.

Ellen Brown:

No, the health system doesn't see the economic value. That's what I'm saying. You need the resources, but they don't want to provide them because it's a it's a fee for service. Rvu based model.

Justin Politti:

It's like it's an expense as opposed to.

Ellen Brown:

It's a service line. Yeah, yeah.

Justin Politti:

And then eventually there's less volume on the backend for them, if you're healthier Right, so that's the other threat that's in this room that you know, like we've got ourselves to this state.

Gebre Nida:

Yeah, exactly so. The way I build is not even. I'm not mentioning lifetime. I mentioned some concepts of lifetime medicine, but I include some language in my notes and build one level up from level three, level four, level four, level five. That's how I survived. But when we have a platform which values lifetime medicine better, this is the medicine we need for the 80% of our medical burden.

Ellen Brown:

Absolutely, Absolutely. This is like a full episode worthy right.

Justin Politti:

I feel like there's just.

Ellen Brown:

There's so much here. I said to we were talking last night and Ajay was part of the conversation and I said we need to sit down and I need to help. I need to help you as clinicians to better understand the economic value proposition that you bring your system so that you can also, the same way that we want to be champions, you have the better verbiage to be champions as well with your leadership.

Ellen Brown:

That, to me, is a big void. Here, not only do you have the burden of, I have to learn to treat lifestyle medicine, which isn't something that's taught through traditional medical school. Now I have to become an economist right, I learned all these different things, but it's just An ROI cheat sheet.

Ellen Brown:

Yeah, an ROI cheat sheet. That's exactly it. Like I told him, I was, like I sent Ajay an email. I'm going to forward it to you, like just some of the facts that, because we just had somebody in here who's all about pop health, value-based care she knows that so well and has implemented that in an IPA that takes risk, and so they see the true economic value of this, and it's like, how do we A, get the virality of this is the way we need to be practicing medicine, right, Like, which is why we're here to try and help that message. But then B, this is the way that we take 2 trillion out and then we redeploy it. It Go into the vapor, right, it's the ether. It's like we can do something with it. It's, you know, give people choice again.

Gebre Nida:

Yeah, so I may go back to the option again. So I gave this package to 500 plus patients. 220 came back with similar results with my first 45 cohort Wow. And then 10 of my patients are no longer on medications and these people came with double digit A1C to my door. And then a bunch of them are on a minimal dose just one medication just to maintain. And then you know the NIH data from 57,000 patients one drop in A1C saves 13% diabetes-related cost.

Ellen Brown:

So there's a whole lot of interesting data and I think what's beautiful it's a no-brainer, it is, and I think what I love about the simplicity of this is, you know, we talk about the power of being able to deploy, like you said, like if I could have a fully integrated lifestyle medicine clinic right, I feel like we need to put numbers on people's t-shirts and walk around with.

Justin Politti:

I say like each one, Right I?

Ellen Brown:

dropped the A1C three points for 500 people in three months. Like, yes, I love it. I think we should Like that's but or I saved I saved 13% yeah.

Gebre Nida:

I saved this many million dollars. Yeah, yeah, yeah, yeah, yeah.

Ellen Brown:

But I think thing is, this shows the power of simple Like. Not only is lifestyle medicine a simple intervention, but it's also you haven't even pulled in the food yet, right? You're not deploying food as medicine. You're not deploying mental health, you're not right. You're just doing this one little component and you've had wild success, right? So it's just a demonstration of the power of lifestyle medicine.

Justin Politti:

It's why we took the time this week to be here and that people want to get off their medications right, Like who wants to be on medication for the rest of your life. You know what I? Mean when you have the disease burden yeah exactly.

Gebre Nida:

You know, when I joined medical force in 25 years ago in the US, one of the first intriguing questions I have was why are so many patients on so many medications? Why 15, 20 medications? And we still expect them to go to work. I mean, most of the medications are prescribed for a side effect, for another expensive medication, oh okay so, and no one is really willing to sit down and revisit those plants. Once you are on a medication, good luck. You will be only forever, whether you're and it gets auto filled.

Ellen Brown:

exactly that's what slays me, like I go to my parents house and there's like three new bottles of the same thing. He's like, well, they called me from the pharmacy and said it was ready and I'm just like, oh, my gosh Well.

Justin Politti:

and then the other one is like the nurses that we worked on in our health plan. They'd go and visit and their people have bowls of medic. Their medication is in bowls, right, and how it gets complicated especially as you age.

Gebre Nida:

Yes, 50, 60 is very high risk. Plus one other thing I have to add Lifetime Medicine gave me a chance to address diseases where they generate. You know, type 2 diabetes does not happen in the clinic. That's where we're trying to fix it. It develops in the kitchen, where people live, where people work. So we have to go there. That's why I love this concept of community as medicine. We have to go upstream, several layers, not just type two diabetes, cardiovascular disease, dementia, stroke, all.

Ellen Brown:

Cardiometabolic syndrome.

Gebre Nida:

Develop where people live. Yeah, we have to go there if we are serious To meet people where they are. Right.

Justin Politti:

This has been awesome. Yes, thank you so much for being here. Thank you for the opportunity. You've always been my hero, so I'm so glad I appreciate it.

Ellen Brown:

Plus, I always love your Boston.

Gebre Nida:

Yes.

Ellen Brown:

Boston Marathon. He's an amazing runner. Talk about an amazing physician.

Justin Politti:

Equally accomplished runner. I talked to him a couple of months back, right.

Ellen Brown:

Yeah, yeah, I remember Well, thank you so much for joining us Great seeing.