 Yeah, so I was tasked a 30-minute presentation and wrote a eight-hour book It's somewhat challenging And since it's being videoed I have to thank my wife for her patience tolerance and acceptance With with my process. I did something very stupid on Wednesday, and she came home, and I said I rewrote the whole thing She's just like I roll like oh my god. What's wrong with this guy? but anyway, so this is gonna kind of be a three-parter and And Maybe what we're gonna cover is a clinical trial the design and the outcomes right so that's important So we'll kind of set the you know the facts of what we found in our one-year results We'll go through the components of the vert interventions really the pieces right that make it work everything that does the continuous care model On that side. We'll cover a little bit of nutritional ketosis. I think it's been covered in quite length I don't know that I could add anything new to the conversation that's either in the public or that we've Provided if you have ketosis questions, I'd be happy to answer them Then we'll go into you know I called it health coaching with purpose I figured I'd have about 15 minutes and health coaching literally could be a three-day seminar So I thought I'd pick one thing I find to as a practitioner be the most Meaningful to me personally, and I think also for a lot of people to be the most impactful really connecting with purpose and meaning in the deep sense of why for doing this and If you're not a practitioner, I think this really applies to anyone so I coach high school kids coach soccer and track It works there. I have kids I have family members that want to do any time anyone wants to make a behavior change or improve their life Anytime we can connect back to a purpose or a deep sense of meaning and why we're doing something I think that really sets us up to have the foundation to move forward so Okay, so the trial on a high level So I kind of talk with my hands so I'm kind of should have got a laser pointer, but On a high level here's what we saw and this is from two papers that we published this year So 60% of completing patients reverse diabetes, right? So that would be a 1c under 6.5% or glycemic control without the use of diabetes specific medications Okay, on average we had a 1.3 percent average reduction in HBA 1c with 70 percent of the people below 6.5 So the 70 and the 60 are a little different Some of the people are still on diabetes meds under 6.5 So we don't count that as you know full reversal yet and that so that's why those stats are a little different on Medication, you know really probably the most impactful 94% of insulin users reduced or eliminated dosages right and a lot of times very quickly I think we had a hundred percent reduction in sulfonioria use Over 50% DPP fours over 50% SGLT twos I cut that slide out just for time and I thought maybe it's not as technical a conference So it wouldn't be that interesting, but if you want the data obviously I can point you to the papers And show those slides with you to weight loss So we don't specifically market this as weight loss for it. It's diabetes reversal But people do lose weight and that is a goal Sometimes it's the main goal, but it is a goal So we saw a 12% average weight loss from start to day 365 across Population and that would have been an average of 30 pounds per patient. So it does work for weight loss as well I'll show a chart graph there The second paper we published was in cardiovascular Diabetology interesting word So we saw a cardiovascular risk improvement including dyslipidemia, right or cholesterol numbers being off So a 12% improvement in the 10-year ASCVD risk score I do have a chart that's going to kind of outline all the risk markers and all the improvements that we saw there, too So it's not gonna be a deep dive, but give you enough on that Okay, so trial design so this was done in conjunction with Indiana University Health System in Lafayette, Indiana, so it's a five-year non randomized perspective controlled study We recruited four hundred and sixty-five participants through August 2015 in March of 2016 So we're coming up on the three-year mark next year, okay? The active arm an end of 378 and we put these pictures of people up there And this is something that like I fall into the trap of doing is that I see an N number And I don't really think that these are actual human beings, right? You know, it's just like the end of ten thousand or the end of 368 and you know Really every one of those ends is a human with a story, right? Somebody trying to do something life was going on things happened On that side, so I fall in that trap So, you know anytime we can kind of think when we see a study that had humans doing something and then humans Caring for them. They just kind of gives a deeper underlying meaning to what it is 262 of our active arm were diagnosed with type 2 diabetes So we did have a percentage that were pre-diabetic Okay, so a 1c 5.7 up to the 6.5 the usual care arm So that would be your standard of care. We recruited 87 people who just continued whatever they were doing So we do have a comparison group in that side Mean age was 54. You know, these are averages Obviously, there's not probably one specific person in this study that actually is all these averages But they're meaningful for trials. So the mean age is 54 mean BMI of 40.3 weight starting weight 257 The average years of diagnosis for type 2 diabetes was 8.4 So we didn't go out and cherry-pick people who were newly diagnosed On that side and then it was 67 percent female All right, do patients stay engaged so that seems to be an issue with nutrition related trials right can people actually do it and Well, we found was yes. So 83 percent trial retention at the end of one year Obviously people drop out for many reasons could be health reasons. This is it This is a large commitment that they're making. All right. It's not just behavior change You know, they had to go to appointments and labs and see the physician And so it was a pretty large time commitment. So 83 percent of people were willing to stay engaged and continue through year one We are going to publish future papers as a huge priority for us, right? It's a five-year trial. We're not going to end here. I Can't give you the list off hand from memory But it's at least like 10 more papers that are coming out the gate here. Hopefully pretty soon All right, HBAC. So again, we had a 1.3 percent average reduction and 60 percent diabetes reversal So the average starting with 7.5. We have this number here It's 70 days because we did publish a 70-day paper to kind of get something out So even at 70 days the average got below 6.5 Then it comes down to 6.2 out at one year and then the gray line at the top Goes up actually and that would be our usual care arm So the people that just kept doing whatever they were doing and didn't make any changes It got a little worse not bad, but a little worse Okay, here's the weight change Graph so obviously started zero we get down to our 12 percent here The dash line is 5% and so that's what's considered statistically significant in a nutrition weight loss trial Okay, so anytime anyone does any intervention and gets better than 5% that's considered Excellent, so we got 12 86% of patients lost more than 5% and 61% of patients actually lost more than 10% And I don't have exact numbers, but we did have multiple patients lose over 50 and even a hundred pounds individually, right? Okay from the cardiovascular paper so examining all cardiovascular wrist bile markers that Are generally accepted as cardiovascular wrist bile markers. We saw improvement of 22 of 26 of them in the treatment Right, so that's one of the main kind of criticisms of low-carb or ketosis is yeah You can reverse diabetes, but you're gonna give them all heart disease Right and so we're showing that is not this not the case if you look at our usual care arm Zero improvement in any wrist biomarker So whatever biomarker risk or biomarker that you think is the motor most important for risk or your physician does your practitioner Philosophy does zero of them improved in the usual care All right, so what do we actually do so this will be more of the tactical X's and O's nuts and bolts Okay, so we have two sources of innovation so we have continuous remote care That's gonna be enabled through the technology. So I have a phone in my bag I can watch someone's glucose numbers ketone numbers and I can get messages from them pretty much 24 7 I do sleep right, but the system is watching them on the backside. The physician does the same thing So what we call it telemedicine platform in your pocket, right? It's personalized physician and coach care All right, obviously different than the traditional medical mark, right? Somebody goes into their doctor Make a change come back and maybe see us in a month. It's a large gap in care there So really we're using the technology to close that gap Then we have our clinical protocol. So this would be medication management, right? A lot of people are coming in on medications. They need to be monitored They need to be adjusted and then we have individual guidance including nutritional ketosis And I'll get into more we do provide guidance on other things besides just ketosis Okay, so here's how it looks So we have Wilma in the center Just she's fantastic. She's in some of our videos. I haven't got to meet her personally, but her personality is Just super super engaging and you know, I love watching all our videos So we have a biomarker tracking on the left, right? So the patient gets an app We're gonna send them a meter, you know, they're gonna test their blood glucose. They're gonna test their ketones We send them a Cell phone connected scale. So they stand on it and automatically imports to the app, right? That's pretty cool If someone's on hypertensive medication, we'll send them a blood pressure cuff. We want to monitor that as well Okay, that all in real time from the dotted line at the top goes to the health coach So I can see all that right. I can see somebody's fasting glucose. I can see their post meal glucose I can see their ketones. I can see their weight this morning I can see it all in real time and then they get nice charts and graphs and we get nice charts and graphs So we can see trends, right? Especially when it comes to weight trend longer term trends are more important, right? I mean like I remember my experience doing this and every employee can can do it Like I gained two pounds today. Oh my god. It's like Okay, it's not the end of the world. So long-term trends there. So the health coach then we can communicate So there's the the chat stream the message We do also do phone calls and video calls, right? It's not all technology. You know, there's certain things that 500 text messages aren't going to do right but a 15 minute or a 30 minute phone call or a video call can be very impactful, right? information Hey coach, what do you think about this recipe text? Great? Hey, I lost my job today. That's a phone call On the back end of the loop we have health coach and physician communication obviously vitally important, you know for You know just caring for people on that side the physicians do communicate with the patients, right? So they do I Don't know if there's a routine cadence for video calls, but there are video calls so in the process when someone comes in they're gonna do a video kind of like History and physical and get to meet the physician and talk about everything they need so the physician has the background Physicians gonna monitor glucose and progress and make med changes, you know Just like I monitor glucose on that side and then at certain milestones or certain points during the process the Patient is going to do calls with the physician from the physician's request and every once in a while there are reasons, you know Good reasons that a physician needs to talk to their physician, right? It's like going to see your regular doctor So we want to make that available And then down here something we probably haven't talked a lot about Patient community. So this is actually why I started at Verda So the clinical trial was going on and the idea was we need a way for patients to interact with each other right I came out of addiction recovery, so kind of well-stepped in a 12-step model and You know really tried didn't use 12 steps, but really tried to model it off the Philosophy of sharing experience strength and hope right when we get in a room with other people That have suffered through the same thing that we've suffered with we have some kind of connection and affinity Right with them already Friendships fellowship those things build so we wanted to provide a place where people could interact with each other You know and share hey Awesome things that happen right and then also not so awesome things that happen right and have it be a safe place Where they could you know not be judged and be understood and share those things and get validation and also hear other people's stories and realize I'm not the only one right you know Health issues can be very socially isolating right on that side, so I came into Verda Started that up moderated it for a couple of years, and it's a really rewarding experience You know just seeing the friendships that developed Online and then my judge of a really successful community is that people actually started meeting in real life on Their own hey, we're gonna do a meet-up in Portland. Hey, let's get together for a lunch once a week In Indiana who likes to ride bikes who wants to do a walking club all those kind of things, right? So social media is kind of bridging that connection back into the real world You know where we see kind of it's divisive on one end. Here's a positive side of it on another And then we do have a resource center, right? Self-education is big Sometimes people don't want to ask the coach right it might be 1 a.m Well, hopefully they're sleeping, but it might be 1 a.m. And you're like really wanting a recipe So I'm not going to be able to answer you so resource center. We have more articles on different topics You know it's pretty comprehensive, but then we also I think the biggest thing is recipes But that's all in there anything they want to know continuously building on that It's just a place they can go 24-7 on demand to get what they need Without any assistance on that side So the feedback loop so biomarkers, so here's what we're tracking so we have ketones Via blood so beta hydroxybutyrate. We use the precision extra meter I think we've been testing out the keto mojo maybe but we're gonna track blood glucose obviously weight mood Here's what we do on a so that's quantitative and then qualitatively mood and energy hunger and cravings So there's a one to scale one to four sliding scale the patient can check in with right So again, we're looking at trends right? Oh your moods been excellent four four four four four four four four now It's one well your numbers might be good, but that tells me something as a coach Something's going on with this person. I need to reach out same for energy right hunger cravings Those are all important kind of qualitative probably the question that I ask most often is How do you feel? How do you feel? I know what the numbers are I don't know why the numbers are that way I need context How do you feel okay? Do you feel okay great if the numbers are great and you feel great? You're doing great if the numbers are great, and you feel bad something's going on. Maybe that's an early sign Okay, numbers are bad, and you feel great. That's kind of odd And the numbers are bad, and you feel bad. All right. Well, that's that's a pretty good sign there Yeah, so why how do you feel very very important? So health coaches, so what do we do you know kind on a high level we focus on nutrition and behavior change So we have a multi-disciplinary team We wanted to make a wide range of practitioners, and so we have registered dietitians nurses clinical psychologists people of varied backgrounds education levels some of them have PhDs masters those kind of things Kind of goes into phases and these these overlap a little bit So in the early months, you know we're kind of in the reversal phase right so we could take Someone that comes in with a very limited nutrition knowledge, right? What do they need at the beginning? They need to know what to do Right, so they need the plan they need the information they need the education the system's gonna walk them through a set of educational videos Right, so they're gonna do some things on their own. We've got some little quizzes in there You know just to kind of assess how they're doing in the learning process The coach is going to be there to answer questions help them plan figure out what foods they like what foods They don't like you know really kind of set that structure Scaffolding that they can begin to work in the coach at the beginning is also going to work on Behavior change it's not just long-term right we have short-term behavior change. You know, how do we plan our day? How do we grocery shop right? What time do we get up? We might be make we might be cooking more food, right? Okay, we need a lot time for that. Maybe we need to adjust some priorities all those kind of things happen, so Nutritional guidance then on the medication side that's gonna be coming from the physician So like you saw with weight loss in the a1c drop if we take somebody on low-carbon ketosis And they're doing fairly well. They can have very rapid lowering in blood glucose, right? So we need to be really on reducing those medications and the physicians are on top of it And the coaches are communicating with them back and forth on that side and then troubleshooting It's kind of a catch-all. I mean it really could be anything right in the later months so say we have Somebody's getting it and they're doing fairly well They've got a routine down. They've got the basics. They're seeing some success So we kind of shift to long-term behavior change and then navigating life events, right? There might be a life event that happens a weekend, right? Trauma tragedy stress job loss I mean, we can't really predict those things But when we get out in the longer stage with behavior change in life events Probably the I mean the recurring one in a long term where we like people to stay at least a year as you get through every holiday Those are probably the most stressful Planned events or things that we know are gonna come up on the calendar And it's like if you can get a year through and we can get you through a Thanksgiving and a Christmas and an Easter and some birthday parties and birthday cake and You know all those kind of things and you've got some assistance and support that can be very helpful on that side The later months and again We also work with this in the earlier months because this is always important at every phase We do give personal always guidance on exercise sleep stress management and also support and you know Just dealing with body image and those kind of things So I got into ketosis because I was overweight I've lost 60 pounds doing it Elevated a 1c and there were definitely times That's five years ago, but there are definitely times in the weight loss process where I looked in the mirror and saw my old self Right, I think it was just really connected with this old image of myself and that self-esteem Level that I had then would come back right guilt shame Self-hates probably strong, but it's probably a good self-description at times, right? So we help people kind of navigate them and really just hold space Right and then you know let them kind of work through those things and you know really provide validation and reassurance and emotional support So that's a really big part of what coaches do It's not just all the technical X's and O's and meal planning all those things It's really being there for someone as another human being caring for them When we look at Behavioral change techniques, so these are official words So we've cognitive behavioral therapy right which kind of kind of be summed up with Why are you doing what you're doing? Let's be aware of that smart goals, so Measurable actionable Timely all those kind of things and then motivational interviewing which I like to sum up with as a long series of asking people why over and over again And I'll get kind of more into motivational interviewing because that's really the one I like the most And that's gonna be now So usually at this point in a presentation, I'm completely zoned out from staring at PowerPoints and not listening to the person anymore So I figured I'd at least put something up there You would like to stare at and zone out too if you're not paying attention, so and that's okay if you're not So really this is gonna be more on purpose and I did kind of draft some stuff So I'll take my notes out so that I don't kind of lose my my train of thought here on this I'm more of a rider than a presenter. I had this like extreme freak-out moment when they offered for me to do this I think neuroscience would describe that as an overactive amygdala Right, that's fine. I'll just throw this up here. So I've got my little support slides So this is gonna be a little more philosophical and when I could talk about health coaching literally could be three days So I think I'd pick the if I could pick the one thing that's the most meaningful to me and I pointed on that at the beginning It's really kind of like purpose and meaning and finding our deep why so for me as a coach It was really a formal exercise that was suggested to me to do this in my practice So if you're a practitioner or a care provider or really you care about people I think it's really worth going through this process of Outlining what our purpose and meaning and why it is we do what we do I think we generally have an idea in our head We want to help people Right, but I think going through this process and really outlining it can be very powerful I heard this podcast. I don't know if you guys are familiar with Jaco willing kind of Navy Seal guy. It's pretty good so podcast one two three he had on Marine Corporal Jake Schick and I had a real affinity for him he had PTSD addiction issues trauma loss all those kind of things I struggled with a lot of those things and he said this thing and it's not really new to me or probably new to any of us Very simple. He said we're here for two reasons to love and be loved everything else is filler, right and Our family we had recently gone through a tragedy. My wife lost her oldest son On May 2nd, which kind of made this trip a little challenging But I heard that sitting out in our yard like two weeks after that You know it's kind of Jaco's podcast is pretty heavy and I'm like, you know, I was searching for something it's you know some meaning something to grasp by that glimmer of hope right in the moment of tragedy and Corporal Schick goes through a story and it's very traumatic But here he is on the other side saying we're here for two reasons to love and be loved And so that really I think is really I kind of changed what I wanted to talk about today Actually, I'm like if I'm gonna fly to Montana in the midst of all this family stuff and be away Then I actually want to say something that's meaningful that you guys might get something out of I mean, I can read slides But I mean, I don't know. It's like I got a mic. I might as well use it So it kind of reconnected me with my purpose, right? And so my purpose is being of service to others with no expectations Okay, pretty simple. I also use that as my definition of love So when I look at my wife or my kids or anyone in the room or patients, you know be of service with no expectations Right. It is an extremely difficult practice especially with children You know Admittedly don't don't do that. Well, but I think it's worth the effort and having that as a foundation for life so I think of it as kind of a philosophy of life and a purpose and a meaning that on that I Underlies everything I do and I don't always succeed, right? But I build off that foundation from the bottom to the top If that resonates with you, you can obviously take it. I didn't invent it It's not an original thought. I don't think I've had an original thought I can claim If you're not feeling that that's awesome too I really the exercise is to sit down with pen and paper and outline a purpose statement for why we do what we do Right, and if you get deep enough to one that undergirds everything in life, I think you found something really solid there Here's how I got there Right, so I had a sponsor in recovery Pretty wise guy. I picked a guy who was very successful material is successful I'm like I want what he has and then he gave me something. I didn't know I wanted He just sat down and he suggested we don't give advice. We make suggestions He's like, yeah, you might want to sit down and write a purpose statement Really kind of think about it And that was really the spark that kind of kicked off this journey at the same time, you know things kind of intertwined I was studying Buddhism and training of meditation. We have a local monastery in St. Louis, right? And it came across Four qualities of love in Buddhism. They're called the four measurable minds They're basically loving kindness, which is really the desire to offer happiness to others Compassion joy and the equanimity, which is really the desire to accept everything, right? No expectations Everyone comes as they come we accept them how they are for how they've been what they're doing today and how they will be, right? No judgment So why did I decide to talk about this today? Well, others have been having this conversation Right, I think the more in coaching and health and wellness and medicine The conversation as a whole the collective we is going less from the prescriptive and the technical, right? To how do we actually help people do this? I Have one patient who cares about the biochemistry of ketosis One it's fun to geek out with him. No one else cares, right? They want to know how their life is going to get better, right? We still have to be competent in the technical aspects of coaching, right? The X's and O's we have to know what we're doing or we can't just run out with blind compassion and not know anything That's not gonna work And I look at that and really what attracted me to Phinean volux work I look at that as the art and science of coaching Right, they have the art and science of low-carb living and the art and science of low-carb performance This is really the art and science of coaching and the art and science of living, right? We have to have competence and we have to care The most meaningful thing and Maybe that's a strong statement But the thing I get maybe get the most pleasure out of working with a patient is helping them walk through this process of finding their purpose and meaning Developing a philosophy of life and their why a lot of times it's super easy, right? Yeah, people run in that. I love my family. I love my work. I love my community. I volunteer They haven't figured out generally they do really well with behavior change, right? They have something else to go to It's usually when we don't have a real connection with that sense that things get off kilter Patients come in motivated generally by fear and pain and suffering. It was a very strong motivation But it's temporary Okay, especially when they get better Right, and that's a very common thing Come in we're super motivated. We can do anything for one two three months, right? The pain and suffering so intense and this is the same thing that happens in addiction and they call it the pink cloud phase Rapid change everything's excellent. Life is great. There's never a problem. We hit our goals This is the new normal. We stopped doing what we were doing complacency sets in right and then we go off track a little bit, right? And so this is when I jump in as coach and see it as invaluable Information, I know what I should be doing and I'm not doing it. Okay. Let's reconnect with your purpose And when I do a video call, I see the eyes light up and then I know I've got something And if I'm on a phone call the tone changes people like talking about their purpose and meaning they want to connect with it They don't want another meal plan. They don't want to hear a biochemistry lecture, right? They want to be talked to as a person and really connect to and find a deep meaning in life So it kind of looks like this So we set a purpose Purpose for a living purpose for doing anything we're doing we set standards, right? No expectations and also no rules I coach high school kids. They like to break rules. Adults like to break rules, too. Okay So we set standards standards are positive. They're affirmative. There's something to aim for I've never heard someone say I want to break standards ever Right, we want to meet standards. Okay, and on top we set goals Goals change Sometimes we meet goals. Sometimes goals are unrealistic goals are not a stable place to put ourselves They need to be on the top And when you look in the technical side of the standards Yes, some of those standards with behavior are going to be related to goals and maybe I could have made this like a nice circle, but I tried to make this design myself like two days ago and realized I have third-grade capability and paint and so I kind of rushed and got it to our tech guys and they gave me this nice wonderful Design so I will continue to work on it and maybe evolve it some more So if you leave with one thing Purpose standards goals, right? We have to have a purpose for doing what we're doing and Oh Last slide more information So there's our website We have a Twitter account. I have a Twitter account. I read tweets every once in a while post a tweet I write a lot of tweets that I then delete and don't post Usually Arguments I don't need to involve myself in about nutrition There's my email address. We are hiring Maybe that's the takeaway message read your tweet twice before you post it It's like Job opportunities. Here's the actual links to the papers on that side And if you do have any questions really about anything with verta feel free to reach out to me while I'm here or afterwards I mean, I think one of the reasons we come to this thing is to connect with people, right? I mean, obviously it's going to be videotaped and all those kind of things, you know But we all made an effort to come here to meet real people and I like people still so And then Christ is here. She's in the back. She actually is volunteering here as well She works for verta, so she'd be happy to answer any questions that you guys have to so if you want to catch her if I'm not around Yeah, let's Q&A Okay, thank you very much so big hand We have a microphone over there on the right if people want to ask questions Please line up and use the mic since the questions are being videotaped You know me. Thank you Linda Doug. Thank you so much for coming Especially given what you've told us about what a challenge it was to be here. So These data are astonishing and so The obvious question is how does it get scaled and I'm curious about what kinds of conversations you're having at verta About how to have a larger impact and it also strikes me listening to you that you're clearly An extraordinary coach How do we get these results on a much larger scale? Are you guys talking to insurance companies? Are you talking to the Buffett Bezos? You know three employer Effort, how do we scale it? So I honestly I'm in the room for those conversations But what from I don't I mean, I don't know if somebody knows Bezos or not, but maybe we're talking to them I don't know Yeah, on an enterprise level we do work with corporations, right? We're offered as a benefit basically through the HR packages and that's that's a really good strategy for growth, right? Employers are bearing a huge cost of medical care for their employees and then we could throw on You know absenteeism lowered performance, right if we don't have a healthy employee how impactful they're being on our business, right? So it's not just the ROI and the expense on the corporate side And I'm not anti-capitalist or corporate I mean, I have I have a tendency to believe in the good in people and I think most corporations do care about their people Obviously, that's not across the board But I like to come in with a positive aspect about everyone until I have evidence. It's different On that side generally think companies care about their people even if it is just you know, sometimes It does help the ROI and that's a that's a big point. So that's a big growth strategy I believe we are talking to insurers I think that would really open up that and then that's one problem with the current system is it's trapped by insurance Realistically and also the general public. We're just not used to paying for medical care, right? And that is changing You know, so the people that come and pay cash out of pocket they see the value, right? And maybe they also have the financial ability to make that though, right? And I think we really want to democratize health through the technology All right, we don't want this to be for the 1% all right. We want this to be for everyone on that side That kind of cover all of all the bases. Okay, okay Very impressive results that you got and I think one of the key elements was the continuous coaching model You're not sort of sporadic, but you're always there on top of it So you never let things go astray. So I have two questions about this study though I assume I'd like to know a little bit more how you recruited the patients. Was it voluntary where they selected? Did they come running to a site and how would this work in just a General population where you didn't have that voluntary sign up. The other is could you go beyond? Diabetics could you because the benefits here could apply more widely to cardiovascular benefits and and all the other benefits of ketosis So those two questions are Voluntary recruitment or you know, and then could you scale it to other conditions? Yeah, so on the recruiting that I Wasn't around at the beginning of the recruiting But I know the stories and that was a huge amount of work by our by our team to recruit I didn't realize the amount of work that went into trying to get people to sign up for a trial. It was voluntary. I mean Mailers, you know, you go into your doctor's office and there's a little TV screen. We'd have little ads up I think they even ran thing ran actual TV or radio commercials Right, but those are motivated people then right so how would this apply to a group of people who weren't as motivated see? You have to be kind of motivated to get through the process to become a patient We're trying to make that easier, but there's a level of commitment, right? We do require You know, we are practicing medicine our physicians are practicing medicine. So if you go to a new doctor There's a level of effort just to go see a new doctor, right? You're gonna have to fill out the forms and you got to go and there's a level of commitment So we have the same thing here, you know, the process is really going to be they can sign up on the website You know anybody can sign up on the website But then you're gonna do a call with an intake specialist who's gonna explain the program, right? Make sure it's right for you on that side and then you got some forms to fill out We do ask people to get you know blood work done so we can baseline them if they haven't had updated labs, right? We want to track their progress There's multiple steps in the process to becoming a patient that if you're really just not that motivated and kicking the tires I don't think they're gonna make it through I would and then how about expanding beyond diabetes? Yeah so our corporate line is Safely and sustainably reverse type 2 diabetes and other chronic metabolic diseases Right, and I think I saw your talk and I think we all generally know that this works for some other things We want to be evidence-based So if sometimes maybe we get a little criticism for being a little slow into jumping into other things One we want to make sure that we build the structure correctly to do this first Right, if we do this correctly Then doing those just we've got the model. We've got the setup, right? Board we're definitely interested in those things and some of it's gonna be dependent on research that other groups do right? We could all speculate about what ketosis cures, but we are practicing medicine. So we want More evidence on some of those things, but when it comes out, I think we'll definitely be looking at those Yeah, good morning. My name is Christoph from South Africa and I'm also a health coach and I wanted to Know thank you. Firstly, I'm for the very very nice Insights and and sharing your purpose But I wanted to know how best to onboard some potential doctors Physicians, they might be referred to Very often by their patients Very often the patients say my doctor is not supporting this and is there any onboarding procedure or any Resources you have to share to get those doctors on board as well Okay, so we have a couple things so we only accept patients in the United States But we do have physician outreach Okay, so if you have a physician or you are a physician There is a page on the website. They can go fell out They kind of get on a mailing list, but that would give them the opportunity in Some cases to speak with some of our doctors right on that side if a doctor has a patient in our clinic Obviously our physician is talking with someone's primary care, right? We want to have an open line of communication I think that's the right thing to do for the patient Nothing more frustrating than when someone has four specialists and they don't Communicate I mean it just drives people nuts. I mean it's just it's not the right thing to do for people on that side So, you know, we want their primary care to know what they're doing on that side We do have a Facebook group for practitioners Nutritional ketosis for physicians and providers sponsored by Virta health I wrote that in the paper and I didn't say it because I didn't read it because I didn't want to read it but yeah, so we have over 800 people and Happy anybody that wants to join it's an open group on that side. So You