The Patient: Linda, a 63-year old real estate agent and Hawaii resident.
Why she came to see me: When Linda’s attempt to find new pants required going up yet another size, she knew it was due time to take action. At 165 pounds, she was more than 30 pounds over the weight she’d enjoyed before menopause at age 50. In addition to the extra pounds she was carrying, Linda complained of digestive problems and persistent, whole-body pain—a feeling of “aching all over” that, combined with her weight, often left her fatigued and depressed. She said she was ready to sell the real estate company she had established and return to the town in Northern Germany where she was raised. “I don’t want to leave paradise—I hate winters,” she said, “but I’m also so unhappy with myself that all I want to do is hide.”
How I evaluated her: Linda and I began with a frank discussion about her diet and weight. When she wasn’t dieting—which was characterized by weeks of deprivation, followed by months of indulging—her diet reflected her home country’s mores. Breakfast typically consisted of bread with cheese, butter or Nutella…lunch was comprised of potatoes, meat and vegetables…and dinner was usually a hearty sandwich from her favorite deli. She ate primarily at home and concluded dinner with dessert—often something that included chocolate.
I also ordered a number of different labs:
- A complete blood count, which looks at white cells, red cells, and platelets.
- A comprehensive metabolic profile, which assesses liver and kidney function, as well as blood glucose and other key health markers.
- A thyroid panel.
- A fasting lipid panel, which tests cholesterol and triglycerides (fats) in the blood.
- A Comprehensive Digestive Stool Analysis
- A food allergy test.
- A hemoglobin A1c—a test that examines glucose levels from the preceding 3 months—in addition to a fasting insulin.
- A high sensitivity C-reactive protein (hs-CRP) test.
What my evaluation revealed: Linda had metabolic syndrome, a group of risk of factors that includes insulin resistance, obesity and hypertension. With this syndrome, often people have high levels of fats in their blood as well. The syndrome puts people at risk for diabetes and heart disease—and more than a third of US adults are estimated to have it. This condition (and her insulin resistance in particular) was compounded by Linda’s history of yo-yo dieting, which often results in a slower metabolism.
Both her cholesterol and triglycerides were high. The latter means there is more fat in the blood than desired, further indicating poor carbohydrate metabolism. Her HBA1c results demonstrated that, at 5.9, she was in the pre-diabetic range. What’s more, her hs-CRP, which measures inflammation in the body, was also high at 4.0—normal is deemed less than 1.0, while “optimal” levels are less than 0.6.
Additionally, Linda’s food allergy test revealed that she was highly reactive to gluten and dairy, while her Comprehensive Digestive Stool Analysis showed an overgrowth of yeast in her intestines, as well as not enough friendly bacteria, which have many health benefits including detoxifying pro-carcinogens. Otherwise known as dysbiosis (or imbalanced intestinal flora), this condition can result in gas, bloating, indigestion, and systemic inflammation, which can manifest in—you guessed it—whole-body pain.
How I addressed the problem: Linda’s diet was our biggest hurdle but also the simplest to surmount. I put her on a ketogenic diet with the suggestion that this new eating regime, characterized by high fat, moderate protein and low carbohydrates, ought to be seen as a new lifestyle for her, not a temporary plan before she recommenced her carb-heavy diet.
Designed to aid people in becoming efficient fat burners, the ketogenic diet prohibits all grains (and, thus, gluten). I also recommended that she avoid all dairy products. I advised her to cook with coconut, macadamia nut, and olive oils (some flavored), and to include medium chain triglyceride (MCT) oil in her morning coffee. MCTs are from coconut oil and they easily cross the blood-brain barrier, thus supporting ketosis—the goal in a ketogenic diet. (Ketosis is a state in which a person is burning fat for energy instead of carbohydrates.) My recommendation on MCT with coffee is a twist on the Bullet-Proof Coffee fad, which uses butter. I don’t recommend butter on this diet even if it is from friendly, happy, grass-fed cows! To safeguard her results, I asked Linda to check her urine twice a day in order to chart her level of ketosis so that we could see if her body was fat-adapting. (The amount of ketones in the urine is a reflection of whether or not this is happening.)
Note: The ketogenic diet isn’t for everyone, but it is for a case like this. When a patient has high triglycerides and metabolic syndrome, it will reverse the condition. The diet should be modified, as I advised to Linda, so that a person is eating only high-quality fats and not a lot of saturated animal fat, which so many keto diets recommend.
And while most Americans eat between 200-300 grams of carbohydrates per day, I advised Linda to limit hers to 30. In doing so, she would be working towards eradicating unfriendly yeast in her intestines while also lowering her inflammatory markers and urging her body to become more “insulin sensitive.”
Finally, I prescribed friendly bacterial flora in the form of lactobacilli and bifidobacteria (100 billion organisms daily) and recommended she add more garlic to her diet to further assist in the eradication of yeast.
The patient’s progress: While Linda was hesitant to start “yet another diet”—all others had failed her in the past, and spectacularly at that (often leading to more weight gain)—she quickly discovered she could eat many of the foods she banned when she was depriving herself: eggs (with the yolks!), avocados, yogurt (made with coconut milk), blueberries, and olive oil (Linda, like many, was under the erroneous belief that one must avoid fats when trying to lose weight). Her usual breakfasts were replaced with egg scrambles and yogurt parfaits…lunches became salads with chicken or turkey…and dinners were transformed into low-carb steamed vegetables with grilled fish.
She maintained her enthusiasm for this new lifestyle by keeping in mind that a state of ketosis not only potentially aids in weight loss but also shifts one’s metabolism from being a carbohydrate burner to a fat burner. What’s more, it can decrease inflammation and improve digestion—and she was desperate to find relief from both.
Within four weeks of being on the diet, Linda reported that her brain was sharper, her digestion enhanced and her energy higher. The “background,” whole-body pain she’d endured since menopause had also vanished. To her delight, she’d also lost weight in what she felt was an “effortless” way, starting off with a rapid 10-pound loss during her first month (which I explained was likely water weight) before weighing in a total of 18 pounds less by the start of her fourth month of treatment.
Her lab values validated the good work she’d done with her diet, with her fasting insulin, trigyclerides, cholesterol and glucose levels now within normal range. Optimistic and lighter—in more ways than one—Linda no longer felt the need to hide. Indeed, she was ready to start relishing paradise again, inside and outside of her body.
Linda will need to be on this diet in some form for life, meaning a lower-carb diet, to maintain being an efficient fat burner. She may not need to be so strict later on and can add in some higher-carbohydrate days or eat more of a paleo diet, but in general her body type needs to avoid carbohydrates to be healthy.
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