Client Profile
Client 'A' is a post-menopausal female, 1.57 m tall, with a starting weight of 95 kg and a goal weight of 72 kg.
A has her own business and is quite active during the business day, but does no additional gym activity. She is the primary income generator in her home and is seeking to divorce her spouse. Her stress is high in the evenings, and she finds a glass of whisky helps her cope.
A has tried several weight loss programs and paid a small fortune to various practitioners to help her reach her goal. She was prescribed the ketogenic diet by one — and actually gained weight on it.
Clinical Diagnosis
A has several factors driving her fat gain and fat loss resistance:
The disease of obesity creates its own storm of metabolic disruption — an imbalance of insulin and leptin drives an insatiable appetite for high-sugar, high-fat foods.
Auto-immune conditions compound the problem:
- Lipodema — an estrogen-dominating disease that creates large fat cells resistant to lipolysis.
- Lymphedema — characterised by sluggish lymphatics, meaning her body is in a constant state of inflammation.
This combination of metabolic stress, inflammation, and financial and emotional stress drives cortisol levels high, which further disrupts insulin responses.
Post-menopause hormone levels further affect her ability to lose fat:
- Low testosterone affects mood, energy level and muscle growth.
- High levels of estrone (a fat-making estrogen) drives de novo lipogenesis (new fat cells) and competition for iodine, putting her in a state of subclinical hypothyroidism.
On top of all this, A also has NAFLD (non-alcoholic fatty liver disease) which drives de novo lipogenesis at a rate 3× higher.
How We Addressed This Complicated Case
Firstly, we explained to A that lowering calories and increasing exercise will never be enough to heal her system. She is a complicated case, and only a sympathetic, nuanced approach will work.
We started her on our 5-day preliminary diet designed to reduce insulin levels so her food cravings were dampened. We implemented just 2 meals a day, starting her day with protein — she makes a large crustless quiche at the start of the week and takes a slice to work with her.
Protein breakfast is essential to induce mTOR — the signal to switch the metabolism on after its overnight fast. A high-protein breakfast fuels the body longer, so the midday hunger signal (which coincides with an insulin dip) is dodged. This allows an easy time-restricted eating schedule that lets the liver start cleaning itself of fat.
After 4 weeks, A had lost 6 kg doing this. Then we stalled.
Breaking Through the Stall
Sometimes there is a natural adjustment to weight loss, but when the stall goes on for too long, we look at other culprits.
In A's case, we diagnosed Rouleaux — a blood condition where platelets stack up on each other like sticky discs. This is common in those with fat loss resistance and is related to blood proteins building up and restricting oxygenation in the blood.
For this, we have a particular 3-day eating protocol with jelly and custard to get the flow moving again. By day 2, A had dropped 1.2 kg — signalling we were back on track!
Ongoing Journey
A continues to lose weight at a steady rate. Her clothes are now noticeably looser, and she is delighting in pulling some of her 'small clothes' from the back of the closet.
Healthy, sustainable fat loss is a marathon, not a sprint. Each week I continue to guide and adjust her progress as necessary. Each week her 'happy' quotient rises — and when decisions are made from an emotionally strong position, they are generally better choices too.