Beverly B. is a 60-year old, 5’6 ½”, 202-pound female who presented at our office for weight loss. Beverly is an ER nurse who has been monitoring her blood sugar for pre-diabetes and has had a 20-year history of elevated liver enzymes since being treated for exposure to tuberculosis. She works four 12-hour shifts a week, was exercising 6 times a week, most recently doing the Insanity Workout without successful weight loss.
Presenting Medications/Supplements:
- Cardiotrophin
- Cardio Plus
- CoQ10
- Cataplex
- Cyrata Plus
- Drenamin
- Red Yeast Rice
- Cetyl M
- MSM & Glucosamine
- Fish Oil
- Prilosec
- Zyrtec D
Prior to starting the SHAPE Program, a comprehensive metabolic panel, thyroid panel, CBC with differential, A1C, C-Reactive Protein, ESR and U/A were performed by LabCorp. Abnormal results of the laboratory analysis were as follows:
- Glucose – 100 mg/dL (65-110)
- HGB A1C – 6.1% (4.4-5.7)
- eGFR – 78 mL/min (>59)
- Sodium – 90 mmol/L (135-149)
- AST (SGOT) – 85 IU/L (0-40)
- ALT (SGPT) – 149 IU/L (0-32)
- GGT – 389 IU/L (0-60)
- Cholesterol, Total – 236 mg/dL (100-199)
- Triglycerides – 284 mg/dL (0-149)
- LDL – 130 mg/dL(0-99)
- T. Chol/LDL Ratio – 4.8 ratio units
- Her initial diagnosis was 1) Elevated Transaminases 2) Glucose Diathesis (Pre-Diabetes Mellitus) 3) Early Monocytic Anemia
Recommendations were made for the following:
- Obesity: Weight Management, SHAPE Program
- Elevated Liver Enzymes: Methionine, Choline & Inositol, Liver Glandular
- Glucose Diathesis: Glucoset Supplement (Douglas Laboratories) Strength 1/each meal
- Early Anemia: Continue Vitamin B12 and Folic Acid
Beverly’s physical exam revealed a normal heart rhythm and rate. Lung sounds were clear to auscultation and tactile fremitus. Abdominal exam was unremarkable for masses and or pulses. The liver was non-tender to palpation and/or percussion, appearing to be of normal size.
Beverly started the SHAPE Program for weight loss on March 22, 2012. After the load days, weight was 204. Beverly completed 21 days of the restricted calorie diet (RCD), 3 days of RCD with no drops, and 3 weeks of maintenance. Total weight loss was 26 pounds and 26.5 inches. Initial BMI was 33.09 and is now 28.67. Evaluation for body fat revealed percentage of fat dropped from 41.6 to 39% and total pounds of fat dropped from 85 to 70 pounds. By week 2 of RCD, she had stopped all OTC meds, including Zyrtec D and Prilosec Daily, she reported hot flashes were considerably less intense, and noted she was not limping for first time in approximately 16 years since a right radial heel chip fracture and felt like scar tissue was less inflamed. She noted she was now tasting foods as if for the first time, and that her energy level was at a level she cannot remember for many, many years. Beverly continued to do the Insanity Workout as she had been doing this workout for 6 months, but did find that she needed to bring the intensity down some after about a week of the RCD.
Using the inflammation questionnaire, substantial improvements were noted in 70% of areas noted to be troublesome, and the remaining areas showed improvement or stayed the same across the board. Follow-up lab results on 5/3 were as follows:
- Glucose – 104
- HGB A1C – 5.9, 0.3 improvement
- eGFR – 82, 4 mL/min/1.73t improvement
- Sodium – 140, 30 mEq/L improvement
- AST (SGOT) – 22, 63 IU/L improvement
- ALT (SGTP) – 32, 137 IU/L improvement
- GGT – 119, 270 IU/L improvement
- Cholesterol, Total – 174, 62 mg/dL improvement
- Triglycerides – 118, 166 mg/dL improvement
- LDL – 111, 19 mg/dL improvement
- T.Chol/LDL Ratio – 4.5, .03 improvement
Discussion:
Beverly was successful with weight loss, with a BMI improvement of 4.42 points. There were significant improvements in lipids and liver enzymes! While we made recommendations for her conditions with supplements to her liver, we normally don’t see this dramatic of a drop in elevated transaminases in this time frame when using the supplements without the prescribed diet and/or homeopathy solution. Her C-Reactive Protein was not elevated and it is harder to justify this as an inflammatory reaction.
We recommended the following protocol to continue:
- Continue Glucoset for Glucose Diathesis
- Omega III EPA/DHA 1000/day for Hyperlipidemia
- Continue Methionine 1000mg/day, add Yakitron 90mg/day, Beta Carotene 75,000 iu/day
- Repeat lab in 12 weeks
- Beverly plans to start another round of the SHAPE Program in the next few weeks
Submitted by Thomas W. Jensen, D.C., D.A.B.C.I.
Dr. Todd’s Teaching Assessment:
I so enjoy reviewing these monthly case study submissions. Those of us that practice functional medicine can offer more to our patients than the average doctor. SHAPE ReClaimed opens the door for many to step into the arena of functional medicine like never before. This case study is thorough as well as self-evident of what happened.
SHAPE ReClaimed was birthed as a weight loss program, but it became quite obvious it is so much more and this case study is an excellent example of the many side benefits we are all seeing with our patients.
I would like to point out the highlights of this case:
- Worked out 6 times weekly and no success with regard to weight loss.
- She had a 20-year history of elevated liver enzymes. I was surprised that her liver was not enlarged.
- She was on an excellent supplement regimen.
- She lost 26 pounds and 26.5 inches. We have found the average SHAPE patient typically drops ½ inch per pound lost. Anything above that amount is phenomenal! This was a shockingly high amount of inches lost.
- Note the elimination of Zyrtec D and Prilosec, the reduction of hot flashes, not limping for the first time in 16 years!
- The retest of her blood work speaks for itself.
Decreased inflammation, enhanced immune function, normalizing of blood sugar and hormones are what SHAPE ReClaimed is all about. And its side effect? Weight loss!
We like to keep our patients on Phase I for as long as we have ground to gain with health symptoms. The longest we kept a patient on Phase I was 14 months and he lost 196 pounds. We have found motivation is greatest the first time a patient does the program. With successive rounds, we see less motivation and notice the patient finds ways to cheat through the program. This definitely decreases the long-term benefits of the program as the patient oftentimes will revert back to unhealthy dietary habits, thus putting them back in the vicious cycle of gaining and losing the same weight. Our goal is to help our patients develop a new and healthy lifestyle that will support keeping their weight off and inflammation under control. In the future, we recommend this patient stay in Phase I until she reaches her goal.
