Lean Doc Diaries, a great start to 2013

It has been a very successful year thus far for many of my patients in their quests to lose that belly fat and significantly improve their health. I picked out just two of the many stories to give an example of what working with your physician and other health providers along with a motivated approach to changing your lifestyle towards a Leaner Living lifestyle can do!

Post-meal walks have worked wonders!

The first is a heart-warming story of a 56 year old legally blind female with long history of severe obesity complicated by metabolic syndrome including type 2 diabetes and obstructive sleep apnea on multiple medications who began seeing me about 6 months ago after many years of frustration with doctors (including bariatric surgeons) who she felt did not believe in her any more. When I saw her initially, she weighed 286lbs with a BMI of 51 and waist circumference of 49″. Her HbA1c had recently risen to 6.7 (diagnostic of DM2) with hyertriglyceridemia though with low LDL-c (87), reasonable HDL-c (58) and non-HDL at goal but not optimal (125) for her level of risk while on statin treatment. She had been referred to bariatric surgery in the past but due to her blindness, was deferred for concern of post-surgical compliance ability. She was very excited to have a physician interested in helping her and, more importantly, a physician who believed in her. We focused on dietary improvements per our Leaner Living quality recommendations, initiated daily walks (she worked up to post-prandial walks three times a day), and emphasized improved sleep quantity/quality with her cpap machine. We switched her antidepressant from citalopram to bupropion and discussed using a GLP-1 agonist but just continued metformin. One of our important goals was to improve her blood pressure in order to stop her beta-blocker which can hinder weight loss and also feeling of well-being. She saw me a few times over the past 6 months and has continued to slowly lose weight, feel more motivated, and never need further medication. At our last visit her weight was down to 272lbs, had lost over 4″ from her waist, and her BP was low enough to stop the beta-blocker. Her non-HDL is now optimal (without changing meds) with lower triglycerides and her A1c is well below goal at 6.0. She is very excited, feeling better, and even more encouraged to continue her Leaner Living lifestyle. I am confident that she will continue to do so and thus reap the rewards of a healthier and longer life.

My next story is an example of more aggressive treatment to treat metabolic syndrome with the goal of essentially putting diabetes into remission with long-term potential to be cardiometabolically disease free. This is a 42 year old obese male with history of metabolic syndrome, including type 2 diabetes, who was referred to me by my endocrine colleagues for continued difficulty losing weight despite treatment with metformin and exenatide. When I saw him, the few underlying issues after thorough evaluation other than insulin resistance were significant work-related stress and he suffered from mild secondary hypogonadism with work-up unrevealing and most likely related to obesity and symptoms concerning for obstructive sleep apnea. He weighed 267lbs with BMI 37 and waist circumference 45″. His lipids and blood pressure were at goals but on high dose atorvastatin and lisinopril (statin & ace-inhibitor) respectively. After a long evaluation and discussion, he was very motivated improve his diet, get back to a consistent exercise regimen including emphasis on resistance training for his testosterone, and improve his sleep amount in addition to cpap compliance. Due to trouble adhering to dietary recommendations, we did start the most recently FDA approved obesity tx phentermine + ER topirimate in combination with Leaner Living MRPs 2 times daily (for breakfast or lunch and a snack) plus CoQ10 combined with his statin tx. Over the past 4 months of treatment and adherence to our dietary recommendations and MRPs, he has lost an amazing 20lbs, his BMI is down to 33, and his waist is down to 42″. He feels great and is now committed to continuing this lifestyle in the long-run. His symptoms of “Low T” have also nearly resolved and correlate with improved testosterone levels now within the “normal” range. We will also now be able to start decreasing medication dosage and hopefully will be able to stop some of his medications all together!

Additionally, I wanted to provide a positive update on our neighbor, Bruce. He has continued to lose weight and is struggling to fit into his old clothes. His blood sugars are nearly normal on a consistent basis and his HbA1c has remainede around 6 using 1-2 Glycosolves daily and just one 500mg dose of metformin. His next goal is to ditch the metformin all together and continue with only the natural supplement as treatment optimizing his great adherence to Leaner Living!

Glycosolve

Hopefully these stories serve as motivation that everyone is able to make changes, sometimes requiring the help of a dedicated physician, and live long, live well, and live lean!