Multiple diet, behavior, and supplement changes overlapped during this phase, which made cause-and-effect unclear and led to a growing focus on liver evaluation.

​

Primary Intent at Phase Start:

• Continue weight loss

• Increase protein intake to improve lean mass retention

 

Implementation Chosen at Phase Start:

• Change to Keto Diet (55% Fat / 35% Protein / 10% Carbs)

• Continue existing resistance training 2-3 days/week and increase activity level

• Increase blood test frequency to monitor diet/supplement changes

• Continue documenting biomarkers and anthropometric data

• Transition away from alcohol use

• Supplement use was broad and non-targeted, with the exception of Fatty15 added on 2/26/25

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Measurements Introduced / Emphasized:

• FitnessPal food tracking used during Keto diet transition

 

Observed Directional Trends:

• Anthropometric Data (4/2/25 to 4/17/25)

  • 224.2 lbs to 220.6 lbs

    • 3.6 lb reduction (32.1 lbs total)

    • Ave. loss per week: 0.5 lbs

  • Fat/Lean Mass (per Withings Body Comp scale):

    • 24.9% / 71.3% to 23.6%/72.5%

    • Lean Mass Change: +1.2%

  • Waist/Height Ratio:

    • 0.56 (single measurement)

  • Waist/Hip Ratio:

    • 1.02 (single measurement)

  • BMR:

    • 1,857 to 1,839 kcals
       

• Blood Tests (Footnote 1​) - for details, see Blood Test Master File

  • Lipid Markers (mg/dL):

    • Total Cholesterol (TC): 143 to 284

    • Triglycerides (TG): 121 to 155

    • HDL Cholesterol (HDL-C): 49 to 48

    • LDL Cholesterol (LDL-C): 67.2 to 205

    • ApoB (measured): 89 to 149

  • NMR LipoProfiles (LabCorp):

    • LDL Particle Count (LDL-P) (nmol/L): 1056 to 2615

    • Small LDL Particles (sdLDL-P) (nmol/L): 447 to 1235

    • Insulin Resistance Index (LP-IR): 56 to 45

  • Fasting Glucose–Insulin Index (HOMA-IR) (calculated from lab data): Unavailable

  • Fasting Insulin (µU/mL) (Footnote 2): 9 (total insulin – St. Lukes) to 3.9 (active insulin - LabCorp)

  • Alanine Aminotransferase (ALT) (IU/L): 72 to 63

  • Aspartate Aminotransferase (AST) (IU/L): 74 to 64

  • Gamma-Glutamyl Transferase (GGT) (IU/L): Unavailable

  • Homocysteine (umol/L): 19.4 to 11.6

  • FIB-4 Index (calculated from lab data): Unavailable

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Key Discoveries / Signals:

• Lipid biomarkers increased sharply across standard and NMR panels

• Primary Care Physician assessed AST/ALT abnormality and independently calculated elevated FIB-4, escalating issue to imaging

• Alcohol intake was no longer viewed as neutral to health status

• Weight loss continued, but focus shifted toward a broader metabolic context

 

Constraints / Confounders Noted:

• Multiple concurrent changes limited ability to identify a cause for the observed lipid spike, including:

  • Change to Keto Diet

  • Reduction of alcohol use in March and April

  • Start of Fatty15 supplement on 2/26/2025

  • Start of Urolithin A supplement on 4/4/25

• All alcohol was stopped after 4/16/2025 in response to high ALT/AST levels

• Transition to Keto added a small portion of cruciferous vegetables as the only carbohydrate source.  Increased leaner cuts of animal proteins. Satiety was maintained but any mid-day cravings were indulged with proteins.

• CGM monitoring did not yield actionable insights during this phase and did not play a measurable role in future phases

• Stopped use of bulletproof coffee and discontinued measurement of ketosis

 

Open Questions at Phase End:

• Further diet adjustments warranted in response to lipid spike.

• Review of supplementation stack is needed to eliminate possible impacts on lipid levels and/or liver.

• Decision pending whether to continue use of my cardiologist-prescribed Fenofibrate in light of diet-reduced TG levels and possible liver impact.

 

FOOTNOTES:

1. For each biomarker, the first value represents the earliest available measurement obtained on or shortly after March 10, 2025, and the second value represents the most recent measurement obtained on or shortly before April 17, 2025. Exact test dates, laboratories, assays, and reference ranges are documented in the linked source file. 
    

2. “Total” insulin refers to assays that may detect circulating insulin plus proinsulin and proinsulin fragments, depending on laboratory methodology. Values are therefore assay-dependent and not directly comparable across laboratories. Directional interpretation is appropriate within-lab only. Where available, insulin-specific assays are referenced separately.