Phase 3 focused on confirming the significance of prior lipid abnormalities and evaluating liver health, culminating in objective diagnosis and escalation to specialist-directed care.

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Primary Intent at Phase Start:

• Continue weight loss

• Evaluate blood lipids and take actions to reduce them

• Obtain liver scan results

 

Implementation Chosen at Phase Start:

• Continue Keto Diet

• Stop supplementation temporarily to eliminate possible lipid raising compounds

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

• Maintain blood test frequency

• Continue documenting biomarkers and anthropometric data

• Stop Fenofibrate use and monitor TG levels

 

Measurements Introduced / Emphasized:

• Liver Elastography (5/5/25) (Results)

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Observed Directional Trends:

• Anthropometric Data (4/17/25 to 5/17/25)

  • 220.6 lbs to 218.5 lbs

    • 2.1 lb reduction (34.2 lbs total)

    • Ave. loss per week: 0.5 lbs

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

    • 23.6%/72.5% to 22.1%/74.0

    • Lean Mass Change: +1.5%

  • Waist/Height Ratio:

    • 0.54 (single measurement)

  • Waist/Hip Ratio:

    • .98 (single measurement)

  • BMR:

    • 1,839 to 1,831 kcals
       

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

  • Lipid Markers (mg/dL):

    • Total Cholesterol (TC): 284 to 173

    • Triglycerides (TG): 155 to 112

    • HDL Cholesterol (HDL-C): 48 to 44

    • LDL Cholesterol (LDL-C): 205 to 109

    • Apolipoprotein B (ApoB, measured): 149 to 94

  • NMR LipoProfiles (LabCorp):

    • LDL Particle Count (LDL-P) (nmol/L): 2615 to 1871

    • Small LDL Particles (sdLDL-P) (nmol/L): 1235 to 988

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

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

  • Fasting Insulin: Unavailable

  • Alanine Aminotransferase (ALT) (IU/L): 63 to 51

  • Aspartate Aminotransferase (AST) (IU/L): 64 to 41

  • Gamma-Glutamyl Transferase (GGT) (IU/L): 12 (single measurement)

  • Homocysteine (umol/L): 11.6 (single measurement)

  • FIB-4 Index (calculated from lab data): 3.78 (Phase 1) to 2.60

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Key Discoveries / Signals:

• Liver elastography confirmed advanced hepatic steatosis with F2–F3 fibrosis (11.05 kPa)

• Specialist guidance identified GLP-1/GIP agonist therapy (tirzepatide) as a potential primary intervention for liver disease

• Lipid biomarkers declined substantially across standard and NMR panels following elimination of confounding inputs

• An earlier coronary artery calcium (CAC) score of 3 from 2019 was rediscovered during cardiology review

• Stopping Fenofibrate use had no notable effect on TG levels

 

Constraints / Confounders Noted:

• Multiple simultaneous changes during this phase (supplement cessation and selective reintroduction, diet modification, and fenofibrate discontinuation) limited the ability to attribute lipid improvements to any single intervention.

• Lipid particle measures (LDL-P, small LDL) remained elevated relative to the September 2024 baseline despite substantial improvement from Phase 2 peak values.

• Alcohol cessation occurred prior to this phase, making it unlikely to account for the magnitude or timing of lipid changes observed here.

• PCP response to liver elastography results did not include treatment escalation

• A limited, general supplement stack was reintroduced to ensure sufficient intake of Omega-3, Vitamin C and D3, and B12

 

Open Questions at Phase End:

• Identify the best source of Zepbound and begin its use

• Fully transition to a low saturated fat Mediterranean diet in response to liver findings

• Carefully assess the use of any additional supplements in light of liver vulnerability

 

FOOTNOTES:

1. For each biomarker, the first value represents the earliest available measurement obtained on or shortly after April 17, 2025, and the second value represents the most recent measurement obtained on or shortly before May 29, 2025. Exact test dates, laboratories, assays, and reference ranges are documented in the linked source file.