Phase 4  involved starting targeted treatment for liver disease and tracking early changes across liver, lipid, and body composition measures.

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Primary Intent at Phase Start:

• Liver recovery

• Continued weight loss

• Maintain low saturated fat diet

 

Implementation Chosen at Phase Start:

• Change to Mediterranean Diet (30% Fat / 30% Protein / 40% Carbs)

• Begin and maintain use of Zepbound for liver therapy

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

• Maintain blood test frequency to monitor relevant biomarkers, focusing on liver recovery

• Continue documenting biomarkers and anthropometric data

• Use DEXA Body Composition scans to confirm optimal target weight goals

 

Measurements Introduced / Emphasized:

• DEXA Body Composition Scans (6/24/25 and 10/3/25)

• CT Cardiac Angiogram (7/15/25) (results)

• Liver FibroScan (12/3/25) (results)

• Cardio IQ® LP PLA2 Activity blood test (8/7/25 and 9/29/25)

• Began use of ChatGPT on 10/24/25 to assist in data aggregation and analysis, supplement stacking and review, and diet support

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Observed Directional Trends:

• Anthropometric Data (5/17/25 to 11/23/25)

  • 218.5 lbs to 197.9 lbs

    • 20.6 lb reduction (54.8 lbs total)

    • Ave. loss per week: 0.76 lbs

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

    • 22.1%/74.0% to 18.9%/77.0%

    • Lean Mass Change: +3.0%

  • DEXA Body Comp Scan Results (10/3/25)

    • Total Mass: 203.7 lbs

    • Lean Mass: 149.9 lbs / 73.6%

    • Fat Mass: 44.9 lbs / 23.0%

    • Visceral Fat:

      • 3.56 lbs (mass)

      • 7.9% of total fat mass

    • Subcutaneous Fat: 1.3 Lbs

  • Waist/Height Ratio:

    • 0.50 (single measurement)

  • Waist/Hip Ratio:

    • .94 (single measurement)

  • BMR:

    • 1,831 to 1,737 kcals

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

  • Lipid Markers (mg/dL):

    • Total Cholesterol (TC): 173 to 149

    • Triglycerides (TG): 112 to 68

    • HDL Cholesterol (HDL-C): 44 to 57

    • LDL Cholesterol (LDL-C): 109 to 78

    • ApoB (measured): 94 to 72

    • Cardio IQ® LP PLA2 Activity (nmol/min/mL):

      • 139 (8/7/25)

      • 103 (9/29/25)

  • NMR LipoProfiles (LabCorp):

    • LDL Particle Count (LDL-P) (nmol/L): 1871 to 1054

    • Small LDL Particles (sdLDL-P) (nmol/L): 988 to 536

    • Insulin Resistance Index (LP-IR): 45 to 30

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

    • 2.0 (11/10/25)

  • Fasting Insulin (Active) (µU/mL):

    • 5.0 (LabCorp) (8/7/25)

    • 8.7 (LabCorp) (11/10/25)

    • 5.3 (LabCorp) (11/24/25)

  • Alanine Aminotransferase (ALT) (IU/L): 51 to 46

  • Aspartate Aminotransferase (AST) (IU/L): 41 to 35

  • Gamma-Glutamyl Transferase (GGT) (IU/L): 11 to 13

  • Homocysteine (umol/L):  Unavailable

  • FIB-4 Index (calculated from lab data): 2.60 to 1.72

 

Key Discoveries / Signals:

• Marked resolution of advanced hepatic steatosis and reduction in liver stiffness from F2–3 to F0–1 were observed on FibroScan (12/3/25).

• CAC score of 94 obtained from 7/15/2025 CT Cardiac Angiogram providing updated coronary risk assessment

• DEXA scans revealed visceral fat to be 7.9% of total body fat

• Achieved goal weight range of 195-200 lbs by end of phase

 

Constraints / Confounders Noted:

• Zepbound initiation occurred partway through the phase (6/26/25), limiting attribution of early improvements to pharmacologic therapy alone

• Other concurrent interventions (diet change, coffee filtration, selective supplement use) overlapped with the start of treatment, constraining causal determination

• Expanded supplement stack starting August 2025 to include liver and CVD supportive nutrients such as Kyolic garlic, Phosphatidyl Choline, Acetyl-l-Carnitine, and Taurine, each followed by blood testing to assess response

• The duration of pharmacologic exposure prior to follow-up FibroScan was limited, and findings reflect early response rather than long-term stabilization.

 

Open Questions at Phase End:

• Reevaluate Zepbound dosage (7.5mg at phase end) given achievement of reaching goal weight while continuing liver therapy benefits

• Change diet toward maintaining weight, with a focus on maintaining and growing  lean mass and continued improvement of biomarkers associated with CVD progression

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FOOTNOTES:

1. For each biomarker, the first value represents the earliest available measurement obtained on or shortly after May 30, 2025, and the second value represents the most recent measurement obtained on or shortly before December 4, 2025. Exact test dates, laboratories, assays, and reference ranges are documented in the linked source file.