Nicole’s case: keto solves lifelong obesity and food issues


At 67 years of age, Nicole had been obese nearly all her life. At the age of 5, she remembers a photo of herself sitting on the foyer alongside her sisters and cousins at her aunt’s house. It was clear in the photo that she was already obese. At 14, she weighed 95 kg( 210 pounds ). It was a pain suffer for her being called overweight at school.

When she was 17, Nicole went to see a dietician, who have contributed to her get down to 66 kg( 145 pounds ), which she maintained until she got married at 22. A time into her matrimony, her husband left to work in Northern Quebec for six years old. He would come back for ten days of trip every two months, and in the winter, he was at home from December until March.

It was during this time she started to regain weight. At 24, she weighed 100 kg( 220 pounds ), and condemned her weight gain on emotional eating, as she lived alone the majority of the year. This heavines gain started huge amounts of guilt.

Nicole had two maternities, gaining only 9 kg( 20 pounds) during each. Nonetheless, between and after her pregnancies, she continued to gain more weight. She found herself at 145 kg( 320 pounds) at the age of 58.

In 2010, Nicole lost 45 kg( 100 pounds) with the help of a naturopath that “shes seen” weekly. She followed a high-protein diet that included barrooms, cookies, and shakes. She eat one meals per day, and the rest of the day she depleted artificial packaged protein makes that, by the end, she couldn’t even swallow.

Nicole regained 27 kg( 60 pounds) during the two years that followed. For several years, she continued losing, gaining, losing, and gaining weight over and over again.

Having been obese almost all her life, Nicole was perplexed and slam herself in. Nevertheless, she was successful in her professional life as an administrative assistant for the director of a large company. She worked hard to be the best and to be appreciated by her coworkers but felt inferior to others, even though she knew she was modified in her location. In her intelligence, because of her force, she felt that the other administrative aides were always better than her.

In hindsight, Nicole realizes that she spent her life in a state of mild depression. She had hyperphagia onrushes at night several times a week, and subsequentlies would be overcome with guilt. She knew she was destroying herself, but she couldn’t understand why she couldn’t just stop. She has two beautiful children, both of whom have character 1 diabetes. When they were young, she could hardly play with them because she wasn’t able to sit on the flooring with them, run alongside or play outside with them.

Nicole was poignant to miss so many things. In addition, she told herself she has not been able to live to an old age as she had several chronic diseases, including high blood pressure, high-pitched cholesterol, asthma, sleep apnea, and sort 2 diabetes, for which “shes had” taken four daily insulin injections for 33 years.

The ketogenic nutrition leads to weight loss and diabetes change

Nicole enrolled in the Reversa Clinic program and started the ketogenic diet on October 27, 2018. She weighed 113 kg( 248 pounds ).

As I do with all diabetic patients on SGLT2 inhibitors who start a ketogenic diet, I finished her Invokana on that first day. Taking this type of medication while starting a low-carb or very-low-carb diet can increase the risk of ketoacidosis. This remedy manipulates by making the kidneys eject some of the glucose circulating in the blood. Since my patients “re no longer” chewing sugar, I think they can do without this expensive drug.

On October 30, her blood sugar grades has so far been lowered, and we were able to discontinue her short-acting insulin, while lowering her long-acting insulin, from 15 contingents to 10 units.

When we’re in the process of weaning patients off insulin, we aim for blood sugar positions to be between 8 and 12 mmol/ L or 144 and 216 mg/ dL. Higher numbers are treated with an insulin sliding flake, while lower amounts indicate that it might be time to reduce the insulin some more. These carbohydrate positions are definitely not optimal and are tolerated merely for a short period of time, while individual patients “re working on” their food and life habits.

If we find no progress in their blood sugar degrees for a few weeks, we troubleshoot with individual patients. It can be a carb pussyfoot, but it’s often a combination of a few things, like bad sleep, increased stress positions, sting, or infections.

On October 31, we abbreviated her long-acting insulin from 10 sections to 5. The following daytime, her carbohydrate elevations proved she no longer needed insulin of any kind.

Within the next few daytimes of starting a ketogenic nutrition, that insulin was no longer necessary. It was a big victory! I’d like to emphasize the fact that Nicole had had type 2 diabetes for decades, and had been using insulin for the past 33 years. Within the next few epoches of starting a ketogenic food, that insulin was no longer necessary. It was a big victory!

We’re not able to completely stop insulin with every single patient. Sometimes, the pancreas is too impaired. This is the reason why we check their c-peptides, to make sure the pancreas is still able to produce fairly insulin to take over, once we remove the exogenous insulin. In her example, as she had been quite diligent with her medication and her blood sugar degrees all her diabetic life, there didn’t seem to be too much irreparable damage to her pancreas.

Added health increases and remedy reduction

In November 2018, Nicole decided on her own to stop her inhalers for her asthma. She saved the inhalers, though, merely in case. I don’t deprescribe asthma medication, but numerous cases has definitely reported not needing them as much after starting a low-carb diet. Her weight was down to 102 kg( 225 pounds ).

On December 20, 2018, she had an appointment with her family doctor, who shortened her amlodipine from 10 mg to 7.5 mg, because her blood pressure was getting too low. At the time, she was also on a diuretic, which is the drug I would have stopped first since it offsets patients urinate more, and she previously had an overactive bladder with some incontinence. Diuretics also determine electrolyte control more challenging.

On January 30, 2019, her value was down to 90.5 kg( 199 pounds ). Her blood sugar levels were so low-pitched, we were able to reduce her metformin from 850 mg twice a period to 850 mg once a day. It is the manner in which she preferred it. I typically prefer to decrease each quantity. In this case, I might have reduced her metformin to 500 mg twice a era, and then 250 mg twice a date or 500 mg once a day. I picture these are all good options, and there isn’t exactly one correct way to deprescribe metformin. The best path is likely the one individual patients prefers.

I also stopped her diuretic drug, since her blood pressure was once again too low.

In February, her heavines was 85.5 kg( 188 pounds ). Nicole stopped her antacid medication she had been taking for acid reflux. She no longer felt she needed it.

On March 4, her blood pressure was back to being too low, so her family doctor stopped her amlodipine completely.

On April 15, 2019, she went to get a second ultrasound to see if her fatty liver helped improve. The u/ s report had pointed out that her formerly severe hepatic steatosis was now mild.

On May 29, 2019, her last day in the program, we perfectly stopped metformin. She weighed 73 kg( 161 pounds ). It was a marvelous daylight!

I simply shorten or stop metformin when blood sugar levels are pretty much regular all the time, be indicated in the morning. Until then, metformin seems to help with weight loss and insulin predisposition. Some patients preserve taking a small dose of metformin after they have done their 6-month program with us. It’s really instance by case.

She was full of energy and wasn’t obsessed about menu the working day long anymore.On the working day, Nicole too was just telling me that her humor had improved a lot. She no longer suffered from constipation, which “shes had” knowledge all her life. She didn’t have urinary incontinence anymore, was full of energy and wasn’t preoccupied about nutrient the working day long anymore. Best of all, she hadn’t had any hyperphagia or binge eating occurrences since October.

I was so happy for her, and so proud of her!

In the following months, I discontinued up expecting Nicole is she wanted to become my patient. I felt accepted when she agreed. I didn’t know it at the time, but Nicole was about to become my teacher.

The return of hungers, out-of-control eating, and weight addition

A few months later, Nicole came to my medical clinic for extensive consultations. She was in distress. “Shes had” been gaining force. She told me that she and her husband had celebrated their wed anniversary in July. For the motive, they agreed to share a dessert at a neat eatery. Nicole hadn’t had any sweet food or dessert since October 27, 2018. They thought it would be harmless, considering how well “shes had” been doing so far.

It turned out to be a big mistake.

Nicole was back into craving specks and carbohydrates, and was having hyperphagia episodes again. She didn’t know how to stop this from happening. She was coming for help, but I felt like she was deep in a creek full of strife, struggling to stay afloat, panicked, while I just watched her from the shore, without any course to help her not drown. I didn’t have any life vest to propel at her.

This was my introduction into the world of menu cravings, which I didn’t know existed before. Of trend, I knew about anorexia nervosa, like anorexia and bulimia, but this was something else.

Sugar and food addiction: brand-new concepts and penetrations

Note: Although they are gaining acceptance among professionals, sugar addiction and food addiction remain controversial identifications, and the terminology and its application are not reach agreement on all.

I informed myself on nutrient cravings, first by see Food Junkies, by Dr. Vera Tarman, who is a Toronto-based family doctor who has been working with all kinds of addictions for the past 20 years, and is herself a nutrient junkie. I highly recommend her work to healthcare professionals and patients alike.


There is also lots of information on Diet Doctor’s website about sugar craving, including a great video series with Bitten Jonsson, a registered nurse who is an expert on nutrient and carbohydrate cravings. Bitten doesn’t do cases consultations anymore, but she develops healthcare professionals in sugar addiction.

I likewise highly recommend the textbook on processed food addiction by Joan Ifland, for healthcare professionals who want to diagnose and cure treat cases with meat addictions.


I would also suggest to healthcare professionals to start using the Yale Food Addiction Scale to screen for meat addictions in their patients who may have an abnormal liaison with menu, as is also suggested by Dr. Tro in this video, where he talks about his own struggle with food addiction. Sometimes, these patients can appear as “not following your advice, ” “being unmotivated” or “self-sabotaging.”

These patients rarely speak up about their craving. As a matter of fact, they may not even know they have a food addiction! They likely condemned themselves for their recited flops, and believe it’s their faulting for not being decided enough. They think they need to work harder to control this.

But as with any addiction, it cannot be controlled. That is not how it works. Believing we can control it and have “a little bit in moderation, once in a while” is doomed to failure. We all know that an alcoholic who has managed to be sober for 10 years should not celebrate with having “just one brew, ” because that person is likely not going to be able to stop after one brew. This is what happened to Nicole when she shared a dessert with her husband. One bite was too many, and a thousand wasn’t enough.

The DSM-V doesn’t recognize food addiction as an entity. However, it rolls criteria for diagnosing a element help disease, which could certainly apply to food cravings, where junk food, sugareds, and processed foods are the substance of abuse.

The criteria for substance use disorder — which are well-detailed in context with processed food in Ifland’s textbook — are: unintended use, miscarried strives at trimming back, the amount of time spent, longings, failure to fulfill capacities, interpersonal difficulties, undertakings given up, physically hazardous utilize, use in spite of knowledge of consequences, advance and withdrawal.

Nicole and I discussed a few strategies to get her back on the pony. She tried going to meetings for Overeaters Anonymous, which is a 12 -step program similar to Alcoholics Anonymous, available in many countries all over the world. However, after attending a few periods, she felt it wasn’t for her. She also visualized a healer who specialises in compulsive eating, but she didn’t find it helpful. In the end, she committed to total abstinence, and we agreed to meet on a regular basis, chiefly for support.

This started me realize that as long as food addiction isn’t officially recognized, patients will keep on struggling to find adequate help locally, and/ or in their language, at a reasonable cost. This surrounding deserves more awareness from healthcare professionals and medical organizations.

Last time I recognized Nicole, she was doing really well and had not had any recent hyperphagia episodes. Her weight was stable, and her blood sugar heights remained in the normal range. Above all, she had serenity.

I’m sorry Nicole has had to struggle with food her entirety life, to the point where she developed form 2 diabetes, obesity and other complications from her addiction. But I’m grateful that she swept my course, and cured me learn about food addiction. She has became me a better physician, I believe.

/ Dr. Evelyne Bourdua-Roy, MD


Case report: Denis, and how the ketogenic diet saved “peoples lives”

Case report: Christian- Or how one follower claims to have found the fountain of youth on low-toned carb !

Low-carb case report: Patrick

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