This month, I wanted to profile a patient that shows what is possible through the power of the internet and intelligent collaboration between professionals.
Hansraj is a 38 year old man who presented to Dr Prakash Chhajed in Indore, India in March of 2015. He had multiple problems and was already on multiple medications despite his young age. He had Type 2 Diabetes (T2D) for 10 years and was on a combination of voglibose, metformin and gliperide for this. He had high cholesterol and high triglycerides, taking rosuvastatin and fenofibrate for this condition. He had high blood pressure, taking olmasartan and amlodipine. He had also previously had a mastectomy for cosmetic reasons and psoriasis on methotrexate.
He was significantly overweight with a height of 180cm and a weight of 104 kg. This gives him a BMI of 32.1, well within the ‘obese’ category. Further testing also revealed the presence on ultrasound of fatty liver as well as elevated liver enzymes, which indicates that there is chronic damage being done from the excessive fat stored there. This is also know as Non-Alcoholic Steatohepatitis (NASH). While it sounds pretty benign (hey- what’s wrong with a little fat in the liver?), that is a dangerous misconception. NASH will very soon be the leading cause of liver cirrhosis in North America. Even though the amount of damage done is very slight, it often persists over decades. So a little damage done over a very long period of time still ends up causing cirrhosis.
Blood tests also revealed a high homocysteine level. This is an amino acid. The reason we worry about it is because high levels of homocysteine are associated with heart attacks, strokes and blood clots. They do not cause these problems (except in the rare genetic cases) but high levels are good markers of risk. High levels will identify patients that are at very high risk of cardiovascular events.
The diagnosis here was quite classic – metabolic syndrome, sometimes called syndrome X. This is a cluster of diseases that tend to all occur together – including, in this case,
- Fatty Liver
- Type 2 Diabetes
- High Cholesterol
- High Blood Pressure
- High Homocysteine levels
There are millions of these types of patients seen every single day in medical clinics throughout the world. And I would wager that 99% of those patients would be counselled to continue or increase their medications. My guess is that 99% of these metabolic syndrome patients are never counselled as to the proper cause of this disease and the proper dietary treatment of it. And these patients will continue to get worse over time. He was already taking 7 medications and he’s only 38 years old. Jeez. His HgbA1C was 8% despite all those medications. He’s in the express lane to Diabetes World, where blindness, amputation, kidney failure, heart disease and stroke are free with admission. Not exactly the happiest place on Earth.
But Hansraj is a lucky man. He is friends with Dr. Chhajed, who immediately recognized that metabolic syndrome is really a cluster of disease all caused by hyperinsulinemia. The treatment, therefore, is not medications to treat the symptoms of high BP, high sugars, fatty liver etc., but to instead treat the root cause of the disease – hyperinsulinemia. So, he contacted me through my website for some advice regarding this patient. We designed a program that included a Low Carb, High Fat, grain-free diet, Intermittent Fasting, and High Intensity Interval Training.
- Weight Loss – He dropped 20 kg over 5 months and now weighs only 84kg. This gives him a BMI of 25.9 – within spitting distance of being normal!
- Fatty Liver – repeat ultrasound showed resolution of fatty changes. Bloodwork reveals that there is no further damage to his liver. NASH cured!
- T2D – Almost completely reversed. He has been off all his medications and now has a HgbA1C of 6.1%. Fasting blood sugar is 92 mg/dl
- High Cholesterol – He has stopped both medications for high cholesterol and high triglycerides.
- High Blood Pressure – He has stopped both medications for blood pressure and latest BP is normal.
- Homocysteine levels dropped almost in half from 14.34 to 7.5.
There were other side benefits, as well. His energy levels, which had previously been extremely low, had improved tremendously. Best of all, we were able to effect all of these changes without the need for medications or surgery. Only the application of knowledge is required here. Dr. Chhajed was literally able to save this man’s life with nothing more than the knowledge he acquired. That and the courage to challenge conventional ‘wisdom’. So Hansraj has gone from 7 medications for various manifestations of the metabolic syndrome to zero in only 3 months! Terrific. Can somebody remind me why we keep prescribing drugs for a dietary disease?
What I really love about this case is the fact that Dr. Chhajed was able to reach out over half the world to me in chilly Canada for an opinion. Even if he did not have the knowledge himself for parts of the treatment, he was able to acquire this knowledge, almost in real time, via email from a doctor that he had never met. We exchanged emails, and discussed his case and formulated a well defined plan that he was able to implement for this patient.
Dr. Chhajed spent some time with me recently in Toronto in the Intensive Dietary Management program and my hope is that he is able to spread the knowledge to his part of the world. Someday, perhaps, we will be able to cure all these patients with nothing more than the simple application of knowledge we already have.