ex150 trial case study: 37 y/o female loses 9lbs in 30 days

<Witty subtitle goes here>

This is the fourth case study from the ex150trial. If you recall, I put out a post asking for volunteers to try the ex150 diet for 30 days. The first few have finished their trials, and this is one of them.

Previous case studies:
48 year old female loses 14.6lbs in 30 days
26 year old male loses 5-8lbs in 26 days, mostly water weight
38 y/o female loses 11lbs in 30 days eating 2,700kcal/day

Subject: 37 y/o female with history of depression

The subject gained 30lbs over the last 6 months, which came on with COVID, inactivity, and stress. Diagnosed with clinical depression, she takes Sertraline/Zoloft. Just out of curiosity I checked, and that drug does not commonly seem to lead to much weight gain, unlike other SSRIs.

Her main goal was to lose weight, and a secondary goal was not disrupting her mood, in which case she would abort the diet experiment. Luckily, this did not happen.

The subject had a lot of experience with low-carb/keto diets, yet hadn’t quite found one that worked super well for her:

Like yourself I've tried lots of different [diets] and never had much success, except with Atkins. However, I found phase 1 too unpalatable as tomatoes aren't allowed and then phase 2 was too vague to stick with for me. I liked your combination of pasta sauce, minced beef and veg as I tried it and enjoyed it. I felt I could stick to it.

Tomato sauce. I’m onto something here. Just makes everything so delicious!

If you can tell, subject is British. Luckily for me, she submitted her weight in pounds instead of the “stones” I’ve seen Brits throw around sometimes.

I have a partner doing the potato diet but I know I wouldn't be able to stick to only potatoes. We might trigger each other's cravings but we are both keen to experiment and do our own meals.

Huh! Very cool to experiment together and encourage and motivate each other :-) She reports her partner has lost 20lbs over a few months of doing the potato diet.

Experiment: Huge initial drop, a bit of cheating, big sprint to the finish line

Like most people on the diet, the subject lost a very substantial amount of water weight right away. She deviated a bit from the diet and plateaued during the middle of the 30 days, but went strict again at the end, losing another 4-5lbs.

Big drops in the beginning and at the end, with some off-diet meals in the middle.

We see a familiar pattern with carbs: even pretty moderate-carb meals like a poke bowl with quinoa, a few drinks, and a small bag of chips, set the subject back 4-5 days.

Overall, she was down 9.2lbs, which is quite impressive.

Like most of the other subjects, she found it more difficult to stick to the diet at social events. Work gatherings and visiting friends were the main reasons she deviated. Still, she would usually minimize the damage pretty effectively, not giving in to all the temptations.

A few times, her work was particularly stressful, and she got a “cheat meal” for stress relief.

That’s just the real world. Almost nobody can stick to a crazy diet 100% of the time. So it’s encouraging to see that, after a few days back on the diet, the weight just started coming off again.

Developing a strategy to minimize damage at social events

One thing I need to think about more might be a sort of “social meal” strategy for minimizing damage. I’m pretty anti-social myself, which has always helped me run these experiments. I’m the kind of asshole who orders sparkling water at the restaurant and nothing else.

But not everybody is like that, and since the diet still seems to work pretty well if you go off occasionally, especially if you limit the damage, it would be silly to insist everybody be anti-social like me.

Subjective well-being:

The first few days, the subject’s mood was pretty low.

Mood was pretty low today. Depressed.
Didn't experience hunger as such, but did get some cravings.

Really low mood. Very close to cracking and comfort binging - managed to pull through - not feeling hungry as such just wanting to 'feel better' through food.

She began suspecting that she didn’t eat enough:

Not eaten much today - feeling spacey/hard to concentrate.
Need to eat more cream and bring some to work.

I followed up and she confirmed this was the case:

I definitely wasn't eating enough initially- towards the end
I found coffee and cream to be the best combo to get enough calories.
I started half filling a cup with coffee and putting loads of whipped cream on top.

Individual fat preferences vary

A combo of both blunted food cravings and not being very enthused by eating more cream on its own. Coffee and cream I ended up enjoying a lot. By adding loads of whipped cream you get more contrast of cold cream lumps with hot coffee -  delicious.

This is another interesting insight, and why I love the extra “non-quantifiable” tidbits and commentary from the trials so far.

People’s preference/appetite for fats or specifically heavy cream seems to vary wildly. Some participants in the trial just looove whipped cream, as do I. Others are so-so about the whipped version, but like sipping it straight. Others, like this subject, find it way more palatable if masked by some flavor, like with coffee. Or maybe it’s more the texture?

Another thing I noticed is that I personally can barely eat a bite of butter. It’s just too fatty. Somehow, cream, and especially whipped cream, hits exactly the spot where it’s delicious yet fatty. Other people can just eat butter like it’s nothing. I have a friend like this and I’m super jealous - he brings a zip loc bag of cocoa butter to the movie theater and snacks on it. I have to gag from just a single bite.

I’m not sure where these different preferences come from. Is it genetic? Is it just a preference thing, but if we forced it down, it’d still work? Or are these signals that we’ll give ourselves digestive distress if we ate so much fat it made us gag?

Whatever the cause, I think it’s now reasonably clear that cream works in many shapes & forms. And some people can handle even denser forms of fat, and ex150 might work just as well for that.

Undereating because of a non-palatable fat source doesn’t work

One major limitation when you can’t stomach your chosen fat source: you’ll severely under eat. And when you under eat for more than a few days, while you might lose some weight, you’re just putting it “on your metabolic credit card.”

As I’ve written about previously, you can under eat too much. Should your body go into an internal caloric deficit, i.e. you can’t access enough energy to fulfill your energy demand, your body will start being more frugal. It’ll down-regulate all sorts of things like core body temperature, immune function, endocrine (hormone) function, and building/maintenance processes. You’ll also constantly have to think of food and be super sensitive to food smells and other cues.

This is not a good place to be. I highly recommend NOT getting into an internal caloric deficit, because you’re basically taking on metabolic debt. And you’ll have to pay it back sooner or later.

Some CICO-bots might argue that this is a great strategy - after all, eating less will make you lose fat, right?

Except it doesn’t work. If it did, why even bother with the cream - we could just fast until we had six-pack abs, right?

As almost everyone who’s ever tried fasting knows, that doesn’t actually work. Your metabolism will start shutting down, and after a few days at the latest you’ll be unable to continue.

Solution: modify your fuel/fat source to be palatable - for you

With the subtle hunger signals on ex150 it’s very easy to ignore this. The subject easily went 4-5 days severely under eating cream, and she had low mood and trouble concentrating at work because of it.

I’ve done this too: I can convince myself it’s fine for a few days. But eventually, the lack of energy makes itself known and I realize I’ve severely under eaten for the last few days.

You have to find a way to make your main fuel source (the fat/heavy cream on ex150) palatable enough to eat to satiety. Otherwise, the diet won’t be sustainable; it’ll just be an inefficient fast.

It seems that this is another pretty important piece with ex150 going forward. Several of the participants almost had to force themselves to get enough cream in, while others really enjoyed it.

This subject experimented a bit until she found a way to consume enough cream in her coffee. Nice job!

Going forward, it might not be that important to eat the cream in whipped form, as long as you find a way to get enough of it.

Interesting quotes

With regards to the diet I don't hate it - it is boring but if I hadn't had emotional issues it is fairly easy to comply with because the cravings aren't there too much.

[..]

I've certainly been on diets where all I can think
about is food and this isn't one of them.

[..]

Work conference today - very testing as free buffet of cake, pastries and a free lunch of sandwiches and crisps - managed to turn all of it down except for the celery and hummus which at least seemed relatively low carb. Felt a bit out of sorts/spacey.

I find these types of comments pretty interesting. Cream isn’t the most exciting, delicious food, but it gets the job done and won’t leave you with cravings. Almost all subjects so far haven’t seemed to have big compliance problems. Even if they didn’t love the diet, it didn’t leave them with constant cravings or thoughts of other food.

This subject was even able to resist the temptation of a free buffet at work, something that is just about the kryptonite of most dieters.

That said, there were certainly situations where the subject preferred the comfort of other foods:

Low mood. Not a good day. Work has been shit
this week so just cracked and got McDonald’s.

But there seem to have been very few, isolated cases of this, with the other deviations mostly being social events.

Adding “fun meals” as a new category?

There have been a few trends now after these case studies:

• The cream provides enough fuel/satiety for most people on a day-to-day basis, leaving them in a good metabolic state (aka no starvation/cravings)

• The lunch meal seems to go from “fine” to “very delicious” depending on how closely the subjects’ palate matches my own ;-)

• The preferred modality of cream intake varies

• There is a big hole in the ex150 diet when it comes to dealing with social meals and psychological/variety/comfort eating

I can’t help but wonder: if we added a non-offending, but tasty meal like the last case study’s subject had with her Illegal Carrot Salad, would the diet work just the same while adding a tremendous amount of variety and meals that are just more satisfying on a psychological/comfort level?

I suspect that the answer is yes.

A similar “fun food” that I’ve heard anecdotally are pickles. I can’t say that I miss pickles, but I do like them in general. Like carrots, they have a nice, crunchy texture. They have a very strong flavor. There are only about 5g of sugar in an entire pound of pickles, so you’d be hard-pressed to overeat them and cause a massive insulin spike.

These “fun meals” could serve a dual purpose: they might be more socially acceptable and attainable (e.g. you could probably get reasonable versions of these in many restaurants), and they would increase variety and the general sense of exciting flavors and textures that we enjoy about eating.

I’ve added ex150funmeals to my list of experiments to try. So many experiments, so little time!

Going forward: change it up a bit, vinegar & sauerkraut, chicken

The subject has decided to largely continue with the diet, but is modifying it for variety and personal preference:

I have changed it up a bit - I eat sauerkraut before the main meal and if I am at home and get hungry I'll sometimes snack on it. It is a tip from the 'glucose goddess' to have vinegar before meals so I'm trying it out. It's something I enjoy eating anyway.

I'm alternating between chicken and beef - I don't think the colon cancer link with red meat is necessarily well-founded but I'm wary as there is a genetic link - still cooking in copious amounts of butter.

I'm also adding more veg and I'm not sticking to green vegetables but no root veg. I'm also having skimmed milk with tea - I missed it too much. Sorry but cream in tea is just wrong.

And with that, we have 4 case studies under our belt.