ex150 trial case study: 64 y/o female loses 5.7lbs in 30 days, massively improves fasting glucose, down 3 belt holes

This is the sixth 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
37 y/o female loses 9lbs in 30 days
60 y/o male loses 13lbs in 30 days

Subject: Barely overweight at 25.7 BMI, near-diabetic

The subject is interesting because she wasn’t exactly very overweight to begin with. At a BMI of 25.7 on day 1, she barely qualified as “overweight,” which is defined as a BMI > 25.

But one of her goals was to control her blood sugar better, since she had pretty high numbers. An interesting case showing how someone can be not particularly overweight, yet have questionable blood sugar control. They don’t always go together. She reports being told something was off with her blood sugar at the age of 19, when the doctor told her she was “hypyglycemic,” because she had extreme glucose spikes and subsequent crashes.

Subject is European, where blood glucose comes in mmol/L instead of mg/dl. I will translate throughout for my own sanity, since I’m only intuitively familiar with the latter units. Subject also recorded her weight in kilograms, which I’ve translated to pounds.

Experiment: At this point, a familiar picture

Steep water weight loss, then slower weight loss. Tiny infractions caused big water gains.

Subject lost just over 4lbs in the first 7 days. Given her low BMI, this seems pretty proportional to what happened in the other trials. Less mass, less water weight to lose.

What’s crazy: the 2 “deviations” from the diet are extremely minimal, yet had a massive impact on her weight. The first one, she ate one hamburger with the bun. I.e. just one hamburger bun sent her weight up for about a week.

The second “deviation,” she accidentally drank about 150ml of flavored water before realizing it had sugar in it. The 150g of sugar water set her back 4 days.

These seem extremely small amounts of “cheat foods” to cause this much interruption. In this way, the subject is even more extreme than me: I will often gain a ton of water weight and take 5-7 days to come back down, but from eating 4lbs of meat, not 1 hamburger bun.

Just looking up the macros for a random hamburger bun, there seem to be less than 25g of carbs in one. You would think that’s nothing, or at least nothing to set you back a week.

This points to the subject having some issues with glucose control. More on that in a bit.

Overall, the subject had this to say about her outcome:

I wished I could have had a better outcome because the diet looks so good on paper. It could be that I'm not overweight enough to benefit from this particular diet?

Now I think she’s underselling it. The graph looks pretty much like that of any other trial participant. Of course, somebody with a 25.7 BMI is going to lose fat slower than somebody with a much higher BMI, that seems pretty reasonable.

While most of the weight came off in the first week and was likely water weight, we do see the curve at its lowest at the very end of the trial, and it seems she might’ve lost a pound of fat.

Her body weight on the last day puts her at a BMI of 24.8. That’s right, she went from the “overweight” category to the “normal weight” category. Congratulations!

I think this is a pretty decent result for somebody who didn’t really have a big weight problem to begin with.

Fasting glucose

As mentioned above, the subject had set a goal to improve her fasting glucose. She recorded it every morning for the duration of the experiment:

Subject’s fasting glucose

Her fasting glucose started out quite high, but improved rapidly. After the initial drop, she stayed below the WHO and U.S./ADA levels for prediabetes almost the entire time, minus the 2 “incidents” with the hamburger bun and the sugar water.

This indicates some serious glucose tolerance issues. Ingesting <25g of carbohydrate should not lead to a sustained glucose level that lasts to the next day in the form of elevated fasting glucose.

For reference, I looked up a random popular brand of flavored sugar water (Vitamin Water), and it has 27g of sugar per bottle. A bottle of coke has 38g. 150ml of either of these would elevate blood glucose briefly, but that spike should come down within an hour at most.

Since this has apparently been the case since at least age 19, which puts it in… 1978.. I doubt that this is an acquired-by-junk-food property. I don’t know what Europeans ate up until 1978, but it was probably pretty healthy. I suspect the subject has a genetic issue with glycemic control.

Luckily, she is aware of this issue and had pretty good glucose control during the ex150 trial.

She was nice enough to write up the pros and cons of the diet for us:

Pros:

• The diet is ridiculously easy to follow.

• And crazy cheap.

• It's very monotonous so thinking about meals not necessary and no room for errors.

• Hardly any shopping!

• Hunger completely disappears.

• Lovely blood sugar numbers.

Cons:

• It's a highly anti social diet and it is difficult to hide in public. It's not like carnivore where you can leave the greens on your plate pretending you're not that hungry.

• There were a fair amount of sluggish days due to very low blood sugar. During the day sometimes I measured 3.9 [70mg/dL].

• I expected to have a lot of energy because of ketosis but that was mostly not the case.

• Hunger cues disappear completely so I got into a little trouble when I forgot to eat too long.

Highly anti-social, not like carnivore :D
Rub it in, will ya?

Subjective well-being:

From time to time, the subject felt exhausted, had cramps, or headaches:

In the beginning I had a lot of cramps. That went away after the water weight settled.

I was tired a lot of the time. This usually (not always) correlated with low blood sugar during the day. A couple of times I fell asleep during the day but I didn't record it at first so I'm not sure how many.

I wonder if the tiredness was due to eating very little overall, and often forgetting to eat? The hunger cues on ex150 are very subdued for most people.

Interesting quotes

My weekly intake averaged around 9460 calories
where the most calories were used in the first week.

That comes out to about 1,350kcal/day, an unbelievably low number. No wonder she was tired from time to time :)

Maybe it’s because the subject made the acquaintance of cement-truck satiety:

At times it was just impossible to eat a single bite. Cement truck satiety all day.

In all seriousness, though, that is a very low amount of food. Since the hunger cues can be so weak on ex150, I do recommend people “make themselves sick” with heavy cream from time to time. When you’re sick of it, you know you’re not undereating.

Despite not dropping as much weight as she had hoped, the subject got some good pants-size success in:

Non scale victory. I had to move up 3
belt holes to keep my trousers up :)
Weight wouldn't budge.

The belt thing started after "hamburger bun day" I think,
week 2. In week three I really started to notice it.

Maybe I had inflammation because of the high glucose
and it settled down after a week of cream.
Also the minimal volume of the ex150 diet may have something to do with it.

On her response to the “cheat” “meals” she had this to say:

The infamous hamburger with bun day. We have dinner with the kids once a week.
I thought I could mitigate the damage by eating hamburger with bun so the bun would be the only addition to the ex150 diet and wouldn't cause that much damage.

I have never been more wrong.
It took me a week to get back on the same weight.
Needless to say I didn't do that again.

Someone gave me flavoured water with sugar in it
which I realised after I drank about 150 ml.
Next morning glucose 7.0 [126mg/dL] and 400gr [0.9lb] extra water weight :(

Going forward: ex250, fat fasts, maybe low-fat?

Like most people on the trial, the subject is planning to up her protein to a more sustainable level:

Starting tomorrow it will be ex250 with
occasional fat fast days (once or twice a week)
fat protein ratio 2:1.

It ends at 60 kg (132lbs).

There will be no cheat days but there will be pause days:
e.g. Sinterklaas, Christmas, new-year.

I think this will take me to March 14 2024.

She says she is also considering the idea of a very-low-fat, very-high-carb diet. Some people have called this “carbosis” (similar to ketosis), and report very good results both for fat loss and for blood glucose control.

No matter which experiment she will try next, I wish her all the best :)