4 Hour Body Slow Carb Grand Rounds – A Case Presentation

by Stephen

Susan is a 34 year old female who was first seen in our clinic on November 2007 at the age of 28.

This is her story, a story of slow carb success, a story of a hard earned paradigm shift. A story that took years to play out, but proves that life is a process and we should never give up on ourselves.

Problem list circa 2012:

  • Polycystic Ovarian Syndrome
  • Infertility
  • Diabetes Mellitus Type II with an A1C of 10.3
  • Depression/Anxiety
  • Acne
  • Generalized Fatigue
  • Obesity
  • Chronic Allergic Rhinitis

Medication list:

  • Allegra
  • Celexa 20 mg daily
  • Wellbutrin SR 150 mg daily
  • Metformin 1000 mg twice daily
  • Amaryl 2mg once daily
  • Lexapro 10 mg once daily
  • Lisnopril 10 mg once daily
  • Calcium and Vitamin D3

The History of a Pathology

The following is a timeline of office visits dating from September 2007 through April 2013:

September 2007

Seen for a chief complaint of chest pain. After workup initial diagnosis was diabetes mellitus with a fasting blood sugar of 286, hypertension and atypical chest pain. Her weight was 179 lbs. she was placed on Metformin 850 mg daily and Lisinopril 5 mg tabs.

November 2007

Seen for a chief complaint of chronic daily headaches. Given a diagnosis of stress related tension headaches, started on muscle relaxants and anti-inflammatory medications. Weight now 183 lbs.

March 2008

Diagnosed with carpel tunnel syndrome and worsening diabetes mellitus. Her A1c was 9.o, she had gained 2 more pounds, continued to have frequent headaches and chronic fatigue. She had been placed on Glyburide and Actos by a different physician. Her fasting blood sugars were now worse and she developed diabetic nephropathy (kidney disease).

Two weeks later she followed up, with better glucose control and a weight of 186 pounds. She was having response to bilateral wrist braces used for carpel tunnel.

Mach 2009

Seen for a mild case of bacterial conjunctivitis (pink eye) weight 184 lbs.

April 2009

Seen for upper respiratory tract infection, weight 183 lbs.

August 2009

Chief complaint of headaches and stress, weight 182 lbs.

October 2009

Hirsutism, dizziness. tentative diagnosis of PCOS. Diagnosed on that day with influenza.

Feb 2010

Anxiety, diabetes mellitus, chest pain again. This time she was started on Ativan as needed for anxiety.

Two weeks later in February still with chest pain, sent to cardiology for evaluation and had normal workup, weight 177 lbs.

May 2010

Anxiety, depression, PCOS, suicidal ideations, diabetes mellitus. Weight 176 lbs., medications Amayrl 2 mg daily, Metformin 1000 mg twice daily, lisinopril 5mg daily, prn Ativan.

June 2010

Ativan refill, in office counseling, crisis line was given as precaution to suicidaltiy, weight 173 lbs. started on Wellbutrin.

November 2010

Discontinued Wellbutrin, doing better with new counselor, weight 180 lbs.

January 2011

Susan became more involved with counseling. Started on Celexa 20 mg daily for depression, sent for more labs.

April 2011

Allergic rhinitis had become more sever she was placed on Allegra 180 mg tabs daily and Iprotropium Bromide nasal spray, weight 183 lbs.

January 2012

New diagnosis of hyperlipidemia, DM, PCOS, HTN.


The Slow Carb Manifesto

May 2012

I saw Susan and despite her initial reluctance we initiated the Slow Carb Diet. Her weight was 170lbs. She had worsening diabetes. We had 30 minutes of in office counseling. Blood pressure on meds 134/90.

June 12 2012

Just one month on the slow carb diet and her weight was now 164 lbs. Her resting blood pressure was 102/70. We discontinued her Amaryl and for several reasons I placed the patient back on Wellbutrin SR at a dose of 150 mg daily. She continued twice daily Metformin.

October 31 2012

After 6 months on the slow carb diet her weight was now 136 lbs. Her resting blood pressure was 120/80. Her diabetes was now diet controlled with no oral meds, she was off all her BP medications and the Wellbutrin.

April 1, 2013

BP 102/66, weight 128 lbs, BMI 25 off all meds, fasting blood sugar 89, A1C 5. 9, Cholesterol is perfect!

Problem List April 2013

  • “I have to purchase new clothes every month”

Her medication list April 2013:


What Secret The Pharmaceutical Company Hasn’t told You

You are perfect the way you are.

The healthy that many of us seek is locked up inside an ailing body. Let your healthy out, believe that you can make a change today, find a support system and somebody who is willing to work with you and believe in you. Believe in yourself and most of all… The road is often long and bumpy, but please don’t give up.

When I walked into the exam room on April 1’st I may have seen Susan for the last time, but I left with a new hope of where we may be headed, if we take the time to change our process. And as medical providers, if we take the time to believe in our patients.

The slow carb diet may not be the answer for everyone, but it has changed my practice of medicine and had a direct impact on countless lives.

The fact that this came from a lifestyle hacking guru from Silicon Valley who just published a book on how to kill and skin game, give a 15 minute orgasm and how to live a 4 Hour Workweek…. Priceless!!!


{ 3 comments… read them below or add one }

Dr. George Smolinski April 15, 2013 at 7:53 am

Kudos to you for assisting this patient. You literally saved her life! She did do the hard work of the personal change needed to embark on this journey and lifestyle change, but had she not met you, she would have continued down the road to an early death.

You’re absolutely right: people are perfect the way they are, they just need to discover it! The most powerful tools we have are our own minds and bodies.

“Everything we need is already inside”.


Stephen April 19, 2013 at 8:44 am

It is often hard to see that our minds and bodies are our tools for making a stronger mind and body. So we often reach to the medicine cabinet. But I guess in a way we have been programmed to think like this, especially in the medical field.

I will be at the PriMed conference in Anaheim at the end of the month. It is a huge conference that is sponsored 100% by the pharmaceutical industry. This wouldn’t have to be a bad thing, but I can guarantee you that 10 out of 10 lectures on any particular day will be about modern drug therapy in the treatment of chronic illness.

I guess not surprisingly I spent the first 7 years of my practice thinking along this line. And it is sad, as we pass this mentality on to our patients.

And it is not that we don’t care, but we are ill informed. And the only way to change this is to change the system. Hopefully a change is in the air, and then we can convince our patients – whom are also bombarded with commercial products that have big claims, that they have the power to make a healthy life change. This will take time, work and much patience. But then again this is probably the recipe for anything worthwhile.


Matt April 17, 2013 at 10:06 am

That’s an amazing story! Thanks for sharing it!


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