Facilitated

30| 3-Month Reversal: How One Patient Beat Sky-High Triglycerides with Food, Movement, and Mitochondria

• The Facility Denver • Episode 30

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We share how a midlife patient reversed severe hypertriglyceridemia in three months using precise nutrition, movement, and targeted support after costly conventional care failed to move the needle. The story shows how education, not shame, turns effort into measurable change.

• baseline labs showing triglycerides rising to 2,251 and fatty liver risk
• why triglycerides climb with fructose, refined carbs, and hepatic overload
• plan design: ultra‑low‑carb, moderate protein, 30g+ fiber, monthly 24–36h fast
• net carbs explained and how a refeed ritual sustains adherence
• morning movement targets, post‑meal squats, and gradual jog intervals
• supplements for AMPK activation, omega‑3s, tocotrienols, glutathione, PRMs
• removing sugar traps like orange juice and sweetened instant coffee
• results: triglycerides 2,251→154, glucose in the 80s, liver and kidney markers normalized
• next steps: raise HDL, interval work, strength training, micronutrient depth
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Mitchell:

Welcome to Facilitated, where we bring you real stories, strategies, and science from the world of functional medicine. I'm Dr. Mitchell Rasmussen, a functional medicine practitioner. And I'm Kate Darty, a certified nutritionist. We are the owners of the facility, a functional medicine clinic here in Denver, Colorado. We help people improve their biology and get out of their own way. In my view, our work is about getting to know the person with the condition much more than it's about understanding which condition the person has. As I always say, diagnose the biology, not the disease. On this podcast, we break down complex health topics, share real patient cases, anonymized, of course, and explore cutting-edge wellness strategies so you can make informed decisions about your health. Quick heads up before we dive in. This podcast is for education and general information only. We're here to share insights, not to diagnose or treat. So if you're dealing with a health issue, chat with a qualified healthcare provider before making any changes. All right, let's get into it. Nice little Thursday. Got a little trip this weekend to see my friends. Looking forward to that. Feeling inspired about a recent patient case that I think we want to talk about today. Are you excited? Oh yeah, we forgot to come up with a a mnemonic. Is that what it's called? No. Moniker. A moniker? Which is a name. I thought we said we were gonna call him Tim. No, I think we should call him Elmo. Elmo? Okay, I want it to be something that no one is like Is that me? Yeah. Well, and we're not working with Elmo, so Alright, so we're gonna tell a little story about Elmo today.

Kate:

Yeah.

Mitchell:

Okay. Cool. That's kind of throwing me off a little bit. I'm in a personal note, I'm planning a wedding. Yeah. It's kinda I mean, I don't know how much I'm doing. Mostly just going, okay, that sounds good. I've never planned a wedding. No. No. I mean, you had a wedding? I didn't plan it. Who did? There was no planning. I mean you asked me to officiate it. That's true. Picked a day. I know who I'm going to ask. But I'm not doing it yet. Okay. So that's fun for me. Little secret. That's fun. Fun fact. My wedding dress cost less than my hiking boots for the day. Did you buy something off the rack? What does that mean? Like you just went to a store and said that one looks like it. I didn't even go to a store. I bought something online. Did you have to get it tailored? I did have to cut the bottom off. You just cut it? How did it fit? You just just general size? Just a size medium? Small, medium, large. That's how you know it was expensive. Yeah. That was when my dad was in high school. He got a suit and he was like big into athletics. Didn't really ever think about suits or his appearance. My mom loves to tell the story that she asked him, Well, what you know, what's your suit size? And he was like, large. We always get a laugh at that. Like, not 36 long, blah blah blah, whatever, just large. Did it fit perfect? Probably not. But anyway, that's not what we're here to talk about today. We're here to talk about Elmo. Elmo. Yeah, we uh I do want to share more patient cases, and I think today I'd even like to take you guys, the listeners, through kind of how we proceeded with this guy and the exact steps we took, and then what he came in with and the outcomes. Sounds like a patient case to me. Cool. Yeah, well, Elmo is a mid-50s man. Came in after having spent, he's actually a telehealth client, and he had gone to the cardiologist and he was billed $25,000. Say that again. He was billed $25,000. And do you want to know what the conclusion of that visit was? Well, I know the punchline. Yeah. Eat a vegetarian diet. That was the direction. He had a $13,000 nuclear stress test, and he was prescribed Moonjaro, which is a GLP1 agonist. Even he knew because what he came in with was massively elevated triglycerides, which runs the risk of leading to pancreatitis. Even he didn't feel comfortable with the moonjaro because he knew that it could cause pancreatitis. So $25,000, take something that makes the condition we're concerned about more likely, even though you're not diabetic, and eat a vegetarian diet and go home. One of the first things he said to me was that he's lazy. And but do you remember that conversation? I remember pretty profound for him because I stopped him in his tracks and I said, Elmo, that's hard to do. I said, Elmo, none of this is laziness. Have you ever been guided on how to repair your health? And that was profound for him because he realized he works hard in so many other ways with his children and with his wife and with his work and all these things, and he never really had the chance to turn it in and focus on himself. And as we've heard so many times, you've got a thousand problems until you don't have your health, and then you've got one problem, and finally he was able to be uh supported through that process. So back up a little bit. Do you have some of his lab results before he came in to see us? Sure. Hold please, audience. We are back. You created an awesome little chart for him. What does it say? So we have lipid panel history going back to December 2023. He had this multiple times checked, and we're I mean, can we just list off numbers with no context? Well, for triglycerides. Triglycerides was the major thing. All the way in 2023, 719. Let me remind you the optimal range that we're looking for in this male particular in particular, male population, 55 years old, less than 100. So 719. Fast forward five months later, 1877. Fast forward a year later, 2,251. This is not a lab error. This is a progression of increased triglycerides happening over and over and over that we're seeing, and we can feel pretty confident this is a real result. Yeah, and essentially, when you think about high triglycerides, the body is not, the liver is not clearing things from the bloodstream. And I always tell patients it's much more dangerous short term to allow sugars to go rampant in the bloodstream because it can lead to uh all sorts of metabolic issues, coma, death, essentially. Triglycerides will go up on and on and on if they're not checked. And essentially, triglycerides will go up when the body is not handling uh glucose in the bloodstream very well, and when the liver is not working very well. This guy also had, he was told you're pre-diabetic. He was holding on to probably 50 extra pounds or so. You know, not a super tall guy, so it was much more exaggerated on his frame, and that was part of where his laziness came from because he would just look at himself and just my wife is so thin and I'm a failure because I'm overweight and I need to go on a diet that I don't think I can adhere to. There's no guidance. I think you could be a you could eat a crappy vegetarian diet, right? We see it all the time, and seeing that progression in 2023 from 700 all the way up to when we really dove in together was was that July 8th of this year, 2,251. Uh, with that, we're seeing total cholesterol all over the place as well. Really, really high. He was prescribed Zedia and Resuvastatin, and the numbers only kept getting worse. Yep. He knew there was something better. Some people he knew had seen us, so we started talking. And did we run a bunch of labs when we met him? We didn't. We had the lab data we needed to get started. And that's the thing back to like you've got one problem, you don't have your health. Once we saw this, it became all hands on deck to improve this process. We couldn't even really think about what are your hormone levels. Do you have heavy metals? Do you like all these things? Because this was about saving this man's life. Um, I was actually quite worried about him, but you know, again, 25,000 at the cardiologist, and you know, not showing much blockage, and it was just a matter of take Vacepa, you know, add another med. We'll we'll check again. Yeah, we'll check again. And that's all that kept happening was it just kept going up and up and up with more medications on board. And no real, he wasn't like didn't pick up drinking, didn't pick up smoking, you know, it was just more of the same of his lifestyle. So I told him we need to make a drastic change in our choices, and vegetarianism is not part of it. So you gave a bunch of directions diet-wise. And this was a patient who was very willing and very motivated to make change. So this was pretty strict the direction that I gave him as a starting direction compared to most patients. And so I told him I wanted him to be extremely low carb. His maximum carb limit was 50 grams a day. I told him I wanted him to eat moderate protein based on his body weight, so it was 120 grams minimum per day. We suggested he do some extended fasting, so a 24 to 36 hour fast, we suggested one time per month. And we did give him direction that alongside extremely low carb, moderate protein, also fairly high in fiber, so 30 grams a day was our fiber minimum that we gave him. Looking back, jumping ahead just a little bit, but also looking back on this, I I think it was my mistake that I didn't take enough time to explain to him the concept of net carbs. So, net carbs is a calculation that you get from total carbohydrates minus total fiber equals net carbs. So Elmo being the extremely diligent patient he was. I had also told him I wanted him having psyllium husk every day. That was about six grams of fiber. He was counting that towards his total of 50 grams of carbs a day. He was 99% diligent with this 50 gram limit, including the fiber that he was eating. It was certainly much lower than I intended him to go, but I'm so impressed at how diligent he was, even misunderstanding that. So we've been working together for three months and we we spoke about a month and a half in. So we've seen this guy three times. We sat down in July, we saw him again late August, and then we got his follow-up labs two days ago. And then I called him yesterday to throw a party together. Um, and what was funny is when we met him at that halfway point, he it was like he threw a party when he realized, wait, the more fiber I eat, the more carbs I can eat. So I actually appreciated it because he was already doing well with more strict behavior, and then it felt like we opened the world up to him.

Kate:

Yep.

Mitchell:

I also introduced the concept of refeeding to him. So we had told him extended fasting one time per month. He was actually doing it about every 10 days, and so a new direction, a new layer that we added on to it was when you're doing this extended fast, we want you to break the fast with a intentional refeed. So throw away this carb maximum, protein minimum, fiber, refeed, refuel your body with what it's wanting. And for him, he likes to go to a restaurant with his wife, and it became a perfect bonding experience for them, a celebration of all the work between. And it was almost like a little carrot for him to keep going, right? And and the way most people describe it is a cheat meal, and that implies that you're doing something wrong. And he even mentioned on the phone when I called him yesterday the way you introduced the idea of refeed really helps me wrap my head around that. This is something that my body can utilize and want. It's not that I need to then punish myself for the next 10 days and go into a fast, it's literally just creating a sustainability plan for me and something to look forward to. Right? So, nutrition-wise, that was pretty much the initial. He will not eat fish. He's allergic, so that's out. So, but he can handle fats from fish. So, fish oils, which we know can lower triglycerides, were right on the table. This was something that frustrated me. He was told by his doctor, who again wasn't giving him any real direction. He was told you can't take fish oil, but you can take a pharmaceutical fish oil. And then the fear-mongering about, well, supplements are contaminated, this and that. We don't use companies that don't have strict production guidelines that aren't in a what we'd call pharmaceutical grade. He was asked to pay for a pharmaceutical four grams per day, and told that a supplement would be dangerous because potentially for atrial fibrillation and all these things. Well, we know that the the medication has those same risk factors, so that was silly. And another reason or another time where he didn't really trust the advice he was been he was given. We also told him a minimum of 150 minutes a week of mild to moderate movement. I I did not want to get his heart rate up too high. I I didn't know him good enough, I didn't trust that he wouldn't shoot a clot or you know something with his heart could go wrong. So we told him you're keeping your heart rate low, but you're just getting in the arena, you're moving every morning. That was huge for him. An activity guideline. I think we told him squats after meals. Yeah, just 20 times squat after meals. Because keep in mind he had he had blood sugar, he he was on the way to diabetes as well. Yeah. So when we met at that six-week mark, checking in on the movement guidelines, he told us he was doing three to three and a half miles every single morning. Some mornings he was even running and jogging parts of it. He had significantly less knee and hip pain while he was doing it. He said he still kind of felt like the fat kid running around the lake with all the old folk taking their morning power walk. But he used it as a motivation, as a look at me doing this. And he dropped 18 pounds in the first six weeks. 18 pounds. And he wasn't he didn't have that much to lose. So I actually told him I don't want it any faster. I don't know if that's sustainable. So that was really where those refeed days helped him realize, okay, I am ahead of the curve as far as this goes. From a supplement perspective, we were really pushing not just like blood thinning, right? Or anti-clot work, but we were really pushing a mechanism called AMPK. AMPK is an enzyme system that helps mitochondrial efficiency, helps your body burn things within the mitochondria. It is upregulated with things like fasting and berbering, and there's various nutrients that can do that. Um, but essentially, since he was having so long periods of not eating, this was helping his mitochondria burn what he had around and become much more efficient. We also did a lot of work on his liver. The liver is dense with mitochondria, he had fatty liver, so that was a massive part for us. Obviously, we used pro-resolving mediators, which are my favorite, and then some glutathione is an antioxidant. Just, you know, we know this fat tissue stores crud, whether it be hormone disruptors from plastics, or it be metals from our water or from rice or whatever. So I wanted to make sure as he's burning tissue and liberating fat. Yeah, and liberating fat, that we would also be able to bind and buffer some of those toxins that were being released from his fat stores so that he wouldn't have other impacts or distribution to other tissues. Um, so really it was pretty simple. We gave him you know, delta gold tocotrienols from a plant called anatto, which have been shown to benefit the liver, the immune system. It's the best form of vitamin E that we can get. Like I said, really pushing mitochondrial efficiency through upregulation of AMPK, antioxidant status, and pro-resolving mediators. You know, we didn't do extensive labs on him, so we could only focus on this one big project. Do you remember he told us six weeks in that he wants to run a 5K? I know. New goal. Yeah. I think that was a celebration. Yeah, and he's getting rid of this one big scary thing, so now he can start to focus on like what does the last 40% or 50% of my life look like? Like, what does this next chapter look like for me? I've raised my kids, they're successful, they still love me, I still have my wife who loves me. What else is there for me now that I don't have to be this patient going in every three months and being told you're lazy, you're not eating vegetarian, you need more meds? Right? That was oh, and I also gave them acetyl-L-carnitine just to help with not only neurological function, but theoretically helping again with that mitochondrial efficiency quite a bit. Minerals, B vitamins, and that was it. Oh, and also, just kidding. Yeah, so yeah, he lost a bunch of weight. He what he that was going great. I told him there's no doubt your labs look better. I don't know to what degree, but I certainly wasn't expecting what we got two days ago. It's awesome. So less than three months, he's kicking butt. What are his triglycerides? So just a refresher, July 2025, 251. Most recent labs, October 3rd, 154. I mean, and he said when we when I called him yesterday, I was talking to my son, I was talking to my wife, they saw the hard work. Now they're such believers in natural medicine because this was only getting worse. Going to the most expensive doctors I could, and now I spent three months thinking about my the leverage points I have, and now I'm almost not even going to flag with my triglycerides. Right. I was gonna say, so our optimal is less than 100. I think LabCorps' normal range is less than 150. So we're at 154. He is so, so close. And here's the fun thing his cholesterol came down so low now that he has to go back to his primary care provider the next week to get off of medications. This is three months of effort, and his cholesterol is now, I would say pathologically low. And it's just fun to I'm looking at that chart right now, looking at the trend for him. It's again with all the medications on board, just kept creeping up. Now, through lifestyle, he literally doesn't need this these two medications for his cholesterol anymore. The other big thing is liver enzymes normalized, GFR, creatinine, and bun are perfect. That's kidney function tests. He's having some kidney strain, and his fasting blood glucose was in the 80s, which is ideal.

Kate:

Yeah.

Mitchell:

Right? You become pre-diabetic when uh you see enough fasting glucose is over a hundred, and we want something around you know 82 to 87 or so. I think he was 86, which I didn't think was possible this soon. I thought that was amazing. Ironically, you mentioned his cholesterol being a little bit on the low end. Our next project now is his HDL, which we kind of think of as good cholesterol. So his HDL is we want to raise it. And so some of the new direction we've layered in is encouraging a little bit more in interval training while he's doing his morning three and a half miles, so maybe incorporating a little bit of jog walk and then doubling down on that fiber recommendation, so making sure 30 grams of fiber or more working on that uh 50 grams of net carbs, not 50 grams of total carbs. I don't mean to be like belaboring this point, but I just remembered something. He was drinking orange juice every morning, and nobody told him that the fructose might be leading to some of these liver issues and elevated triglycerides, and that you vegetarian, like no mention of things that are actually causing this. I just remembered something else. So it was orange juice and it was cafe bustello. Remember that? Cafe Bustello, it's an instant coffee that has sugar. It is delicious. It's a vegetarian though, right? But he was so willing. As soon as he had the awareness and the understanding, he was like, Oh, oh yeah, I'm gonna cut that out right now. And what's really cool about this is he's his his energy is better, right? It might sound like such restriction, but we had to back this guy off the ledge. His energy is better, his brain function is better. I mean, yesterday and we were talking, he can't wait to bring this information, everything he's learned from us back to these doctors. And and I said, look, they will take the credit. You are the one who deserves the credit, and I don't see any research that says that VICEPA will lower your triglycerides from 2251 to 154. So if they try to take the credit for that, you hold strong and remind them that this came from you seeking help outside of their system to where you actually started to heal. And you know what we talked about yesterday was well, what's next? You know, now I can focus on optimal nutrient reserves, I can focus on strength training, um, building muscle, you know, uh detox, you know, all these other things, a hormone optimization. I mean, all these things, because now we've removed this big scary thing, and now we can really get back to what it means to be well, and that's what I'm looking forward to. Yes. Good job, Elmo. Proud of him. Yeah, heck yeah. So we'll get new labs next, or we'll get a follow-up with PCP next week, and then we'll sit down and think about what's next together. But I think part of the reason we wanted to do this is number one, it's possible to heal, right? You are not, you're oftentimes not your genetics, you do not have a medication deficiency. Medications can save your life, medications can remove risk factors. But if for the vast majority of things, if there's not guidance and education on underlying biology, systems biology, if you will, the medications are never going to correct that for the vast majority of things, right? And when you have a side effect from a medication, that's a known issue. That's your body kind of talking back at you because it's being insulted by pushing a certain system so hard. And it doesn't so often when we're doing these visits with people, it's about educating them on how all of these things work together and how you have the power. And that's what I'm inspired about today is again reminded that the choices you make primarily drive your outcomes, and that's what medicine should be about. What does doctor mean? Teacher. And I reminded him that yesterday. I said that's all I'm trying to do with you is teach you, is guide you, show you the show you what can be done, and you have to do the hard work. It's easier to take Resuvastatin and Zedia and Vicepa than it is to fast, go low carb, push fiber, moderate your physical activity, hit those guidelines. It's way more difficult, but choose your hard man. And he chose his hard, and now it's I would say easy. Right?

Kate:

For more about what we do at the facility, check out our website www.thefacilitydenver.com. You can also follow us on Instagram at the facility Denver for extra tips, behind the scenes fun, and updates on new episodes. Thanks for listening. Now go facilitate your own health, and we'll see you next time.