Why Lifestyle Changes Feel So Hard After Diagnosis

A Conversation with a Client

Recently, I asked a client if she could interview me for this blog.

She said, "I don’t want another article telling me to ‘try harder.’ I want to understand why this feels so difficult."

I agreed.

Here is part of our conversation.

Client:

…When I left my doctor’s office, I felt overwhelmed. I had a diagnosis, a prescription, and a list of things I was “supposed” to change. Eat better. Exercise. Sleep more. Reduce stress.

I actually wanted to do it. So why did I feel like such a failure? I fell off track so fast!

Berryl:

First, I've known you for 6 months as a client and a few years before that as a friend. I want to say this clearly: you are an alpha female, and that experience is normal.

After a diagnosis, you're tuned in, and motivation is usually high. You care a lot, and you don’t ignore it.

But motivation is not the same as implementation. Good motivation prioritises the now. So when you are given medical advice which is correct in principle, the difficulty arises in translating broad recommendations into daily, realistic actions that will stick in the now and in the 4months from now.

Without prioritisation and sequencing, everything feels urgent. When everything feels urgent, the system collapses. It’s not a good feeling.

None of us are meant to be on high alert all the time. And if you are female, being on high alert is so extremely damaging to your body. 

Client:

…But I kept thinking, "Maybe I’m just not disciplined enough." I see other people changing their lives. Why can’t I just stick to it?

Berryl:

Oh, there's that word that raises flags for me. Discipline.

Yes, we need discipline to accomplish things, but take a pause if you think you can fool your body into hard stops and clear cuts. Our bodies' needs, reactions, and processes don't change from Friday to Monday when YOU decide to start. Have you seen the reel on Instagram about the parent who took the iPads away from her kids, and they went into full primate attack mode? Discipline is often blamed when structure is missing. I'm using this example because all of us, not just the kids, can easily get addicted to our screens, but when structure is in place, a predictable bedtime, a designated hour for screens, and a substantial winding down from screens, that behaviour is less likely to happen.

Behavioural science tells us that sustainable change depends more on environmental design than on willpower alone. Let's put willpower on the back burner for a sec. I know I will not be able to tap into it when I'm handling five crises related to my business and my family.

If the plan is vague, “eat clean,” “move more,” your brain has to make constant decisions; it has to loop back to you “getting alarmed” by that diagnosis, and what tends to happen is decision fatigue.

Good structure, on the other hand, reduces the number of decisions required. And make you have to make fewer decisions, we increase adherence.

Therefore, I don't buy the 10-pack of my favourite chocolate bar, and don't buy quick-bake breads, I keep the menu simple. I never put away my weights; they are always in my path, and so on. It is about designing your daily structure better.

Client:

Oh yes, I bought myself a nice weight rack that I keep right in front of my TV. ...Something else happened, too. After my diagnosis, I couldn’t think clearly. I was anxious. I kept googling things. I felt scared half the time. Is that part of why it’s so hard?

Berryl:

Yes.

A hard diagnosis increases cognitive load.

You are processing new information, risks, unfamiliar terminology, and what gets us most is the uncertainty. And let's be honest, there's a lot of data involved in a diagnosis. Your doctor studied for a decade or more to learn the data, and sometimes it gets dumped on you in 12 minutes or less.

When cognitive load is high, the brain’s capacity for complex behavioural change decreases.

This is why trying to change everything at once often backfires.

In those moments, simplification is protective.

Client:

[big laugh] I did try to change everything at once. I bought supplements, changed my diet completely, started walking every day...

Berryl: 

...may I suggest you grab your heaviest kettlebell instead?

Client:

Yeah, I knew you'd say that. Those things scare me, if I drop that thing on my toe...oh I also tried to fix my sleep. It lasted maybe three weeks. Then I crashed.

Berryl:

Because simultaneous overhaul creates friction.

Every change requires energy, physical and mental. Try getting my clients to take their blood pressure and glucose every day! It's a real battle.

When multiple high-effort behaviours are introduced at once, stress increases.

The nervous system resists sustained overload. Particularly if you're female. Our stress hormones are reactive to uncomfortable change. 

Sustainable implementation works differently. It stages a change in manageable sections. It asks:

What is the minimum effective shift right now? What can wait? What would reduce strain instead of increasing it?

Gradual sequencing produces more durable outcomes.

Client:

So what does “structured implementation” actually look like? I keep hearing that phrase from you, but what does it mean in real life?

Berryl:

It means narrowing the focus.

Instead of a long list of improvements, we identify two or three priorities that matter most in this phase. We design them around your real life:

Your schedule. Your energy. Your finances. Your family responsibilities. A lot of people I know can't afford a ketogenic diet in Costa Rica because red meat is expensive.

We track a small number of indicators, not 97 all at once, even though our epigenetics test tracks close to that.

And we review regularly.

Implementation is progressive. It evolves.

It is less dramatic than a total reset and, therefore, more sustainable.

Client:

Sometimes I feel like doctors assume I’ll just “figure it out” between appointments. But months can pass before I see them again. I’m just on my own with a prescription.

Berryl:

I get it! That gap between visits is significant. Here in Costa Rica, those intervals are about three months to a year if you're using the national socialised medicine. They are not designed to build a daily behavioural structure. They leave that to you.

In regions where follow-up access is limited, including parts of Limon, where I live, that gap can feel even wider. I am continually surprised by how often people must travel to San José for routine care....but anyway, our structured support during that period does not replace medical care. It complements it so that the medical care can succeed.

Client:

Ok, so now I'm going to corner you a bit...If you had to say it simply, why does lifestyle change fail after diagnosis?

Berryl:

Because the person responsible for execution is often overwhelmed and under-supported.

Some patients can easily carry the burden of implementation, but most cannot because they have dinner and homework to worry about, and they can't pay attention to the minutiae of the blood glucose numbers…or my WhatsApp messages asking for their blood pressure numbers.

Once you leave your doctor's office, implementation requires good design. When the executioner, that's you, has no system to translate knowledge into action, intention dissolves under pressure. And, there is pressure from all sides if you own a business and have children and a family.

And in my humble opinion, having someone else, outside of your family unit, that maintains a structure for you, helps stabilise the goals set by your doctor over those three months to a year.

Client:

So maybe I just didn’t have a system.

Berryl:

[laughter]Exactly. Well ...if I remember correctly, I had to "pretty please" you for your blood tests for about 4 weeks, and your CGM readings didn't budge for a whole month...

Jokes aside, frustration often signals effort. I could see that you cared enough. But we did have to make some changes for the plan to fit your actual life.

I'm glad we did it. 

Client:

As am I. Thank you for your time.