S.G. is a 33 year old male whom I met in February 2022 with chief complaints of weight gain and disturbed sleep. His desire to lose weight has been hampered by: stressful work obligations, sedentary lifestyle, confusion about the most effective dietary measures for weight loss and frequent food cravings.
His past medical history included a recent diagnosis of severe obstructive sleep apnea in 2020, for which a CPAP was prescribed, but not compliantly used, and a COVID infection in 2021. His initial in-office weight was 110 kg (243 lbs), and his September 2021 lab results showed a suboptimal metabolic profile: TSH=4.26 mU/L, FBG=6.3 mmol/L, triglycerides=2.03 mmol/L, and HDL-C=0.92 mmol/L. Of note was a family history of diabetes and obesity. He was otherwise healthy, unmedicated, and motivated.
I started the patient on inositol at 4 g QD for its action on improving insulin sensitivity and a tincture of Gymnema sylvestre at 4 ml BID before meals for its anti-obesity, anti-lipidemic and anti-diabetes actions. Inositol was prescribed for 4.5 months, and the tincture for approximately 1 month’s duration. The patient had been taking Ashwagandha (not standardized), self-prescribed at 1000 mg QD for energy, so I advised an increase in dose to 2000 mg BID to support thyroid function. Due to budget constraint, no other supplements were prescribed despite several others being considered, including biotin with chromium, magnesium, alpha-lipoic acid (ALA) and resveratrol alongside other antioxidants, berberine, Panax ginseng and Momordica charantia, all for their support in improving metabolic syndrome markers. To address the patient holistically, he was also advised to initiate the following dietary and lifestyle interventions:
- Incorporate intermittent fasting by gradually narrowing his eating window by 30 min every 3 weeks until reaching a 10-hour eating window.
- Eat all meals on smaller/side plates to assist in reducing overall portion size.
- Consume 38 g QD of fibre (as is the current RDA for men).
- Ensure adequate hydration and consume 500 ml of water before each meal.
- Include a small amount of protein with each meal.
- Avoid highly processed, fried and simple carbohydrate-rich foods.
- Prepare and take the time to eat all meals without distraction.
- Schedule time every week to do something that makes him happy, in order to reduce overall stress.
- Ensure 150 min of exercise per week inclusive of both cardio and strength training.
- Wear his CPAP to optimize oxygen saturation and improve sleep.
Lastly, he was advised to obtain labs 3-4 months post-supplementation to further assess his health status, provide re-assessment of previous labs taken, and allow for an objective assessment of progress. These included: CBCD, a 4-point OGTT with insulin, HbA1C, creatinine and eGFR, a lipid panel, ALT, GGT, CRP, ESR, vitamin B12 and 25-OH D.
At his return visit in early April, the patient not only had his ratings of stress decreased by 2.5 points and both his energy and sleep quality increased by 1 point (out of 10), but he detailed feeling “rejuvenated and energetic until evening” with a resolution of his lethargy. He noted that his food cravings had decreased and that incorporating healthy habits and routines had provided him the willpower and motivation to continue making healthy choices. He admitted that due to his work schedule, his physical activity remained low. He also admitted that other than avoiding junk foods, eating healthier meals, and incorporating intermittent fasting (reducing his eating window to 7 hours, most days), he had not incorporated any other dietary or lifestyle measures.Though labs were not obtained at this time, they likely have also improved. Despite the initiation of only a few treatments, a reduction in weight to 105 kgs (231 lbs) was observed over this 7-week period.
The few supplements advised were prescribed due to their ability to positively influence metabolic health. Myo-inositol has considerable evidence for improving insulin resistance through a variety of mechanisms. Gymnema sylvestre has been shown to have a multitude of favourable effects on metabolic syndrome including reducing body weight, inflammation and vascular kidney damage.
Ashwagandha (Withania somnifera) has several medicinal actions including being anti-inflammatory, immune-modulating, rejuvenating, adaptogenic, tonifying, sedative and even an aphrodisiac.
With global estimates projecting 1 billion adults to be obese by 2030, the burden on our health care system will continue to increase without appropriate treatment interventions and forethought regarding prevention. I believe that naturopathic doctors can play a critical role in preventing and addressing the obesity epidemic using a wide spectrum of naturopathic therapies to reduce weight, improve lab markers, optimize health and reduce disease burden.