Halting the Trajectory of Cardiometabolic Dysfunction: A Case Study
A Case Study by Gemma Martin
The combination of poor blood glucose control and dyslipidaemia poses a significant risk to cardiovascular health. Although symptoms are not always evident, routine blood tests can reveal underlying cardiometabolic dysfunction. With early detection and effective intervention, practitioners can support patients to improve their current health status while helping to reduce the future risk of cardiometabolic disease, including type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). In this case, a Western-style diet, combined with stress and poor sleep, likely contributed to the patient’s cardiometabolic dysfunction and informed the treatment approach.
Initial Presentation
A 41-year-old male presented with a three-month history of fatigue, slow exercise recovery, high stress, and poor sleep. He noticed that he was very sore and tired after gym sessions and felt like he was losing muscle mass. The patient described himself as a highly strung person, suffering from overthinking, irritability and poor stress tolerance.
A case history revealed:
• A decline in daytime energy from his usual 8-9/10 to 7/10
• Poor sleep, going to bed at 11 pm-12 am and waking 4-5 times nightly
• Waking at 5 am feeling fatigued
• Wakes with a sore jaw in the morning
• Loose bowel movements several times weekly
• Burping after eating
• Anxiety several times per week, manifesting as a hot feeling with racing thoughts
• Stress levels rated 6/10
• Cravings for sugar, salty foods and caffeine
• Blood pressure 153/83 mmHg
• Muscle twitching and tongue quiver
• Low libido, usually high
• High caffeine intake (2-3 double shots daily) plus a pre-workout supplement on gym days
• High glycaemic index (GI) diet including processed carbohydrates, sugar as well as processed meat
• Gym 5 days per week which included weights and cardio training
Previous tests revealed:
• Testosterone 7.2 nmol/L (11.0-40.0 nmol/L)
• Fasting blood glucose (FBG) 6.2 mmol/L (3.6-6.0 nmol/L)
• Triglycerides 3.0 mmol/L (<2.1 mmol/L)
• High-density lipoprotein (HDL) 0.74 mmol/L (>0.89 mmol/L)
• Cholesterol/HDL ratio 5.9 (<4.6)
• Alanine aminotransferase (ALT) 53 U/L (5-40 U/L)
• Glycated haemoglobin (HbA1c) 5.6% (<6.5%)
Treatment Plan
The initial prescription was aimed at improving symptoms whilst addressing the underlying drivers of the patient’s cardiometabolic dysfunction. The goal was to improve his stress response and poor sleep, to lessen his cortisol response and subsequent insulin resistance. Metabolic support was aimed at supporting testosterone production, balancing blood sugar levels and improving his lipid profile through diet, lifestyle and nutritional/herbal approaches.
Prescription
The patient’s prescription included:
• Herbal sleep tablets, containing Humulus lupulus (Hops) 720 mg, and Valeriana officinalis (Valerian) 2.5 g: 2 tablets half an hour before bed
• Reproductive Support Tablets, containing Tribulus terrestris (Tribulus) herb 12 g, standardised to contain furostanol saponins calculated as protodioscin 100 mg: 1 tablet three times daily
• Glucose Metabolism Support Tablets, containing Gymnema sylvestre (Gymnema) leaf 3.2 g, standardised to contain gymnemic acids 50 mg, chromium (as chloride and nicotinate) 223 µg, zinc (as gluconate) 15 mg, and cofactors for balancing blood glucose levels: 1 tablet two times daily with meals
• Magnesium (as citrate) 400 mg: once before bed
Dietary and lifestyle advice included:
• In bed by 10:30 pm. Listen to a meditation or an audiobook to help switch off the brain.
• Reduce bread intake to maximum 2 slices daily. Switch to wholemeal sourdough.
• Avoid high GI foods. Replace these with whole grains, protein and vegetables.
• Consume a smoothie for breakfast with oats, nuts, green vegetables, and hemp seeds
• Switch from cow milk to coconut or macadamia milk
• Avoid the pre-workout formula if it contains caffeine and artificial sweeteners
• Include healthy fats such as avocado, olive oil, coconut oil, nuts, and seeds
• Avoid processed meat
• Include wild caught fish twice weekly
• Consume garlic as often as possible
• Referral to general practitioner (GP) for a mental health plan. Referral to see a psychologist for counselling.
6-Week Follow-Up
The patient reported feeling significantly better. His energy had improved to 8/10, libido had increased, gym recovery time was reduced by half, and was now only waking 1-2 times nightly. The patient was going to bed earlier and falling asleep easier; however, he was experiencing lots of dreams which made him feel exhausted in the morning. He reported fewer sugar cravings, a reduction in caffeine intake and considerably less anxiety. The patient had quadrupled his vegetable intake and was no longer experiencing loose bowel movements.
Prescription
The following was added to his prescription:
• Vitality & Stamina Tablets, containing Rhodiola rosea (Rhodiola) root 720 mg and Panax ginseng (Korean Ginseng) root 500 mg: 2 tablets at breakfast and 1 tablet at lunch
The herbal sleep tablets were replaced with:
• Sleep Well Tablets, containing Melissa officinalis (Lemon Balm) leaf 650 mg, Ziziphus jujuba var. spinosa (Zizyphus) seed 650 mg, Magnolia officinalis (Magnolia) stem bark 600 mg, Lavandula angustifolia (Lavender) essential oil 10 mg, pyridoxine (vitamin B6) [as pyridoxal 5-phosphate monohydrate] 16.5 mg, and magnesium (as amino acid chelate) 40 mg: 2 tablets half an hour before bed
The herbal tablet to support blood glucose control was ceased.
14-Week Follow-Up
The patient reported that he was sleeping almost perfectly. He was falling asleep at 10 pm within minutes of going to bed and not waking until the morning. His morning energy had improved, and stress levels had reduced to 5/10. He was a little more relaxed with his diet and was including more processed meat and sugar again, which he felt had a negative impact on his daytime energy.
Follow-up blood tests revealed:
| Previous | Current | Range | |
| Triglycerides | 3.0 | 1.8 | <2.1 mmol/L |
| HDL | 0.74 | 0.85 | >0.89 mmol/L |
| Chol/HDL ratio | 5.9 | 4.9 | <4.6 |
| FBG | 6.2 | 5.9 | 3.6-6.0 mmol/L |
| ALT | 53 | 38 | 5-40 U/L |
| Testosterone | 7.2 | 8.0 | 11.0-40.0 nmol/L |
| Blood pressure | 153/83 | 135/79 | mmHg |