Female, 29 years old, presented to the clinic struggling with excess weight. She also complained of poor sleep and low mood.

The client weighed 102kg and is 165cm tall; this placed her BMI at 37.5. Her waist to hip ratio was 0.9 (high cardiovascular risk) and she presented with central adiposity. The client couldn’t recall when she last had a good night’s sleep; it usually took at least an hour for sleep onset and then she would wake one to two times during the for no apparent reason. The client generally felt tired on waking and found that her energy levels throughout the day rarely exceeded 4/10. Upon further questioning, it was revealed that the client’s motivation and drive was the lowest it had ever been, she found that even the two to three coffees that she drank each day were unable to levels of enthusiasm.  The client occasionally went to the gym to walk on the treadmill but expressed that she really didn’t enjoy it and ‘couldn’t be bothered’.

Client History

The client had gained approximately 15kg over the previous year following elevated stress levels during a relationship break down. In the same period of time, the client’s dog had died and she also lost her job. As a child and adolescent the client had ‘always been chubby’ and struggled with depression and anxiety throughout her teenage years into her early 20s.  At the age of 24 the client had decided to follow a vegetarian diet and commence cross-fit which she found improved her mood and assisted her in losing around 20kg of body weight.  A fairly typical health history included regular antibiotic use throughout childhood, frequent infections such as bronchitis and tonsillitis, as well as symptoms such as alternating diarrhoea and constipation alongside bloating, distension and overall digestive system irritability.

Diet:

The client’s diet over the last 15 months had been fairly consistent; the client enjoyed eating out and so regularly ate rich pasta meals and hamburgers as well as wine, cheese and creamy desserts. She would often notice that she felt bloated and unwell after meals containing a lot of cream or cheese and so had decided to ‘clean up’ her diet by removing red meat, eggs, gluten, dairy and refined sugars. An average day’s diet now consisted of gluten free muesli and almond milk for breakfast, buckwheat crackers with tomato for lunch, almonds and apples for snacks and chicken and steamed vegetable or salad for the evening meal. Although she felt less bloated, she hadn’t noticed any change in her body composition over a two-week period and found that she still had low appetite and experienced burping after dinner that she was unable to link to any specific meal or food. The client expressed that she felt very unhappy on this diet and was scared of having to follow this sort of diet on a long-term basis.

Physical signs:

The client’s nails had multiple white spots, vertical ridging and were brittle and flaky. Her tongue had a thick off-white coat and a quiver. Blood pressure was 120/80 but pulse was fast at 90 beats per minute.

Treatment Plan:

Although the client’s primary concern was to lose some weight, it seemed that there was a lot more to her health picture that needed to be addressed; the excessive tiredness and low motivation prevented the client from any significant amount of movement while nutrient deficiencies aggravated her digestion and poor sleep. 

Initially our treatment priorities were to:

• Improve mood and sleep by supporting neurotransmitter synthesis, specifically dopamine (as evidenced by the low motivation and coffee cravings) and serotonin (indicated by low mood and poor sleep). This was facilitated by providing nutritional cofactors, herbal support and lifestyle advice.
• Support digestive function by removing irritating foods, encouraging microbiota health and providing nutritional support for digestive enzyme production.
• Improve energy levels by supporting resilience to stress, balancing blood sugar levels throughout the day and providing nutrients essential for optimal mitochondrial function.

I spoke to the client about sustainability of her diet rather than a short-term fix and assured her that we could make her diet enjoyable and appealing. We agreed to reintroduce eggs so that she could enjoy vegetable omelettes in the morning with a sheep’s cheese and I provided some tasty gluten free recipes. The client was open to including some fermented foods in her diet such as sauerkraut, water kefir and pickled vegetables; I felt this would be an effective way to begin introducing a larger variety of probiotic strains to support her digestive function.

In order to ensure adequate protein intake for neurotransmitter synthesis, (specifically serotonin and dopamine), energy production and blood sugar regulation, a protein powder was recommended to be included in the diet as a breakfast or snack option. The protein powder was based on a whey protein concentrate and also contained ingredients such as flaxseed and chia seed powder to promote satiety and support bowel health, proteolytic enzymes to aid digestion, an adaptogenic herb Gynostemma pentaphyllum powder and essential nutrients such as zinc, iodine, chromium, magnesium, selenium, vitamin D and nicotinamide. This formulation, in combination with frozen berries and an activated almond milk, provided a more substantial breakfast option for the client alongside her muesli while working towards rectifying nutrient deficiencies.

A herbal and nutritional formula was prescribed containing rhodiola , saffron, acetyl-L-carnitine, tyrosine, magnesium, folinic acid, zinc, activated B6 and activated B12, to be dosed twice daily morning and lunchtime; this combination was prescribed because Rhodiola has both pharmacological and traditional evidence supporting its use in fatigue, cognition and mood, including depression and generalised anxiety disorder while Saffron’s active constituents have been shown to inhibit reuptake of dopamine, norepinepherine, and serotonin. Saffron has also been shown to be effective for reducing depression and anxiety while improving sleep quality. In addition, the nutrients contained in the formula support nervous system health and energy production; the white spots in the nails and suspected low hydrochloric acid (shown by the low appetite and burping) support the inclusion of zinc.

To address the client’s delayed sleep onset, we spoke about sleep hygiene and reducing blue light in the evenings. The client also agreed to leave her phone outside of the room so that she couldn’t access it when she woke throughout the night.

Finally, we spoke about forms of movement that could be included in the client’s life that could possibly also bring joy rather than walking on a treadmill. The client became more lively to share her passion of animals, particularly dogs, and so she agreed to start incorporating more joyful activities in her days.

2-Week Follow-Up

The client sent through a food diary she had kept using a phone app (this hadn’t been a request) as she was excited to share the recipes she had started incorporating into her diet. The client’s energy levels had increased to 7-8/10 and she was already feeling increased motivation in her day; she had started planning a new business venture as a dog walker and seemed energised by this.

Sleep had improved in the last week particularly and the client had been waking feeling more refreshed. She was finding that her digestion was fine despite having added some foods back into her diet and she reported feeling ‘a lot less puffy’. Although the client had only lost 2kg on the scales, I felt that the client was on a much more positive trajectory towards better health as her mental health had begun to improve.

Although not every client will respond as readily as this one, I feel it is important to highlight that returning to one of our guiding principles, to treat the whole person, is a crucial part of our role as practitioner particularly in a weight loss scenario as it is not a healthy weight that makes a healthy person but rather a healthy person, mentally, physically and emotionally, who will naturally return to their healthy, ideal weight.