Client: 55-year-old-male
Initial presentation: The client, a 55-year-old-male, presents with central adiposity, persistent fatigue, elevated blood glucose, hypertension and dyslipidaemia. He reports gradual weight gain over the past 10 years, particularly around the abdomen, alongside decreasing energy levels, poor motivation and increasing brain fog during the afternoon.
Recent blood tests performed by his GP identified prediabetes. He is not currently taking any medications and is motivated to improve his health naturally before considering pharmaceutical intervention.
Additional symptoms include:
- Increased abdominal bloating after meals
- Cravings for refined carbohydrates and sugary snacks in the afternoon
- Poor sleep quality with multiple nighttime awakenings
- Sedentary lifestyle with minimal exercise
- Elevated stress associated with his health status.
Diet consists predominantly of convenience foods, takeaway lunches, processed snacks and 3 coffees daily to sustain energy levels throughout the day. Vegetable intake is low and alcohol intake is typically 2 beers most evenings.
Measurements and pathology findings:
- Waist circumference: 98 cm
- Blood pressure: 138/85 mmHg
- Total cholesterol: 4.5 mmol/L
- LDL cholesterol: 4.0 mmol/L
- HDL cholesterol: 1.2 mmol/L
- Triglycerides: 2.1 mmol/L
- Fasting glucose: 6.4 mmol/L
- HbA1c: 44 mmol/mol
Naturopathic assessment: 55-year-old male presents with metabolic syndrome characterised by insulin resistance, central adiposity, hypertension and dyslipidaemia. Poor dietary patterns, high alcohol intake, disrupted sleep and a sedentary lifestyle contribute to systemic inflammation, impaired glucose metabolism and cardiometabolic dysfunction.
Key factors considered:
- Insulin resistance & glucose dysregulation
Metabolic syndrome is strongly associated with reduced insulin sensitivity, resulting in impaired glucose uptake. Excess visceral adipose tissue contributes to inflammatory cytokine production and worsens insulin signalling pathways.
- Chronic low-grade inflammation
Adipose tissue acts as an endocrine organ, releasing pro-inflammatory mediators TNF-α and IL-6. Persistent inflammation contributes to endothelial dysfunction, oxidative stress and progression toward cardiovascular disease and type 2 diabetes.
- Liver overload & dyslipidaemia
High intake of refined carbohydrates, ultra-processed foods and alcohol may contribute to impaired liver metabolism. Elevated triglycerides and central adiposity suggest hepatic insulin resistance.
- Gut dysbiosis & digestive dysfunction
Bloating and poor diversity may indicate alterations in the gut microbiome and impaired digestive function. Dysbiosis can influence metabolic health through increased intestinal permeability and inflammatory signalling.
- Stress & sleep dysfunction
Sustained psychological stress and inadequate sleep elevate cortisol, which can worsen insulin resistance, promote gluconeogenesis, increase abdominal fat deposition and dysregulate appetite hormones including ghrelin and leptin.
Herbal medicine:
Black pepper (Piper nigrum) - Enhances the absorption and bioavailability of curcumin and thymoquinone, to amplify their therapeutic properties. A potent antioxidant to neutralise reactive oxidative species (ROS).
Fenugreek (Trigonella foenum-graecum) - Traditionally used to support healthy blood glucose regulation and insulin sensitivity. Fenugreek may assist glucose uptake into cells and reduce postprandial blood glucose spikes. Its cholesterol-lowering activity works to improve lipid profiles.
Hawthorn berry (Crataegus spp.) - Is a potent cardiac tonic with significant antioxidant activity. It supports cardiovascular function by improving myocardial contractility, thereby enhancing coronary blood flow and circulation. Its vasodilatory effects contribute to reduce vascular resistance and healthy blood pressure regulation. Hawthorn has also been shown to reduce LDL cholesterol levels through inhibition of the acyl-CoA-cholesterol acyltransferase (ACAT) enzyme. Through these combined cardioprotective and metabolic effects, Hawthorn is a valuable herb in the management of metabolic syndrome.
Nigella (Nigella sativa) - Is a multifaceted herb that supports cardiometabolic health through several mechanisms. Its primary active constituent, thymoquinone, exerts notable antioxidant effects by reducing reactive oxidative species (ROS) and enhancing nitric oxide availability, thereby supporting healthy blood pressure regulation. Its anti-inflammatory effects are mediated through the reduction of pro-inflammatory cytokines, including IL-1, IL-6 and TNF-α, as well as inhibition of the NF-κB signalling pathway. In addition, Nigella exhibits anti-dyslipidaemic activity by inhibiting HMG-CoA reductase expression while increasing LDL receptor expression. Thymoquinone has also been shown to act as a PPAR-γ agonist, contributing to improved insulin sensitivity.
Turmeric (Curcuma longa) - The benefits of Turmeric for metabolic syndrome are largely driven by its primary active constituent, curcumin. It has been clinically shown to improve insulin sensitivity, glucose regulation, lipid profiles, obesity-related markers and inflammatory status. Its mechanism of action includes antioxidant and anti-inflammatory effects, suppression of adipogenesis and angiogenesis, activation of AMPK pathways, enhanced expression of glucose transporters and modulation of inflammatory pathways (NF-κB).
Herbal formula for cardiometabolic support - 500 mL
Black pepper (Piper nigrum) 1:2 - 25 mL
Fenugreek (Trigonella foenum-graecum) 1:2 - 150 mL
Hawthorn berry (Crataegus spp.) 1:2 standardised - 75 mL
Nigella (Nigella sativa) 1:2 - 150 mL
Turmeric (Curcuma longa) 1:1 - 100 mL
Dosage: 7.5 mL twice daily (BD). Take 30 minutes before food, morning and night.
Note: The client was advised to drink one glass of water with each dose of herbal medicine, to support the liver and kidneys natural processing of alcohol.
Additional recommendations:
Dietary modifications
- Move towards a Mediterranean-style dietary approach - Transitioning toward a predominantly whole-food rich diet rich in vegetables, legumes, olive oil, nuts and seeds and oily fish to support lipid balance, modulate the gut microbiome, reduce inflammation and improve glycaemic stability and cardiometabolic health. Aim for 25-30g of protein with each meal alongside high-fibre foods to improve satiety, regulate blood glucose responses and stabilise energy levels throughout the day.
- Increase plant sterols - Plant sterols are naturally occurring compounds that have a similar structure to cholesterol, differing slightly due to the presence of an additional methyl or ethyl group, or an extra double bond on the side chain. They help reduce LDL cholesterol levels by competing with cholesterol for absorption in the bloodstream, resulting in more cholesterol being excreted in stool. Good dietary sources include avocados, nuts, seeds and unrefined vegetable oils.
-
Increase soluble fibre intake - Aim for 5-10g of soluble fibre (oats, psyllium husk, ground flaxseeds, chia seeds) daily to support cholesterol excretion via bile-acid binding and to improve satiety.
- Reduce alcohol intake - Gradually reduce beer consumption by one drink per week, with the goal of reaching a point where the client has more alcohol-free nights than nights that include alcohol each week. While complete abstinence (zero alcohol drinks per week) would be the ideal long-term outcome, that is not currently a realistic goal for the client. Reducing alcohol intake is associated with improved liver health and can contribute to better regulation of blood pressure and blood lipid levels.
- Increase hydration - Aim for 2-2.5 L water daily, which is particularly important to accommodate increased fibre intake. Gradually reduce coffee intake to no more than 2 cups daily, supplementing with green tea as needed.
- Incorporate pomegranate juice into weekly fluid - Pomegranate displays beneficial effects to metabolic syndrome through its antioxidant and anti-inflammatory activity. Clinical observations include reduced LDL and total cholesterol levels, lowered blood pressure and improved insulin sensitivity. Aim for 250 mL daily.
Lifestyle modifications
- Increase physical activity - Begin with 30-minute walks three days weekly, progressing towards resistance training 2-3 times per week to improve insulin sensitivity and preserve lean muscle mass. Increasing physical activity also supports a gradual reduction in visceral adiposity.
- Improve sleep hygiene - Aim for 7-9 hours of sleep each night. Avoid blue light exposure one hour before bed, maintain consistent sleep times and avoid caffeine after midday to improve sleep quality and reduce nighttime wakefulness. Consider using a herbal sleep product, such as Kiwiherb Sound Asleep, for a short period of time to shift the sleep pattern.
- Stress management - Implement heart coherence breathing (6 deep breaths per minute) to reduce sympathetic nervous system activation and cortisol burden. Clinical studies have shown 15 minutes of daily deep breathing is associated with lowered blood pressure, both immediately and over several days.
Supplements
- Myo-inositol (4 g/day) - Is one of the most well-studied and clinically effective supplements for improving insulin resistance. Individuals with insulin resistance and diabetes often exhibit lower levels of myo-inositol. Clinical studies have demonstrated that myo-inositol can reduce serum glucose levels and improve insulin sensitivity, with some evidence suggesting effects that may exceed those observed with metformin and pioglitazone. These effects result from enhanced GLUT-4 translocation to the plasma membrane in skeletal muscle, facilitating glucose uptake in response to hyperglycaemia.
- Magnesium glycinate (300-400 mg/day) - Is a highly bioavailable form of magnesium that supports nervous system function and sleep regulation. It helps reduce nervous system excitability, promotes muscle relaxation and supports regulation of the body's cellular circadian rhythms. Magnesium glycinate also supports metabolic health by improving insulin sensitivity, aiding glucose metabolism, helping maintain healthy blood pressure, and supporting fatty acid metabolism.
- Omega-3 fatty acids (EPA/DHA 1-2 g/day) - Have been shown to support the management of metabolic syndrome through their beneficial effects on several cardiometabolic risk factors. They reduce circulating triglyceride concentrations, promote adipogenesis, and exert anti-inflammatory effects, thereby contributing to improved metabolic health and a reduced risk of cardiovascular disease.
Follow up:
At the four-week follow-up, the client reported improved energy levels and reduced afternoon fatigue. Sugar cravings had decreased significantly, and episodes of bloating were occurring less frequently. Alcohol intake has been reduced to one beer each evening, and he had begun walking around the neighbourhood after dinner several times per week.
Sleep quality had improved moderately following the implementation of sleep hygiene strategies, with fewer overnight awakenings reported. Waist circumference had decreased by 4 cm, and home blood pressure readings averaged 135/84 mmHg.
The client had adhered well to the prescribed herbal formula and was advised to continue for a further two months, with efficacy to be reassessed following repeat blood testing arranged through his GP.
The client had committed to prepping his weekly work snacks consisting of protein- and fibre-rich foods, as this was considered more achievable than preparing lunches in advance. He continued to purchase lunch at work but had consistently selected meals that included a quality protein source, low glycaemic carbohydrates, a variety of vegetables and a healthy fat such as avocado, nuts, seeds, and/or olive oil.
Continued treatment was indicated, with emphasis placed on sustained dietary consistency, stress reduction, implementing progressive resistance exercise and reducing long-term cardiometabolic risk. Ongoing monitoring of blood glucose and lipid markers through his GP was recommended over the following 3-6 months to assess changes in glycaemic control and cardiovascular risk markers. In addition, referral to his GP was recommended for assessment of possible prostate enlargement, given his age and reports of frequent nocturnal waking.
New Zealand prediabetic reference intervals
|
Test |
Range |
Units |
|
Fasting glucose |
6.1 – 6.9 |
mmol/L |
|
HbA1c |
41 – 49 |
mmol/mol |
|
Waist circumference |
>94 in males >80 in females |
cm |
New Zealand blood lipids reference intervals
|
Test |
Range |
Units |
|
Total cholesterol |
<4.0 |
mmol/L |
|
Triglycerides |
<1.8 |
mmol/L |
|
LDL cholesterol |
<3.5 |
mmol/L |
|
HDL cholesterol |
>1.0 |
mmol/L |