Hypothetical Case Study #1 Obesity and Metabolic Syndrome

Hypothetical Case Study #1: An Approach to Obesity and Metabolic Syndrome

By Laura Sheehan

I am going to discuss my hypothetical client Marilyn. Marilyn has come to me for nutritional help, with the goal of making dietary modifications to get off her medications. She is 65 years old and obese.

Multiple definitions for Metabolic Syndrome (MetS) have evolved over the past two decades 1. The most recent and applicable definition to my clinical practice is the NCEP ATP III (2005 revision). In order to be diagnosed with MetS, my imaginary client Marilyn would need to meet three of the following five criteria: abdominal obesity (waist circumference >35 inches in women), high triglycerides (≥ 150 mg/dl), low HDL cholesterol (< 50 mg/dl in women), high blood pressure (≥ 130/≥ 85 mmHg), and high fasting glucose (≥ 110 mg/dl). According to these criteria, Marilyn fits all the criteria for MetS. She has obesity, type II diabetes with a fasting glucose of 190 mg/dl, hypertension (180/90 mmHg), high triglycerides (202 mg/dl), and low HDL cholesterol (40 mg/dl).

Insulin resistance has been proposed as the common thread linking the symptoms of MetS 2. In response to diminished sensitivity to circulating insulin, the pancreas produces more and more of this necessary hormone, and the result is high levels of glucose and insulin in the blood. These elevated levels of insulin and glucose are damaging to the body and are associated with a myriad of negative health effects, especially cardiovascular disease and diabetes mellitus, with its complications of increased susceptibility to infection, diabetic retinopathy, cataracts, and chronic renal disease3. To help Marilyn, I will need to focus on reversing her insulin resistance and MetS. I will need to provide guidelines to make her body more insulin sensitive.

Several metrics will help me to monitor Marilyn’s progress towards her goals of increasing her insulin sensitivity and getting off her medications. I will try to regulate Marilyn’s measurements toward normal. Her waist circumference should be progressively decreasing to below 35 inches, her fasting glucose toward normal (80-100 mg/100ml), her triglycerides toward normal (70-110 mg/dl), HDL cholesterol increasing toward ≥ 55 mg/dl4, and blood pressure toward normal (120/80 mmHg).

Although there is quite a bit of debate in the literature, simple biochemistry indicates that MetS and insulin resistance are effects of too much sugar in the diet. It makes sense that I would consider recommending changes to Marilyn’s carbohydrate consumption. Lowering the overall glycemic index of carbohydrates in Marilyn’s diet could be successful5, but It would be simpler in practice to reduce Marilyn’s total carbohydrate intake6. Both approaches could be successful in reducing waist circumference and hyperlipidemia. A carbohydrate restricted diet combined with added soluble fiber could increase HDL and decrease LDL levels78.

Within Marilyn’s carbohydrate-restricted diet, I will emphasize that she avoid processed sugars and focus on complex carbohydrates in their whole form. Processed sugars, especially high-fructose corn syrup, have been shown to contribute to MetS by increasing the deposition of fat in the liver9. I will also stress increasing soluble fiber as the literature suggests a benefit to lipid profiles7. After implementing these changes, provided Marilyn can stick to her diet long enough, she should see improvements in her MetS criteria and be able to visit her family doctor for a medication review.

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1. Huang PL. A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms. 2009;2(5-6):231-237. doi:10.1242/dmm.001180.

2. Reaven G. 1988 Banting Lecture: role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.

3. Hall J. Insulin, Glucagon, and Diabetes Mellitus. In: Hall J. Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA: Saunders Elsevier, 2011: 939-954.

4. Weatherby D, Ferguson S. Blood Chemistry and CBC Analysis: Clinical Laboratory Testing from a Functional Perspective. Jacksonville, OR: Bear Mountain Publishing, 2002.

5. Finley CE, Barlow CE. Glycemic Index, Glycemic Load, and Prevalence of the Metabolic Syndrome in the Cooper Center Longitudinal Study. Journal of the American Dietetic Association. 2010;110(12):1820-1829. doi:10.1016/j.jada.2010.09.016.

6. Volek JS, Phinney SD. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids. 2008;44(4):297-309. doi:10.1007/s11745-008-3274-2.

7. Wood RJ, Fernandez ML. Effects of a carbohydrate-restricted diet with and without supplemental soluble fiber on plasma low-density lipoprotein cholesterol and other clinical markers of cardiovascular risk. Metabolism. 2007;56(1):58-67. doi:10.1016/j.metabol.2006.08.021.

8. Yancy WS, Westman EC. A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss. Archives of Internal Medicine. 2010;170(2):136. doi:10.1001/archinternmed.2009.492.

9. Havel P. Dietary Fructose: Implications for Dysregulation of Energy Homeostasis and Lipid/Carbohydrate Metabolism. Nutrition Reviews 2005; 63(5): 133-157.

Effect of Carbohydrate Intake on Depression

Effect of Carbohydrate Intake on Depression

By Laura Sheehan

I was never formally diagnosed with depression and I have never taken depression medication, but I can attest to the effect that altering my carbohydrate intake had on my depression symptoms. In short, I am cured of my symptoms when I avoid refined white sugar, and my symptoms return when I begin to consume refined white sugar again.

Research by Akbaraly et al.1 concluded that a processed-food based diet is associated with increased risk for depression while a whole food based diet is protective. In another older study 2, nondepressed individuals were found to consume more protein relative to carbohydrates, but in depressed individuals it was the other way around.

So does this mean that high carbohydrate diets are associated in general with increased risk for depression? Recent research has revealed that depression is more a result of systemic inflammation than a chemical deficiency in the brain.3 Because of the inflammatory effect of high blood glucose 4, one can conclude that eating too much sugar and carbohydrates causes depression.

Many nutrition textbooks state that carbohydrate intake should be no lower than 50-100 grams per day. 5 It is my clinical experience that lowering carbohydrate intake in general to these levels can have a positive impact on mood and help individuals with depression.


    • 1. Akbaraly TN, Brunner EJ. Dietary pattern and depressive symptoms in middle age. British Journal of Psychiatry. 2009;195(05):408-413. doi:10.1192/bjp.bp.108.058925.
    2. Christensen L, Somers S. Comparison of nutrient intake among depressed and nondepressed individuals. International Journal of Eating Disorders. 1996;20(1):105-109. doi:10.1002/(sici)1098-108x(199607)20:1<105::aid-eat12>3.0.co;2-3.
    3. Leonard B, Maes M. Mechanistic explanations how cell-mediated immune activation, inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression. Neuroscience & Biobehavioral Reviews. 2012;36(2):764-785. doi:10.1016/j.neubiorev.2011.12.005.
    4. Dandona P, Ghanim H. A. Insulin infusion suppresses while glucose infusion induces Toll-like receptors and high-mobility group-B1 protein expression in mononuclear cells of type 1 diabetes patients. American Journal of Physiology-Endocrinology and Metabolism. 2013;304(8). doi:10.1152/ajpendo.00566.2012.
    5. Insel P, Ross D. Carbohydrates. In: Nutrition. 6th ed. Burlington, MA. Jones & Bartlett Learning; 2016: 138-171.

Acupuncture and Anxiety

by Guinevere Crescenzi, Licensed Acupuncturist

Acupuncture is very effective for treating the symptoms of anxiety and depression.  Numerous studies have shown that it is an exceptionally useful tool either in combination with western pharmaceuticals  and therapy or as a stand alone method.  When used in combination with pharmaceutics, acupuncture reduces unpleasant side effects from the medicine.

If you suffer from anxiety and/or depression, we will discuss your symptoms and develop a personalized treatment strategy.  You may be given homework and nutritional advice based on Chinese medical theory.

Patients have told me that they notice that they are calmer, less worried, less depressed, and have an easier more positive outlook on their lives. Many have also reported they feel results almost immediately, but this is not always the case.

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