Developing an Integrative Nutrition Plan for Cardiometabolic Disorder

Matthew was referred for nutrition intervention related to cardiometabolic disease. He is a 15-year-old male in an inpatient psychiatric unit for residential treatment. Upon admission at 14 years old, he weighed 278 pounds and had a body mass index (BMI) of 39.3 indicating obesity. 

Initial labs confirmed insulin resistance with hemoglobin A1C (HgbA1c) of 6.1 percent. Matthew reported having been diagnosed with “borderline diabetes” prior to admission.  In addition, his family history is positive for type 2 diabetes in both parents.

When I met with Matthew for the initial assessment, he reported daily consumption of regular soda, processed and fast foods, and his vegetable intake was extremely limited. Matthew was skeptical of any significant dietary change and he was especially hesitant to give up soda and concentrated sweets. 

I discussed with Matthew the importance of nutrition-related change in disease prevention and, when faced with the possibility of developing type 2 diabetes, he agreed to some minor diet-related changes.

We started with a no-concentrated-sweets diet and I encouraged him to increase his non-starchy vegetable intake and physical activity. After one month, his weight had dropped to 273 pounds and Matthew reported less difficulty walking up the stairs.

After several weeks, there was no significant improvement—his fasting glucose, HgbA1c, and weight remained essentially unchanged. I met with Matthew again and he agreed to walk for ten minutes after every meal, consume one half teaspoon of cinnamon daily at breakfast, and we added a multivitamin with B complex and 1,000 milligrams of omega-3 fatty acids daily.  An attempt was made to add walnuts and olive oil to his plan, but Matthew was resistant to this recommendation. One month later, there had been no change in his weight. 

I met Matthew a third time and after significant education on the long-term risks of cardiometabolic disease, he agreed to a calorie-controlled, consistent carbohydrate meal plan that included 45 grams of carbohydrate per meal with double nonstarchy vegetables. I also added a probiotic to target gut health and insulin resistance. One month later his weight had dropped to 260 pounds. Matthew reported having more confidence and was pleasantly surprised with his progress. 

At the one-year follow-up, his HgbA1c dropped to 5.9 percent, weight was 243 pounds, and BMI decreased to 34.3. Matthew reported being happy with his 35-pound weight loss and said he felt much better. He agreed to the addition of onequarter cup of walnuts, which, while not the therapeutic dose, is a step in the right direction, He also added two tablespoons of extra-virgin olive oil per day. 

One and a half years after the initiation of nutrition and lifestyle therapy, Matthew’s HgbA1c is down to 5.5 percent, his weight is 212 pounds, and his BMI is down to 30.4. Being creative, flexible, supplying specific nutrients, and allowing Matthew to participate in his own plan have been successful interventions. He struggled with manipulative behaviors and his food intake has been difficult to control at times, but he has been successful with reducing his overall risk and he is hopeful to prevent type 2 diabetes.

Editor’s Note: This is an excerpt from the e-book, Components of a Successful Nutrition Protocol. To access the full text, click here.