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Vicky

46-year-old professional female and mum to 2 children, 2 and 5

Key aim is to lose weight

•BMI = 25

•W:H ratio = 0.92 ideally no more than 0.85

Is not obese but had never got back into shape after pregnancies

No energy for exercising

What do we know so far?

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Breakfast - add nuts, seeds to introduce healthy fats and protein. Possibly berries which are lower in sugar. consider taking protein powder to increase protein

Snack - consider dropping the larabar. Increase protein in the snack. Hummus with the crisp breads, maybe a hard boiled egg?

Lunch - Consider adding protein to the pasta eg tuna, chicken. If she upped protein and good fats in her main meals she may feel less need to snack during the day

No coffee after 12 pm. Consider herbal teas or a decaf coffee

Lower the sugar content of pm snacks. Are there any savoury snacks she'd consider?

Does she eat with the family? What time do they eat dinner?

Alcohol - one night off a week? Glass of water between each glass.

Instead of the family sized haagendaaz - what about home made ice cream? Kids could be involved in making it. Home made popcorn. Maybe frozen yoghurt instead? Gelato? Maybe find these substutions for one night a week

Main meal - vegetables. smaller portion of potatoes - new potatoes with skin. Cool and reheat or sweet potatoes

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Chia seeds soaked in almond milk, with pineapple, nectarines and honey, 1 coffee

4 crispbreads + Larabar

Left-over pasta in tomato sauce and salad

Apple, 2 satsumas + MiniMagnum, 1 coffee

Pork chops and potatoes

Half bottle wine most evenings

1 family sized Haagen Daaz + family sized bag of crisps

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Mood swings – becoming easily irritable

Energy is 3/10 most days

Repeated bouts of thrush

Poor sleep – able to get to sleep but awaking 4am and staying awake, always gets up to wee

Cravings for sugar/starch/alcohol and significant guilt about not being able to control eating especially in the evenings

Mid-afternoon slump – has to have a cup of coffee to be able to continue working

What else do we want to know?

Are there any red flags?

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List your dietary advice at the bottom provide explanation as to why.

DIET

•Breakfast - add nuts, seeds to introduce healthy fats and protein. Possibly berries which are lower in sugar. consider taking protein powder to increase protein

Snack - consider dropping the larabar. Increase protein in the snack. Hummus with the crisp breads, maybe a hard boiled egg?

Lunch - Consider adding protein to the pasta eg tuna, chicken. If she upped protein and good fats in her main meals she may feel less need to snack during the day

No coffee after 12 pm. Consider herbal teas or a decaf coffee

Lower the sugar content of pm snacks. Are there any savoury snacks she'd consider?

Does she eat with the family? What time do they eat dinner?

Alcohol - one night off a week? Glass of water between each glass.

Instead of the family sized haagendaaz - what about home made ice cream? Kids could be involved in making it. Home made popcorn. Maybe frozen yoghurt instead? Gelato? Maybe find these substutions for one night a week

Main meal - vegetables. smaller portion of potatoes - new potatoes with skin. Cool and reheat or sweet potatoes

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LIFESTYLE

• Stress management

Try to find time for activities her (rather than work/for others) - with friends

Breath work, non-sleep deep rest, meditative practices --> to down regulate SNS and stimulate PSNS

Journaling, gratitude practices

• Circadian rhythm alignment

Light exposure in the morning (e.g. have brekkie in garden)

Getting outside more during the day

Minimise blue light in evening (e.g. device use, TV)

• Increase movement

Introduce more movement into her life, e.g. through getting off bus a stop earlier etc.

Activities with kids

Gentle activity, e.g. yoga

• Sleep hygiene

Trying to get to bed earlier in the evening

Incorporate sleep 'routine' (e.g. meditative practice, reading) to help get her body and brain ready for bed

Short naps (e.g. 20 mins) not too late in the day

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What lab testing would you recommend for Vicky. Consider what would be easily done with GP. Consider the utility of these tests the insights from chosen tests would have to inform your interventions.

LAB TESTS

• Thyroid Test - low thyroid hormones could contribute to low energy, T3 to T4 conversion/levels? --> to potentially rule this out/identify this as a driver behind low energy levels

• Liver Function Test - Apple shaped body - does she have any signs of fatty liver (scan), status of detoxification of environmental toxins?, ALT-Levels (measuring alanine aminotransferase)

• Vitamin & Mineral status, including B12 Levels (low-protein diet), triglyceride & LDL levels

• Measure insulin levels together with blood glucose levels to determine at which stage of the journey of IR Vicky is? (Would that change our diet/lifestyle approach?) --> could change the Vicky's motivation for changing her diet

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What are Hythe main drivers of her symptoms? Consider what biochemical imbalances might be at play here. Support your answers with points from the case information.

BIOCHEMICAL IMBALANCES

•HPA axis dysregulation - poor sleep & Dysglycaemia

•Dysglycaemia - mood swings, irritability

•Hyperinsulinemia & Hyperglycaemia - fat around the middle

•Obesity - driving leptin resistance

Oxidative stress - not enough antioxidants in her diet, exposure to chemicals

Mitochondrial dysfunction