32 Homeopathy TODAY • NationalCenterForHomeopathy.orgWinter 2011

Battle the Bulge &

Battle the Bulge &

A Whole Person Approach to Metabolic Syndrome: hypertension, high cholesterol,pre-diabetes, & obesityby AMY ROTHENBERG, ND, DHANP

A Whole Person Approach to Metabolic Syndrome: hypertension, high cholesterol,pre-diabetes, & obesity

33NationalCenterForHomeopathy.org • Homeopathy TODAYWinter 2011

“I’d never even heard of that until mydoctor wrote it down for me,” she said.After doing some reading on metabolicsyndrome, Caroline was feeling over-whelmed by the gravity of her health chal-lenges and what seemed like anunavoidable downward slide.

The funny thing was, Caroline didn’tfeel too bad! She expressed concernthough about taking a lot of medications,as until fairly recently, she had not takenany at all beyond a multivitamin and anoccasional Vitamin C. “Now, it seems thateach time I go to the doctor, he gives meyet another drug to take!” she said. Caro-line was taking a statin drug to lower cho-lesterol, two different drugs to lower bloodpressure, and Metformin to help herbody’s insulin work more effectively,thereby lowering blood sugar.

A syndrome of epidemicproportionsRight on the heels of the epidemic obesityin the US, we have an epidemic of meta-bolic syndrome*—defined as a cluster ofconditions occurring together that affectmetabolism, including hypertension, highblood sugar, an unhealthy cholesterol pro-

file, and the presence of extra abdominalfat. Any one of these would not be ideal,but when they exist together, a person isripe for all sorts of serious health prob-lems related to blood vessels, heart disease,stroke, and type II diabetes. Some sourcesreport upwards of 25 to 30% of Ameri-cans over age 20 have metabolic syn-drome—an epidemic by any measure.[See “Do you have metabolic syndrome?”on page 34.]

The “spare tire” as culpritAccording to the National Library of Med-icine’s PubMed Health, the two mostimportant risk factors for metabolic syn-drome are:• An apple-shaped vs. a pear-shaped

body—as your waistline grows, so dothe risks for serious illnesses; extraabdominal weight is worse than extraweight distributed elsewhere or moreevenly throughout the body.

• Insulin resistance—when your body’scells don’t respond adequately to normallevels of insulin (the hormone that car-ries glucose into the body’s cells), glucoselevels in the blood rise; and abdominalfat contributes to insulin resistance.Other risk factors for metabolic syn-

drome include aging, a family history oftype II diabetes, lack of exercise, and abody-mass index greater than 25.

There is hopeThe good news is that lifestyle modifica-tion alongside a handful of natural medi-cines can mitigate the cascade of metabolicsyndrome. And even if the syndrome can-not be entirely reversed for every patient,we can often improve the risk factors forillness (e.g., lower the blood pressure,triglycerides, blood sugar, etc.), which willallow the person to take fewer or lowerdoses of pharmaceuticals, thereby reduc-ing unwelcome drug side effects.

Get Healthy!Get Healthy!Caroline was a robust and outgoing woman in her mid-50s who had lived alife filled with family, friends, satisfying work as a teacher, and community involve-ment in her hometown. That she was overweight seemed part of her life story, thoughshe said it hadn’t noticeably affected her health until the past few years. When she wasin her 40s, her blood pressure had crept up, and her cholesterol profile had worsened.Likewise, her fasting blood sugar had climbed higher than normal, and her weighthad further increased to the point that she was now 50 pounds overweight. With allthese risk factors for heart disease, stroke, and diabetes layering one atop the other,her family doctor had recently diagnosed her with “metabolic syndrome.”

Right on the heels of the epidemic obesity in the US, we have an epidemic of metabolic syndrome.

Where does homeopathy fit in? Afterseveral decades of practice, I can sayclearly that homeopathy, in and of itself,can help with blood pressure issues. Butmore to the point, homeopathy can help apatient with the impact of stress, whichoften gets in the way of healthy foodchoices, exercise, and mindfulness prac-tices—each an essential component oftreating someone with metabolic syn-

drome. I also have found that a well-pre-scribed constitutional remedy can give aperson the additional resolve andwillpower needed to make the difficultlifestyle changes essential to improvingmetabolic syndrome.

Goodbye visions of sugar plums...Holiday times can be the most challengingfor patients who struggle with these issues,

since we have the triple whammy of familystress, sugary and fatty foods everywhere,and travel/schedule shifts that interferewith diet and exercise routines. For patientswith metabolic syndrome, I always sched-ule an appointment before the holidays, asa combination homeopathic/naturopathicfollow-up visit, alongside a strategy/cheer-leading session. Caroline’s visit coincidedwith the start of this challenging season.

Our first goal was to take an honestlook at her diet. There is no magic formulafor weight loss, and my recommendationswere all things she already knew: smallerportion sizes, fewer refined foods, morefiber (through vegetables, whole grainsand some fruit, especially those lower onthe glycemic index**), and the addition ofheart-healthy foods. On that list I alwaysplace legumes, oat bran, garlic, andonions. Over the years, I have found thathelping people put foods into the diet isoften just as important as getting foodsout of the diet.

My dietary recommendations arealways individualized to the patient, muchlike a homeopathic remedy; they are basedon the person’s current diet and their rela-tionship to food at the time of our visit.It’s all well and good to make sweepingrecommendations according to one of thepopular dietary approaches promoted formetabolic syndrome and/or weight loss—from extremely low carb to completelyvegan, and everything in between. Butsince these dietary changes are going toneed to be permanent, I would rather apatient make gradual and sustainablechanges than grandiose ones they cannotmaintain.

So if a person is drinking soda 3 or 4times a day, I would start with helpingthem discontinue the soda habit. If theperson has been vegetarian, I wouldencourage them to consider adding meatand fish into the diet, as adequate proteinis essential to feelings of satiety and theseare easy forms of nutrient-dense food. Ingeneral, I encourage my patients to eat alow fat, natural foods diet where carbohy-drates are limited and complex and veg-etables are plentiful. I like to increase theuse of olive oil and decrease or eliminatedairy foods (or at least shift to low- or no-fat dairy).

34 Homeopathy TODAY • NationalCenterForHomeopathy.orgWinter 2011

Do you have metabolic syndrome?

The American Heart Association and the National Heart, Lung, and BloodInstitute list 5 factors that make up metabolic syndrome. The diagnosis of

metabolic syndrome is made if you have at least three of these:

Large Waist Size For men: 40 inches or largerFor women: 35 inches or larger

Cholesterol: High Triglycerides Either150 mg/dL or higherorUsing a cholesterol medicine

Cholesterol: Low EitherGood Cholesterol (HDL) For men: Less than 40 mg/dL

For women: Less than 50 mg/dLorUsing a cholesterol medicine

High Blood Pressure EitherHaving blood pressure of 130/85 mm Hg or greaterorUsing a high blood pressure medicine

Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher

With Caroline, I spent time talkingabout healthy snacks that contain proteinand do not include refined carbohydrateslike those in cookies, candy, and cake.Snack examples that topped my list for herwere: low fat cheese with whole graincrackers; a small palm-sized portion ofnuts with an apple; hummus with carrots.

Because of her high blood pressure, wealso spoke of the need to seriously reducesalt intake, best accomplished by not eat-ing prepared foods in general, readinglabels carefully, and not eating out as oftenas she did. The recommended amount ofsodium for people with high blood pres-sure is about 1500 milligrams a day. Anyreduction Caroline could make in her saltintake might help, though not all hyper-tensive patients are impacted similarly.

Essential exerciseThough Caroline was not as sedentary asmany of my patients, she did not get goodsustained aerobic exercise very often. Shedid enjoy working weekly with a traineron weightlifting and Pilates-type exercises,and I encouraged her to stick with that.Muscle burns more calories than fat, sotoning up helps. I encouraged her to get apedometer and aim for 10,000 to 12,000steps a day, as a consciousness raiser if

nothing else! It can beenlightening to realize youhave only walked 640 steps ina day and for some, that’sfrom the bed to the desk tothe bathroom to the refriger-ator to the couch! Addingphysical activity helps withweight loss while simultane-ously decreasing the risk ofdiabetes and coronary heartdisease. At least 30 minutes ofmoderately intense exercise aday is recommended. Walk-ing is fine! I often encouragepatients to walk with afriend; if you make a socialdate, you are more likely todo it!

Counteractinginevitable stressI also knew that in Caroline’scase her blood pressure was

worse when she was stressed, and the pastseveral years had found members of herextended family in a number of crisis situ-ations, which weighed heavily on herheart. We talked together about what shecould do that would be stress-reducing—from meditation to yoga, from painting toplaying the guitar. She agreed to sign upfor a mindfulness meditation programand give that a whirl. We are never too oldto try new things, and Caroline was readyto try something different.

Whole person homeopathyFor homeopathic treatment, I needed tofind a constitutional remedy for someonewith high blood sugar and hypertension,who was also generous and outgoing. If we look in the Synthesis Repertory, in the“Generalities” section, we can find therubric: “Hypertension.” Also, in the“Urine” section, we see the rubric, “Urine:Sugar,” which is another way to say dia-betes. Even way back when many of ourhomeopathic books and tools were writ-ten and created, we had illnesses likehypertension and diabetes.

In interviewing Caroline, I took her fullhomeopathic case and learned a few addi-tional things of interest to aid my remedysearch. She had a history of very difficult

menstrual cycles, with strong symptomsof PMS including irritability, feeling hot,excessive bleeding, and abdominal pain,all very much relieved when the flowbegan. She would also get significant pre-menstrual headaches. She was just aboutfinished with monthly cycles, though thusfar, menopause had not been easy for her.Between mood swings and hot flashes, sheoften felt on edge. Her family laughedwith her about these symptoms, but shecould get to feeling overwhelmed prettyeasily, and then she’d snap, especially ather husband. She got over it quickly, apol-ogized, and they’d move on. She was look-ing forward to the end of these hormonalups and downs.

Caroline also had a history of sorethroats; it seemed to be her weak area, andshe could count on one or two bad ones ayear, which she treated at home with rest,gargling, and extra fluids.

The only other issue Caroline had wassleep apnea, which interfered with herrest. She had difficulty with the C-PAPmachine she was supposed to use at nightwhen she slept (a ventilation device thatblows a continuous stream of air into thenose to keep the airway open) and hadmostly abandoned it. I encouraged her togo back to her sleep doctor and try a dif-ferent machine, as a connection betweensleep apnea and metabolic syndrome hasbeen postulated in recent years, andimprovements have been made to the C-PAP machines as well.

Good health history, not-so-good geneticsBesides the birth of her two children, whowere now grown, Caroline had never beenhospitalized, and prior to ten years ago,she had never taken medications. Herfamily history was notably replete withdiabetes, hypertension, and overweight.Her grandparents all lived to their 70s, andall had passed away from things related tothese risk factors. We had an honest and difficult conversation about how geneticscan be hard to beat. I saw how concernedshe was and how much work thesechanges were going to be for her—but Ialso saw how very motivated she was andthat she was determined to not becomeanother statistic.

35NationalCenterForHomeopathy.org • Homeopathy TODAYWinter 2011

It can be enlightening torealize you have onlywalked 640 steps in a dayand for some, that’s fromthe bed to the desk to the bathroom to the refrigerator to the couch!

It can be enlightening torealize you have onlywalked 640 steps in a dayand for some, that’s fromthe bed to the desk to the bathroom to the refrigerator to the couch!

That she had a supportive husband athome and friends who were going to helphad me optimistic about her ability tochange the course of her health. We brain-stormed ways she could ask for support(e.g., don’t bring sweets into her home, bea walking buddy, take a meditation classtogether).

Caroline had a lot of confidence, shespoke articulately, and directly. Her energywas outward, not inward, if you will. Shewas easy to connect with. The only bodilysymptom she felt that related to the meta-bolic syndrome was a sense of pulsation inher neck and head, likely due to her highblood pressure.

A remedy for CarolineIn a basically healthy, warm-blooded,extroverted, confident, patient who hasmenstrual/menopausal symptoms alongwith hypertension and blood sugar issues,I am usually thinking about four reme-dies: Sulphur, Lachesis, Belladonna, andMedorrhinum. People needing each ofthese remedies tend to be extroverted,upbeat, and able to easily connect withothers. While there are many possibleremedies that might be considered for herchief complaints (hypertension and dia-betes), in reality, she had very few physicalsymptoms related to her diagnoses. So

instead, I needed to rely more on physicalgeneral symptoms and modalities along-side temperament and personality to finda remedy for Caroline.

Sometimes students ask me, how can itbe that easy? I suppose it’s not that easy,because a certain amount of experienceand understanding goes into arriving atsuch small handful of remedies! Once Iam at that small group of remedies, I usemy understanding of differential materiamedica—that is, comparing remedies thatshare certain aspects—to then choose theremedy that best matches the patientbefore me.

I chose Lachesis for Caroline as she hadthe keynote confirmatory symptom ofgenerally feeling better with the menstrualflow. She also had the history of sorethroats (often a weak area of the body forLachesis patients) and the sleep apnea (aLachesis keynote—gasping while fallinginto deeper sleep, found in the repertoryrubric “Respiration, difficult, sleep, dur-ing.”) The way Caroline described herheadaches, where the main thing shecould report was that the pain was betterwith the start of her menses, was anotherclear Lachesis symptom (see the repertoryrubric: “Head, pain, menses, before,beginning of, ameliorates”). She also artic-ulated a feeling of fullness when her blood

pressure was elevated, which pointed toLachesis.

Like many of our more emotionallybalanced patients, Caroline did not havethe classic jealousy or ragefulness that wesometimes see with those needing Lach-esis. She was certainly chatty and had a lotto say, but she had not crossed that line ofbeing unbearably loquacious (a classicLachesis symptom). She did tend to getsnippy with family especially during thePMS time or more recently, related to per-imenopause (those needing Lachesis cansometimes be malicious or nasty), but Idid not see these as dire symptoms thatwere deeply impacting her life. Nonethe-less, you can see shades of Lachesis in thesetendencies, and I did use that understand-ing of her emotionality to confirm myprescription.

I recommended one dose of Lachesis200c.

Natural medicine supportIn addition to the lifestyle counseling andhomeopathic prescription, I recom-mended some supplements for Carolineaimed at helping to improve her body’sability to use insulin, lower total choles-terol, lower LDL cholesterol, raise HDLcholesterol, and support normal bloodpressure. These prescriptions were basedon Caroline, the results of her lab tests, hercurrent weight, and other medications shewas taking. Some of the things I use insuch cases include Guggul commiphora tolower cholesterol, fish oil to help withhypertension and the cholesterol profile,and the cardio-protective supplementsCo-Q10 and the amino acid L-carnitine. Ifyou or a loved one has the same diagnosis,in addition to seeing a good homeopath,please refer to a well-trained naturopathicphysician. (See www.naturopathic.org forreferral listings.)

Positive stepsWhen I next saw Caroline at our one-month follow-up visit, she was happy toreport that she had lost three pounds. Herhot flashes had become less frequent andless intense, for which she was thankful.“I’m sleeping much better now, too. Idon’t feel like I’m waking that often,” shesaid “but I made an appointment for

36 Homeopathy TODAY • NationalCenterForHomeopathy.orgWinter 2011

As if having excess belly fat wasn’t ascourge in itself whenever we pass by amirror or try to zip our favorite jeans, wenow know that it puts us at risk for all kinds of serious illnesses! The culprit is notso much the soft fat you can pinch withyour fingers but the deep, hard visceral fat that collects around the abdominalorgans. Those abdominal fat cells secretehormones that have far-reaching effects,contributing to insulin resistance andincreased inflammation throughout thebody. Excess belly fat is much worse

than the fat that collects on the thighs, legs,or upper arms; it has been linked to meta-bolic syndrome, diabetes, cardiovasculardisease, asthma, dementia, breast cancer,stroke, colorectal cancer, and more.

Just some more great reasons to make that New Year’s resolution toexercise 30 minutes a day, cut out the sugaryfoods, and drop those

extra pounds!

Trim your tummy in 2012

another sleep study for next monthanyway.” Caroline had been taking hersupplements twice a day, though sheoften forgot her evening doses. She hadstarted in with the meditation class; shewasn’t sure it was for her but plannedto stick with it for a while.

Caroline had made it through theholidays in Lachesis style, telling every-one she ran into about her diagnosis,what it was, what she had to do to helpherself, and getting all kinds of supportand encouragement from friends andfamily. Overall, Caroline seemed to bedoing very well. While weight loss isoften associated with an improvementin sleep apnea, it would take a lot morethan three pounds to make the kind ofdifference Caroline had reported. Sothe significant improvements in her

sleep, her sleep apnea, and her hot flashestold me that we were on the right trackwith the homeopathic remedy. I did notrepeat the remedy at that visit.

A year of progressCaroline continued to see me periodicallyover the following year and continued tomake progress on all fronts. She had fewerillnesses in general, with no reported sorethroats. After years of monthly headachesbefore her periods, she was amazed to havehad many months without a premenstrualheadache, even though her menstrual peri-ods seemed to be back to regular. Althoughshe still had the occasional hot flash, theywere nothing terrible and certainly not assevere or frequent as before.

At the one-year mark, Caroline wasthrilled to have lost 14 pounds and, work-ing with her primary care doctor, to havebeen able to eliminate one of her bloodpressure medications without an increasein blood pressure. Her sleep doctor con-firmed that she no longer had sleep apnea

at all, which I would assume was a result ofthe weight loss—with help from thehomeopathic remedy. Caroline felt morein control with her eating and was faithfulto her exercise program of weightliftingand walking. Her LDL cholesterol wentdown and her HDL cholesterol went up.She was still on Metformin and Lipitor®but had already discussed the possibilityof lowering each with her primary caredoctor. Emotionally, she felt much morestable, less overwhelmed, and more calm.

A key to increased resolveHomeopathy and natural medicine ingeneral, are not going to be cure-alls formetabolic syndrome. Serious examinationand modification of lifestyle factors willnecessarily be the cornerstones of anytreatment of a patient with this diagnosis,but homeopathy should be used to helpwith stress reduction and to increase theresolve patients often need to make suchhealth-centered changes.

I have had the unique perspective of

doing constitutional homeopathy in thecontext of a general naturopathic prac-tice for more than 25 years. I have a sen-sibility about what is doing what for apatient. When I see menopausal symp-toms abate and sleep apnea disappearand headaches and sore throats cease, Iknow the homeopathic remedy is hardat work. Although I use whatever tools Ihave to help my patients (e.g., supple-ments to help lower cholesterol andlifestyle counseling to lose weight), thehomeopathic prescribing is key: it helpsto optimize the impact of all the otherthings, it gives the person’s vital force apush, it gives the patients some addi-tional energy and the willpower tomake essential changes.

I use a dose of a well-indicatedhomeopathic remedy when patientsneed a boost, when there are physical

symptoms that just won’t budge, andwhen the spirits are flagging. And I leanon my naturopathic knowledge, too! As istrue for all patients with metabolic syn-drome, including Caroline, I love having arange of approaches to help them alongtheir path toward better health!

Footnotes* Metabolic syndrome is also sometimes calledSyndrome X or Insulin Resistance Syndrome.** The glycemic index (GI) ranks carbohydratefoods on how quickly they affect blood sugarlevels. Foods that break down quickly to releaseglucose into the bloodstream have a higherglycemic number than those that release glu-cose more slowly. For example, cherries have arelatively low GI at 22, while watermelons havea high GI at 72. It is easy to find glycemic indexcharts on the internet.

37NationalCenterForHomeopathy.org • Homeopathy TODAYWinter 2011

Amy Rothenberg, ND, DHANP, is the author of The A CappellaSinger Who Lost Her Voice &Other Stories from NaturalMedicine. See www.amyrothen-berg.com. For information about The New England

School of Homeopathy, see www.nesh.com. For information about Dr. Rothenberg & Herscu’spractice, Naturopathic Health Care in Enfield, CT,see www.nhcmed.com

A B O U T T H EA U T H O R

Holiday times can be the most challenging …the triple whammy of family stress, sugary and fatty foods everywhere, and travel/schedule shiftsinterfere with diet and exercise routines.