Case Studies and Reviews Keywords Cardiometabolic disease Nutritient depletion Andrew Heyman, MD, MHSA Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA James B. Lavalle, RPh, MS College of Pharmacy, University of Cincinnati, Cincinnati, Ohio, USA Ernest B. Hawkins, RPh, MS Integrative Health Resources, Asheville, NC, USA Lena Edwards, MD Balance Health and Wellness Center, Lexington, Kentucky, USA E-mail: ahheyman@med.umich. edu Online 24 April 2010 An integrative medicine approach to managing nutrient depletions in the cardiometabolic patient Andrew Heyman, James B. Lavalle, Ernest B. Hawkins and Lena Edwards Abstract This article presents a further exploration of the risk factors underlying cardiometabolic (CM) disease and their identification and management within an integrative medicine framework as illustrated by the case of a 30-year-old obese African American male who presented for a follow-up visit with regard to his metabolic syndrome (MeS). This article reviews in detail the pathophysiology of common nutrient depletions and their contribution to CM disease risk, as well as drug-induced nutrient depletions incurred during treatment for CM disease and the MeS. The review also includes a detailed discussion on the evaluation and treatment of nutrient deficiencies. The article concludes with a detailed discussion of the case resolution. Following an extensive metabolic evaluation, a program of specific nutrient repletion was instituted alongside testosterone replacement therapy in addition to instituting stress reduction techniques and herbal supplements to improve his physiologic stress response. The patient returned to clinic after 3 months to review progress and laboratory results. He had lost 15 pounds, reported increased energy levels, and complete elimination of joint aches. He was scheduled to return to the clinic after a further 3 months for re-evaluation. ß 2010 WPMH GmbH. Published by Elsevier Ireland Ltd. Case A 30-year-old obese African American male with a body mass index (BMI) of 36 presented for a follow-up visit with regard to his meta- bolic syndrome (MeS). At a prior visit, he was encouraged to lose weight and begin an exer- cise program. At the latest visit, he also com- plained of generalized joint aches for which he self-medicates with ibuprofen as needed. He had a waist circumference of 46 inches, blood pressure 138/89, fasting blood glucose 110 mg/ dl, fasting insulin 36 mU/ml, high-sensitivity CRP (hs-CRP) 4.5 mg/l (elevated risk), total cho- lesterol 235 mg/dl (LDL 160 mg/dl, HDL 39 mg/ dl), and triglycerides 174 mg/dl. His compre- hensive metabolic panel was otherwise unre- markable. There is a history of premature coronary heart disease in his father and older brother, and his parents and two older broth- ers suffer from diabetes and several related complications. The patient reported that his busy work schedule and increase in business travel have precluded him from adhering to a proper dietary and exercise regimen. Since the patient has been unable to voluntarily improve his health, drug interven- tion is likely necessary. According to current ß 2010 WPMH GmbH. Published by Elsevier Ireland Ltd. Vol. 7, No. 2, pp. 145–158, June 2010 145