Please respond to to this student’s DB, use one peer reviewed source This patie

Please respond to to this student’s DB, use one peer reviewed source
This patient meets the criteria for metabolic syndrome based on her insulin resistance, obesity, hypertension, and clear signs of inflammation. Based on her physical examination, it is likely that she has intestinal hyperpermeability and dysbiosis that may be exacerbated by her chronic antibiotic use. Her recent diagnosis of autoimmune thyroiditis and elevated CRP tells me that she has underlying inflammation as well. She is at high risk for cardiovascular disease due to her familial history of heart disease, elevated homocysteine, hypertension, insulin resistance, and obesity. She is also showing signs of hormonal dysregulation and likely estrogen toxicity, indicating that she could use detox support.
She should be placed on a cardiometabolic diet, which focuses on cardiovascular health and weight loss. She should be on a 300-500 calorie deficit to facilitate for weight loss. More specifically, a mediterranean diet high in antioxidants has been shown to decrease inflammation and heart disease risk factors as well as assist with weight loss (1). By adding in lots of leafy green vegetables high in antioxidants such as vitamin C and E, as well as green tea, she can combat the inflammatory side effects of increased weight and high blood sugar to assist with vascular damage repair. Additionally, she should be sure to include cruciferous vegetables in high amounts to help detox estrogen.
Ideally I would order a stool test to determine the best way to re-establish her microbiome in a healthy way. I would also order a full thyroid panel, salivary cortisol, and lipid panel.
The first recommendation I would make is for her to increase her activity. This doesn’t necessarily have to be a gym workout, but just any kind of movement she enjoys. I would recommend she start incorporating walking or yoga as an introduction to workouts. Additionally, she should start taking a probiotic to support her gut health and assist with weight loss (2). Initially I would have her take 25 billion units, dropping down to 10 billion units after 12 weeks. She may also find some benefit from behavioral therapy to address her identified stress eating habits.
References:
1-Rinott E, Meir AY, Tsaban G, et al. The effects of the Green-Mediterranean diet on cardiometabolic health are linked to gut microbiome modifications: a randomized controlled trial. Genome Med. 2022;14(1):29. Published 2022 Mar 10. doi:10.1186/s13073-022-01015-z
2-Álvarez-Arraño V, Martín-Peláez S. Effects of Probiotics and Synbiotics on Weight Loss in Subjects with Overweight or Obesity: A Systematic Review. Nutrients. 2021;13(10):3627. Published 2021 Oct 17. doi:10.3390/nu13103627