Kimberly M. Sanders, ND

Assistant Professor of Clinical Sciences and GraduateUniversity of Bridgeport School of Naturopathic Medicine

“Steven is a 56-year-old male who first presented in June 2018 for management of left knee osteoarthritis which he rated a 5/10 in severity.  He was morbidly obese with a BMI of 47.8.  Upon physical exam, I noted mild effusion in the left knee but no erythema or pain upon palpation.  There was restricted flexion of the left knee noted as well.  The right knee examination was normal.  On his first visit, I ordered basic labs to evaluate his blood sugar and cholesterol levels, along with vitamin D and thyroid panels.  His fasting glucose returned slightly elevated at 101 mg/dL, A1C at 5.8%, and his insulin was high at 21.8 uIU/mL.  His vitamin D was also low at a 25 ng/mL.  His cholesterol panel was within normal limits.  Based on these findings, I determined that insulin resistance was contributing to his obesity, which was a likely underlying cause for his left knee osteoarthritis.  In addition, his vitamin D insufficiency could also be an obstacle to cure, as lower vitamin D levels may be related to worsened osteoarthritis progression.  My focus for the patient was on symptomatic control in the short-term with a long-term goal to improve insulin sensitivity and promote weight loss to reduce tension on the joint.  He was given an exercise and dietary plan to improve insulin sensitivity along with vitamin D replacement therapy, a bioflavonoid complex, high EPA omega-3 preparation, and a curcumin preparation for symptom control and anti-inflammation.

Steven returned in August 2018 with updated labs.  His fasting glucose remained elevated at a 103 mg/dL but his insulin was now an 11.6 uIU/mL.  His A1c% was not re-run since only two months had passed.  He had not yet noticed weight loss or pain reduction, but also admitted to irregular compliance with the diet.  He did comply regularly with the exercise regimen, which is likely responsible for the drop in insulin noted.  After another two months, his fasting glucose remains elevated at a 106 mg/dL but his A1c% is now a 5.5%.  His insulin is still an 11.1 Uiu/mL, and his vitamin D is now a 31 ng/mL.  Most notably, however, is a 30% improvement in his knee pain and function at this visit.  He noted that the combination of curcumin and high EPA fish oil preparation seemed to provide great relief after consistent use, despite not yet losing weight.  At our last visit with Steven in February 2019, his insulin continues to hold at 11.2 Uiu/mL and his A1c% is now 5.3%.  Now that the holiday season has passed, he notes better compliance with his dietary plan since the new year, and has already noted a 16-pound weight loss.  His knee pain remains a 2/10, and he has reduced his dependence on ibuprofen by instead using curcumin and high EPA preparation.”