Dr. Anjanaa Subramanian, MD (Natural Medicine), CFMP, MPT, PGDHM
How early insulin resistance and poor dietary diversity impaired performance in a lean adolescent athlete — and how targeted herbal and functional interventions supported metabolic recovery.
ABSTRACT
A 16-year-old female competitive swimmer presented with increased central adiposity, elevated body fat percentage (32%), poor post-exercise recovery, and cognitive fog, despite adherence to a high-protein diet and intensive training regimen. Initial investigation revealed an elevated fasting insulin level (11 μIU/mL), indicating early insulin resistance—often underrecognized in lean adolescents with athletic physiques. The dietary pattern—predominantly animal protein with low phytonutrient and fiber diversity—alongside training-related adrenal strain was identified as a root contributor to metabolic inflexibility, impaired hormonal recovery, and inflammation.
A functional medicine approach was initiated, including a customized herbal adaptogenic blend (Withania somnifera, Bacopa monnieri, Tinospora cordifolia, Glycyrrhiza glabra, Rubia cordifolia, Asparagus racemosus) targeting insulin regulation, cognitive resilience, and hormonal axis support. Additional interventions included high-fiber, plant-forward dietary shifts, intentional breathwork, and yoga for autonomic balance.1-3
Over 12 weeks, the patient demonstrated improved recovery, reduced brain fog, and a trend toward fat redistribution. This case emphasizes the need to evaluate metabolic, neuroendocrine, and gut-immune contributors in young athletes with unexplained fat gain and under-recovery. Herbal therapeutics, when applied with precision, may offer significant benefits in adolescent metabolic recalibration and performance optimization.2-4
CASE NARRATIVE
A 16-year-old female competitive swimmer presented for integrative consultation with concerns of persistent abdominal fat, a high body fat percentage (DEXA: 32%), and inadequate post-exercise recovery, despite maintaining a strict training regimen and a high-protein diet for over three years. The patient reported daily fatigue, poor muscle recovery, and memory fog, which were beginning to affect her athletic performance and academic focus.
Her diet consisted predominantly of animal protein, with minimal fiber or plant diversity. Training included daily swim sessions combined with resistance work 5–6 times per week. Despite discipline in both exercise and nutrition, the patient had experienced a plateau in performance and visible fat accumulation around the midsection.
Initial functional labs revealed a fasting insulin level of 11 μIU/mL, suggestive of early insulin resistance. This is increasingly recognized in adolescents exposed to high-intensity training, poor dietary diversity, and suboptimal recovery strategies.1 No major abnormalities were seen in standard blood work. However, based on symptomatology and dietary history, functional insulin resistance, overtraining-related adrenal stress, and subclinical neuroinflammation were considered contributing factors.3
A tailored herbal protocol was introduced, combining adaptogenic and metabolic herbs including Withania somnifera (ashwagandha), Bacopa monnieri (brahmi), Glycyrrhiza glabra (licorice), Zingiber officinale (ginger), Tinospora cordifolia (guduchi), Rubia cordifolia (manjistha), and Asparagus racemosus (shatavari). These herbs were selected for their established roles in modulating cortisol, supporting mitochondrial function, reducing neuroinflammation, and improving insulin sensitivity.2-4 They were dispensed as a powdered blend in capsules, taken twice daily.
Nutritional interventions included increased fiber from seasonal vegetables, soaked seeds, lentils, and fermented foods; low-glycemic fruits; and structured breathing and yoga practice for autonomic regulation.
After 12 weeks, the patient reported significant improvements in recovery, mental clarity, and reduced bloating. Follow-up body composition testing revealed a reduction in fasting insulin to 6 μIU/mL and a decrease in visceral fat to 25%. The case highlights the clinical relevance of functional markers in adolescent athletes and the therapeutic potential of herbal medicine in restoring metabolic balance and performance capacity.
Dr. Anjanaa Subramanian, MD (Natural Medicine), CFMP, MPT, PGDHM, is a functional medicine practitioner and sports physiotherapist. She is the founder of Recover Integrative Medicine, where she helps patients reverse chronic metabolic and autoimmune conditions using a personalized blend of herbal remedies, nutrition, exercise, and gut-focused therapies. Dr. Anjanaa specializes in treating insulin resistance, thyroid dysfunction, PCOS, arthritis, and digestive disorders through non-pharmacological, root-cause approaches. Her work combines modern diagnostic insight with time-tested herbal interventions, making her a sought-after expert in the integrative medicine community. She regularly publishes clinical case studies and educates practitioners on bridging the gap between physiotherapy and natural medicine.
References
1. Packer CJ, et al. Overtraining in adolescent athletes: neuroendocrine and metabolic considerations. Curr Sports Med Rep. 2021;20(3):130–136.
2. Kalra S, Sahay R, Unnikrishnan AG. The Ayurveda–Endocrinology interface. J Ayurveda Integr Med. 2013;4(1):8–16.
3. Lopresti AL. Cognitive and mood effects of adaptogenic herbs: a review. Phytother Res. 2017;31(5):643–655.
4. Kalra S, Agrawal N, Dhingra S. Insulin resistance and herbal medicine: a review. Ind J Endocrinol Metab. 2017;21(2):294–296.