A 44-year-old female presented with progressive fatigue over 18 months, central weight gain despite no dietary change, brain fog, and difficulty maintaining sleep beyond 4–5 hours. HbA1c was 41 mmol/mol (borderline), fasting insulin elevated at 22 mIU/L, and HOMA-IR 4.8. TSH within normal range. Had been told by her GP that her bloods were "normal."
Detailed history revealed high occupational stress, evening screen use until midnight, coffee intake of four cups daily including one at 4pm, and a history of childhood antibiotic courses. Pittsburgh Sleep Quality Index score was 14 (severe impairment). Cortisol awakening response (salivary) showed a blunted morning peak and elevated evening cortisol. Comprehensive stool analysis identified reduced microbial diversity and low Akkermansia muciniphila.
Sleep: no caffeine after 12pm, blue light glasses from 8pm, consistent 10:30pm bedtime. Nutrition: time-restricted eating (8am–6pm), Mediterranean dietary pattern, no refined carbohydrate after 3pm. Gut: targeted probiotic including Lactobacillus rhamnosus and inulin-based prebiotic. Stress: daily 20-minute slow breathing practice using resonance frequency protocol. No pharmaceutical intervention.
Patient reported significant improvement in energy, cognitive clarity, and mood. No adverse events. Fasting insulin at target range at 6-month review.
A 31-year-old female with a 4-year history of IBS (bloating, alternating constipation and diarrhoea), anxiety, and irregular menstrual cycles (ranging 24–38 days). Previous colonoscopy normal. On low-dose SSRI for 18 months with partial response. Had tried FODMAPs elimination with initial improvement but symptom return.
Comprehensive stool analysis revealed elevated Candida, low secretory IgA, and high calprotectin at 180 μg/g. DUTCH hormone test showed low progesterone in the luteal phase, elevated beta-glucuronidase (indicating impaired oestrogen clearance), and low cortisol awakening response. Dietary analysis identified high sugar intake and regular alcohol use (12 units/week).
Phase 1 (weeks 1–6): antifungal protocol (caprylic acid, oregano oil), removal of refined sugar and alcohol, high-fibre anti-inflammatory diet. Phase 2 (weeks 7–16): targeted probiotic for gut restoration, calcium-d-glucarate to support oestrogen clearance, magnesium glycinate 300mg at night. Referral to gynaecologist for cycle support in parallel.
SSRI dose successfully reduced under GP supervision at month 4. Patient remained on dietary protocol at follow-up with no relapse of gut symptoms.
A 52-year-old male presented 14 months post-COVID-19 infection with persistent fatigue, post-exertional malaise, cognitive impairment, and heart rate instability on standing (orthostatic tachycardia). Previously athletic and professionally active. Standard workup negative. Had been referred to cardiology — ECG and echocardiogram normal.
HRV monitoring showed severely reduced resting HRV (RMSSD consistently below 15ms). Comprehensive stool analysis revealed significant dysbiosis with markedly reduced Firmicutes and elevated Proteobacteria, low secretory IgA. Organic acids testing showed elevated oxidative stress markers and impaired mitochondrial function (elevated citric acid cycle intermediates). Salivary cortisol profile blunted across the day.
Phase 1: paced activity management (no exertion above symptom threshold), anti-inflammatory dietary pattern, gut restoration protocol. Phase 2: mitochondrial support (CoQ10 300mg, ribose, magnesium malate). Phase 3: gradual HRV biofeedback using resonance breathing, increasing slowly over 8 weeks. Vitamin D optimisation (was 28 nmol/L at baseline).
Patient returned to light exercise at month 8. Ongoing monitoring recommended. Full recovery not yet achieved but trajectory consistently improving.
