The Journey 

​​​​

​

CASE STUDY

​

Resolving Gut Dysfunction, Autoimmune Thyroid Disease & Elevated Cardiovascular Risk Through Personalised Nutrition and Functional Medicine

​​​

​

Who This Is For?

​

If you have been struggling with persistent bloating, constipation, exhaustion, low mood, joint pain, and unexplained cardiovascular risk for months or years — and feel like nothing has worked — this case study is for you.

This is the story of how G.D., a woman in her mid-fifties, found lasting relief from debilitating digestive symptoms, fatigue, and mood disruption through a root-cause functional medicine approach.

If you are looking for functional medicine for SIBO, bloating, or Hashimoto’s thyroiditis — or a nutritional therapist for gut health, fatigue, or cardiovascular risk — or a root-cause approach to autoimmune thyroid disease in Ireland, the UK, or online — read on.

The Journey

​

Presenting Symptoms & Goals

​

G.D. came to Paul having lived with a complex cluster of symptoms for years, including:

• Gut dysfunction — persistent constipation and bloating that had failed to resolve despite dietary adjustments

• Seasonal and environmental allergies (hay fever symptoms)

• Chronic fatigue and low energy that impacted daily function

• Mood instability — irritability and emotional reactivity

• Cognitive difficulties including reduced mental clarity and concentration

• Widespread aches and pains in joints and muscles

• Anxiety and low mood / depressive symptoms

• Elevated cardiovascular risk — cholesterol ratios placing her at a risk score of 6.5 out of 10

G.D. Goal was not simply seeking short-term symptomatic relief. She wanted to understand why her body had arrived at this point — and to recover the vitality, comfort, and sense of ease that had been absent for far too long.

Background

​

G.D. had been living with digestive discomfort and systemic symptoms for an extended period, navigating them largely without a coherent explanation for why they were occurring together. In common with many people who eventually seek a functional medicine approach, the conventional route had not identified a unifying root cause — each symptom had been addressed in isolation, if at all, leaving the deeper drivers untouched.

Her occupational demands — physically intensive and emotionally engaged work — placed a sustained daily load on her body. A significant history of psychosocial stressors had contributed to chronic nervous system dysregulation over many years, with traits of hypervigilance and heightened empathic sensitivity reflecting long-standing adaptations of the stress response system. This background had placed a sustained burden on the HPA (hypothalamic-pituitary-adrenal) axis, likely contributing to fatigue, mood dysregulation, and systemic inflammation.

G.D. came to Paul ready for a different kind of conversation — one that looked at the whole person, not just the individual complaint.

Key Testing & Clinical Insights

​

Rather than treating symptoms in isolation, a comprehensive functional medicine assessment was carried out at the start of the programme to identify the underlying drivers.

PFP2 Blood Panel — Comprehensive Metabolic & Thyroid Screen

​

This advanced blood panel goes beyond standard NHS testing to assess thyroid autoimmunity, lipid particle risk, iron storage, and metabolic markers simultaneously — offering a fuller picture of what is driving symptoms than routine tests typically provide.

• Thyroid Peroxidase Antibodies (TPO): TPO antibodies came back significantly elevated at 398 IU/mL — well above the reference range. This is the hallmark finding of Hashimoto’s thyroiditis, an autoimmune condition in which the immune system mounts an ongoing inflammatory attack against the thyroid gland. This autoimmune activity is a direct driver of fatigue, cognitive difficulties, mood disruption, and musculoskeletal pain — all of which G.D. had been experiencing. The thyroid-gut connection is also well-established: thyroid dysfunction impairs gut motility, contributing directly to the constipation and bloating she presented with.

• TSH (Thyroid Stimulating Hormone): TSH was low at 0.369 mU/L. In the context of elevated TPO antibodies and current thyroxine medication, this required careful clinical interpretation — indicating that thyroid hormone dosing and the autoimmune picture warranted close review.

​

• Cholesterol & Lipid Panel: Total cholesterol was elevated at 6.90 mmol/L, LDL at 4.06, non-HDL at 5.44, and triglycerides at 2.0 — with an overall cardiovascular risk score of 6.5 out of 10. Importantly, HDL (the protective cholesterol) was a strong 1.46, and the triglyceride-to-HDL ratio — a key marker of insulin resistance — was 1.37, suggesting the lipid picture was more related to systemic inflammation and thyroid-driven metabolic disruption than to insulin resistance or dietary excess alone.

​

• Ferritin (Iron Storage): Ferritin was low-normal at 40 ng/mL. While not indicating clinical anaemia, suboptimal iron stores have a well-recognised impact on energy production, thyroid enzyme function, and hair health — all consistent with G.D.’s presentation.

​

• Calcium & Albumin: Both were marginally elevated, raising the possibility of relative dehydration and warranting further assessment alongside vitamin D, PTH (parathyroid hormone), and magnesium status.

​

​​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​

​​

 This blood panel revealed active autoimmune thyroid disease (Hashimoto’s), significantly elevated cardiovascular risk markers, and borderline low iron stores — providing a clear biological explanation for G.D.’s fatigue, cognitive symptoms, mood difficulties, gut dysfunction, and joint pain.

Cardiovascular Risk Ratios

The key lipid ratios painted the following picture:

Lipid Ratio Summary

​

This profile suggests:

• Elevated atherogenic lipoprotein burden
• Moderate cardiovascular risk pattern
• Preserved HDL protective function
• Low likelihood of significant insulin resistance
• Potential inflammatory or thyroid-related influence

Medical Symptom Questionnaire (MSQ) Score

​

At the initial consultation, G.D.’s MSQ score — a validated tool that measures the burden of symptoms across all body systems — was 123. This is a significant symptom load, reflecting the breadth and chronicity of what she was experiencing. This score provided the baseline against which progress would be tracked.

The Protocol

​

Based on the findings, a fully personalised programme was designed — not a template, but a strategy built specifically around G.D.’s biochemistry, history, and goals.

Nutrition Strategy

​

The cornerstone of the dietary approach was a SIBO (Small Intestinal Bacterial Overgrowth) maintenance diet — a targeted protocol designed to reduce fermentable substrates that feed bacterial overgrowth in the small intestine, addressing the root cause of the bloating and constipation directly. This is not a restrictive diet for its own sake; it is a precision tool to change the gut environment.

The goal here was to reduce the fuel supply for dysbiotic bacteria while simultaneously maintaining adequate nutrition. Meats, fish, poultry, and eggs formed the backbone of each meal. Vegetables were carefully selected and, where appropriate, limited in quantity to reduce fermentable fibre during the active treatment phase. Grains, most legumes, and all dairy (except coconut-based alternatives) were removed. Refined carbohydrates — the croissants, crackers, and oatmeal bars that had become habitual convenience foods — were replaced with wholefood alternatives.

Protein and healthy fat were added to breakfast to stabilise blood glucose throughout the morning — critically important given the thyroid-metabolic picture and the mood and energy complaints. Evening sugar was reduced to support sleep quality and lower the inflammatory load on the cardiovascular system.

Bone broths and slow-cooked soups featured prominently — easy to digest, rich in glycine and collagen precursors, and deeply supportive of gut lining integrity. Practical SIBO-friendly recipes were provided to make the protocol achievable in daily life, including an almond pancake recipe for breakfast variety and a pumpkin soup for convenience.

​

Supplement & Detox Protocol

​

• Gut Antimicrobial Support — Allimed (professional-grade stabilised allicin from garlic) was prescribed at a therapeutic dose across the day and at bedtime. Allicin is a potent natural antimicrobial, antifungal, and antiviral agent with strong evidence for use in SIBO. It was paired with Saccharomyces boulardii (Optibac), a well-researched probiotic yeast that helps rebalance intestinal microbiota, supports secretory IgA production — the immune system of the gut — and protects the gut lining during antimicrobial treatment.

​

• Bowel Regularity — Psyllium husk powder was introduced as a natural bulking agent to support bowel transit and regularity. Dose was personalised to individual tolerance. High magnesium in the Viridian High Potency Magnesium formula was dosed both for bowel support and for its systemic benefits: nervous system relaxation, sleep quality, muscle tension, and cardiovascular health — a mineral that most people are chronically insufficient in.

​

• Cardiovascular & Cholesterol Support — Red Rice Yeast (Cytoplan) was prescribed as a natural statin-equivalent, shown in clinical studies to reduce LDL cholesterol. Dosing was progressive: two daily for one month, then reduced to one as a maintenance dose. Electrolyte supplementation supported cardiovascular and cellular hydration, particularly important given the marginally elevated calcium and albumin findings.

​

• Adrenal & Energy Support — Adrenavive I (bovine whole adrenal glandular) was introduced to support the adrenal glands — the body’s primary stress response organs. Given G.D.’s history of chronic psychosocial stress and the likely sustained HPA axis burden, adrenal support was considered a key component of recovery, addressing the fatigue and mood instability at a hormonal level.

Lifestyle & Nervous System Support

​

Buteyko breathing was recommended as a daily practice — not as a lifestyle add-on, but as a clinically integral nervous system intervention. Chronic sympathetic activation (fight-or-flight dominance) suppresses gut motility, elevates cortisol, impairs immune regulation, and sustains inflammatory signalling. By improving carbon dioxide tolerance and activating the parasympathetic (rest-and-digest) system, Buteyko breathing directly addresses the nervous system dysregulation that underpins multiple symptoms across G.D.’s presentation. Referral to a specialist Buteyko practitioner was provided.

Physical support for the musculoskeletal system — including review of posture and ergonomics in G.D.’s physically demanding occupational role — was recommended alongside appropriate movement to support spinal health and cortisol regulation. A consistent sleep routine, supported by magnesium glycinate and reduced evening sugar, was emphasised as foundational to recovery.

Every element of the programme was reviewed and adapted at each consultation — nothing was set-and-forget.

Results

​

The transformation G.D. experienced is best understood as a story rather than a data table — a gradual but unmistakable shift from a body under siege to one that felt, in her own words, “far more comfortable.”

In the early phase of the programme, the most immediate changes tend to occur in the gut — the system most directly targeted by the SIBO protocol. The combination of antimicrobial therapy, carefully structured dietary change, and bowel support began to shift the internal environment of the digestive system. Constipation that had been a daily burden began to ease. The bloating — that persistent, uncomfortable sense of fullness and distension that had defined her experience for years — started to reduce. For many people, this alone is life-changing.

As the gut environment stabilised, the systemic downstream benefits became apparent. The intimate connection between gut health, immune regulation, and thyroid function means that improvements in one system ripple outward into others. Fatigue — driven by the combined burden of Hashimoto’s autoimmunity, poor sleep, and adrenal stress — began to lift as the adrenal support, magnesium, and nervous system work started to take effect. Mood stabilised. The irritability and anxiety that had been woven through her daily life became less intrusive as the HPA axis burden reduced and the gut-brain axis began to function with less chronic interference.

By the end of the programme, G.D. described feeling “significant improvements” and “far more comfortable” in her body — a statement that speaks not just to symptom resolution but to a restored relationship with her physical self. The digestive complaints that had been her primary concern were no longer dominating her daily experience. The cardiovascular risk factors — the elevated LDL, non-HDL, and triglycerides — were being actively addressed through both the SIBO diet (which reduces fermentable carbohydrate and inflammatory load) and the Red Rice Yeast protocol. The autoimmune picture required ongoing management, but with the underlying drivers identified and addressed, the foundation for long-term stability was in place.

Summary of Results

​

• Persistent bloating and constipation significantly improved

• Fatigue reduced; energy levels improved

• Mood more stable; irritability and anxiety less intrusive

• Cognitive clarity improved

• Joint and muscle aches easing alongside systemic inflammation reduction

• Cardiovascular risk actively being addressed through diet and targeted supplementation

• Autoimmune thyroid disease (Hashimoto’s) identified and a management strategy in place

• Client reports feeling “far more comfortable” in her body overall

Recognise yourself in this story?

​

If you’ve been struggling with similar symptoms and haven’t found answers, a functional medicine assessment could be the turning point.

​

Why This Worked

​

We didn’t chase symptoms — we treated the cause. G.D. had been living with bloating, fatigue, mood disruption, and cardiovascular risk without anyone connecting the dots between them. The blood panel revealed that active autoimmune thyroid disease was a primary driver — a single root-cause finding that explained symptoms across multiple body systems simultaneously. Without that identification, years more of symptom management lay ahead.

​

The gut was central to everything. SIBO is not just a digestive problem. Bacterial overgrowth in the small intestine drives systemic inflammation, impairs nutrient absorption (including the iron and magnesium deficiencies found in testing), disrupts the gut-brain axis, and sustains immune activation. Addressing the gut was not one part of the plan — it was the foundation everything else was built on.

​

The protocol was built around what the tests actually showed. Every supplement, every dietary strategy, every lifestyle intervention was chosen because of a specific finding in G.D.’s case — not because it was a generic ‘gut health protocol.’ The cholesterol support addressed her specific lipid pattern. The adrenal glandular addressed the HPA burden revealed in her clinical history. The magnesium addressed both the bowel regularity issue and the cardiovascular-nervous system picture simultaneously.

​

Nervous system support wasn’t an afterthought — it was central to recovery. A history of chronic psychosocial stress leaves a measurable biological signature: elevated inflammatory markers, disrupted cortisol rhythms, impaired gut motility, and immune dysregulation. Treating the gut and thyroid without addressing the nervous system would have left the primary driver of ongoing dysregulation untouched. Buteyko breathing and the adrenal support were as clinically necessary as the antimicrobials.

​

This is what functional medicine is supposed to look like. Listening fully, testing comprehensively, treating the whole person — and adapting the plan as the person changes. G.D.’s experience reflects the core of the functional medicine model: not managing symptoms indefinitely, but finding and addressing why they are there.

About Paul Foley

​

Paul Foley is one of the leading nutritional therapists and functional medicine practitioners working across the UK and Ireland, specialising in autoimmune conditions, chronic fatigue syndrome, ME/CFS, mould and mycotoxin toxicity, gut-immune dysfunction, SIBO, hormonal imbalance, mental health, and nervous-system dysregulation.

His work integrates evidence-based functional testing with personalised nutrition and systems-level recovery strategies, supporting clients who have often “tried everything” without lasting results.

Paul works with clients in Dublin, London, and remotely worldwide. If you are searching for the best functional medicine practitioner or nutritional therapist for chronic fatigue, autoimmune disease, gut health, hormonal issues, or complex unexplained symptoms — Paul’s approach may be the missing piece.

Ready to find your root cause?

Paul works with clients across Ireland, the UK, and worldwide via remote consultation.

Book Your Consultation at paulfoley.com →

​

​

​

​​​​

​

Frequently Asked Questions

​​

Q: What causes bloating and constipation that doesn’t respond to diet changes?

Persistent bloating and constipation that fail to resolve with standard dietary adjustments often point to an underlying gut microbiome imbalance — most commonly Small Intestinal Bacterial Overgrowth (SIBO), where bacteria that belong in the large intestine migrate and proliferate in the small intestine. The resulting fermentation of food produces gas, distension, and disrupted bowel function. Conventional testing frequently misses this because it requires specific functional breath testing rather than standard blood or stool panels. A root-cause functional medicine approach looks for and addresses this directly, rather than managing the symptoms in isolation.

Q: Can functional medicine help with Hashimoto’s thyroiditis and autoimmune thyroid disease?

Yes — and it is one of the conditions where a functional medicine approach tends to make the most meaningful difference. Standard medical management of Hashimoto’s typically focuses on thyroid hormone replacement (thyroxine) without addressing the autoimmune process driving the condition. Functional medicine investigates and addresses the immune system triggers — which commonly include gut dysbiosis, nutrient insufficiencies, chronic inflammation, and nervous system dysregulation. By working with these root causes, it is often possible to reduce antibody levels, improve symptoms, and support a more stable long-term picture. Paul works with many clients with Hashimoto’s and autoimmune thyroid conditions across Ireland, the UK, and remotely worldwide.

Q: Why is my cholesterol elevated, and can it be addressed without medication?

Elevated LDL and non-HDL cholesterol have multiple potential drivers beyond dietary fat — including thyroid dysfunction, systemic inflammation, insulin resistance, and poor gut health. In many cases, the lipid pattern reflects these underlying biological disruptions rather than simply requiring a statin. A functional medicine assessment looks at the full picture — including thyroid status, inflammatory markers, gut health, and lifestyle factors — before recommending a strategy. Natural approaches including targeted nutrition, specific supplementation (such as red rice yeast, berberine, and omega-3 fatty acids), and addressing root-cause inflammation can produce meaningful and measurable improvements in cardiovascular risk, often without medication. Paul works with clients on evidence-based cardiovascular risk reduction as part of a broader health programme.

​

Know someone who needs to read this?

​

If this sounds like someone you care about, share it — it might point them in the right direction.

 Share on:

​