Clinical cases
Reason through 14 cases.
Each case teaches the integrated read — what to test, what to treat, what to refer, and the common pitfalls.
- Case 01 · Vagus · Microbiome · Labs
IBS-D with anxiety and disrupted sleep
32 y/o with post-infectious IBS-D, HRV trending low, poor sleep.
Teach- DGBI framework
- Vagus + microbiome overlap
- Behavioral therapy first
Pitfalls- Empiric food restriction
- Stool-test-driven supplements
- Case 02 · Peptides · Labs · Genomics
Metabolic syndrome considering GLP-1 therapy
48 y/o BMI 34, prediabetes, dyslipidemia, family CVD.
Teach- Indication & monitoring
- Body composition
- Lipid follow-through
Pitfalls- Skipping baseline labs
- Cosmetic-only framing
- Case 03 · Microbiome
Recurrent C. difficile after antibiotic course
67 y/o with second CDI recurrence.
Teach- FMT pathway
- Antibiotic stewardship
Pitfalls- DIY FMT
- Case 04 · Vagus · Labs · Genomics
Chronic fatigue with normal basic labs
Unrefreshing sleep, low HRV, wide differential.
Teach- Rule-out before functional testing
- Sleep architecture
- Avoid single-SNP supplements
Pitfalls- Methylation-clock-driven plans
- Case 05 · Peptides · Vagus · Labs
Refractory reflux on PPI
GERD symptoms despite PPI; new GLP-1 therapy.
Teach- Mechanism overlap
- Behavioral & positional therapy
- Re-evaluate diagnosis
Pitfalls- Indefinite dose escalation
- Case 06 · Vagus · Microbiome · Labs
Postpartum mood and microbiome shift
Mood symptoms 4 months postpartum.
Teach- Holistic differential
- Sleep & autonomic load
- Referral pathway
Pitfalls- Probiotic-only treatment of depression
- Case 07 · Peptides · Labs
Investigational peptide use without disclosure
Patient self-administering grey-market peptides.
Teach- Sourcing risk
- Open communication
- Harm reduction
Pitfalls- Punitive framing that drives concealment
- Case 08 · Vagus · Labs
Athlete with low HRV and overtraining picture
Performance plateau, RHR up, sleep down.
Teach- Autonomic load
- Recovery prescription
- Avoid stimulant escalation
Pitfalls- Adding interventions instead of subtracting load
- Case 09 · Genomics · Labs
High LDL-C and family history of early heart disease
28 y/o, LDL-C 235, father MI age 41.
Teach- FH suspicion
- ApoB / Lp(a) / cascade testing
- Lifestyle as adjunct, not substitute
Pitfalls- Supplement-only care
- Delaying statin referral
- Case 10 · Genomics · Labs
BRCA family history asking for functional prevention
Mother BRCA1+, breast cancer at 39.
Teach- Genetic counseling first
- Surveillance / risk-reduction options
- Lifestyle as adjunct
Pitfalls- Replacing oncology pathways with supplements
- Case 11 · Genomics · Microbiome · Labs
IBS patient with DTC report showing MTHFR and FUT2
Brings raw 23andMe-style PDF asking for protocol.
Teach- Don't overinterpret
- Pair with homocysteine, B12, folate
- Patient communication
Pitfalls- Methyl-folate by default
- Microbiome panel cascade
- Case 12 · Genomics · Peptides · Labs
Severe medication side effect and PGx review
5-FU patient with severe toxicity.
Teach- DPYD logic
- CPIC workflow
- Document phenotype
Pitfalls- Ignoring renal/hepatic context
- Rechallenge without review
- Case 13 · Genomics · Vagus · Labs
Longevity patient with DNA methylation clock result
'My biological age went down 3 years.'
Teach- What clocks can and cannot show
- Use validated outcomes
- Lifestyle as the real lever
Pitfalls- Selling 'age reversal'
- Replacing labs with clocks
- Case 14 · Genomics
Patient asks whether CRISPR can fix their risk genes
APOE ε4 heterozygote requesting gene editing.
Teach- Risk variant ≠ treatable monogenic disease
- Approved vs trial vs speculative
- Ethics & long-term safety
Pitfalls- Wellness CRISPR framing
- DIY biology