Treatment pathways
Five-pillar care planning.
Each pathway maps the patient through microbiome, peptide, vagus, genomic, epigenomic, and lab layers — with referral and stop rules.
Every plan should include an evidence grade and a clear stop / refer / escalate rule.
Microbiome
Fiber tolerance build-up; diversity-supporting diet; address constipation/SIBO before escalation.
Peptides
GLP-1/GIP per indication; baseline labs; body-composition tracking; long-term safety review.
Vagus
Sleep, breathwork, daily activity; autonomic load reduction.
Genomics
FH genes when LDL-C very high; Lp(a)/LPA; APOE caveats; TCF7L2/FTO polygenic context.
Epigenome
Exercise, sleep, protein, fiber, glycemic control, inflammation reduction.
Labs
ApoB, Lp(a), HbA1c, fasting insulin, ALT, renal, body composition.
Referral
Endocrinology / cardiology where indicated.