Medical Symptoms Questionnaire
60 → 20
Pain, nausea and tiredness
7/10 → resolved
The Patient Programme
5 months
The Patient’s
Outcome
Clearer energy, better sleep, some weight loss
“My abdominal pain, nausea and bloating settled. Sleep improved, daytime energy came back, and I lost weight over five months.”
Female client, 60s – gut symptoms & fatigue
Presentation & Background
A woman in her mid-sixties sought functional medicine input because extreme tiredness, severe gripping abdominal pain and constant nausea were dominating daily life. Baseline ratings for tiredness, pain and nausea were each 7/10, with bloating, burping, heartburn, mucus in stools and an alternating bowel habit. Some fruits caused burning on the lips and tongue, then more nausea. Sleep was broken, naps were frequent, and confidence around food was low.
She was already under her GP for blood pressure and respiratory symptoms (amlodipine, bendroflumethiazide, Duoresp, salbutamol). Conventional care had a place, but it had not fully explained why her gut and energy were so tightly linked. In clinic, the pattern fitted gut-driven fatigue and digestive distress: an out-of-balance microbiome, low levels of beneficial gut fuels (short-chain fatty acids, especially butyrate), a gut parasite (Blastocystis), opportunistic bacteria, and food triggers, rather than inflammatory bowel disease on the tests we had.
Presenting Symptoms
- Extreme tiredness (7/10), with frequent napping
- Gripping abdominal pain (7/10)
- Constant nausea (7/10)
- Bloating and burping
- Heartburn and mucus in stools
- Alternating constipation and looser stools
- Burning lips/tongue after some fruits, then nausea
- Broken sleep and night-time thirst
- Low daytime energy and caution around eating
Root-Cause Findings
We used targeted Functional Testing: comprehensive stool analysis, a urine organic acids test, and Conventional blood tests to look beyond symptom labels and map what was driving the picture.
Gut microbiome
Clear dysbiosis (imbalance). Culture showed Citrobacter diversus and heavy E. coli growth; Blastocystis was found on stool testing, patterns often linked with bloating, pain and nausea.
Gut “fuel” and barrier support
Low total short-chain fatty acids and low butyrate—the compounds that nourish the gut lining and support a calm local immune response.
Metabolic context
HbA1c was 40 mmol/mol (still in range, but close enough to the pre-diabetes border to stay mindful of sugar and refined carbs). Blood pressure medicines continued with the GP.
Cellular energy and nutrients
Organic acids suggested a need to support energy pathways (including CoQ10 and vitamin B6), optimise folate cycle function, and support the amino acid glycine, with some microbial-related acid markers elevated.
Immune Tone at the Gut Surface
Faecal secretory IgA sat toward the lower end of range; blood IgA was low, relevant to how the gut handles microbes and food proteins.
The Programme
1. Calm the triggers
A structured elimination focused on gluten and dairy, then guided reintroduction. White bread stood out as a bloating trigger; oats did too for her. Protein was prioritised; salt was moderated while potassium-, magnesium- and calcium-rich foods supported blood-pressure goals. The aim was simple: reduce what was irritating the gut so repair could begin.
2. Rebuild the microbiome
Once stool results were in, the plan layered prebiotic foods, resistant starch, fibre and fermented foods, plus a multi-strain probiotic and prebiotic powder, with gut-lining support as prescribed. This matched the low-butyrate, high need-for-prebiotic pattern on testing, feed the beneficial microbes, don’t only restrict food forever.
3. Support energy, sleep and long-term metabolic health
Supplements were sequenced gently (one at a time, from low dose) to match the organic acids picture: CoQ10, a comprehensive multivitamin (including B6 and folate), staged cod liver oil, later quercetin and NAC, then glycine. Sleep habits improved (including Epsom salt foot baths). Walking continued; light resistance work and short yoga or Pilates sessions were encouraged. Stress tools she already trusted were kept in place. A cardio-metabolic style food plan was introduced once gut symptoms had settled, to protect energy, blood pressure and future diabetes risk—always alongside GP monitoring.
Supplement & Support Focus
(clinician-supervised)
- Probiotic + prebiotic powder — rebalance flora and support short-chain fatty acids
- Gut lining support — soothe and reinforce the barrier while symptoms settled
- Omega’s — nutrient density during recovery
- CoQ10 — cellular energy support for fatigue
- Daily multivitamin — B6, folate and CoQ10 coverage aligned to test findings
- Quercetin + NAC — extra antioxidant and inflammatory support
- Glycine — amino acid support highlighted on organic acids
All products were prescribed with clear start and finish dates and reviewed in follow-up. Medicines (including amlodipine and inhalers) stayed under GP care.
Why This Worked
Food triggers were reduced first, so bloating and reactivity had room to fall—something symptom-only approaches had not achieved. Stool testing explained why the gut felt so reactive (dysbiosis, Blastocystis, opportunistic bacteria, low butyrate), so rebuilding the microbiome was targeted rather than generic. Organic acids explained lingering fatigue biology after pain and nausea improved, so energy nutrients were added when they were more likely to be tolerated. Quiet inflammatory markers (including low calprotectin and a negative coeliac screen) avoided the wrong rabbit holes while still taking microbial drivers seriously. Lifestyle and a blood-pressure-aware way of eating locked in better sleep and day-to-day energy. Conventional care held the heart and lung medicines; functional care mapped the gut–energy pattern. Together, that showed up as a sharp drop in symptom score and resolution of the original gut complaints.
Key Results
- MSQ: 60 → 26 → 20
- Abdominal pain, nausea and bloating resolved
- Tiredness markedly improved
- Better sleep
- Some weight loss
- More tolerance of fruit and vegetables
- ~5 months
Conditions & Themes Addressed
- Bloating and IBS-type gut symptoms
- Gut dysbiosis
- Low butyrate / short-chain fatty acids
- Blastocystis
- Opportunistic gut bacteria
- Food-triggered bloating
- Fatigue and low energy
- Gut immune tone
- Functional nutrient suppor
- Blood-pressure-aware lifestyle
Testing Used
- Comprehensive stool microbiome & digestion panel
- Urine organic acids (Organix)
- Conventional bloods (blood count, kidneys, liver, thyroid, HbA1c, vitamins, iron stores, inflammation markers, coeliac screen, immunoglobulins)
- Serial symptom questionnaires (MSQ)
- Stomach acid and H. pylori history discussed with GP where relevant
Timeline
Start (January)
MSQ 60 · tiredness, abdominal pain and nausea each 7/10 · elimination and gut testing planned
February (5 weeks)
Tiredness 4/10 · abdominal pain ~3/10 · nausea 4/10 · less napping · stool results reviewed · plan refined
Early March
MSQ 26 · nutritionist-led reintroduction support
May Review
MSQ 20 · pain, nausea and bloating resolved · energy and sleep improved · goals met · cardio-metabolic food plan · Long term maintenance phase then review planned
Is this you?
Recognise yourself in this story?
If bloating, gripping gut pain, nausea and crushing fatigue are part of your daily life and standard tests still haven’t explained why—the missing piece is often the gut ecosystem itself: microbiome imbalance, food triggers and cellular energy support, read together and addressed systematically in a personalised plan.
This case study is for education and information. It is not personal medical advice and results vary. Programmes are supervised by qualified practitioners and designed to work with—not replace—your GP. Medications were not changed by the functional medicine team without appropriate medical oversight. Symptom and MSQ changes are taken from consultation records; not every marker was re-tested at the end of the programme.