Dr. Brian Lamoreaux, ND, MA, LPCC
A clinical case exploring the interconnected roles of HPA axis dysfunction, gut dysbiosis, food reactivity, and stress physiology in new-onset fatigue and premenstrual symptoms.
This case report follows a 38-year-old woman with new-onset fatigue, food sensitivities, brain fog, and worsening PMS who underwent an integrative treatment plan targeting HPA axis dysfunction and gastrointestinal dysbiosis. Through personalized nutrition, adrenal support, microbiome restoration, and a structured gut-repair protocol, the patient experienced complete resolution of fatigue, improved food tolerance, and significant symptom recovery.
Initial Visit, May 2024:
A 38-year-old female presented with chief complaints of worsening fatigue, food sensitivities, and PMS with cramping. She first noticed the symptoms after getting the covid vaccine and has observed them increasing in severity since then.
The patient reported that the fatigue was manageable most mornings, but starting around midday her energy would drop even lower for the rest of the day. Her sleep was generally okay, with the exception of sometimes waking up with an “adrenaline rush” feeling. She could fall back asleep when this happened, and ultimately was getting around 7 hours per night.
When consuming dairy, gluten, watermelon, and spicy foods she experienced stomachaches, bloating, and an increase in brain fog. She told me she cut down on the amount she was eating of these foods but was not fully avoiding them.
She shared that for most of her life her menstrual cycles were 28 days with no PMS symptoms. After receiving the covid vaccine, her cycles dropped to 20 days for many months, before eventually returning to 26-28 days. After the vaccine she also began having PMS cramps bad enough to occasionally miss work, which have gotten worse over time. Her gynecologist evaluated her and found no abnormalities.
After completing the intake, I suspected that the fatigue could be connected to her diet and food sensitivities. With food sensitivities I start by thinking about dysbiosis, leaky gut, and HPA axis dysfunction. I also considered if she was eating balanced regular meals, and whether she was having a blood sugar drop after lunch.
Recommendations:
I gave her a referral to a trusted nutritionist to go over her diet in more depth and support her with regular balanced meals.
I asked her to avoid trigger foods.
I recommended Magnesium Glycinate complex, 2 capsules at night. I chose magnesium to
- Relieve PMS cramping pain
- Support her blood pressure (BP in office was 150/95)
- Support sleep and decrease night awakenings
I requested the following labs:
- Salivary Cortisol and DHEA
- GI MAP stool test
- Blood labs to rule out causes of fatigue
The patient stated that she wanted to hold off on the stool test, and that she would like to go through her PCP for the blood labs. I asked her to request the following blood labs (CBC, CMP, lipid panel, HgA1c, iron panel with ferritin, B12, vitamin D, TSH, free T4+T3, and thyroid antibodies).
2nd Visit, July 2024:
The patient returned 2 months later for a follow-up. She reported working with the nutritionist, who felt that she was actually doing well with macronutrients, micronutrients, caloric intake, and meal structure and timing. The patient was still eating small amounts of the foods she is sensitive to, despite the fact her reactions to those foods were getting even worse. It was difficult for her to avoid the trigger foods because her significant other cooked for them, and she had limited food options near her workplace. She also noticed the appearance of strong sugar cravings.
She was taking the magnesium as prescribed and felt that she may be sleeping better.
Her blood lab results and the salivary cortisol were back. Her PCP had not ordered the iron panel, ferritin, or free T3.
- CBC was WNL, making anemia less likely for fatigue
- CMP and HgA1c were WNL, making insulin resistance and dysfunction with liver, kidney, and electrolytes less likely for fatigue
- TSH, free T4, were 1.110 and 1.49 respectively, and thyroid antibodies were WNL, making thyroid dysfunction less likely for fatigue
- B12 was 721
- Vitamin D was deficient at 25.2
Salivary cortisol showed mild HPA axis dysfunction. Her cortisol was borderline low for AM, normal for noon, and elevated for evening and night samples. Her salivary DHEA was low.
Recommendations:
I reviewed the importance of completely avoiding the trigger foods during her healing process. Since she did not feel she’d be able to do this, I gave her Similase GFCF digestive enzyme complex, 1 capsule with each meal. I also directed her to take an additional 2 caps prn when she had stomachaches or episodes of brain fog. I wanted to help relieve her symptoms with these digestive enzymes if she couldn’t be strict with removing food triggers.
- Adrenal Manager adrenal support complex, 2 caps in the morning. I wanted to support her HPA axis and energy levels, and felt that this blend of herbs, nutrients, and glandulars would be a good fit for her.
- Amino Replete amino acid complex, 1 scoop daily. I wanted to give her free form amino acids. I find that free form amino acid blends help with sugar cravings and fatigue.
- Vitamin D+K2 Liquid, 8 drops daily (4,000 IU) to address vitamin D deficiency as a cause of fatigue
3rd Visit, August 2024:
The patient reported that she has been doing much better with avoiding the trigger foods by using substitutes that we had discussed. She was taking the supplements as prescribed and shared that for the first 3 weeks she had a major improvement in how she felt and was essentially symptom free. The benefits then seemed to level off, and her energy dropped again.
This visit her blood pressure was 120/88. She noted that previously she had been getting headaches from time to time, and they seem to have stopped. Her PMS cramps this past cycle were also better.
She stated that she would like to go forward with the GI MAP stool test.
4th Visit, September 2024:
The patient reported that she feels about the same as the last visit, with no significant updates. She has been eating about the same and taking the supplements.
GI MAP results showed:
- Presence of genes for C. difficile toxin A and B (GI MAP does not test for toxin levels)
- Elevated H. pylori
- Low levels of Lactobacillus
- High levels of Streptococcus
- High levels of Pseudomonas
- Low secretory IgA
Recommendations:
In order to address the dysbiosis findings in the stool test, I wanted to do a 5R gut protocol (Remove, Replace, Reinoculate, Repair, Rebalance). We had already started Removal with trigger foods and Replace with the Similase enzyme support.
- SBI (serum bovine immunoglobulins), 2 capsules 2x/day. This was to start binding and removing unwanted microbes and toxins (Removal). She would do this for 1 month then stop.
- Strengtia Probiotic/Prebiotic complex, 1 capsule 2x/day. This blend included Lactobacillus probiotic and arabinogalactan as a prebiotic to help address the patient’s low Lactobacillus levels (Reinoculate). It also included Saccharomyces boulardii to increase low secretory IgA. She would use this for 3 months then stop.
5th Visit, October 2024:
She reported using all the 5R protocol supplements as prescribed and finished the SBI. Her stomach discomfort was much better; she was no longer having bloating, stomachaches, or brain fog. She started eating dairy again occasionally and found that she was tolerating it well. Her energy was still not as high as she wanted.
Recommendations:
- Continue probiotic/prebiotic complex for 2 more months then discontinue.
- Biocidin Antimicrobial Liquid Formula – start with 1 drop 3x/day and gradually increase to 5 drops 3x/day. She would use for two months then stop. I chose this anti-microbial formula to finish the Removal portion of the 5R protocol. I discussed with the patient how to identify and navigate a die-off reaction should it arise.
- GI Detox Binder Blend – take 1 capsule at least 1 hour away from food, supplements, or medications. I included this binder blend to help avoid potential die-off reactions.
6th Visit, December 2024:
The patient discussed feeling better and better. She shared that she has been eating gluten and dairy occasionally, and went on a trip to Mexico and did fine with the food. She used the supplements as prescribed, stopping as directed. She successfully titrated the Biocidin up to 5 drops 3x/day with no issues, and tolerated it well.
She reported that she had been doing well with sleep, exercise, and managing her stress the past few months.
Recommendations:
- Butyrate/Prebiotic blend, 2 capsules daily for one month then stop. This blend included butyrate (SCFA) and prebiotics. I wanted to use this for Repair and Reinoculate respectively.
- RepairVite, 1 scoop daily for one month then stop. This is a blend of glutamine and demulcent herbs that would also support Repair.
- Continue with exercising, managing stress, and prioritizing sleep.
7th Visit, February 2025:
The patient shared that she has been doing very well and is happy with her results. The fatigue had completely resolved, she didn’t believe she was reacting to any of the trigger foods anymore, and her PMS symptoms improved. She told me that her overall wellness was what she wanted it to be. She reported that she decided to train for a marathon.
She finished the supplements for the 5R protocol, and discontinued the adrenal botanical blend, amino acid complex and gluten/dairy digestive enzyme complex. At this time, she was taking only vitamin D and magnesium, and a multivitamin she added in for marathon training.
Recommendations:
Schedule follow-ups as needed
Bio:
Dr. Brian Lamoreux, ND, MA, LPCC
Dr. Brian Lamoreux is a licensed naturopathic doctor and licensed counselor in the state of California, who specializes in treating mental health conditions. Over the course of his clinical work, he has also developed expertise in gastrointestinal health, women’s health, men’s health, and bioidentical hormone replacement therapy (BHRT). His extensive training in both medicine and psychotherapy gives him a unique perspective in working with the dual mind-body nature of mental health conditions.
Dr. Lamoreux believes in collaboration and empowering patients to achieve their goals for health and wellness. He practices an integrative approach to healthcare, employing evidence-based applications of therapies such as botanical medicines and nutrients, diet and lifestyle changes, hormones alongside conventional therapies.
He earned his Bachelor of Arts in chemistry at the University of Kansas, and earned both his doctorate in naturopathic medicine (ND) and master’s degree in counseling psychology at Bastyr University. Dr. Lamoreux completed a fellowship in anti-aging and metabolic medicine (FAAMM) through the American Academy of Anti-Aging Medicine (A4M). Currently, he is in the process of completing a fellowship in functional psychiatry through Psychiatry Redefined.
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Disclosures/conflict of interest/sponsorship – none
