A case report of a functional GI testing protocol in a 35-year-old woman with gastrointestinal and joint complaints
Gastrointestinal complaints can present with a range of symptoms including abdominal pain, bloating, diarrhea, constipation and reflux. For many, these symptoms can be debilitating, affecting daily activities, eating habits, and overall quality of life. According to a current survey61% of Americans reported experiencing at least one gastrointestinal symptom in the past week, and diagnoses such as irritable bowel syndrome (IBS) are common. This affects an estimated 6.1% of adults. Despite the prevalence of gastrointestinal distress, many people find it difficult to find lasting relief. Among patients who received prescribed therapy for gastrointestinal diseases, more than half say they are dissatisfiedThis highlights the clear need for approaches that go beyond symptom management to address the root cause.
While musculoskeletal pain and gastrointestinal discomfort are often treated as separate conditions, new research suggests that the two may be more closely linked than previously thought. Dysbiosis, an imbalance in the intestinal microbiota, It has been shown to influence musculoskeletal health by compromising the integrity of the intestinal barrier, promoting immune activation and driving systemic inflammation. One nutritional factor that may contribute to this process is gluten. For gluten-sensitive people without celiac disease Gliadin protein can increase intestinal permeability and trigger immune activation that can extend beyond the intestine. Although these symptoms are often treated as separate conditions, they may have a common cause that stems from disorders occurring primarily in the intestines.
A Current case report examined the effects of a personalized nutritional and nutraceutical protocol in a 35-year-old woman with a long-standing history of gastrointestinal and systemic symptoms, including bloating, altered bowel function, fatigue, cognitive complaints, and progressive musculoskeletal symptoms. Although she tried various dietary changes, chiropractic care, and over-the-counter supplements, she found little lasting relief. Comprehensive stool analysis revealed digestive insufficiency, altered microbial balance, and markers of intestinal barrier disruption, including elevated zonulin and elevated anti-gliadin IgA, an immune response to gliadin in the intestine. Baseline symptom burden was assessed using the Medical Symptom Questionnaire (MSQ) and the Gastrointestinal Symptom Rating Scale (GSRS). Initially, her MSQ total score was 75, while the GSRS domain score was elevated in several categories, including indigestion (4.0), diarrhea (3.6), and constipation (3.0). The patient then underwent a targeted intervention consisting of dietary modification and nutraceutical support over a period of approximately ten weeks.
Given the patient’s elevated anti-gliadin IgA, a targeted nutraceutical protocol was implemented alongside a gluten-free diet. The protocol included emollients such as deglycyrrhizinated licorice (DGL), aloe vera extract, slippery elm, marshmallow root, okra extract, and chamomile extract; Mucosal support nutrients including L-glutamine, zinc from zinc-L-carnosine, N-acetyl-D-glucosamine, citrus pectin and mucin; Ingredients to support healthy inflammatory responses such as quercetin, cat’s claw, methylsulfonylmethane (MSM), and omega-3 fatty acids (EPA and DHA) from fish oil; a multi-strain probiotic blend containing Lactobacillus and Bifidobacterium species; a butyrate postbiotic in the form of tributyrin; a resistant starch and fiber blend, including green banana flour and arabinogalactan; and a topical cannabidiol (CBD) cream for local musculoskeletal support.
After the procedure, the patient was examined again at approximately five and ten weeks. The results for both measures were remarkable. The total MSQ score improved from 75 at baseline to 31 at five weeks, representing a 58.7% reduction in overall symptom burden, and further decreased to 13 at final assessment, representing an 82.7% improvement from baseline. Improvements were observed in several categories including digestive tract, joints and muscles, weight, energy and activity, and cognitive symptoms. GSRS scores followed a similar pattern: at last follow-up, diarrhea symptoms improved by 55.6%, indigestion by 43.8%, and abdominal pain by 23.1%.
Within the first two weeks of starting the protocol, the patient reported that facial swelling had disappeared, bloating had subsided, joint pain had disappeared, and her energy had improved. At final assessment, she described waking early without an alarm and feeling refreshed, which was a meaningful change from baseline. No adverse effects were reported throughout the intervention.
The findings from this case highlight the connection between gastrointestinal and musculoskeletal health. Although a causal relationship cannot be established in a single case report, the speed and extent of improvement suggest that intestinal barrier dysfunction and microbial imbalance likely contributed to the ongoing immune activation beyond the gut. Given the patient’s elevated anti-gliadin IgA and zonulin levels, elimination of gluten likely reduced an important factor in intestinal permeability and downstream immune activation. The nutraceutical protocol targeting microbial balance, barrier integrity and inflammatory signaling may have further supported this process by improving the intestinal environment and reducing immune stimulation. In combination, this approach appears to have addressed the underlying dysfunction rather than just treating individual symptoms, which likely contributed to the broader improvements observed across multiple systems.
This case highlights the value of a more holistic approach in managing overlapping gastrointestinal and musculoskeletal symptoms. By using functional stool testing to guide a personalized nutritional and nutraceutical protocol, significant improvements have been observed across a wide range of symptom areas in a relatively short period of time. As with any individual case report, these results reflect an individual response and may not be generalizable. Further research is needed to better understand how gut-targeted interventions may influence musculoskeletal outcomes in broader populations and to clarify the contribution of individual components within personalized protocols.
Learn more about gut and joint health:
A case report of a personalized nutraceutical, diet and lifestyle protocol to support an 11-year-old boy with Crohn’s disease
A case report of dietary supplementation with Anaerostipes caccae in a 47-year-old woman with long-term food intolerances
Osteoarthritis and the intestinal microbiome: Is there a connection?
Meta-analysis examines omega-3 PUFAs and age-related changes in joint health
By Jesse Martin, MS
