From a Systemic Struggle to Holistic Health

Where he started

Otto came to me in his late 50s having spent the better part of several years focused entirely on someone else.

His wife had died from a chronic illness after a long and difficult decline. He had been her caregiver through most of it. And somewhere in those years, his own health had fallen apart. Not all at once. Gradually, quietly, in the way that things fall apart when you stop paying attention to them.

He described his health trajectory without much self-pity: "I have been refocusing on my health after neglect and abuse."

He had already started turning things around on his own. He'd begun Mounjaro the previous summer and lost 67 pounds by the time he sat down with me. His blood sugar was improving. He was tracking things, asking questions, doing the work. But he knew that what he could see on a standard panel was only part of the picture. And the parts he couldn't see were what kept him up at night.

His coronary calcium score was severely elevated. He had a history of deep vein thrombosis with documented vascular damage. And after years of being managed by specialists who each owned one piece of him — the endocrinologist, the cardiologist, the primary care doctor — nobody had ever looked at all of it together.

He wasn't coming in for one thing. He was coming in for all of it. He wanted one provider who could see the full picture and help him address all of it together. That's not what most practices are set up to do.

That's exactly what functional medicine is for.

What the testing actually showed

A standard panel had been missing most of this for years.

His endocrinologist had told him they didn't need to test fasting insulin. His cardiologist had been calling him asymptomatic. His previous lipid management had included simvastatin for years — a medication Otto himself would later describe as "garbage" that hadn't moved the needle at all.

When we ran the full workup, what came back was a connected web of dysfunction, as opposed to  just isolated problems.

• Lp(a) at 236. This is a largely genetic lipid marker that most standard panels don't test. At 236, it represents extreme independent cardiovascular risk — the kind that doesn't respond to statins and requires targeted intervention.
• hsCRP at 9.0. Severe systemic inflammation. The normal goal is below 1. At 9, his body was in a state of chronic inflammatory overdrive.
• Fasting insulin above 20. His endocrinologist had never ordered this test. It confirmed significant insulin resistance that was quietly driving weight gain, fatigue, and cardiovascular damage.
• Sleep apnea AHI of 24.8. Severe, and poorly controlled despite CPAP use. Untreated sleep apnea sabotages blood sugar, testosterone, energy, and cardiovascular recovery all at once.
• Low pancreatic elastase on stool testing. His gut wasn't producing enough digestive enzymes. He was malabsorbing fat and nutrients without knowing it, which was contributing to his fatigue and deficiencies.
• Methane-dominant SIBO. Bacterial overgrowth in the small intestine, consistent with constipation and bloating symptoms he'd been living with.
• ADMA elevated, SDMA borderline. These are markers of endothelial dysfunction — the lining of his blood vessels wasn't functioning well, which connects directly to cardiovascular risk and erectile dysfunction.
• Low ferritin, MTHFR mutation, low vitamin D. Nutrient gaps that had been accumulating without anyone addressing the root cause.

None of this was random. The years of elevated stress during caregiving, the unchecked insulin resistance, the inflammation, the sleep dysfunction was all one story. The systems had been quietly failing each other for a long time.

For the first time, he had the full picture.

The protocol we built together

We approached this in layers, because the temptation with a case this complex is to try to fix everything at once. That's how you burn a patient out and lose the gains within three months.

The cardiovascular picture was the most urgent thread.

Repatha, a PCSK9 inhibitor, brought his Lp(a) from 236 down to 104, which was a meaningful reduction for a marker that most medications can't touch. We layered in ezetimibe and later Nexletol as data supported it, and tracked the decision carefully: when Otto stopped ezetimibe to simplify his regimen, his particle numbers worsened. We put him back on it.

The question was never what sounded right in theory. It was what the numbers showed for this specific person.

Metformin was stopped entirely. He'd been on it since 2021 and, in his own assessment, "it didn't seem to do anything helpful." The data agreed. Mounjaro was doing what metformin couldn't, and keeping both was just managing a list.

For endothelial health — the blood vessel lining that drives both cardiovascular risk and erectile function — we added Arterosil HP, low-dose tadalafil (Cialis daily), L-citrulline, pycnogenol, and a dietary shift toward nitrate-rich foods: arugula, beets, spinach. He added high-polyphenol olive oil. These aren't flashy interventions. But endothelial function responds to consistent, layered support over months, not a single medication.

The gut findings led to Pure Encapsulations Digestive Enzyme Ultra with meals, which addressed the fat malabsorption and nutrient absorption issues that had been dragging his energy levels. The SIBO findings pointed toward garlic and oregano oil as a next step if enzymes alone weren't enough.

For sleep, we worked on the basics: TrueDark blue-blocking glasses two hours before bed, light elimination in the bedroom, magnesium L-threonate at night for sleep quality and cognitive support. His daily infrared sauna habit stayed.

The accountability piece here looked different than it does with other patients. Otto didn't need walk photos. He needed a collaborator.

Between what Otto had already built on his own and what we added through the collaboration, he ended up tracking nearly everything: continuous glucose monitoring, blood pressure, arterial health, and sleep. He came to every appointment with data and a list of questions.

That made every decision more precise. And it meant that when something wasn't working, we knew quickly.