Client: 30-year-old female marketing manager
Initial presentation: The client presents with recurrent upper respiratory tract infections (URTIs), experiencing 8-12 episodes over the past two years. Four episodes progressed to secondary bacterial infections which required antibiotic treatment, with her most recent antibiotic course completed two months ago. Symptoms typically begin with a sore throat and fatigue, followed by nasal congestion, sinus pressure, post-nasal drip and a persistent cough lasting 1-3 weeks.
The client was increasingly concerned by her susceptibility to infection, prolonged recovery times and inability to maintain energy levels during busy work periods.
In addition to recurrent URTIs, the client reported several ongoing health concerns:
- Persistent fatigue
- Reduced exercise tolerance
- Difficulty concentrating
- Bloating following meals
- Excessive flatulence
- Poor stress tolerance
- Difficulty switching off after work
- Sleep averaging 5-6 hours a night
Recent blood tests ordered by her GP revealed low iron stores, with ferritin measured at 25 ng/mL.
Dietary intake is inconsistent due to workplace demands. Breakfast is often skipped, lunch is frequently purchased on the go, and evening meals vary depending on workload. Red meat intake was minimal, and overall plant diversity is low. She consumes 2-3 coffees daily and often forgets to drink water, particularly during stressful periods.
Naturopathic assessment
30-year-old female presenting with recurrent URTIs, low iron stores, fatigue, chronic stress and gastrointestinal disturbances. Contributing factors include impaired immune resilience, HPA-axis dysregulation, gastrointestinal dysbiosis, inadequate sleep and nutritional insufficiencies.
Key factors considered
- Impaired immune resilience - Nutrition, microbial diversity, psychological stress, sleep patterns and previous infections are factors that continuously interact to shape immune reactivity and tolerance. Prolonged immune activation can lead to functional exhaustion of immune cells, particularly T cells. Exhausted T cells exhibit reduced antiviral activity and impaired immune regulation, which can manifest as increased susceptibility to subsequent infections.
- Iron deficiency - Iron is essential for oxygen transport, energy production and immune cell activity. Fatigue, reduced exercise capacity, dizziness and impaired concentration are consistent with low iron status and are likely contributing to reduced resilience during periods of physiological stress.
- HPA-axis dysregulation - Persistent stress can contribute to elevated cortisol levels, which can impair immune responsiveness and increase vulnerability to recurrent infections. Chronic stress can also negatively affect sleep quality, recovery and overall vitality.
- Gut-immune dysfunction - Approximately 70% of the immune system resides in the gut, where gut microbes interact closely with immune cells, influencing immune tolerance, inflammatory signalling and pathogen resistance. The client's history of multiple antibiotic courses may have further influenced gastrointestinal microbial balance, potentially contributing to both digestive symptoms and altered immune function.
- Sleep deprivation - Averaging 5-6 hours of sleep per night may impair immune surveillance, tissue repair and recovery. Poor sleep is a common contributing factor in recurrent respiratory infections and prolonged illness recovery. Sleep deprivation has been associated with altered immune regulation, reduced resistance to infection and impaired recovery following illness.
- Nutritional insufficiency - Irregular eating patterns, low dietary diversity, inadequate hydration and limited intake of iron-rich foods may contribute to reduced availability of nutrients required for optimal immune function and recovery.
Herbal medicine
Ashwagandha (Withania somnifera) - Plays a central role in post-viral recovery where fatigue, poor sleep and nervous system dysregulation are present. Its withanolides exert immunomodulatory effects through regulation of cytokine activity and enhancement of natural killer (NK) cell function. Ashwagandha also modulates the HPA-axis, supporting its relevance for immune dysfunction compounded by chronic stress.
Astragalus (Astragalus membranaceus) - Is commonly used to restore immune competence. Its polysaccharides enhance macrophage activity, support interferon production and promote T- and B- cell proliferation, thus strengthening both innate and adaptive immunity.
Echinacea blend (Echinacea purpurea & angustifolia) - Is one of the most versatile immunomodulators in Western herbal medicine. Alkylamides are responsible for Echinacea's immune-modulating effects. They help regulate immune function by interacting with the body's endocannabinoid system. These immunomodulatory effects are context-dependent, strengthening the immune system when it is underactive and calming it when it is overactive.
Reishi (Ganoderma lucidum) - Offers a unique combination of immunomodulatory, anti-inflammatory and adaptogenic properties. Its polysaccharides, particularly β-D-glucans stimulate macrophage phagocytosis, promote dendritic cell maturation and support T- and B- cell proliferation. Reishi's triterpenoids regulate inflammatory pathways by modulating NF-κB and MAPK signalling.
Siberian ginseng (Eleutherococcus senticosus) - Acts as both an adaptogen and immunomodulator, enhancing resilience during recovery from prolonged illness. It supports mitochondrial function, improves endurance and reduces stress-induced immune suppression.
Herbal formula for immune resilience, stress support & recovery 500 mL
Ashwagandha (Withania somnifera) 3:2 standardised - 50 mL
Astragalus (Astragalus membranaceus) 1:2 - 100 mL
Echinacea blend (purpurea & angustifolia) 1:2 standardised - 100 mL
Reishi (Ganoderma lucidum) 1:2 - 150 mL
Siberian ginseng (Eleutherococcus senticosus) 1:2 - 100 mL
Dosage: 7.5 mL twice daily (BD). Take upon waking and before bed, away from food.
Note: The client was advised to drink one glass of water with each dose of herbal medicine, to support the liver and kidneys natural processing of alcohol.
Additional recommendations
Dietary modifications
- Increase iron-rich foods - Include lean red meat 2-3 times weekly and increase iron-rich plant foods such as lentils, black beans, kidney beans, chickpeas, pumpkin seeds, hemp seeds and dark leafy green vegetables. Pair iron-rich foods with vitamin C-rich foods to enhance absorption.
- Reduce factors that inhibit iron absorption - Separate caffeinated beverages from iron-rich meals by at least one hour where possible.
- Increase plant diversity to improve microbial health - Aim for 30 different plant foods weekly (fruits, vegetables, grains, nuts, seeds, herbs and spices) to increase antioxidant intake and maximise diversity in the gut microbiome to combat inflammation and oxidative stress.
- Improve meal regularity - Aim for three balanced meals daily containing protein, healthy fats and complex carbohydrates to support stable energy and healthy immune function.
- Increase hydration - Aim for 2-2.5 L of water daily to support mucosal health and recovery. The respiratory tract relies on healthy mucosal barriers and secretory immune defences to prevent pathogen colonisation.
Lifestyle modifications
- Stress management - Implement mindfulness practices, breathwork, yoga or meditation to support nervous system regulation. Schedule regular breaks throughout the workday, ideally away from a screen. Establish clear work-life boundaries where possible, such as not engaging with work-related activities after leaving the office for the day.
- Sleep hygiene - Aim for 7-9 hours of sleep each night. Avoid blue light exposure one hour before bed, maintain consistent sleep times and avoid caffeine after midday to improve sleep quality. Consider using a herbal sleep product, such as Kiwiherb Sound Asleep, for a short period of time to shift the sleep pattern.
- Moderate exercise - Focus on walking and restorative movement practices to gradually increase exercise tolerance.
- Support lymphatic flow - Lymphatic vessels participate in the immune response by providing structural and functional support for the transport of antigens and antigen presenting cells to draining lymph nodes. Unlike the circulatory system, the lymphatic system relies largely on body movement to keep lymph circulating. Without regular movement, lymph flow can become sluggish, reducing its ability to collect and transport cellular waste. Practices such as dry brushing, lying flat with the legs elevated against a wall and regular physical exercise can help support healthy lymphatic drainage.
Supplements
- Iron bisglycinate (50-100 mg/every 2nd day) - Given the low ferritin level and associated symptoms, iron supplementation is necessary alongside dietary intervention to replenish iron stores and improve serum ferritin levels. Dietary intervention alone is not sufficient to raise near deficient levels. Dosing is advised on alternate days, as oral iron intake increases hepcidin levels for approximately 24 hours, reducing subsequent iron absorption. Alternate-day dosing optimises iron absorption and may improve treatment efficacy. Reassessment of ferritin and iron status is recommended after 12 weeks of supplementation.
- Zinc (15-25 mg/day) - Is essential for immune cell development, antiviral and antioxidant activity and cytokine regulation. Zinc deficiency impairs both innate and adaptive immune responses.
- Vitamin C (250-2000 mg/day) - Supports iron absorption and immune function. Adequate vitamin C intake may reduce the duration and severity of respiratory infections. Prophylactic prevention of infection requires lower dosing (250 mg/day), while treatment of acute infection requires higher dosing (1000-2000 mg/day) to compensate for the increased inflammatory response and metabolic demands.
- Vitamin D (1000-4000 IU/day) - Influences both innate and adaptive immunity. It promotes antimicrobial peptide production and helps regulate inflammatory responses. Low vitamin D status has been associated with increased susceptibility to respiratory infections.
- Strain-specific probiotic (Lactobacillus rhamnosus GG) - To support the recolonisation of the gut with beneficial bacteria following antibiotic exposure. Lactobacillus rhamnosus GG (LGG) is well studied for is ability to colonise the gastrointestinal (GI) tract, where it can inhibit pathogenic bacteria through competitive exclusion and the production of antimicrobial compounds. LGG may also enhance GI barrier integrity and promote mucosal healing by supporting cellular growth and proliferation. In addition, it can modulate immune function, exerting effects both locally within the gut and systemically.
Follow-up
At the four-week follow-up, the client reported a noticeable improvement in energy levels, with less afternoon fatigue and improved concentration during busy work periods. She described feeling more resilient overall and had not experienced any new upper respiratory tract infections since commencing the wellness plan.
Digestive symptoms had improved significantly, with less post-meal bloating and reduced flatulence. She reported improved awareness of eating patterns and has successfully established a regular breakfast routine. She has been gradually increasing plant diversity in her diet and was making a conscious effort to eat more iron-rich foods. Hydration had also improved, with the client now carrying a water bottle at work.
Sleep duration had increased to an average of 6.5-7 hours per night. While occasional difficulty switching off after work remained, she reported falling asleep more easily and waking feeling more refreshed. Stress levels were perceived as more manageable, which she attributed to establishing clearer boundaries around work-related communication in the evenings.
The client had adhered well to the prescribed herbal formula. She had started to go for 15-minute walks a few times a week without excessive fatigue following activity.
Given the positive response to treatment, continuation of the herbal formula was recommended for a further two months to consolidate improvements in immune resilience, stress adaptation and recovery. Ongoing emphasis was placed on maintaining consistent sleep patterns, dietary diversity, adequate protein intake and gradually increasing physical activity.
Repeat blood testing was recommended at 12 weeks to reassess ferritin and iron status. Continued monitoring of infection frequency, energy levels, digestive symptoms and sleep quality was advised over the following 3-6 months to evaluate longer-term improvements in immune function and overall wellbeing. Attention was placed on reducing future antibiotic requirements through optimisation of immune resilience and restoration gastrointestinal health.
New Zealand ferritin reference intervals
|
Sex |
Age |
Interval |
Unit |
|
N/A |
0 – 4 months |
15 - 400 |
ng/mL |
|
N/A |
5 – 12 months |
15 - 80 |
ng/mL |
|
N/A |
1 – 14 yrs |
15 - 150 |
ng/mL |
|
N/A |
15 – 19 yrs |
15 – 170 |
ng/mL |
|
Female |
20 – 30 yrs |
20 -170 |
ng/mL |
|
Female |
30 – 40 yrs |
20 - 190 |
ng/mL |
|
Female |
40 – 99 yrs |
20 - 380 |
ng/mL |
|
Male |
20 – 30 yrs |
20 - 320 |
ng/mL |
|
Male |
30 – 40 yrs |
20 - 400 |
ng/mL |
|
Male |
40 – 99 yrs |
20 - 450 |
ng/mL |