FNA Clinical Vault
Six DUTCH and hormone case reviews from FNA office hours, led by Rachel — FNA's lead clinical mentor. Watch how FNA students work through real patient cases, from lab results to clinical plan.
Case 01 · DUTCH · PCOS · Mitochondria
The Mitochondrial Missing Link in PCOS
27-year-old · PCOS, irregular cycles, acne, anxiety, severe irritability, breast tenderness, orthorexia history
A student brings her first DUTCH case — a patient she hasn't yet met. The results raise immediate questions: mismatched cortisol dials, low testosterone relative to DHEA, estrogen dominance with low progesterone, and glutathione below range. Rachel works through what's driving each marker and how to prioritize care without overwhelming a patient who already has a complicated relationship with supplements.
What Rachel covers
Mismatched free vs. metabolized cortisol — what it means and why you can't answer the "why" without a full thyroid panel first
DHEA → testosterone conversion happens in the mitochondria — and why that changes your treatment priority for PCOS
Reading estrogen + progesterone together (not just individual markers) to explain this patient's irritability, breast tenderness, and cramps
Vitex dosing, timing, and the 750mg formulation Rachel prefers
NAC as a double-whammy: glutathione support and estrogen metabolism pathway support at the same time
Why Rachel wouldn't use MACA for this patient despite low testosterone
Case 02 · DUTCH · GI Map · SIBO · Perimenopause
When SIBO Makes Everything Else Impossible to Treat
46-year-old · Endometriosis, perimenopause, on thyroid meds + HRT, constipation + loose stools, became intolerant to supplements
The student had been working this case for months — building up the gut, clear plan in place — until the patient stopped tolerating every supplement she was put on. The SIBO test wasn't in the original plan. But the supplement intolerance turned out to be the most important clinical clue. Rachel explains why the DUTCH results have to wait, and how to sequence care when multiple systems are dysregulated at once.
What Rachel covers
Why supplement intolerance — not GI symptoms — was the flag pointing to SIBO
Reading SIBO breath test results when they're incomplete, and when to treat anyway
Candibactin AR + BR: Rachel's dosing protocol and why she chose it over berberine here
How to explain to a patient why her hormone results have to wait
The difference between always-intolerant vs. became-intolerant — and what that tells you about biofilms
Amino detox approach for patients who can't tolerate standard interventions
Case 03 · DUTCH · Thyroid · T3 Conversion
T4 Is Fine. T3 Is Not. Here's Why That Matters.
58-year-old · Perimenopause, anxiety, dry skin, nighttime waking, hypothyroid pattern — wants to avoid medication
This patient's T4 is optimal. Her T3 is low and her TSH is elevated. She's producing plenty of thyroid hormone — she's just not converting it. Rachel walks through the full thyroid panel, explains exactly where the breakdown is, and models how to have an honest conversation with a patient who wants to avoid medication without dismissing that option.
What Rachel covers
How to read T4, free T4, total T3, and free T3 together — and what elevated TSH is actually telling you
Why T4→T3 under-conversion is a liver and gut problem, not a thyroid production problem
The medication conversation: what T4-only meds do and don't fix, and how to present it without being prescriptive
Selenium (two Brazil nuts), zinc, and iodine — what to prioritize and when to test before supplementing iodine
ZRT urinary iodine test: when to use it and what it tells you that topical assessment doesn't
Thyroid antibodies: when a mild elevation warrants attention and when treating root causes (liver + gut) brings them down anyway
Case 04 · DUTCH · Birth Control · Estrogen Dominance
Reading DUTCH When a Patient Is on the Pill
28-year-old · PCOS, on hormonal birth control for 8 years, weight gain, insulin resistance, low energy, thinning hair
When someone is on hormonal birth control, their DUTCH results should show suppressed hormones. This patient's don't — her estrogen is robust despite being on the pill. Rachel explains why that's happening, what it tells you about the underlying clinical picture, and how to approach a case where the labs don't match what you'd expect from the chart.
What Rachel covers
What DUTCH should look like on hormonal birth control — and what it means when it doesn't
Why the estrogen is still showing up and what that tells you about what the pill has (and hasn't) been doing
Reading estrogen metabolite ratios when a marker is flagged — when to be concerned vs. when the ratio is proportionate
DIM and calcium D-glucarate: what they're doing mechanistically and when to reach for each
B6 and B12 deficiencies on DUTCH — when to investigate absorption rather than assume it's the pill or diet
The quinolinate marker: what it signals, when it matters clinically, and how to explain it without alarming a patient
Case 05 · DUTCH · High Cortisol · AdrenalReading DUTCH When a Patient Is on the Pill
High Cortisol, DGL, and the Body That Won't Slow Down
43-year-old · Anxiety, low energy, weight loss resistance, alternating bowel movements, elevated cortisol + cortisol awakening response
A naturopath recommended DGL for this patient's GI symptoms, but the practitioner wasn't sure if licorice root was safe with elevated cortisol. Rachel answers that clearly, then works through the full picture: a cortisol deactivation pattern that tells a specific story about what this patient's body is doing, and how to communicate that to a patient in a way that actually changes her behavior.
What Rachel covers
DGL vs. licorice root — why they're different and why DGL is appropriate even with high cortisol
What it means when the body is rapidly deactivating cortisol into cortisone — and how Rachel explains this to patients
Phosphatidylserine and melatonin timing for a high-cortisol, poor-sleep pattern
Low progesterone + estrogen dominance in the context of adrenal dysregulation
When DHEA and testosterone dials don't line up and what the mitochondrial connection looks like in practice
Managing care when a patient has multiple practitioners — and how to have that conversation
Case 06 · DUTCH · GI Map · Complex Autoimmune
When the Labs Look "Unremarkable" But Something Is Clearly Wrong
41-year-old · Celiac, gastroparesis, fibromyalgia, RA, Raynaud's, pelvic floor dysfunction, on birth control, wants to conceive
Five autoimmune diagnoses. Daily enemas to feel empty after a bowel movement. A GI map that isn't — as the practitioner says — "screaming anything." This case is a lesson in knowing when to look past the labs. Rachel navigates the structural, nervous system, and hormonal pieces, and models the birth control + preconception conversation in a way that's honest, empowering, and practical.
What Rachel covers
Reading a GI map when markers are present but not dramatic — and why clinical context changes how you respond
Migrating motor complex, prokinetics, and why grazing + gastroparesis + pelvic floor dysfunction is a triple problem
Pelvic floor PT, ileocecal valve massage, and when to suggest a colonic for ileocecal valve stimulation
When daily enemas might signal something worth addressing beyond the physical — and how to raise that carefully
The birth control + preconception conversation: the 100-day egg maturation window, the fifth vital sign, and how to frame it as an invitation
Mismatched cortisol dials with liver burden and birth control — and when a thyroid panel is worth adding
Your Guide
Rachel Heintz, MS, RDN, IFMCP, FHP-C
Lead Clinical Mentor · Funk'tional Nutrition Academy
Rachel is the lead clinical mentor inside FNA - the practitioner students bring their most complex cases to. She has deep clinical experience in functional nutrition with a specialization in DUTCH interpretation, hormone health, and the kind of multi-system cases that don't fit neatly into any protocol.
The sessions in this vault are pulled directly from Rachel's monthly office hours with FNA students. What you're watching is Rachel working a real case in real time, thinking out loud, asking the questions that need to be asked, and modeling the kind of clinical reasoning that takes years to develop on your own.
Inside FNA, practitioners have access to these sessions every month with their own patient cases. This is a window into that experience.
When You Enroll in FNA
You get this every month — with your own cases.
The sessions you just watched are part of what every enrolled FNA practitioner has access to. Monthly live office hours with Rachel, where you submit your real patient cases and work through them together.
Not a recorded Q&A. Not a static curriculum. A live session where Rachel looks at your actual labs, asks the questions you didn't think to ask, and works through the clinical reasoning with you in real time.