i’ll preface this by clearly stating I am not a doctor. I have been fortunate to learn from the amazing SSRP faculty and I have a few insights that could be helpful. First thing I always ask myself is, where is the breakdown happening? And in this case, it’s not just one area—it’s hitting across three systems: cellular metabolism, immune metabolism, and the microbiome. That’s actually not unusual when we’re looking at something like longstanding anosmia, sleep dysfunction, IBS, and a history of autoimmunity. These symptoms don’t exist in isolation—they’re usually the result of unresolved cell stress that’s shifted the body into a chronic adaptive state. Think Cell Danger Response stage 2 or 3, where the body’s trying to survive but isn’t switching back into repair mode. The anosmia and poor sleep tell us a lot. Loss of smell that’s been around for years, especially with a family history of Parkinson’s, puts up a big red flag for impaired neurogenesis and neuroinflammation, particularly in areas like the olfactory bulb and hippocampus. Poor delta sleep—especially when it’s that limited—is a big clue that glymphatic clearance is impaired, GABA signaling is disrupted, and mitochondrial redox potential is off. That’s probably why interventions like ipamorelin, TA1, and gut peptides haven’t moved the needle—they’re trying to stimulate systems that don’t have the foundation in place to respond.
I’d keep things simple and focus first on restoring redox balance and supporting communication between the brain, gut, and immune system. VIP nasal spray is a great starting point. It helps reset the neuroimmune axis, promotes better circadian alignment, improves glymphatic flow, and supports olfactory bulb signaling. That’s a huge win for both sleep and anosmia. I’d go with 25–50 mcg intranasally once or twice a day—ideally morning and mid-day. Since he struggles with oral supplements, using butyrate or tributyrin suppositories makes a lot of sense. These short-chain fatty acids support mitochondrial function, improve gut barrier integrity, and help lower neuroinflammation. By bypassing the GI tract, we avoid the intolerance issue. Start with one suppository every other night and slowly work up. I’d also recommend red or near-infrared light therapy daily, especially 40Hz NIR over the forehead. Ten to twenty minutes a day can help with mitochondrial signaling, BDNF expression, and even sleep architecture. Magnesium L-threonate is another easy win. It crosses the blood-brain barrier and helps with NMDA/GABA balance, which supports deeper sleep and cognitive clarity. Taken at night, it stacks well with taurine or glycine. Once you’ve built some momentum there, then I’d add nasal Selank or Semax. Selank is great for calming the system and boosting GABA tone, while Semax supports BDNF and overall cognitive resilience. Start low—Selank around 250–500 mcg twice a day, Semax 100-300 mcg once or twice a day depending on how he tolerates it. If you’re able to get Epithalon, I’d definitely include it. It helps regulate pineal gland signaling, supports telomerase activity, and has strong effects on sleep-wake cycles and aging neurons. I’d go with 5–10 mg subQ at bedtime for about 10–20 days, then take a break. On the plasmalogen front, even if he’s not interested in testing, it might still be worth trying. I’d suggest starting with one capsule of both Neuro and Glia in the morning for two weeks, and if tolerated, move up to two. These support membrane health, olfactory bulb regeneration, and synaptic function—all areas that need help in this case. If progress stalls or if he’s ready for the next level, low-dose naltrexone could be helpful. At 1.5–4.5mg at night, it calms microglial activation and supports neuroimmune balance. It also pairs well with butyrate and VIP. You might also consider adding 1-MNA or 5-amino-1MQ with apigenin in the morning. These support NAD+ salvage pathways and improve endothelial and mitochondrial function without overstimulation. It’s a subtle but powerful way to rebuild energy metabolism. For evening support, adding glycine and TUDCA can help settle the system, support GABA tone, and improve bile acid signaling. This helps with both gut-brain communication and redox regulation. One last point—if Pentosan doesn’t show clear benefit in six weeks, I’d consider discontinuing it. It may not be the right tool for this specific situation. Also, given his oral sensitivity, I’d stay away from anything unnecessary—less is more until the redox status improves. The key metric to watch is delta sleep. That will be your best marker for glymphatic flow, neuroinflammation resolution, and overall nervous system regulation. Subjective changes in smell, gut function, and mood will follow. You can track changes in anosmia using simple scratch-and-sniff kits, and use a stool log for IBS tracking. This case is a great reminder that symptoms like anosmia and poor sleep aren’t the problem—they’re signs of the problem. And the answer is never to throw more at the system, but to remove the blocks, rebalance redox, and create an environment where the body can start to repair.
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