Note that this is not the same as an Ironman mode with limited Saves and such (although I suppose that could be included).
Since Larian made some obvious 'homebrew' choices with the game and deviated from RAW D&D 5e, I think that they should think about including a grittier mode that takes this even further and corrects some of what I see as issues and mistakes in 5e's design. Some examples include:
1) Regain full HP on a long rest. Seriously? I'm literally at death's door and after a good meal and a nap, I'm FINE? A LR should restore half of your HP at a maximum (possibly less) with the assumption that healing magic and rituals can cover the difference.
2) Half of your HP for a Short Rest that happens in an instant? Same problem as above. IMHO a SR should advance the game clock an hour (it can still happen with the press of a button though) and restore as many HP as you roll on your Hit Dice. If you blow all of your dice in one go, you can't take another SR today. This would make Feats and magic items that increase your HP recovery useful again.
3) The hit-or-miss system of AC has always been hot garbage. That's not how armor works and it's so over-simplified as to be laughable. Light armor should still provide an AC number but damage taken should be reduced by 1. Medium armor would be 2 points and heavy would be 3. This coming from a medieval reenactor...it IS possible to take a full-on hit and not be injured. That's what armor if FOR. Yes, this means that the Heavy Armor Master Feat would need to be redone but it's much more accurate and thematic to the setting.
4) Certain types of armor should be more or less effective against certain kinds of damage. Slashing at Plate armor should be a waste of time for non-magical weapons. Piercing for most smaller weapons (like arrows and daggers) should go through chain easier. Padded armor should be worn under most armor and help against bludgeoning damage and so on.
5) Enchanted armor should provide at least some protection against environmental damage. An armored knight with a shield at the ready will take less damage from the gout of flame than the Wizard running around in his PJs.
6) Exhaustion should be a thing. Carrying less for long periods of time should make you have to rest less often and even improve your movement speed. Carrying heavy loads should make you rest more and move slower.
These are just a few things that I've implemented in my TT games or have played in games with such rules. I'd like to hear from others about what they think.