00:00:00
The gut brain axis is a real and well documented bidirectional communication system.
00:00:05
When the gut is inflamed, the brain knows it.
00:00:08
Anxiety and low mood are increasingly linked to gut dysbiosis, specifically because the gut
00:00:14
produces the majority of your body's serotonin.
00:00:17
Welcome to Health Decoded, your number one source for real health information with your
00:00:22
host, doctor Alessi and Matt Tack.
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There's a pattern we see in this practice more than anything else.
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People coming in having been told that their labs are normal.
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They've seen multiple doctors.
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They've been handed referrals, maybe a prescription, maybe a recommendation to reduce
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stress, but they still feel terrible.
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Fatigue that doesn't respond to getting enough sleep, bloating, gas, unpredictable digestion,
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brain fog or joint pain, skin issues, anxiety that doesn't match their life circumstances.
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These are all the things that seem to be just unmeasured, unmanaged, and really unaware in
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the medical profession.
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And not a single specialist is connecting the dots because each one is only looking at their
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corner of what they do.
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We look at the whole picture.
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And when we do, very often the answer starts in the same place, the gut.
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If you've been listening to the show long enough, if you've followed along long enough,
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you know that the gut is the starting point for most, if not all chronic disease and
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inflammatory conditions.
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And so today, I want to walk you through exactly what is happening inside the gut and
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the most common pattern that we see and treat.
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And that is leaky gut combined with inflammatory dysbiosis.
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I want to explain what it actually is, what it does to your body, how you can test for it
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accurately, and how you can treat it in a way that makes sense from a mechanistic point.
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So, let's get right into it.
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Again, welcome to Health Decoded.
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I'm your host, Doctor.
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Lesse.
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If you're new here, I'm an integrative functional medicine doctor, which means I'm not
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your conventional doctor and I'm not trying to be.
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Conventional medicine is great.
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It's essential.
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It's extraordinary for acute care, emergency interventions, and diagnostics, diseases that
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are already declaring themselves being proven.
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What it is not built to do is to catch the slow burn or the internal things that are under
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wraps that eventually will gradually unravel and cause dysfunction years before anything
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shows up on testing.
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And that is the space that I work in.
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The gut is almost always part of that conversation.
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So, today's episode is going to have four parts.
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Number one, what is leaky gut and dysbiosis?
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What they actually are, what they produce symptomatically, and why?
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How we test for them with precision with specific tests that we use within our clinic
00:03:17
and at home that patients can do, and how we treat them through structured logical
00:03:23
protocols.
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No guessing, no oversimplification.
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So, let's go.
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Let's get right into it.
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So, let's start off with the first piece here.
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What is leaky gut, dysbiosis, the connection, and why is it so important?
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So, first, to break it all the way down, let's start with the gut itself Because most people
00:03:44
significantly underestimate what it actually does.
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The gut is not just a tube.
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It's not just a digestive tube.
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It is your body's most sophisticated interface with the outside world.
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So everything that you eat, you drink, you ingest has to pass through or be processed by
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the gut before it enters your body properly.
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And the gut has evolved to be extraordinary selective about what it lets through.
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The inner lining of your intestines is one cell layer thick.
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That's it.
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One single cell layer and that layer is held together by protein structures called tight
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junctions that are arranged in almost like a linear way.
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Think of them as like the seal between tiles.
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Right?
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And so when those seals are intact, the gut is going to allow specific nutrients through like
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water and specific molecules in a controlled and selective way.
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Everything else like toxins, bacteria, larger undigested food particles is not supposed to
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pass through.
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It's basically blocked or limited.
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That is what we call selective permeability.
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So your gut or a healthy gut has a controlled selective border.
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Now, inside that gut leaves an inside that gut lives an ecosystem of roughly
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38 microorganisms.
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This consists of bacteria, yeast, fungi, viruses, parasites, more microbial cells than
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you actually have human cells in your body.
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This ecosystem is what we call the microbiome.
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That's a term people have heard.
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It is not incidental to your health.
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It is central to your health.
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So essentially, we're controlled more by bacteria than we are by our own neurology.
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The microbiome trains your immune system.
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It works in conjunction.
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It basically tells it what to do through signaling molecules.
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These are what we call neurotransmitters.
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So your microbiome produces neurotransmitters including the majority of your body's
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serotonin.
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About 80% of serotonin is produced in the gut, which regulates inflammation.
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The microbiome communicates directly with your brain via the vagus nerve.
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You ever been really stressed out and really anxious and had kind of like an upset stomach?
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That's because of that connection.
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It metabolizes hormones.
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It is one of the most metabolically active systems in your body.
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And for most of modern medicine's history, we have pretty much ignored the gut.
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It's been something that has not been addressed, not been looked at, and almost
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basically abused when we give people medication without actually understanding.
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And so, when the microbiome is balanced, the right organisms in the right ratios, you're
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going to have resilience.
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When it's imbalanced, you have what we call dysbiosis, imbalance.
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Dysbiosis means the ecosystem has gone wrong.
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Beneficial bacteria are possibly depleted.
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There's opportunistic organisms, pathogens, or what we would call pathobionts.
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They have overgrown and they take the territory over.
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And so this can include harmful bacterial strains, yeast, parasites, fungus, and other
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organisms that in small amounts are manageable and we should have, but when they dominate,
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they become significant drivers of dysfunction.
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Dysbiosis does something very specific and very damaging to that one cell thick gut lining.
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So harmful bacteria, particularly gram negative bacteria, produce a compound called
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lipopolysaccharide or LPS.
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LPS is essentially the outer membrane fragment of those bacteria and it is directly toxic to
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the tight junction proteins that hold your gut lining together.
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When LPS accumulates, which happens reliably in states of dysbiosis, those tight junctions
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begin to degrade.
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The seals fail, the gut lining becomes permeable.
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Things that should stay contained inside the gut are now able to pass through into your
00:07:53
bloodstream and lymphatic system.
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This is what we call intestinal hyperpermeability.
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The lines are becoming open.
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Leaky gut is what we will reference it as.
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I want to address that term directly though because it does get questioned in conventional
00:08:09
medicine.
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Primary care doctors, conventional medicine doctors, they say leaky gut sounds colloquial
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and some physicians often dismiss it just on those grounds alone.
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But the underlying mechanism, intestinal hyperpermeability, tight junction degradation,
00:08:26
LPS translocation, this is extensively documented in peer reviewed research.
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We use both terms because leaky gut is what people recognize.
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It's what people are searching for.
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It's understood.
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If I said intestinal hyperpermeability, that goes over people's heads, they often would just
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dismiss that and not be aware of what that means because that is what is scientifically
00:08:51
precise.
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So it's the same condition, both terms are valid.
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For sake of this episode, I will use both.
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And so to kind of wrap up what leaky gut is, again, the gut microbiome becomes imbalanced.
00:09:05
That's the dysbiosis piece.
00:09:07
That imbalance then leads to degradation of the protective lining of the gut.
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That's the intestinal hyperpermeability or leaky gut.
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The barrier that was supposed to protect your bloodstream from the contents of your gut has
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been compromised.
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What happens next is where this becomes a whole body problem, not just a gut problem.
00:09:28
And so, let's get into it.
00:09:30
What does the gut produce?
00:09:33
What does leaky gut produce?
00:09:35
The immune cascade that occurs, and why it can look different for different people.
00:09:40
So, the gut barrier begins to break down, the immune system is going to become the next
00:09:46
chapter of this story.
00:09:48
And understanding that is what explains why leaky gut and dysbiosis produce such a wide,
00:09:55
just confusing range of symptoms and across different people.
00:10:00
So, here's the mechanism.
00:10:02
Roughly 70 to 80% of your immune tissue lives in and around the gastrointestinal tract.
00:10:09
It's positioned there deliberately.
00:10:11
This is to survey what crosses the gut lining and respond to threats.
00:10:16
When the barrier is intact, this system works perfectly.
00:10:20
When the barrier is compromised, the immune system begins encountering things it was not
00:10:25
designed to tolerate at scale.
00:10:28
Bacterial fragments, partially digested food proteins, and specifically that compound LPS
00:10:35
that I described earlier, which the immune system will identify these immediately as a
00:10:40
threat, as a pathogen signal.
00:10:43
There is a receptor on your immune cells called TLR four, toll like receptor four.
00:10:48
Its job is to detect LPS.
00:10:52
When it detects it, it activates an inflammatory signal, which is a cascade that
00:10:57
orders the production of inflammatory proteins called cytokines, specifically one called TNF
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alpha, another one called interleukin six or IL-six, and interleukin one beta.
00:11:12
These are your body's alarm signals.
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In an acute infection, this response is appropriate and it's lifesaving and it can
00:11:20
prevent you from having big deal things.
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The immune system fires.
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And so, this clears the threat, the threat stands down.
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But when the gut barrier is chronically compromised, LPS is not just happening one
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time, it's crossing continuously.
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The immune alarm is not just responding to a single event, it's running all the time.
00:11:43
Now, this is where this can become an issue.
00:11:45
This is what we call chronic systemic inflammation driven by gut permeability.
00:11:51
And this is what we mean by inflammatory dysbiosis, an ongoing low grade immune
00:11:57
activation state that originates in the gut, but it's going to express itself throughout the
00:12:03
body.
00:12:04
Now, let me explain why the same issue can look different from person to person.
00:12:11
That inflammatory signal, those cytokines travel through the bloodstream and lymphatic
00:12:16
system.
00:12:17
And they land wherever your individual genetics, your prior exposures, your
00:12:22
nutritional status, and your stress load make you the most vulnerable.
00:12:27
The gut is the source, the expression itself is individual.
00:12:32
So, one person's chronic gut inflammation can manifest as joint pain and stiffness because
00:12:38
their immune response targets joint tissue.
00:12:41
Another person's manifests as eczema or psoriasis because the skin becomes a reactive
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site.
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Someone else develops brain fog or mood disturbances, anxiety, because
00:12:52
neuroinflammation is their pattern.
00:12:54
Another person would develop thyroid antibodies.
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This was my story.
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Another person can have recurring sinus infections or these pressures in their head.
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Another has expanding food sensitivities.
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Someone else could have metabolic dysfunction or weight gain.
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Again, the same upstream cause, completely different downstream presentations.
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This is precisely why patients cycle through specialists without resolution.
00:13:22
You know, because the rheumatologist sees the joint inflammation, the dermatologist sees the
00:13:27
skin, the psychiatrist sees the anxiety.
00:13:30
None of them are looking at the gut because conventional medicine doesn't have a framework
00:13:35
for a single gut based mechanism that produces multisystem symptoms.
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Each symptom gets its own diagnosis.
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Each diagnosis gets its own medication.
00:13:46
And none of it actually addresses what is driving the problem in the first place.
00:13:50
So, let me walk through specific symptom clusters that we commonly see so that you can
00:13:56
recognize patterns.
00:13:57
So, the first one is often, you know, the most common digestive symptoms.
00:14:03
These are often present, but not always the chief complaint, which can surprise people when
00:14:08
it comes to leaky gut.
00:14:10
So, things like bloating, particularly the kind that accumulates throughout the day, gas,
00:14:16
irregular bowel habits, constipation, diarrhea, or alternating between the two, abdominal
00:14:23
discomfort after eating, reflux.
00:14:26
Some people have significant intestinal hyperpermeability with very mild digestive
00:14:32
symptoms, which is part of why it gets missed and makes it so confusing.
00:14:37
The next thing is often cognitive or neurological symptoms.
00:14:41
We see this all the time.
00:14:42
Extremely common and can be the most debilitating, the brain fog or the mental
00:14:47
cloudiness, difficulty concentrating, finding words, not knowing how to voice something,
00:14:55
memory recall, all of that is a direct product of neuroinflammation driven by systemic
00:15:02
cytokine activity.
00:15:04
The gut brain axis is a real and well documented bidirectional communication system.
00:15:09
When the gut is inflamed, the brain knows it.
00:15:12
Anxiety and low mood are increasingly linked to gut dysbiosis, specifically because the gut
00:15:19
produces the majority of your body's serotonin and dysbiosis disrupts that production.
00:15:25
Non restorative fatigue, so the type that sleep does not fix.
00:15:29
It's another consistent hallmark.
00:15:31
We hear these things all the time.
00:15:34
The next thing is immune dysregulation.
00:15:36
Things showing up as like recurring infections because the immune system is dysregulated
00:15:42
rather than properly calibrated.
00:15:46
Increasingly, we're seeing autoimmune conditions when the immune system is
00:15:50
chronically activated and repeatedly exposed to foreign proteins crossing a permeable gut
00:15:56
barrier, the risk of something called molecular mimicry increases.
00:16:01
Basically, the immune system begins misidentifying self tissue, your own body's
00:16:07
tissue, as foreign and it attacks it.
00:16:11
We see this in skin manifestations, things like acne, eczema, psoriasis, or rosacea.
00:16:18
Well established mechanistic connection to gut dysbiosis through the gut skin axis.
00:16:24
Oftentimes, when people start repairing their gut or working towards their gut, they're gonna
00:16:29
have worsened skin issues because of this.
00:16:32
The skin is a common site of immune reactivity when the gut is the source.
00:16:37
We see hormonal and metabolic dysfunction.
00:16:40
The gut microbiome directly participates in estrogen metabolism, thyroid hormone
00:16:45
conversion, blood sugar regulation, and metabolic signaling.
00:16:50
So, dysbiosis can contribute to hormone imbalance, resistance to insulin, and then
00:16:56
weight that resists standard diet and exercise protocols.
00:17:00
And then, one of the main things we also see expanding food sensitivities, one of the most
00:17:05
telling signs.
00:17:06
So when the gut barrier is compromised, food proteins crossing into circulation in a form of
00:17:13
an immune system does not recognize as safe.
00:17:16
So the immune system will mount a reaction over time because the gut barrier remains
00:17:20
compromised.
00:17:22
This list or this amount of reactive foods can grow.
00:17:25
This is not like a food allergy.
00:17:27
So when you have an allergy that is an anaphylactic response that is life threatening.
00:17:33
Things like nut allergies are very common.
00:17:35
This is what we call a sensitivity and it's secondary to barrier dysfunction.
00:17:41
Now, tough part is these are hard to catch because you eat a food, it creates an
00:17:46
inflammatory sensitivity and immune response that often doesn't show up for six, twelve,
00:17:52
maybe twenty four hours.
00:17:53
By that point, you've probably had two, three, maybe four other meals with other foods.
00:17:58
So, it's hard to pinpoint which foods are causing it.
00:18:02
One important clarification that I need to make sure I say is not every person presenting with
00:18:08
these symptoms that I just said has leaky gut and dysbiosis as the primary driver.
00:18:13
These symptoms can have multiple potential causes.
00:18:16
However, the gut is very often the central mechanism.
00:18:20
So, it is not the only possible mechanism, which is why we don't assume, we test
00:18:25
everything and we test comprehensively.
00:18:27
And so, that's what we're going to get into now in this next piece.
00:18:30
But before we get into testing and the action, let's hear a quick word from our show sponsor
00:18:36
today.
00:18:36
Hey, busy professionals and parents.
00:18:38
Let me ask you something.
00:18:40
Do you need help with your low energy, stubborn weight, brain fog, gut issues or hormones, but
00:18:47
you don't know where to start?
00:18:48
Well, you're not alone.
00:18:50
The biggest problem is that modern healthcare is designed to diagnose disease, but often
00:18:56
misses the dysfunction that begins years earlier as under the surface symptoms.
00:19:02
That's exactly why I created the Functional Medicine Starter System.
00:19:06
This is a structured, physician led process designed to uncover what is actually driving
00:19:11
your symptoms, whether it's rooted in gut health, metabolic function, inflammation,
00:19:17
nutrient status, or hormonal imbalance.
00:19:20
No guessing, no generic protocols, just real data and a clear plan.
00:19:25
So, you're tired of searching for answers, but you're not sure how to begin solving your
00:19:29
health issues, go to the link in the podcast show notes to learn more about the Functional
00:19:34
Medicine Starter System.
00:19:36
Because once you have clarity, you can finally start to feel like yourself again.
00:19:40
Now, let's get back to the episode.
00:19:43
Alright, welcome back.
00:19:45
So, let's get into it now.
00:19:46
How do we test for leaky gut, dysbiosis?
00:19:50
We use what we call a Gut Zoomer test.
00:19:53
One of the most consistent things I hear from patients is that they've been told their gut is
00:19:58
fine based on a colonoscopy or a basic stool culture or a standard blood panel.
00:20:05
The issue is not that those tests are useless.
00:20:08
The issue is that they are not designed to look for what we're looking for.
00:20:12
And that's dysbiosis and leaky gut.
00:20:15
A colonoscopy evaluates the structure of the colon.
00:20:19
It doesn't go far enough up.
00:20:20
It's going to find things like polyps, lesions, inflammation that has progressed to visible
00:20:26
tissue damage.
00:20:28
It tells you nothing about the microbial ecosystem living in the colon.
00:20:32
A basic stool culture tests for a short list of known pathogens only.
00:20:38
So a standard blood panel is also not enough to evaluate the microbiome at all.
00:20:42
So it has nothing to do with it.
00:20:45
Let me rephrase.
00:20:46
It's not that it has nothing to do with it, it's just not deep enough.
00:20:49
None of these tests are detecting dysbiosis.
00:20:52
None of them measure intestinal permeability.
00:20:55
None of them show you what is actually living in the gut because they were not designed to.
00:20:59
And that's not the fault of the test.
00:21:01
It's just not what it's used for.
00:21:03
So if you want more of a precise measurement, you need a more precise test.
00:21:08
And this is the gap that comprehensive functional stool testing will fill.
00:21:13
The panel that we use is called a Gut Zoomer.
00:21:16
It's a DNA based stool analysis that maps the gut ecosystem with a level of precision that
00:21:22
those conventional tests just don't have.
00:21:24
The Gut Zoomer uses quantitative PCR, which is polymerase chain reaction, which identifies and
00:21:31
measures organisms by their genetic structure.
00:21:34
This is not dependent on whether an organism grows in a lab culture, it detects what is
00:21:38
present and quantifies it.
00:21:41
That distinction matters because many organisms that drive significant gut dysfunction are
00:21:47
notoriously difficult to culture.
00:21:49
On a conventional stool culture, they're missed.
00:21:52
On PCR based analysis, they will show up clearly.
00:21:56
And so, let's get into what does the gut zoomer actually measure.
00:22:00
So, number one, bacteria, the full spectrum.
00:22:03
It's going to measure probiotic bacteria, beneficial organisms like lactobacillus and
00:22:09
bifidobacterium, the species that support the immune function and actually produce short
00:22:14
chain fatty acids to maintain integrity of the gut barrier.
00:22:20
We see how depleted they are and we can see by how much.
00:22:24
It measures commensal bacteria.
00:22:26
These are organisms that are neutral in balance, but problematic when overgrown.
00:22:31
It also measures pathobionts, organisms that are present in small amounts in a healthy gut,
00:22:36
but can become drivers of disease when they proliferate.
00:22:40
And known bacterial pathogens, things like H.
00:22:43
Pylori, C.
00:22:45
Diff, campylobacter, E.
00:22:47
Coli, and variants of Salmonella, Shigella, and others.
00:22:51
It's going to measure yeast and fungus, including Candida species, which are among the
00:22:56
most consistently missed drivers of chronic gut dysfunction and something that we catch all the
00:23:01
time.
00:23:02
Overgrowth of Candida is actually not as rare as you would think and it's pretty routine in
00:23:07
patients with a history of antibiotic use, high sugar diets or immune dysregulation.
00:23:13
But it simply doesn't get looked for.
00:23:15
The next thing we see is mold.
00:23:17
Environmental mold can actually colonize in the gut and drive inflammatory patterns that are
00:23:22
rarely considered in standard clinical workups.
00:23:26
Viruses, can interact with and influence bacterial populations in ways that are
00:23:32
increasingly understood to affect the balance of the microbiome.
00:23:37
Parasites and worms, things like giardia, cryptosporidium, blastocystis hominis, know,
00:23:44
the helminth species.
00:23:45
These are not exotic findings.
00:23:48
They're found routinely on comprehensive testing and routinely missed on conventional
00:23:52
testing.
00:23:53
They're also significant drivers of immune dysregulation and barrier disruption.
00:23:58
It also tests, and this is the most important piece for me, is intestinal permeability
00:24:03
markers, including what's called zonulin.
00:24:07
Zonulin is the protein that directly regulates that tight junction integrity.
00:24:13
Zonulin is one of the most clinically meaningful direct markers of leaky gut that we
00:24:17
have.
00:24:18
When it's elevated, the gut lining is compromised.
00:24:21
That's it.
00:24:23
Gut inflammation markers, so calprotectin, which measures active intestinal inflammation.
00:24:28
Secretory IgA which reflects the immune activity and first line defense capacity of the
00:24:34
gut lining itself.
00:24:36
It measures digestive function markers.
00:24:39
Pancreatic elastase tells us whether the pancreas is producing adequate digestive
00:24:43
enzymes.
00:24:45
Fats diatocrit assesses fat absorption.
00:24:48
These tell us whether the gut has the functional capacity to break down and absorb
00:24:52
nutrients properly, which is critical for the treatment plan.
00:24:57
The result of this test is a complete clinical map, not a yes or no answer.
00:25:02
It's a detailed picture of the ecosystem, its deficiencies, its threats, and its inflammatory
00:25:08
state, as well as its functional capacity.
00:25:11
Now that map is what then drives a precise individualized treatment protocol rather than a
00:25:18
generic one drug, one fixed thing.
00:25:21
And so, from a practical standpoint, this is a, you know, an easy test for people to integrate
00:25:27
because it's a home stool collection.
00:25:29
You don't have to go to some lab and have some invasive test done.
00:25:32
Patients collect the sample in their own bathroom, ship it with a kit, and the results
00:25:37
come back in approximately two weeks.
00:25:40
There's no procedure, no preparation, no discomfort.
00:25:43
And for the diagnostic depth that it provides, it is actually one of the highest yield tests
00:25:48
that we use.
00:25:49
And so, now that you have that information, you have a roadmap, you have a clinical
00:25:54
understanding of what's going on in someone's gut, what do you do with that?
00:25:58
How do you treat it?
00:25:59
Well, the process that we use, and it's really just because it makes sense, is called our 6R
00:26:06
protocol.
00:26:06
And so, I'm going get into that.
00:26:09
Treatment is where we see the most well intentioned mistakes because in conventional
00:26:13
medicine and also in the wellness space, it's equal.
00:26:18
The conventional medicine approach when gut issues are acknowledged, tends to manage
00:26:24
symptoms, right?
00:26:24
They're going to give you antacids for reflux.
00:26:27
They're going to give you antispasmodics for IBS symptoms.
00:26:31
They're going to give antibiotics when there's a specific pathogen detected.
00:26:35
But these all have their place, but they don't restore the actual ecosystem, they don't repair
00:26:41
the leaky gut barrier, and they don't address what's driving the dysfunction in the first
00:26:45
place.
00:26:46
In the wellness space, what we're seeing common mistakes, you know, it's different people hear
00:26:51
gut health and they immediately start taking probiotics.
00:26:55
Not that probiotics are wrong, but when they're completely ineffective and can be
00:26:59
counterproductive, when they're introduced into a gut that's overrun with pathogens and has a
00:27:05
compromised lining.
00:27:07
You're basically adding beneficial bacteria to an environment that can't support them.
00:27:12
They don't get established and then the underlying dysfunction just continues
00:27:16
unchanged.
00:27:17
The reason a structured protocol works where these don't comes down to one principle, you
00:27:22
have to sequence the treatment to match biology.
00:27:25
That's it.
00:27:26
The gut ecosystem broke down in a sequence, it has to be restored in a sequence.
00:27:31
We call the protocol that we use the six R protocol.
00:27:34
And this was something that I developed based on my own gut health issues.
00:27:39
I took existing research, existing protocols that worked but were maybe not complete and I
00:27:47
just fine tuned it specifically for dysbiosis and leaky gut.
00:27:52
And so, it makes sense because each step in the sequence follows the previous step.
00:27:58
You can't just start putting up the roof of a house if you haven't built the foundation
00:28:02
first.
00:28:03
So, you have to start in order.
00:28:05
The first step of the six R protocol, R1, is remove.
00:28:09
Because before you can rebuild anything, you have to clear what is actively driving the
00:28:13
dysfunction in the first place.
00:28:15
Now, the remove part has two components, pathogen elimination and driver removal.
00:28:21
Pathogen elimination means targeted interventions against the pathogenic organisms
00:28:26
identified on the gut zoomer.
00:28:28
The bacteria, the yeast, the parasites or worms that are present and problematic.
00:28:33
Depending on what is found, this involves targeted antimicrobials, herbal, possibly
00:28:39
pharmaceutical, specific antifungals or antiparasitic agents.
00:28:43
And it's not just a generic gut cleanse, it's targeted because we know exactly what we're
00:28:48
targeting.
00:28:49
And those specific pathogens often have defenses built in and we need to make sure we
00:28:54
break those defenses down.
00:28:56
The next thing is the driver removal.
00:28:58
So, this means eliminating the dietary and lifestyle inputs that are actively sustaining
00:29:04
the dysbiosis or damage to the gut lining.
00:29:08
Things like refined sugars, processed carbs, these are primary fuel sources for pathogens.
00:29:14
Alcohol directly degrades tight junctions, so this has to go.
00:29:18
Ultra processed foods, certain food additives, and you know, individually identified
00:29:25
inflammatory foods are removed based on this clinical picture.
00:29:30
Any type of chronic NSAID use, so non steroidal anti inflammatory drugs, proton pump inhibitors
00:29:36
and other medications that impair gut integrity, they're assessed and addressed where
00:29:41
clinically feasible.
00:29:43
Chronic physiological stress and sleep deprivation are often huge drivers of gut
00:29:49
permeability and microbiome disruption through the HPA axis.
00:29:54
And so, these are not optional, they're part of the remove phase because we cannot repair the
00:30:00
gut while leaving the primary drivers in place.
00:30:04
And so, this step is critical and creates the conditions for everything that follows.
00:30:09
Now, the next step are to replace.
00:30:12
So once the pathogens are addressed, drivers are removed, the gut still now has a functional
00:30:18
deficit.
00:30:18
And so in states of chronic dysbiosis and inflammation, digestive capacity is frequently
00:30:24
impaired.
00:30:25
The pancreas and biliary systems aren't producing the adequate enzymes and acids to
00:30:30
properly break down food.
00:30:32
This means food is arriving in the lower gut, partially undigested, which becomes its own
00:30:37
driver of microbial fermentation and gas production, and the continued imbalance.
00:30:43
So, this phase, replace means restoring digestive function, targeted digestive enzymes,
00:30:50
hydrochloric acid support if necessary, bile salts for fat digestion.
00:30:56
This step also addresses the nutritional deficiencies that the chronic gut inflammation
00:31:01
and malabsorption have produced.
00:31:04
Things like zinc, magnesium, B vitamins, fat soluble vitamins like A, D, E and K.
00:31:11
These are commonly depleted and must be restored.
00:31:14
Healing requires these raw materials.
00:31:16
If those materials are deficient, healing will be impaired regardless of what you do.
00:31:23
R number three.
00:31:24
So, step three is to reinoculate.
00:31:27
Now, and only now, we reintroduce beneficial microorganisms.
00:31:31
Again, this cannot happen too soon.
00:31:34
So, reinoculating means strategically repopulating the gut with probiotic organisms
00:31:40
that the dysbiosis depleted.
00:31:42
Lactobacillus and bifidobacterium species and others guided by what the gut zoomer showed as
00:31:48
deficient.
00:31:49
It also means introducing targeted prebiotic fibers and substrates that the beneficial
00:31:55
bacteria can use as fuel, so that the introduced organisms can actually establish
00:32:00
themselves and complete effectively for the territory.
00:32:05
In a gut that has been cleared of pathogens and has adequate digestive support, the beneficial
00:32:11
bacteria can now actually take hold in there.
00:32:14
And what they do is they begin to produce things called short chain fatty acids,
00:32:18
particularly a compound called butyrate, which is the primary energy source for the
00:32:24
colonocytes, which are the cells that make up that colon lining.
00:32:28
So, you get to see the picture here, right?
00:32:29
We have to clear out, now we're rebuilding the ecosystem so that the ecosystem can produce the
00:32:36
things that are going to heal the gut barrier.
00:32:38
Because then the next step is what we call repair.
00:32:42
And so, without remove and replace first, the reinoculate phase, it fails.
00:32:48
But with them, it works and sets us up for phase four, which is repair.
00:32:52
Repopulating the microbiome has now created the conditions for the gut lining to heal.
00:32:58
But we also specifically support this with specific things.
00:33:03
The tight junctions that have been degraded by the LPS and the dysbiosis now need the raw
00:33:09
building materials to regenerate.
00:33:11
So, some nutrients with the most evidence that we use, L glutamine.
00:33:16
This is the primary fuel source for the enterocytes, which are the cells of the small
00:33:20
intestine lining.
00:33:21
Zinc carnosine has specific evidence for tight junction integrity.
00:33:26
Collagen peptides are fantastic for structural support.
00:33:30
Deglycerinated licorice or DGL it's called.
00:33:33
It provides restoration of the mucosal lining, which is this like barrier of like a mucus that
00:33:42
lines the guts and keeps them hydrated.
00:33:44
And then N acetylglucosamine, which also builds that mucosal layer.
00:33:49
The butyrate now being produced by the reinoculated bacteria is also driving barrier
00:33:54
repair from the inside.
00:33:56
So, this is another reason why the sequence matters because reinoculating generates the
00:34:01
fuel that repair depends on.
00:34:04
Systemic inflammation that has been running for months or years doesn't resolve the moment the
00:34:09
gut lining heals.
00:34:11
Repair also includes targeted support for reducing the broader inflammatory burden using
00:34:16
things like omega-three fatty acids, anti inflammatory botanicals, and addressing the HPA
00:34:22
axis dysregulation or stress axis.
00:34:26
So, rebalancing, is the fifth R, getting into phase five, it doesn't exist in isolation, it's
00:34:32
in constant bidirectional communication with the immune system and the nervous system, as
00:34:38
well as the endocrine system, the metabolic system, all those systems have been operating
00:34:43
under the influence of a chronic gut driven inflammation, sometimes for years.
00:34:49
So rebalancing these addresses the systemic effects that don't automatically go away when
00:34:54
you heal the gut.
00:34:55
And so that's where we start to focus on hormonal patterns, particularly estrogen
00:35:00
metabolism, which depends heavily on a specific set of gut bacteria.
00:35:05
Thyroid conversion, which has a gut dependent component.
00:35:08
Blood sugar regulation, insulin sensitivity, which chronic inflammation impairs all of
00:35:13
these.
00:35:14
They're managed with dietary structure, targeted support, as well as lifestyle
00:35:17
interventions.
00:35:18
So, this phase is heavily dependent on long term dietary and lifestyle architecture that
00:35:25
will determine whether the gut stays healthy long term or not.
00:35:29
A rebuilt microbiome requires maintenance.
00:35:31
The organisms that were just reestablished need a dietary environment that can continue to
00:35:36
support them.
00:35:37
So, this is where sustainable eating patterns, stress management practices, sleep hygiene
00:35:42
become part of the clinical plan rather than just some generic advice.
00:35:47
And so, this is built directly in for you.
00:35:50
The final phase, this is what we call R6, reintroduce.
00:35:54
So, it's a methodical reintroduction of foods that we removed during treatment.
00:35:59
This step is important to understand correctly.
00:36:01
So, the goal of this protocol is never permanent food restriction, you can never eat
00:36:07
something ever again.
00:36:08
Restriction during the remove and early repair phases is very therapeutic.
00:36:13
It creates the conditions for healing.
00:36:16
Once the gut barrier has been repaired and the microbiome reestablished, many foods that were
00:36:22
previously like reactive or causing inflammation can be tolerated now because the
00:36:28
mechanism driving the reactivity has been corrected.
00:36:31
So, we systematically reintroduce things.
00:36:34
One food at a time, monitoring for reactivity.
00:36:38
Most patients find their food tolerance has expanded significantly compared to their
00:36:43
baseline when they started.
00:36:44
Sensitivities that normally had been maybe present for years, sometimes for a decade, they
00:36:49
often resolve entirely once that barrier is now intact and the immune system is no longer in a
00:36:56
state of chronic activation.
00:36:58
So, appropriate, this phase includes a follow-up gut zoomer to confirm the clinical
00:37:04
picture, the targeted pathogens have been cleared, the beneficial populations are
00:37:08
reestablished at adequate levels, and that permeability markers including zonulin have
00:37:13
normalized.
00:37:14
Because testing is one thing, but retesting is confirmation.
00:37:19
So, now let's take a step back and let's just look at everything.
00:37:23
So, six steps: remove, replace, reinoculate, repair, rebalance, and reintroduce.
00:37:31
Each one follows the biology.
00:37:34
Each one is sequenced to create the conditions for the next.
00:37:38
That is what makes this a protocol rather than a collection of interventions.
00:37:42
You're not throwing things at a problem.
00:37:45
You're restoring a system in the order that systems need to be restored.
00:37:49
And the reason this produces results across such a diverse range of symptoms, fatigue,
00:37:55
cognitive function, joint pain, skin, mood, metabolic, it's precisely because those
00:38:01
symptoms were not separate problems, they were downstream expressions of the same upstream
00:38:07
dysfunction.
00:38:08
Fix the root, the downstream follows.
00:38:11
And so, if what I've described today matches your experience, multi system symptoms,
00:38:17
expanding food sensitivities, fatigue, brain fog, normal labs that don't match how you're
00:38:23
feeling, I want you to understand something very clearly.
00:38:28
Normal labs in conventional medicine means we did not find a declared disease.
00:38:33
That's it.
00:38:34
It doesn't mean that nothing is wrong.
00:38:36
Gut dysbiosis and intestinal hyperpermeability will not show up on standard blood panel or a
00:38:42
colonoscopy.
00:38:43
They are not part of the conventional diagnostic framework, which is why they're
00:38:48
often missed consistently and consistently in people who are genuinely unwell who then show
00:38:53
up in our office years later with the same problem that's now worse.
00:38:58
Because the mechanisms we discussed today are documented, the testing is precise, The
00:39:03
treatment protocol is logical and sequenced.
00:39:06
This isn't some fringe alternative medicine.
00:39:09
This is functional medicine, which is doing what it's designed to do.
00:39:13
Look upstream, find what was missed, give the body what it needs to restore function.
00:39:19
And so, to learn more about functional medicine and any of our functional medicine programs or
00:39:24
to see if this is something you might be dealing with, I would encourage you go to
00:39:28
ascendfunctionalhealth.com, schedule a consultation with myself or one of our other
00:39:33
providers and let's create a personalized plan for lifelong gut restoration.
00:39:38
If you're a listener of the show, you always get an exclusive discount and price reductions
00:39:43
on protocols, lab tests, so be sure you tell us where you heard about us.
00:39:48
As always, if you found value in today's show, please like the show, follow, subscribe, that
00:39:56
way you don't miss anything, and please share this with someone who needs to hear it.
00:40:00
That's how we grow this message, and we're able to change more lives.
00:40:04
Also, go visit ascendfunctionalhealth.com and sign up for our newsletter, or in the podcast
00:40:10
show notes.
00:40:11
Check out our resources page, you can learn more about our cutting edge approaches to
00:40:15
nutrition, our different therapies, and how we are helping change lives, not only in Tampa,
00:40:21
but across the country.
00:40:23
So I want to thank you again for tuning in to Health Decoded.
00:40:26
I'm Doctor.
00:40:27
Lesse, and I will see you on the next one.
00:40:30
Thank you for tuning in to Health Decoded, where we break down the truth about all things
00:40:35
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00:40:37
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00:40:39
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00:40:54
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00:40:59
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00:41:05
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