https://gut.alessifunctionalhealth.com/main-page
(0:00) Introduction and the body as an integrated system (0:29) The root cause of persistent bloating (0:57) Dr. Alessi's Total Gut Reset framework (1:31) Sponsor: Free webinar invitation (1:54) Case study: Karen's health journey (2:46) Addressing the wrong level of the problem (3:32) Episode overview and ketogenic dieting issues (7:26) Thyroid dysfunction and medication inadequacies (10:28) Misuse of antidepressants for hormone-related issues (13:28) The limitations of generic probiotics (17:28) The common flaw in symptom-focused treatments (18:43) The importance of functional medicine (20:25) Preview of the final episode in the miniseries (21:48) Closing remarks and call to action00:00:00
Body is not just a collection of isolated problems.
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It's an integrated system.
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Your gut affects your hormones.
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Your hormones affect your thyroid.
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Your thyroid affects your metabolism and your brain.
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Cortisol affects all of it.
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Your microbiome regulates your immune system, your neurotransmitter production, and your
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ability to detox.
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Welcome to Health Decoded, your number one source for real health information with your
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host, doctor Alessi and Matt Tack.
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Health decoded listeners, if you're dealing with bloating that just won't go away no matter
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what you eat, no matter what you try, I need you to hear this.
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The bloating isn't the problem.
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It's a signal.
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Every external symptom you're experiencing, the discomfort, the fatigue, the frustration has a
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root cause.
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And in my years of clinical practice, it almost always leads back to the gut.
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Nothing else in your body can fully heal until that foundation is restored.
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I built this framework from my own health journey.
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I was that patient, frustrated, dismissed, searching for answers.
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I took everything I learned, refined it through years of clinical testing, and have since
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helped hundreds of patients achieve complete relief from their symptoms.
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That became the Total Gut Reset, a step by step protocol with one goal, reset your gut in six
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months or less.
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If you're ready to learn exactly what's causing your symptoms and eliminate them for good, I'm
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hosting a free webinar where I walk you through the entire framework.
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The link is in the show notes.
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Go ahead and register, and I'll see you there.
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When Karen came to see me, she handed me a list, not a symptoms list.
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It was a list of everything she had tried.
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She'd written it out the night before, and I could tell it had taken a while for her to put
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this together.
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Three different elimination diets, including two rounds of keto.
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She'd been on thyroid medication for years without significant improvement, an
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antidepressant that her doctor had prescribed with ultimately good intentions, but for
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symptoms that had started presenting as anxiety and low mood.
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She was on a probiotic from a health food store for eighteen months.
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She was on hormone creams that she found online, a handful of supplements that somebody
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in her Facebook group had recommended.
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She slid the list across the desk and said, I've done all of this.
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None of it has worked.
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So, I'm either doing something wrong or I'm just somebody who can't be fixed.
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Now, I want to tell you what I told her, and I want you to hear this clearly.
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Nothing on that list failed because of her.
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Every single thing she tried failed because it was addressing the wrong level of the problem.
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And that's not her failure.
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That's a failure of the information she was given.
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Every protocol on that list was a logical response to real symptoms.
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Keto she tried for weight and her blood sugar.
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The thyroid medication she was on because she had a flagged TSH level.
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The antidepressant was for her mood.
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The probiotic was for her gut health issues.
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All of them make sense as to why she tried it, but none of them were designed to address the
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actual root cause system.
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Now, that distinction between a logical response to symptoms and an actual root cause
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solution is what this entire episode is about to be about.
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By the end, I want you to understand exactly why those things didn't work and what would
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have.
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Welcome back to Health Decode It.
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I'm Doctor.
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Alessi, and this is episode three of a four part miniseries.
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We've talked about the gap between not being sick and actually thriving.
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We've talked about the real economics of healthcare and what taking action or inaction
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actually costs.
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Today, we're going more clinical.
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We're going to break down specifically and honestly why the most common approaches women
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try don't produce lasting results.
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I'm going to do it without judgment because every patient I've had this conversation with
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was trying to do the right thing with the information they had.
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Let's get right into it.
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Let's start with ketogenic dieting because it is generally one of the most popular
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interventions I hear about in my new patient consultations and because it actually works for
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a specific mechanism for a specific timeframe in a specific population of people.
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Keto works by dramatically reducing carbohydrate intake, which can lower blood
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insulin levels, shifting the body from burning glucose to burning fat for fuel.
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For people with insulin resistance, and that's a significant portion of the population, this
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can produce some pretty meaningful weight loss changes, improved energy, better blood sugar
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control, and it often happens pretty quick.
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So why doesn't it last?
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Well, the first problem is cortisol.
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A very low carb diet is a physiological stress.
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It triggers an increase in cortisol, your primary stress hormone.
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For a woman in her 40s or 50s who's already dealing with cortisol dysregulation, which as I
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talked about in episode one, is extremely common, adding sustained cortisol stress can
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accelerate the very hormone disruption she's trying to fix.
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Now, elevated cortisol drives storage of fat around the abdominal area.
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It disrupts the HPA axis further and it actually antagonizes thyroid function.
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The second problem with keto diet is the thyroid.
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Prolonged carb restriction, particularly in women, can reduce the conversion of T4 to the
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active thyroid hormone T3.
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Meaning, you might feel great for eight weeks, then you hit a plateau, then you start feeling
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cold, maybe more fatigued, unable to lose weight, despite doing everything right.
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This is your thyroid adapting to what it perceives as a famine.
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And if you already had subclinical thyroid dysfunction going on, which is common and often
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undetected, you've now compounded the problem.
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The third problem is the gut.
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Ketogenic diets are often very low in fiber and resistant starch that feed the beneficial
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bacteria in your microbiome.
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Over time, this can reduce microbiome diversity and impair the production of short chain fatty
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acids, which are critical for gut barrier integrity, immune regulation, and mitochondrial
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energy.
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A gut that starts dysbiotic will often become more dysbiotic on a strict keto protocol.
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If you want to learn more about gut health and dysbiosis and what those terms mean, go back a
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few episodes to the episode I did on gut.
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None of this means keto is actually wrong though.
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It means that keto is a tool, and like any tool, it produces different results depending
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on the context.
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Without knowing your cortisol rhythm, your thyroid status, your microbiome, or your
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hormonal baseline, using keto is often a guess.
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Sometimes it's an educated guess, but it's still a guess, and maybe it's not right for
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you.
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Now, let's get a little bit into where thyroid plays in, and so why thyroid medication often
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isn't enough for these kind of things.
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This one I want to spend some time on because thyroid dysfunction is one of the most under
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diagnosed and most inadequately treated conditions that I see, particularly in women.
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Here's a conventional model.
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Primary care physician orders a TSH, thyroid stimulating hormone.
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If it's above a certain threshold, you're hypothyroid.
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You get a prescription for levothyroxine, which is synthetic T4.
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So you take this, your TSH comes back into range.
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Your doctor tells you that you're managed, you're good, yet you probably still feel
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terrible.
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Now, why does this happen?
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TSH, which is thyroid stimulating hormone, measures what your pituitary gland is signaling
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your thyroid to do.
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It does not tell you what your thyroid is actually producing, or even more importantly,
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whether your body is actually converting that hormone into its active form and getting it
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into the cells.
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Here's the chain that most conventional physicians never evaluate.
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Your thyroid produces T4, mostly T4, which is a storage hormone.
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T4 must then be converted to T3, the active hormone that actually runs your metabolism,
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primarily in your liver and in your gut.
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If your liver is congested, if your gut is dysbiotic, if you're deficient in selenium or
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zinc required for these conversions to happen, if you're under significant physiological
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stress, T4 will instead convert to reverse T3, which is essentially a break on your
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metabolism.
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It blocks T3 receptors and makes you functionally hypothyroid even if your TSH and
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T4 look fine.
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And so, can get confusing.
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I've had patients on thyroid medication for five, ten years who never had their free T3 or
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reverse T3 measured, not one time, because it's not on the standard panel.
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Now, we measure it, the story changes completely for these people.
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Additionally, thyroid medication actually treats the hormone level.
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It doesn't treat the gut dysbiosis, which is impairing conversion.
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It doesn't treat the adrenal dysfunction that's making the whole system unstable.
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It doesn't treat the autoimmune component, Hashimoto's, that in many cases is the actual
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driver of the thyroid dysfunction in the first place.
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Hashimoto's is an autoimmune condition, so managing thyroid hormone without addressing the
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immune system is just that.
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It's management.
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It's not actually treatment.
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Your thyroid isn't an isolated organ.
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It's one node in a hormonal network that includes the adrenals, the gut, the liver, and
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your immune system.
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So treating it in isolation produces partial results at best.
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Now, the problem with antidepressants from this patient that we're discussing, I want to make
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sure I touch on this.
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This is a sensitive topic and I'll address this carefully because the physicians who prescribe
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antidepressants to perimenopausal or menopausal women, they're not being negligent.
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They're responding to symptoms that look in a quick appointment like depression or anxiety,
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and they're prescribing the tool that they have available.
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The problem is it's the wrong tool for the underlying cause.
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Without understanding the deep underlying cause, that can often lead to more problems
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down the line.
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Perimenopausal hormone fluctuation, which specifically looks like declining progesterone
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and the roller coaster of estrogen, it produces symptoms that are clinically almost
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indistinguishable from depression and anxiety.
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If you're not looking at the hormonal picture, irritability, sleep disruption, mood
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instability, this kind of flattened effect, inability to concentrate, low motivation, low
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mood.
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These are textbook perimenopause symptoms.
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They're also textbook presentations for referral to psychiatry.
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So, it's very important to make the distinction.
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When it comes to being a doctor, we always say first do no harm.
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And so, if we're not addressing the deeper underlying causes and just prescribing
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medication, we are not following the do no harm policy.
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SSRIs, they work by modulating serotonin signaling.
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They don't actually restore hormones.
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They don't restore progesterone.
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They don't stabilize estrogen.
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They do not address the HPA axis dysregulation that is often occurring.
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So, might blunt some of the emotional symptoms, which can feel like maybe a partial
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improvement, while the underlying hormonal cause continues to progress untouched.
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And they carry a cost.
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So SSRIs can blunt libido, they can impair your sleep architecture, they can cause weight gain.
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And kind of relevant to our earlier conversation, they do not address the root
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cause, so patients often remain on them indefinitely because it's never resolved.
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Soon as they come off, they're right back to that feeling of lousy.
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I've had patients who've come to me.
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They've been on antidepressants for years, maybe five, six, seven years, and for what was
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from the beginning a hormone problem.
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When we address the hormonal root cause, their mood symptoms often resolve and there's no need
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for these antidepressants in the first place.
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Now, it's not always the case, that's why I wanted to preface it.
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Genuine mood disorders, they require the appropriate treatment, but it is the case often
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enough that it represents a significant systemic failure in how midlife women are
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evaluated and treated.
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That's why we actually work hand in hand with psychiatrists.
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We have a very trusted psychiatrist that we will go back and forth with patients and, Hey,
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does it require medication at this point?
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Or is this more of a functional issue that we need to restore balance and homeostasis?
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And so, if you're on an antidepressant and you've never had a comprehensive hormone panel,
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that's a conversation worth having with a clinician who will actually look at the whole
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picture.
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You can give us a call anytime.
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You can reach out if you're a listener and you want to just have a fifteen minute discovery
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call, we do those all the time to see if this is something that we can help benefit you.
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Now, getting into the next piece of this patient, the probiotic conversation.
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So, a probiotic that doesn't work is worth as much as what it is.
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The probiotic market is worth billions of dollars and the vast majority of the products
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driving that market are actually clinically inadequate and they have pretty meaningless gut
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therapeutic purpose.
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Here's why.
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Most commercial products, the probiotics, contain a small number of bacterial strains.
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It's often lactobacillus, acidophilus, and a few others at the concentrations that are
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basically borderline relevant at best.
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But more importantly, the probiotic you buy at a health food store isn't selected for your
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microbiome.
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It's a generic product designed for general sale.
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Your microbiome is a community of trillions of organisms with over a thousand distinct
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species.
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Supplementing two or three generic strains without knowing what your microbiome actually
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looks like is trying to fix a very specific engine problem by randomly adding some generic
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car parts to it.
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It's a of a crude example, but it makes sense.
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The second issue is sequencing.
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If your gut has significant dysbiosis, meaning an overgrowth of potentially pathogenic
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bacteria, fungus, parasites, or having compromised gut barrier integrity like leaky
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gut, if you just go adding probiotics into that before addressing the problem, it's going to be
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futile and often make the problem worse.
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You're trying to plant seeds in soil that hasn't been prepared.
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And so, we actually utilize a system at Ascend Functional Health called the 6R protocol, Total
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Gut Reset, we follow a systematic approach where we number one, remove.
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Then we replace, reinoculate, repair, rebalance, and then reintroduce the system.
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It exists precisely because sequencing matters.
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You're reinoculating where you're putting beneficial bacteria back in as step one, you're
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skipping steps and oftentimes you're not going to be able to get the gut back to the full
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health where it needs to be.
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Now, the third issue with probiotics is that probiotics alone don't address the gut barrier.
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Leaky gut, which is that increased intestinal permeability, did a podcast on this a few
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episodes back, go listen to that.
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This is a driver of systemic inflammation.
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Anytime a patient comes in and they have immune dysregulation, food sensitivities, brain fog,
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fatigue, joint pain, eczema, itchy skin, those kind of things, we're looking at leaky gut.
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Probiotics don't actually repair the gut lining.
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That requires specific therapeutic nutrition, targeted nutrients, things like L glutamine,
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zinc, carnosine, removing obviously the inflammatory drivers that cause the damage in
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the first place.
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That's why remove is always step one.
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A quality, strain specific probiotic used at the right point in a comprehensive system
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protocol can be genuinely therapeutic.
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Now, a generic probiotic from the supplement aisle of the store used without any assessment
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of your gut problem, save your money because it's going to be counterproductive.
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The common thread of everything what we're getting at in this whole mini series that I
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wanted to really just educate on is that every approach we've talked about, keto, thyroid
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focused medications, antidepressants, generic probiotic use, these all share a common flaw.
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They're designed to address a symptom or a single biomarker in isolation.
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They're not designed to address the underlying biological system.
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Your body is not just a collection of isolated problems, it's an integrated system.
00:17:38
Your gut affects your hormones.
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Your hormones affect your thyroid.
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Your thyroid affects your metabolism and your brain.
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Cortisol affects all of it.
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Your microbiome regulates your immune system, your neurotransmitter production, and your
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ability to detox and absorb nutrients.
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So, these systems do not operate in individual columns.
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When you treat one piece without understanding how it connects to the whole, you get partial
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results.
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At worse, you actually address one problem while maybe inadvertently worsening another.
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As with the example of keto driving cortisol elevation or the thyroid medication ignoring
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the adrenal codysfunction.
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Now, this is not a criticism of people who recommended those things to you, if you've ever
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experienced this.
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It's a description of a functional foundational limitation in how medicine is structured.
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Conventional medicine is organized by specialty, an endocrinologist for your thyroid,
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a gastro for your gut, psychiatrist for mood.
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But it's rare that in conventional medicine, anyone is looking at the entirety.
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No one is asking how the thyroid dysfunction or the gut dysbiosis or the hormonal axis
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disruption and the moods are all connected because they're all manifestations of a same
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underlying biological state.
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Systems medicine, what we call functional medicine, starts from the opposite premise.
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Everything is connected.
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The question is always, what is driving the system into dysfunction?
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And the answer is almost never a single thing.
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So, Karen, that I was discussing from the start of this episode, when we finally had her
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complete picture, we found exactly what I'd have predicted, Significant gut dysbiosis,
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impairing her thyroid hormone conversion, HPA axis dysfunction, which elevated her cortisol,
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disrupted her sleep, her body composition.
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She had estrogen dominance driven partly by impaired gut estrogen metabolism and liver
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basically backed up in a micronutrient profile that made multiple systems deficient of those
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raw materials that they actually need to function.
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Once we had that whole picture, we actually were able to build a protocol that addressed
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them in the right sequence.
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Within four months, she was off antidepressants, working with her prescribing
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physician that wasn't us.
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Her thyroid medication was adjusted based on a proper panel.
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Her energy had fundamentally changed.
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She lost weight that hadn't budged in years.
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She came back at her follow-up and she left us a review saying she's not a person who can't be
00:20:16
fixed.
00:20:17
And she was skeptical, but she was just working with a map that was missing most of the
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picture.
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And so that's it.
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That is exactly it.
00:20:27
Now, I want to leave you guys with this today.
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Next week is the final episode in this series, and it's the one I'm looking forward to the
00:20:35
most because it's all about the destination.
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We've been building this story over the last few weeks, and this is about what actually
00:20:43
thriving in your fifties and sixties and beyond looks like.
00:20:47
Not just managing decline, but genuinely optimizing yourself.
00:20:51
If you stayed with me for three episodes, episode four is where it's going to pay off.
00:20:56
If today's episode described your experience or this felt like it hit home to you, the
00:21:02
approaches you've tried, maybe partial results, frustration from not getting where you want to
00:21:07
be, I want to invite you to have a different kind of conversation.
00:21:11
Not a conversation about just managing your symptoms too.
00:21:14
Conversation about actually finding the root cause for once.
00:21:18
You can book a discovery call.
00:21:19
The link in the show notes will take you to our page.
00:21:22
Bring your history, bring your labs.
00:21:24
If we need to run other labs, we can do that.
00:21:27
Let me know all the things you've tried.
00:21:29
I need to know everything because it all plays into your story in which I can then build a
00:21:34
complete picture.
00:21:35
So again, I'm Doctor.
00:21:36
Alessi.
00:21:37
This is Health Decoded.
00:21:38
I appreciate you sticking with me.
00:21:40
I look forward to seeing you in the final episode of this four part miniseries.
00:21:45
See you next week.
00:21:46
Thank
00:21:48
you for tuning in to Health Decoded, where we break down the truth about all things health
00:21:53
and empower you to take charge of your well-being.
00:21:56
If you found value in today's episode, please subscribe, leave a review, and share it with
00:22:01
someone who needs to hear this.
00:22:03
For more resources, personalized support, or to have your questions answered live on the show,
00:22:08
Visit Ascend Functional Health and head to the contact page to connect with us directly.
00:22:13
Until next time, stay curious, stay empowered, and remember, your health is in your hands.