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Tag: gut

  • What Is Functional Medicine, Anyway?

    If you’ve followed me for any length of time, you’ve heard me use the words functional medicine more times than I can count. I talk about gut health, hormones, metabolic health, inflammation, stress, nutrient status, environmental exposures, and how all of these things connect.

    But recently, I realized I may have skipped over a pretty important question.

    What exactly is functional medicine, anyway? And maybe more importantly, how is it actually different from the medicine you’re already receiving?

    After more than 25 years practicing conventional medicine, I think I’m in a unique position to answer that. I didn’t leave conventional medicine because I stopped believing in it. I still prescribe medications when they’re appropriate. I order traditional labs. I refer to specialists. And if you have an acute medical problem or a disease that needs treatment, I absolutely want you receiving the conventional medical care you need.

    What changed for me was realizing that there was another group of patients we weren’t serving particularly well. They weren’t necessarily sick by traditional definitions, but they certainly didn’t feel well. And telling them everything looked “normal” wasn’t answering the question they came in asking.

    The Question That Changed How I Practice Medicine

    Traditional medicine is largely designed to answer an incredibly important question: What disease or diagnosis could explain these symptoms?

    Functional medicine doesn’t abandon that question. It adds another one.

    What factors may be contributing to why this person feels this way, and which of those factors can we change?

    That may sound like a small distinction, but it completely changes the conversation.

    If you come to me exhausted, bloated, gaining weight, sleeping poorly, struggling with brain fog, and feeling like your hormones have taken on a life of their own, I’m not interested only in assigning each symptom to its own category. I want to step back and look at the person experiencing all of them.

    How are you sleeping? What are you eating, and are you getting enough of what your body actually needs? How is your gut functioning? What is happening with your blood sugar and metabolic health? Are you maintaining muscle? What medications are you taking? Where are you in the hormonal transitions of midlife? What does your stress load look like? Are there environmental exposures that may matter?

    Your body doesn’t operate in departments, even though our medical system often has to.

    That’s one of the biggest differences functional medicine has brought to the way I practice.

    It’s Not Always About Finding One “Root Cause”

    The phrase root cause gets used a lot in functional medicine, and I use it too. But social media has turned it into something much simpler than human biology actually is.

    There isn’t always one hidden culprit responsible for everything you’re experiencing.

    Sometimes what I see is a woman who has spent years accumulating small changes. Sleep deteriorated during perimenopause. Stress increased. Exercise became less consistent because she was exhausted. Muscle started disappearing. Blood sugar became harder to regulate. Her gut became more reactive, so she began eliminating more and more foods. Somewhere along the way she accumulated a cabinet full of supplements, each one intended to fix a different symptom.

    Which one is the root cause?

    Sometimes that’s the wrong question.

    What matters more is understanding how those pieces are interacting and identifying where we have the greatest opportunity to change the trajectory.

    That is where functional medicine becomes useful rather than simply interesting.

    So What Would I Actually Do Differently?

    This is probably what most people really want to know.

    Functional medicine doesn’t mean I automatically order every specialty test available, put you on an impossibly restrictive diet, and send you home with 27 supplements. In fact, sometimes the most important things we uncover are surprisingly basic.

    Maybe you’re not eating enough protein. Maybe you’re sleeping six hours a night and compensating with caffeine. Maybe you’re having a bowel movement every three days and have simply decided that’s “normal for you.” Maybe you’ve lost significant muscle during midlife while focusing exclusively on the number on the scale. Or maybe you’ve become so overwhelmed by conflicting health advice that you’re trying to do everything and have no idea what is actually helping.

    Other times, your history and symptoms tell me we need to look more deeply at your gut, nutrient status, metabolic health, hormones, or another area. And sometimes what I hear tells me that you need further conventional medical evaluation before we do anything else.

    The goal isn’t more testing. It isn’t more supplements. And it certainly isn’t more complexity.

    The goal is to ask better questions, figure out what matters most, and address things in an order that makes sense.

    This Isn’t Conventional Medicine Versus Functional Medicine

    This may be the misconception I most want to change.

    I practiced conventional medicine for decades, and I know what it does extraordinarily well. I would never want to practice without it.

    If you have pneumonia, I don’t want to “heal your terrain” instead of treating your pneumonia. If you need thyroid medication, hormone therapy, blood pressure treatment, an antibiotic, or another prescription, there are times when medication is absolutely the right tool.

    But I also don’t think writing the prescription always has to be the end of the conversation.

    Can we also ask what contributed to the problem? Are there things we can change that may improve how you feel now and reduce risk later? Can we build health while we’re treating disease rather than waiting for another diagnosis to appear?

    That is the space where I believe conventional and functional medicine work beautifully together.

    Maybe We’ve Made Health Too Complicated

    The longer I do this work, the more convinced I am that most women don’t need more health information. They’re already drowning in it.

    Fast. Don’t fast. Eat carbohydrates. Don’t eat carbohydrates. Track your glucose. Fix your cortisol. Heal your gut. Balance your hormones. Take this supplement. Avoid that food.

    No wonder women are confused.

    You shouldn’t need a medical degree-or spend three hours a day listening to health podcasts-to figure out how to take care of yourself. What you need is a way to determine which information actually applies to you, what deserves your attention first, and what you can stop worrying about.

    That, more than anything, is what functional medicine means to me today.

    It isn’t about abandoning good medicine or chasing every possible abnormality. It’s about stepping back far enough to see the whole person, connecting the pieces that actually matter, and creating a plan that makes sense for the person sitting in front of me.

    Because ultimately, the goal isn’t to turn you into an expert in functional medicine.

    The goal is to help you understand your body, know what to work on, and feel like yourself again.

  • The One Toxin Nobody Wants to Talk About

    If you’re reading this, there’s a good chance you’ve already made real changes. You’ve swapped your cookware. You filter your water. You read labels on your cleaning products and your skincare. You’ve done the work.

    So let me ask you something.

    When was the last time you looked at your wine glass the same way you look at a plastic water bottle?

    Most of us never do. We’ve filtered out the “toxic” language when it comes to alcohol, even while we’re applying it to nearly everything else in our homes. And that’s worth pausing on, because alcohol isn’t separate from the toxic burden conversation. It’s part of it.

    The Story We Were Told

    For years, the message was consistent and reassuring: a glass of red wine is good for your heart. Moderate drinking is fine, maybe even beneficial. Having one drink a day is better than having none at all.

    That story is being rewritten.

    In recent years, the U.S. Surgeon General called for cancer warning labels to be added to alcoholic beverages, a significant shift, since it marks one of the first major public health steps toward telling people plainly that alcohol, in any amount, isn’t something to think of as “healthy.” This isn’t a wellness-industry opinion. It’s a signal that the evidence has moved.

    I’m not telling you this to create fear or to tell you to never drink again. That’s not how I approach anything in this work, and it’s not how I’m going to start now. But I do think it’s time we talked about alcohol the same honest way we talk about everything else that adds to your body’s load.

    What Alcohol Actually Does Once It’s In Your Body

    Here’s the piece that doesn’t get talked about enough.

    When you drink, alcohol is absorbed quickly and travels throughout your body, including your brain, which is why you feel it so fast. But the more important story is happening in your liver.

    Your liver has to break alcohol down, and in that process, it converts into a compound called acetaldehyde. Acetaldehyde is toxic, and with repeated exposure over time, it has the potential to damage DNA and drive inflammation in the body’s tissues.

    At the same time, alcohol disrupts the balance of bacteria in your gut and affects the integrity of the gut barrier. If you’ve followed my work at all, you know this is where I always start, because the gut is foundational. When alcohol throws off that balance, it can trigger inflammation that doesn’t stay contained to your digestion. It shows up in your skin, your mood, and your overall resilience.

    And then there’s sleep. Even a single drink can interfere with sleep quality, and sleep is one of the primary ways your body repairs and clears out what it doesn’t need. When sleep is disrupted, everything downstream, energy, hormones, inflammation, has to work harder to keep up.

    This is exactly the pattern I talk about with environmental toxins. It’s rarely one dramatic exposure. It’s the repeated, cumulative load that adds up quietly over time.

    The “Just One Glass” Problem

    Here’s something that surprises most people.

    A standard drink is smaller than what most of us are actually pouring. A true serving of wine is 5 ounces. Many wine glasses hold 8 ounces or more, which means two glasses from a larger glass can add up to closer to three standard drinks, not two.

    The same is true for beer and spirits. A light beer and a double IPA are not the same “one drink.” A generous pour over a single ice cube is often more than a single shot.

    None of this is about guilt. It’s about awareness. Most people are drinking more than they think simply because of how servings are measured out in real life, not in a lab.

    Rethinking Alcohol’s Place in Your Load

    I want to be clear about something. This isn’t about telling you alcohol is evil or that you need to eliminate it completely. That kind of fear-based thinking isn’t useful, and it isn’t how I approach any part of this work.

    What I want you to walk away with is this: alcohol adds to your cumulative toxic burden the same way ultra-processed food, synthetic fragrance, or plastic exposure does. It’s not separate from that conversation. It’s part of it.

    And here’s why that matters for the work we do together. You can make every swap in your kitchen, filter every glass of water, and clean up every product in your bathroom, and still be asking your liver and your gut to work overtime every single night if alcohol is a daily habit. Foundation work only holds if we’re honest about everything that’s asking your body to adapt, not just the parts that are easy to talk about.

    What You Can Actually Do With This

    You don’t have to decide today whether you’re a “drinker” or “not a drinker.” That’s not the point.

    A few places to start, if you want to:

    • Get honest about your actual pour. Measure a real 5-ounce glass once. Most people are surprised.
    • Notice the pattern, not just the amount. Are you reaching for a drink to unwind, to celebrate, out of habit? Naming the why gives you more choice, not less.
    • Space it out. A few alcohol-free days a week gives your liver and gut a chance to actually catch up.
    • Watch your sleep the next morning. Let your own body be the data. You’ll likely notice the connection faster than you expect.

    This is the same approach I take with every part of toxic load: not perfection, not fear, just enough awareness to make an intentional choice instead of a default one.

  • On Hormones and Still Not Right? The Conversation Nobody Is Having.

    You advocated for yourself. You found a provider willing to listen. You started hormone therapy — and you expected to feel like yourself again. And maybe you do, somewhat. But something is still off. The bloating didn’t resolve. The brain fog lifts some days and returns without warning. The sleep is better but not right. And you’re quietly wondering whether this is as good as it gets.

    It isn’t. And the missing piece is almost never the hormones themselves.

    Nobody is talking about the gut. The bloating. The digestion that became unpredictable somewhere in your 40s. The foods your body suddenly stopped tolerating. Those aren’t coincidental. They’re not a separate referral to gastroenterology. They’re directly tied to how your hormones are being metabolized — and they’re often the reason hormone support alone doesn’t fully resolve the picture.

    Most physicians are trained to look at these as separate systems. Hormones go to gynecology. Gut issues go to gastroenterology. And the woman in the middle is left managing two parallel conversations that never speak to each other — while still not feeling well.

    This is what I see all the time in practice.

    Your gut is not downstream from your hormones. It is actively regulating them. And until that relationship is understood and addressed, the hormonal picture will always be incomplete — no matter how well the rest of the protocol is designed.

    Here’s what that actually means — and why it changes everything about where we start.

    Meet the Estrobolome — The System Nobody Told You About

    Deep inside your gut microbiome lives a collection of bacteria with one very specific job: metabolizing estrogen.

    This is called the estrobolome. And it is one of the most important systems in your body that most physicians have never mentioned to you.

    Here’s how it works. Your liver processes estrogen and packages it for elimination. It moves through the digestive tract and, under normal circumstances, exits the body. But the bacteria in your estrobolome produce an enzyme called beta-glucuronidase. When the microbiome is balanced, this enzyme works appropriately. When it’s disrupted — by poor diet, chronic stress, antibiotics, or inflammation — beta-glucuronidase becomes overactive. It unpacks that estrogen before it can leave. Sends it back into circulation. And now you have more estrogen than your body intended.

    This is called estrogen recirculation. And it drives a very recognizable pattern: bloating, breast tenderness, heavy or irregular periods, mood instability, weight gain around the hips and midsection, and an overall sense that your hormones are chaotic — even when your labs look relatively normal.

    On the other side, when the estrobolome is severely depleted, estrogen gets cleared too aggressively. Levels drop. And now you’re dealing with the opposite — low estrogen symptoms in a woman who thought her hormones were fine.

    This is why treating hormones without addressing the gut is, at best, incomplete. The gut is not downstream from your hormones. It is actively regulating them.

    The Relationship Goes Both Ways

    Here’s what makes perimenopause particularly complicated — and what almost no one explains.

    Estrogen supports the diversity and health of your gut microbiome. It helps maintain the integrity of the gut lining, supports motility, reduces intestinal permeability, and promotes the growth of beneficial bacteria. When estrogen is high and stable, your gut tends to be more resilient.

    When estrogen begins to fluctuate and decline — which is exactly what happens in perimenopause — that protective effect weakens. The microbiome shifts. The gut lining becomes more vulnerable. Intestinal permeability increases. Inflammation rises.

    And then the gut, now dysregulated, does a poorer job of metabolizing the estrogen that remains.

    This is a bidirectional breakdown. Declining estrogen disrupts the gut. A disrupted gut mismanages estrogen. Each one makes the other worse.

    This is why so many women in perimenopause describe a sudden worsening of digestive symptoms they never had before. Bloating that appears out of nowhere. Food sensitivities that didn’t exist at 35. Constipation, or unpredictable digestion, arriving alongside the hot flashes and mood changes.

    It’s not a coincidence. It’s the same system breaking down.

    The Triad Nobody Is Connecting for You

    Now add cortisol to this picture.

    Chronic stress — the kind that high-functioning women carry for years without fully registering — physically alters the composition of your gut microbiome. It reduces microbial diversity, increases gut permeability, and drives inflammation. It also directly suppresses progesterone production, because your body will always prioritize cortisol synthesis over sex hormone production when it perceives threat.

    So when stress is chronic and unaddressed, you get lower progesterone, more gut permeability, a disrupted estrobolome, and estrogen that is either recirculating inappropriately or being cleared too aggressively.

    The result is a triad: gut dysfunction, cortisol dysregulation, and estrogen imbalance — all feeding each other, all showing up in the same woman, all being treated as separate problems.

    Bloating gets a GI referral. Anxiety gets an antidepressant. Hormone symptoms get dismissed or managed in isolation.

    And the woman in the middle is still not well.

    This is what I see all the time. And this is exactly why a systems biology approach matters. Nothing in the body operates independently. The gut, the hormones, the stress response — they’re all threads in the same web. Pull one and the others move.

    What This Looks Like in Practice

    The symptom cluster is more recognizable than most women realize:

    Persistent bloating that worsens in the second half of the cycle. Brain fog that lifts some days and returns without warning. Mood instability that feels hormonal but doesn’t fully respond to hormone support alone. Weight that accumulates around the midsection despite clean eating. Sleep that deteriorates even when stress feels manageable. Anxiety that seems to come from nowhere.

    These are not random. They are not separate diagnoses. They are a pattern — and the pattern points to the gut-hormone-cortisol connection as the place to start.

    Where We Begin

    You cannot balance hormones on a foundation that isn’t stable. You can supplement, you can prescribe, you can do all the right things on the surface — but if the estrobolome is dysregulated, if the gut lining is inflamed and permeable, if cortisol is quietly overriding your sex hormones, the results will always be partial.

    This is why the first step in the R.E.N.E.W. Method is always gut restoration. Not because it’s a trend. Because the systems underneath the symptoms have to be addressed first.

    When the gut is functioning properly — when estrogen is being metabolized correctly, when inflammation is reduced, when the microbiome is diverse and stable — the entire hormonal picture shifts. Often dramatically.

    This is the foundation. Everything else builds from here.

    Ready to Build Yours?

    If you’ve been trying to piece this together on your own — reading, supplementing, seeing providers who treat each symptom separately — you already know that approach has limits.

    The gut, the hormones, the stress response. They’re one web. And addressing them in sequence, with the right guidance, is what actually moves the needle.

    RENEW: Elevated Foundations is my physician-designed coaching membership built around exactly that. Each month you get physician-led clinical education, root cause coaching, and a structured path through the systems driving how you feel — in the right order, with support to actually implement it.

    This is where the guessing stops. And where the foundation finally gets built.

    Learn more about RENEW: Elevated Foundations 

    Dr. Christina Massinople | Redefining Medicine, Reclaiming Health