Part 2 - Chapter 7 - It Starts With The Gut

Your hormones are not going to settle if your gut is on fire. That is the blunt truth we keep coming back to as we walk through the hierarchy of healing and why “repair” begins with the gastrointestinal tract.

We unpack what it really means to heal and seal the gut lining: mucosal integrity, tight junctions, secretory IgA, and why absorption and elimination are non-negotiable if you want stable mood, steady energy, clearer skin, and fewer perimenopause symptoms. When the barrier is compromised, endotoxemia and inflammatory cytokines can ripple out into joints, brain, and skin, which helps explain why anxiety, overwhelm, and rashes so often sit alongside digestive issues.

Laura’s case makes it real. She starts the oral contraceptive pill for contraception, then ends up with recurring thrush and candida, severe rashes, gut symptoms, anxiety, fatigue, and PCOS-like features that raise fertility questions. We talk about informed consent, how the pill can shut down the HPO axis and progesterone production, how nutrient depletion can worsen mood and energy, and how dysbiosis, MCAS, and histamine overproduction can create a full-body inflammation spiral. We also zoom out to the “menopause brain” and why lifestyle medicine, movement, sleep, and a gut-supportive diet matter during a time when the brain is rewiring.

We finish with a practical preview of the 12-week heal, seal and repair protocol, including elimination and careful reintroduction to identify triggers like gluten, plus the kind of results that become possible when inflammation drops and ovulation returns. If this resonates, subscribe, share it with a friend who feels dismissed, and leave a review so more women can find a gut-first path back to feeling like themselves. What symptom are you most ready to fix first?

Transcript

Why Healing Starts With Gut

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Part two The Hierarchy of Healing Chapter seven It starts with the gut. Always remember your value is immeasurable, not determined by success, looks, or others' opinions. You are invaluable simply by being you. Dr. Holland, what is the one thing I could do to set myself up to feel good, energized and like myself? To find peace in my body. What would it be? I can't tell you how many times I've heard this question asked with a mix of hope and exhaustion in a woman's eyes. My answer is always the same. Ideally, you do all the things repair your gut, rebalance your hormones, and reclaim your metabolic health. Then I pause and add, but if I had to pick just one place to begin, it's your gut. Without repairing your gut, nothing else will hold. Your gastrointestinal tract is your earth element, your extension to the external world. It's the first place you interact with anything outside of yourself. If there's an issue with your digestion, if there's an issue with proper absorption of nutrients, everything else will fall flat. Remember, my solutions and protocols are based on restoring your foundational health first, your basic biochemistry, beginning at a cellular level. To do this in a way that truly lasts, there is a specific order and timeline to follow. And it begins with the gut. Let's go back to the idea of restumping your house. If the foundation and the bones aren't solid and strong, all the interior design in the world won't matter. In the same way, when your body is going through the transitional state of perimenopause, the renovation of your biochemistry must begin with repairing your gastrointestinal tract, which I call healing and sealing your gut. As you'll discover, the gut is both beautifully designed and complex. Repairing the gut.

Heal And Seal The Lining

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When I speak about repairing the gut, I'm referring to the tightening of the gut mucosa, the beautiful gelatinous inner lining of the intestine and stomach. In one of the previous case studies, I spoke about secretory immunoglobulin A, secretory IgA, or sega. Sega is an antibody found in the mucosal layer that helps prevent pathogens, the bad guy bacteria, from setting up camp and penetrating the intestinal barrier. In essence, secretory IgA supports the immune health of the gut mucosa by strengthening its protective lining. Once you've restored your mucosal integrity, meaning the gastric mucosa is sealed with tight gap junctions, and the rest of your gut is humming along nicely, your body can finally do what it's designed to do. You're able to absorb the nutrients you need and your elimination pathways function properly, so your blood and body are being detoxified effectively. Once these processes are in place and operating at an optimal level, many women find their symptoms begin to dissipate. Your energy can be off the charts, your pain will be greatly reduced or resolved, and your zest for life returns as you reclaim your vibrancy for good. I've chosen a case study from my clinic to show you why repairing the gut is the first step to reclaiming your most vibrant self.

Laura’s Case And The Pill

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I'd like to introduce you to Laura. Laura. When Laura came to see me, she was 36 and already showing early signs of perimenopause. Similar to Marianne's story, Laura's younger age led her GP to dismiss the possibility that hormone imbalances could be at the root of her health struggles, which turned out to be a significant oversight. Laura's symptoms and issues were many and complex, yet without her GP exploring beneath the surface of her existing hormonal imbalances, Laura was left without the answers she so desperately wanted. Most of the symptoms Laura presented with were exacerbated by her high stress levels. She was a young teacher working hard to become excellent in the classroom to impress her headmistress. She was in a brand new relationship and head over heels in love. With the relationship so fresh and Laura and her partner still so young, they weren't ready for children quite yet. For effective contraception, Laura had chosen to go on the oral contraceptive pill. And, as you will see, the pill and its potential side effects lay at the heart of many of the issues she later faced. Before we move on, I want to emphasize that I am in full support of contraception. I believe every woman should have the freedom of choice about when and if she wants to have a child. What I do not support is uninformed consent. In Laura's case, critical information she should have been given about the oral contraceptive pill was not shared with her. This lack of knowledge became the trigger for so many of her health challenges. Laura should have been told about the possible side effects of the pill. For instance, the pill is designed to shut down the communication between her brain and her ovaries, effectively closing down the HPO axis. In simple terms, this meant that to prevent ovulation and falling pregnant, her body would also stop producing progesterone altogether. Without the calm of progesterone, Laura became at risk of experiencing anxiety and insomnia. Laura also needed to know that the pill could disrupt her gut microbiome, which in turn could impact her vaginal health. This disruption was likely the cause of the candida and the thrush Laura suffered every month. Why? Because the vaginal microbiome is closely connected to the gastrointestinal microbiome. Had she been given the full scope of information about the pill and its potential side effects, Laura may have chosen a different contraceptive method. Now that we've set the stage for some of Laura's struggles, let's take a closer look at her health journey and the reasons she eventually walked into my clinic. Laura's health journey. Laura reported her major issues to be severe skin rashes, recurring candida and thrush, extreme anxiety, gastrointestinal issues, and what could be later diagnosed as Picos. Her Picos symptoms also raised questions about her fertility status. What Laura didn't realize at the time was that many of her symptoms could be traced back to an unhealthy gut.

Dysbiosis MCAS And Histamine Spiral

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You see, within the body there are multiple biodirectional communication pathways connected to the gut. In Laura's case, three axes were particularly relevant the skin gut axis, the brain gut axis, and the gut hormone axis. The gut sits at the center, impacting each pathway. When it comes to treatment, the gut simply cannot be ignored. As we walk through Laura's story and protocol, we'll peel back the layers of each axis and explore its specific connection to her symptoms. Hormonal disharmony. Yes, the contraceptive pill provided Lara with reliable contraception, but it also severely impacted her gut microbiome, and not in a good way. Not only was her own hormonal production shut down, but Lara also developed MCAS alongside gut dysbiosis. As a reminder, dysbiosis occurs when there is an imbalance in the bacterial composition in your gut. Essentially, a harmful ratio develops between the beneficial bacteria and the unbenicial bacteria. It's when the bad guys are running the show. When we discuss Lara's MCAS, I will again reference Dr. Tamy Dempsey, a brilliant integrative medicine specialist and world-renowned expert in chronic disease, autoimmune disorders, and mast cell activation. If you recall, Dr. Dempsey described mast cells as immune defense cells distributed throughout the body. When no threat is detected, they sit quietly in your tissues, watching for potential assaults. All is well until they're triggered, at which point they can overreact, leading to chronic inflammation in your organs and tissues. For Laura, her MCAS triggered an overproduction of histamine. Histamines themselves aren't bad. In fact, they're essential in performing several important functions in the body. However, trouble arises when too much histamine is produced and released, causing an imbalance in the immune system. Because around 70% of our immune system is located in the gut, it was Lara's gastrointestinal tract that suffered most. Then Lara's doctor, rather than identifying and treating her underlying MCAS and pill-induced Picos, post-pill and ovulation with Picos-like features, misdiagnosed her with chronic fatigue syndrome. You see, the use of the oral contraceptive pill can disrupt hormonal balance and create POS-like symptoms, which is exactly what happened to Lara. If you recall, from the last chapter, Dr. Dempsey's research has shown a possible connection between MCAS and Picos, with both conditions sharing overlapping symptoms, including irregular periods, metabolic changes, anxiety, and mood disturbances. This added yet another layer of complexity to Lara's case, particularly when it came to her fertility. Another sneaky side effect of the pill is that it depletes the body of activated B vitamins and magnesium. For Lara, this nutrient deficiency contributed to her anxiety and energy crisis or extreme fatigue. The combination of Lara's MCAS and PCOS shared symptoms, fatigue, hormonal imbalance, gut disruption, could easily have confused her doctors. Instead of identifying the root causes that lay beneath, her symptoms were mislabeled first as chronic fatigue syndrome and then tangled with concerns around her fertility. I see women who are misdiagnosed with conditions such as fibromyalgia and chronic fatigue syndrome in my clinic too often, when in fact their symptoms are driven by perimenopause. The good news is that misdiagnosis can be avoided by utilizing the foundational blood testing we discussed in chapter 5 and a thorough understanding of the symptoms, so practitioners and doctors can uncover the true drivers of perimenopausal symptoms before they're mistaken for something else. Your gut axis and what can go wrong. While I believe the pill contributed to Lara's overproduction of histamine, resulting in chronic inflammation, which lay beneath the surface of many of her symptoms, the pill also suppressed Lara's ovulation, leaving her with an estrogen-dominant presentation and progesterone deficiency. These higher levels of estrogen exacerbated the histamine production and inflammation in her gastrointestinal tract, worsening her digestive and mood issues. Without a healthy gut, nothing else could change sustainably for Laura. A woman's hormones are reliant on her ability to absorb the nutrients she needs from the food she eats. Proper absorption provides the biochemical building blocks needed to produce the proper amino acids, proteins, and neurotransmitters, all of which impact hormonal balance, overall health, and, of course, relief from perimenopausal symptoms. If you don't heal and seal the gut and restore mucosal integrity, endotoxemia can develop. This occurs when bacterial toxins and undigested particles leak through the compromised intestinal barrier into your bloodstream, where they have no business being. This triggers your immune system to produce inflammatory cytokines, which can affect your joints and brain, resulting in joint pain and mood issues. For Laura, due to the gut-skin axis, these inflammatory cytokines also attacked her skin, presenting as persistent rashes, especially around her mouth. Then, through the brain-gut axis, inflammation in her tissues and gut likely contributed to changes in her brain and nervous system, causing anxiety and an overall sense of overwhelm. These symptoms left her feeling unable to manage her life. And the culprit behind it all? The systemic inflammation triggered by Lara's unhealthy gut. The full impact of Lara's uninformed consent. To summarize, the contraceptive pill wreaked havoc on Laura's overall health. It impacted her vaginal health, presenting as candida and thrush every month. The pill may have triggered her MCAS, causing skin rashes as well as altering her gut microbiome. This change in her microbiome then impacted the way Lara metabolized food, contributing to weight gain. In addition, she suffered from severe premenstrual dysphoric disorder, PMDD, which included severe anxiety, insomnia, and depressive aggro, driving her sweet boyfriend crazy every month. Just like Lara, when a perimenopausal woman has inflammation in her gut and tissues, it will inevitably impact her brain, her mood, and her anxiety. When you have inflammation in the gut, you have inflammation in your mind and your mood.

Menopause Brain Needs Daily Support

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The perimenopause brain. I want to take a moment to talk about what Dr. Lisa Marconi refers to as the menopause brain. She is a leading neuroscientist and woman's brain specialist, whose research has proven that menopause doesn't just affect your ovaries. It's a hormonal event where the brain plays a leading role. At this point, you know that perimenopause and menopause are two different events in your body. In perimenopause, your brain is actually rewiring itself. During the transition from the roller coaster of perimenopause into the calm of menopause, Dr. Marconi emphasizes how critical it is to support the brain. Without that support, the risk of memory issues and chronic illness such as Alzheimer's and dementia can increase. So how do you support the brain during this transition? Lifestyle medicine is the first line of defense. Physical activity has consistently been linked to reducing the risk of dementia. Second, a diet that supports gut health also contributes to supporting your brain, your cognitive health, and your mood. The perimenopause brain may endure intense challenges, but with the right support, including the way you eat, sleep, move, think, prescribe, and connect in the hierarchy of healing, it can emerge stronger, wiser, and more peaceful. It is in perimenopause that the work needs to be done. It's a time for you to take care of yourself in ways you never have before, so you can successfully transition to the peace of menopause. That's not to say that if you have already transitioned to menopause and are still experiencing certain symptoms, that you can't rewind and do the work to ensure that your graduation into menopause is a peaceful one. This calm transition is my wish for all women. The pathway to decrease inflammation. Inflammation acted as a catalyst for the majority of Laura's symptoms. In her case, the fastest way to reduce her systemic inflammation was to treat her gut. You'll hear more about how her gastrointestinal issues were addressed in the next chapter. Repair. For now, by successfully decreasing inflammation in Laura's gut, we also reduced the inflammation in her brain, which then positively affected her mood and her anxiety. Once again, everything is connected through the three axes we discussed earlier, with the gut sitting at the center. In order to have hormonal harmony, which is what every perimenopausal woman I've worked with longs for most, your hormones will not balance until your gut does. Healing begins with repairing your gut. Laura's story is a testament to what can go awry when your gastrointestinal tract isn't healthy. Without proper absorption and detoxification, your body isn't capable of taking in the necessary nutrients or effectively ridding the body of toxins, which is the reason why Lara experienced dysbiosis and endotoxemia. Her lack of mucosal integrity and an unhealthy gastrointestinal microbiome negatively impacted Lara's vaginal microbiome, skin, and the systemic inflammation throughout her body. Lara's fertility. I don't think I need to explain the reasons Lara chose to go off the pill, but once she did, she was no longer bleeding. She had developed what is called pill-induced POS. In essence, the pill had rendered Lara infertile for a period of time. Alongside healing her gastrointestinal tract, my primary clinical focus was to get her successfully ovulating again with optimal levels of progesterone. This was key to not only restoring her cool, calm, and collected mood and her quality of sleep, but also in improving her fertility. So when Lara does decide it's the right time, she can choose to have a child. As we've touched on, Professor Pryor's work shows that the majority of perimenopausal symptoms stem from progesterone deficiency rather than estrogen deficiency. When we focus on restoring proper ovulation and adequate progesterone production, as we did with Lara, we address the root cause of symptoms rather than merely masking them. Lara's suffering began with her consent to the contraceptive pill, consent given without being informed of the full scope of information about the possible side effects to her health. But there's a hopeful ending for Lara's health journey thanks to her implementation of the hierarchy of healing. Lara's treatment. As

The 12 Week Repair Framework

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you might expect, we began with repairing Lara's gastrointestinal tract. Lara completed my 12-week heal, seal, and repair protocol, which is one of the major clinical tools I use with many clients. In chapter 9, I will walk you through the entire protocol in detail. To give you a brief preview, Lara started with a four-week full elimination food protocol, which brought her body back into a neutral state by eating only foods with a low probability of triggering inflammation. Over the following eight weeks, we carefully reintroduced certain foods so Lara could identify her personal trigger foods. Through this process, Lara discovered she was particularly sensitive to gluten, a critical insight because she would tell you she has always loved bread, but she never realized it was creating dietary issues for her. That awareness became a crucial turning point. Lara is human, she's not a robot, and neither are you. Lara still wants to go to dinner with her girlfriends, and if she wants to give in to her favorite gluten temptations, sometimes she can. The difference is that now she understands the potential consequences, and she has the tools to make an informed choice if enjoying the linguini pasta is worth it. And sometimes it just is. Lara can still enjoy it, knowing that she can then start again the next day or the next week. She always has the ability to get back on track.

Results Fertility Returns And Next Steps

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For Lara the transformation was remarkable. Within the first four weeks the majority of her symptoms had reduced significantly. No digestive issues, no skin rashes, her energy levels skyrocketed. But most importantly, Lara had her first period in ten years. Lara was amazed at how quickly her symptoms resolved, and her boyfriend was ecstatic. By beginning with repairing her gut, Lara reclaimed the vibrant woman she always knew was inside her. She stepped back into her power and into the most vital version of herself. I like to tell my clients and you, that when you heal, seal, and repair your gut, your rose tinted sunnies and zest for life are returned to you. I don't know about you, but I will always choose rose tinted sunnies every time. Lara did, and so can you. The following several chapters are the ones I believe you've been waiting for. The three phases of the hierarchy of healing, so you can begin your own transformation journey back to vibrancy. We'll start with the first phase, repair, which is built on my heal, seal and repair protocol, the very one you've just seen in action with Lara. I'm ready. Are you?