ICYMI 👉

• My (First Ever) Holiday Gift Guide 🎁

• Is Your Gut Trying to Tell You Something?

• A Surprising Fix for Weight Gain, Digestive Woes & Skeletal Pain

In this week’s reader-submitted Q&A, we’re tackling these questions:

• Do you recommend detox’ing after holiday eating?

• What do to about my peripheral neuropathy symptoms?

• Can HRT help chronic hip and muscle problems?

• What is leaky gut syndrome?

📣 Click here to send me your questions for future Q&As! ✍️

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: POST-HOLIDAY DETOX

Hey there Dr. McBride, I’ve been overdoing it the last few weeks (holiday parties, drinks, desserts etc.) I’m feeling sluggish and bloated, and my skin is breaking out - my fault I know! So my question - some of my friends do a detox every January. Is post-holiday detox a good idea? Are there any real risks? -Ginny

Hello Ginny,

I understand the appeal of a detox after weeks of holiday indulgence. It feels proactive, like you’re hitting the reset button. But your body doesn’t actually need a detox program. Your liver and kidneys are designed to process and eliminate waste products 24/7, holiday eating or not. They’re incredibly efficient at their job, and they don’t need juice cleanses or supplements to function properly.

Feeling sluggish, bloated, and breaking out after weeks of rich food, alcohol, and disrupted routines is completely normal! It’s not because “toxins” are building up—it’s because your body is adjusting to more salt, sugar, alcohol, and calories than usual (plus probably less sleep and more stress!) These symptoms will resolve on their own once you return to your normal eating patterns and routines.

What actually helps is simple and FREE: drink more water, eat regular meals with plenty of vegetables and protein, cut back on alcohol, prioritize sleep, and move your body. Within a few days to a week, your skin will likely clear up, the bloating will subside, and your energy will return. You don’t need to restrict or cleanse your way back to feeling normal. (I wrote an article about giving ourselves the gift of self-compassion, which is especially important during the holidays, here.)

As for risks: some detox programs can do harm. Extreme calorie restriction can slow your metabolism and leave you feeling worse, juice cleanses can spike your blood sugar and cause nutrient deficiencies, and certain supplements marketed for “cleansing” can stress your liver or interact with medications.

The upshot: If a detox makes you feel good psychologically, it’s probably fine—sometimes the ritual of doing something intentional helps. But you don’t need to spend money on anything fancy!

QUESTION #2: PERIPHERAL NEUROPATHY

Dr. McBride, I’ve had numbness in the balls of my feet and toes for about six months. Sometimes it feels like there’s a pebble in my shoe when there isn’t, and sometimes my feet just hurt/it’s making walking uncomfortable. I’m 79 and otherwise healthy- meaning no diabetes, good circulation, normal blood tests/vitamin levels. I don’t drink alcohol which I know can cause this. I’ve seen multiple doctors and gotten different opinions- one says it’s spine compression and wants an MRI- another thinks it’s local nerve compression and suggests a nerve conduction test, and another says to wait and see. What should I do next? Any advice appreciated! -Eleanor

Hi Eleanor,

This kind of numbness—called peripheral neuropathy—is indeed common as we age, and the frustration of getting different opinions from multiple specialists is also common! The good news is that it sounds like you’ve already ruled out the most concerning causes like diabetes, vitamin deficiencies, and circulation problems.

Let me break down what might be going on: peripheral neuropathy can come from spine issues (nerve compression in your lower back), local nerve compression in your feet (often from tight shoes, foot structure, or repetitive pressure), small fiber neuropathy (which affects the tiny nerves in your skin and doesn’t always show up on standard tests), metabolic or dietary factors (low B12, diabetes, or alcohol use for example) or simply age-related nerve changes that we don’t fully understand. Sometimes it’s a combination of factors, which is why pinpointing one cause is difficult.

Given that this has been going on for six months and is affecting your quality of life and ability to exercise, you may want to consider a nerve conduction test. It’s non-invasive and can help distinguish between local nerve compression (like tarsal tunnel syndrome or Morton’s neuroma) and problems originating from your spine. If that test is normal or inconclusive, then consider the MRI of your lower spine to look for nerve compression there.

In the meantime, pay attention to your footwear. Make sure your shoes have enough room in the toe box and aren’t compressing your feet. Avoid walking barefoot on hard surfaces. Some people find relief from over-the-counter arch supports or custom orthotics that redistribute pressure. Physical therapy focused on nerve gliding exercises can sometimes help, regardless of where the compression is coming from.

The “wait and see” approach isn’t unreasonable if symptoms are mild, but given that this is affecting your walking and exercise (which are crucial for your health and independence) I think pursuing more evaluation makes sense. I hope this gives you some direction!

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QUESTION #3: HRT FOR HIP PAIN

Hi Dr. Lucy - My wife has had constant hip and muscle problems since she started having menopause symptoms a decade ago, and they keep getting worse. I read about “wave technology” hip braces online - do those work? Is there any evidence that HRT can help with these kinds of chronic musculoskeletal problems instead? Thanks a lot in advance. - Brian

Dear Brian,

I love that you are looking out for your wife. Yes, there is evidence that hormone replacement therapy can help with musculoskeletal problems in menopausal women. Estrogen plays a significant role in maintaining healthy tendons, ligaments, muscles, and joints. When estrogen drops during menopause, many women develop new or worsening joint pain, muscle stiffness, and tendon problems—particularly in the hips, shoulders, and hands.

Research shows that HRT can reduce joint pain and stiffness in menopausal women, improve muscle mass and strength, and potentially protect connective tissues from further deterioration. It won’t reverse existing damage, but it creates a better internal environment for healing and can prevent additional problems. If your wife’s hip and muscle issues started around age 40 and have progressively worsened, hormonal changes are very likely contributing.

As for those “wave technology” hip braces you’re seeing advertised, I’d be extremely skeptical. These devices are classic wellness marketing: they sound scientific with vague language about “proprietary systems” and target people dealing with real pain. (I wrote an article on the pitfalls of the wellness industry here.) There’s virtually no good evidence that external wave frequencies from a brace can regenerate damaged tendons. Save your money.

If your wife hasn’t tried HRT yet and her symptoms coincided with perimenopause, it’s worth discussing with her doctor. Many women see significant improvement in musculoskeletal symptoms once they’re on appropriate hormone therapy. That said, HRT works best as part of a comprehensive approach that includes physical therapy, strength training, and addressing any biomechanical issues. She’s lucky to have you! Best of luck to you both.

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QUESTION #4: LEAKY GUT SYNDROME

Hello - I keep hearing about leaky gut syndrome from friends who are convinced it’s causing everything from their bloating to fatigue to joint pain. They all were diagnosed with it in the last few years, and now they’re telling me I should get checked out too. What is leaky gut and is it really a THING? - Joanne

Hello Joanne,

Here’s what we know: the lining of our intestines is naturally permeable—designed to absorb water and essential nutrients while preventing toxins from leaking into the bloodstream. Intestinal permeability is a recognized feature of several inflammatory and autoimmune diseases like Crohn’s disease, ulcerative colitis, and celiac disease.

Here’s where things get murky: “leaky gut syndrome” is not a recognized medical diagnosis. The idea behind it is that the intestinal lining becomes too permeable, allowing toxins and harmful substances to pass into the bloodstream, which then causes widespread inflammation and various health problems. But in the case of inflammatory gut diseases, scientists generally consider increased permeability to be a symptom, not a cause. There’s not enough evidence to support leaky gut syndrome as a standalone diagnosis.

So is it really this common? Because “leaky gut syndrome” isn’t a well-defined or validated diagnosis, the honest answer is we don’t know. What is common is digestive issues—gas, bloating, irregular bowel movements—and there are usually other explanations for this collection of symptoms beyond leaky gut. Things like IBS, food intolerances, stress, diet, or underlying medical conditions often explain what people are experiencing.

Patients express concerns about a leaky gut are usually dealing with these kinds of symptoms. Whether we call it leaky gut or irritable bowel is pretty immaterial. What matters is identifying the root cause by connecting the dots between lab data, dietary habits, stress levels, and other factors, then targeting treatment to the underlying issue and managing symptoms with patience. (I wrote an article about what your gut might be telling you here.)

If you’re dealing with digestive issues, start with your regular doctor to rule out actual medical conditions. Improving gut health through basics—eating more fiber, managing stress, limiting alcohol and processed foods, getting enough sleep—usually helps. I hope this makes the leaky gut confusion a little less murky!

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Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.

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