The Natural Evolution Podcast

Season 2

Episode 12

S2E12 – The Evolutionary Transformation of PCOS with Dr. Felice Gersh

Dr. Felice Gersh, MD became one of the first to be Board-Certified in both OB-GYN and Integrative Medicine giving her a unique perspective on women’s health. She is globally recognized as an expert on women’s hormones, gut microbiome, and circadian rhythm, and specializes in her breakthrough PCOS program helping women heal naturally by always utilizing the most natural treatments first and pharmaceuticals last. 

Dr. Felice Gersh is passionate about helping patients achieve ultimate health. She travels around the world speaking at conferences, hosts various webinars, and has even appeared on multiple medical documentaries. Recently, Dr. Gersh has been working on her book PCOS SOS Fertility Fast Track– a sequel to her best-seller PCOS SOS.

This episode dives into what PCOS is today and how it served our ancestral female relatives.
Dr. Gersh explains why and how PCOS is worse today than ever before and discusses her approach to transforming women living with this condition to a far better state of health. 

Get the First Chapter Free of PCOS SOSSign up to get the first chapter of PCOS SOS and Naturally, Restore Your Rhythms, Hormones, and Happiness. Simply visit the link above and enter your email address for access.

To learn more about Dr. Felice Gersh and her practice, visit: https://integrativemgi.com/

Head over to https://rebelhealthtribe.com/kit to get a free download of our loaded quick start guide to help you along your healing journey.  If you like us, subscribe, review, and share us with your friends, and come join our Rebel Health Tribe group on Facebook.

Listen to Episode #12

Dr. Felice Gersh, Board-Certified in Integrative Medicine and OB-GYN has a unique perspective on Polycystic Ovary Syndrome (PCOS). This episode explains why and how PCOS is worse today than ever before. Dr. Gersh explains her approach to healing – transforming women’s lives by understanding their innate physical and emotional make-up.
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About our Guest

Felice Gersh, M.D. is a multi-award winning physician with dual board certifications in OB-GYN and Integrative Medicine. She is the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive health care for women by combining the best evidence-based therapies from conventional, naturopathic, and holistic medicine.

Dr. Gersh taught obstetrics and gynecology at The Keck School of Medicine of the University of Southern California for 12 years as an Assistant Clinical Professor, where she received the highly coveted Outstanding Volunteer Clinical Faculty Award. She now serves as an Affiliate Faculty Member at the Fellowship in Integrative Medicine, through the University of Arizona School of Medicine, where she lectures and regularly grades the case presentations written by the Fellowship students for their final exams.

Felice Gersh, MD is the bestselling author of PCOS SOS and the PCOS SOS Fertility Fast Track, and her newest book, Menopause: 50 Things You Need to Know, is now available on Amazon. She has also had numerous scientific articles published in peer-reviewed medical journals.

She is a prolific lecturer and has been featured in several films and documentary series, including The Real Skinny on Fat with Montel Williams and Fasting with Valter Longo, Ph.D.

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SE02E12: The Evolutionary Transformation of PCOS with Dr. Felice Gersh

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Podcast Transcript

Michael Roesslein:

And we’re live for a fun conversation today about PCOS. Something I didn’t think I’d ever say in the same sentence. I am joined by Dr. Felice Gersh. Dr. Gersh, thank you for being here.

Dr. Felice Gersh:

Well, my pleasure, and I hope everyone will think it’s an interesting topic.

Michael Roesslein:

When I was reading through the show notes before I thought, “Wow, this is going to be an angle on this I’ve never heard or talked about before.” I think we have quite a few listeners out there who are women and have dealt with PCOS either themselves or somebody in their life or their family, so I think it’ll be really important information for people to know. Or if you may have a woman in your life who’s had that issue and dealt with PCOS and hormonal issues like that, I think it’ll important and a new angle that people haven’t heard.

Before we get into it I will introduce Dr. Gersh as a multi-award winning physician with dual board certifications in OBGYN and integrative medicine. She’s the founder and director of the Integrative Medical Group of Irvine, a practice that provides comprehensive healthcare for women by combining the best evidence based therapies from conventional, naturopathic, and holistic medicine. She taught obstetrics and gynecology at Keck USC School of Medicine for 12 years as an assistance clinical professor where she received the highly coveted Outstanding Volunteer Clinical Faculty Award. She now serves as an affiliate faculty member at the Fellowship and Integrative Medicine through the University of Arizona School of Medicine where she lectures and regularly grades the case presentations written by fellowship students for their exams.

Also an author, Dr. Gersh is the best selling author of PCOS SOS and the PCOS SOS Fertility Fast Track. And her newest book Menopause: 50 Things You Need To Know is now available on Amazon. She’s also had numerous scientific articles published in peer reviewed medical journals, is a prolific lecturer and has been featured in several films and documentary series including the Real Skinny on Fat with Montel Williams and Fasting with Dr. Valter Longo.

You’re a pretty busy lady.

Dr. Felice Gersh:

Well, I like to have a lot of variety in my life.

Michael Roesslein:

I hear you. Yeah. I think that University of Arizona, I think I brought this up last time, that’s where Andrew Weil is, right?

Dr. Felice Gersh:

That is correct. He’s the founder of the fellowship.

Michael Roesslein:

Yeah, that always rings a bell. I can always tell when anybody comes from there. I’ve had very good experiences.

Today… I’m going to just jump right in. We’re going to talk about PCOS and before we get into what I think is really fascinating around the evolutionary transformation of PCOS and kind of how it’s shifted and changed over our evolution or the evolution or whatever type of term would probably be more appropriate there… I want to define it because there might be some people listening to this who have heard of PCOS but they don’t know exactly what we’re talking about. So before we jump into the more detailed discussion, can you just explain to us a generalization of what is PCOS?

Dr. Felice Gersh:

First, PCOS is the most common endocrine disorder of reproductive aged women and the underlying issues, actually, they sort of morph after women go through menopause but many of the problems still remain. It’s the most common cause of infertility and a cause of very high risk pregnancy and complications in pregnancy. It is definitely a big deal and almost everyone knows someone who has suffered with PCOS. The letters stand for polycystic ovary syndrome. As always happens in the medical world, a convention occurred of doctors getting together as a group to define it, to come up with, “Well, what is the definition,” as you said, “of PCOS?” Like in many cases, there was some disagreement but the ultimate label, in order to get that label of, “You have PCOS,” you have to have two of the following three.

You have to have irregular menstrual cycles and/or you need to have ovarian cysts that are consistent with what we call PCOS ovaries which is like, we call it, a ring of pearls. Like lots and lots of little, tiny follicular cysts. Little tiny cysts that are around the rim, the outside rim, of the ovary. And/or, and this is where some of the disagreement came in, because many doctors feel that to have PCOS you have to have elevated levels, or clinical manifestations, of high levels of androgens, male-type hormones. Either testosterone, which is the most common. That would be at least 80% of women with PCOS. Or the adrenal androgen, DHEAS. Most all women with PCOS have elevated androgens, typically testosterone, and typically they will have both of the other two, irregular cycles and also the manifestations of cysts on the ovaries.

Of course my goal is to eliminate all of those things in women through, hopefully, lifestyle methods and then sometimes with pharmaceuticals as needed and deal with reducing all of the really complex metabolic issues. I say PCOS is where metabolism, and metabolic problems, meet reproduction and reproduction related problems. It’s really the perfect storm. Even for people who are not dealing, personally, with PCOS there are lessons to be learned from the condition called PCOS because they’re really relevant across all spectrums of the female lifespan and female health issues. It’s really a complex and extremely interesting problem that has been simplified and not dealt with from the root causes in terms of the way the conventional medical world approaches PCOS which, in many ways, hasn’t changed in decades.

Michael Roesslein:

I like how you mentioned that it’s relevant to anybody, too, because a lot of these conditions I’ve interviewed people about… I don’t know, I’ve lost track of how many different chronic health conditions. When we really nail down, “How does this come about?” Or, “What are the root causes of this?” Or, “What are the triggers of this?” Yes, there’s some variance, some that are unique to certain conditions perhaps. Like, this toxin is more specifically related to this auto-immune condition or something like that, but I would say at least 75%, I’ll throw out there, of the root causes and reasons why we’re seeing, insert disease name, are very similar. Even if you don’t have PCOS or you’re not a woman the things that play into, the factors that play into the development of this condition are probably relevant to just about everybody and so then would be the ways to deal with it, like you mentioned.

At least the lifestyle stuff. You’re not going to give somebody female hormone PCOS related pharmaceuticals, but it’s… I used to think each disease is going to have it’s own specific… You have to do this, this, this, and this to get it or this is going to be… And the more I’ve learned the more I’ve seen that it comes down to very commonly shared root causes. Thank you for sharing that description and I think we can jump in.

The topic today is the evolutionary transformation of PCOS. I have to admit, when I first read that I didn’t really have any idea what that would mean. I didn’t understand. Did people not used to get it or is this a new condition or is it different than it used to be or has our evolution changed the way that women’s bodies react to certain stimulus? How is PCOS, today, different than it was for our ancestral women relatives?

Dr. Felice Gersh:

It’s very different and that’s why I want women who have PCOS to recognize that they come from a lineage of women who were powerful, successful, the leaders of their tribe, and they can regain that. It turns out that women with PCOS have an innate problem, that’s genetically related, that they don’t convert testosterone to the estrogen in the ovary called estradiol as efficiently as, we’ll say, the average “normal woman.” The way that it works in an ovary is that all estrogen in the ovary has a precursor, it’s testosterone. The brain puts out a signal to the pituitary gland to then put out it’s signal to make testosterone and then the testosterone goes down the assembly line and then goes to a different part of the ovary, after it’s made, where it should be converted, in large measure, not completely because some testosterone, of course, is necessary for women, but much of that is converted into estradiol.

Now, the enzyme that makes that conversion is called aromatase and its triggered by the hormone from the pituitary gland FSH follicle stimulating. Well, it turns out that women with PCOS, in our ancestral type of female, they just didn’t do it quite as efficiently so they ended up with just a tiny bit less estradiol and a tiny bit extra testosterone. Well, guess what? Going back thousands and thousands of years ago that turned out to be a survival advantage because those women were just slightly less fertile. Now, the women of today, infertility is rampant with women with PCOS and that’s the most common cause of infertility. Well, way back then it was a very minimal decrease in fertility so it was like a tiny bit of built in birth control which was an advantage. Maybe instead of conceiving and having 10 or eight or 10, nine children, they had maybe four or five. That is, actually, a survival advantage.

Every time a woman would go through pregnancy and delivery that’s potentially live threatening because of hemorrhage, infection, and so on. Plus, it depletes her body of vital nutrients and she’s supposed to take care of this baby, right? She needs to nurse the baby for a long time. And then if she has another baby that comes along too soon that is very challenging. It’s really an advantage because she could spend more time with each child, she has time to regroup he body’s energy and nutrient stores and so on. As well, that little bit of extra testosterone made her a little bit more muscular, a little bit more energetic, a little bit outgoing, braver, and so she became more the leader of the tribe. She was like the dominant woman. She didn’t take no for an answer. She was going to say her peace.

They’ve actually done studies, women who have become Olympic gold medalists will often have a little higher production of testosterone. They’re more like the ancestral woman with PCOS. Healthy, strong, muscular, a high achiever, goal oriented, right? And brave, fearless, and have a little bit of extra testosterone. In fact, we know that females who are like triple X and they don’t make much testosterone, they’re more like estrogen dominant you might say, and they tend to be really meek. They talk in a real high pitched voice and they’re very shy, they’re not outgoing. Our personalities are definitely changed by our hormones. Men know this.

A lot of men know that if a man gets really old and his testosterone level goes down he tends to be less dynamic, less outgoing, and forceful. Men want to have that high testosterone. Well, a little bit extra for women really can set them apart and make them strong, dynamic, and so forth.

But what happens now? Well, over time we now… It’s not that much time. It’s like, now. It’s like, a world that has only been transformed over very few generations. We now live in a world that is highly polluted with ubiquitous endocrine disruptors. These chemicals that actually tremendously interfere with the normal functioning of our hormones and change everything. We have a lot of endocrine disruptors in the form of plastics, flame retardants… All kinds of plastics. Soft plastics and hard plastics. We have changes in terms of heavy metals are now everywhere. We have mercury in our oceans and so on. Mercury and lead are actually endocrine disruptors as well as having other direct effects on the brain.

In addition, we have had tremendous changes in our circadian rhythm because of, like, the invention of the light bulb. It used to be that humans would go to bed when it would get really dark or they just had a little light from a flickering flame, from a fire, and they would get up when the sun came up. They lived with the rhythm of planet Earth. That’s how we evolved. In fact, 90% of the genes in the human body, male and female, have either clock, they’re directly clock genes, or they’re clock gene related. So our circadian rhythm had been totally disrupted and that also tremendously effects how the ovaries work.

A lot of people don’t realize the ovaries are very heavily both lunar rhythm and also circadian rhythm. In fact, there are melatonin receptors on the ovary which are critically important for proper ovarian function. Women who don’t get proper sleep, they’re not getting enough darkness at night, if there’s light flickering in through their eyelids and suppressing their melatonin and of course that ever present chronic stress, which changes how our adrenals function and our cortisol levels change which then effects our melatonin. All of these things have disrupted the circadian rhythm of the ovaries as well. That is also another contributor.

And then our food is so different now. It turns out, and this was originally proven just a few years ago. A dear friend of mine in Australia presented this hypothesis about 10 years ago that the gut microbiome of women with PCOS would be abnormal, what we call dysbiotic, and that was proven. The first group that proved it was out of China because they actually have done a lot of research on PCOS in China. They proved, and then other groups have then, additionally, reproved it, that women with PCOS have abnormal gut microbiomes leading to impaired gut barrier or what we call leaky gut. That creates an entire downstream set of problems that are manifested in women with PCOS creating chronic states of inflammation, immune dysregulation, and brain problems, all kinds of terrible things that happen with leaky gut.

That has also severely exacerbated all the manifestations of PCOS. What turned out to be a wonderful advantage now has turned on its head with the change in diet, the change in our rhythms and the ubiquitous endocrine disruptors have made tremendous changes. One of the things that has also been shown in studies is that not only is estrogen no longer produced properly… So we took a mind dysfunction and made it into a more serious dysfunction. Instead of producing just a little bit less estradiol and have a little bit higher testosterone now you have a major dysfunction, you have way too much testosterone and way too little estradiol.

To compound that problem it’s now been shown that exposure in utero, so when you are developing as a fetus, if you are exposed during critical developmental times of your endocrine system, including the receptors for hormones, you can actually alter the functionality for life of the receptors of the hormones including estrogen receptors which then become dysregulated and don’t work as well. This can also affect other hormones. In fact there’s now some evidence that it effects testosterone receptors and melatonin receptors and other receptors and in women with endometriosis it’s been shown that it effects their progesterone receptors. Many of the diseases that women are dealing with that affect their reproductive systems are also affecting many other systems in the body and can actually be linked back to exposures to chemicals in utero that alter the development of our endocrine systems and the receptors.

Studies have been published showing that women with PCOS will often have dysfunction of the receptors. Most people know about diabetes, type 2, that they have insulin resistance. That means that you can have normal levels of insulin but it doesn’t work properly on the receptor and that’s receptor resistance. Well, that can happen with estrogen receptors. Even if you have a normal amount of estrogen it’s not working properly because the receptor isn’t working right. It’s like you have all the keys but none of them work on the locks, so you can’t get in. It’s like a double, triple whammy that you have now that’s escalating all the effects. Because now we know that endometriosis has a slew of problems from progesterone receptor problems and PCOS has a slew of problems because of estrogen receptor problems. And estrogen has receptors where? Everywhere.

Every organ in the body has estrogen receptors and that’s where it becomes this grand linkage of every organ system, which I love because you brought this up from the get-go. It doesn’t matter if you have a disease that is sort of emphasizing this organ system or that organ system. The underlying issues are really united. They’re very similar. In women with PCOS, because estrogen receptors are in every organ, sort of depending on which organ seems to be the winner of the one that actually has the worst manifestations, they can end up with one of a hundred different types of symptoms in addition to the ones that define the actual condition of the irregular cycles and such.

Because estrogen has receptors in every organ, on the heart, the blood vessels, in the lungs, on the skin, in the bladder, in the brain… Every single organ system. You can end up with so many different problems in women with PCOS. Because the metabolic systems of the body, like the mitochondria, the energy producing factories of the cell, also require estrogen in order to work properly, women with PCOS, because of this estrogen deficiency combined with estrogen receptor problems, they actually have a disability that is so serious they can’t produce energy as well. It’s a different skillset to produce and store fat than it is to burn fat, so women with PCOS are very prone to obesity and so much in our society blames them like, “You’re just a glutton.” You know, “You have some inherent flaw in you. That’s why you’re so overweight.” Or obese.

They’re not understood that women with PCOS have this inability, that’s built into their malfunction of their mitochondria, to have this process called oxidative phosphorylation that causes the burning of fat to create energy. They’re living in a sea of energy stored, energy in the form of fat, but they can’t harness it to create energy. So they’re tired and they’re sluggish and they have a lot of problems because they can’t make energy and yet they have all this stored energy they can’t harness and turn it into energy through mitochondrial function. That effects virtually every other organ system in different ways.

It’s a complex medical condition but when you break it down into the fundamental issues it becomes so simple to understand and then when you look at the treatments then it becomes so much clearer how to approach PCOS than the way that the conventional world has always looked at it which is just stop the ovaries from working altogether. Get rid of the ovaries. That’s always, sort of, the go-to for women’s health in the reproductive years. If you don’t know how to-

Michael Roesslein:

Yeah. Birth control and hysterectomy’s, right?

Dr. Felice Gersh:

You got it. [inaudible 00:21:48]

Michael Roesslein:

Yeah, it fixes everything. Just give them the pill and if that doesn’t work just cut the organs out.

Dr. Felice Gersh:

Boy, Michael, you got it right down to…

Michael Roesslein:

Yeah.

Dr. Felice Gersh:

You’ve got it honed down to a nutshell.

Michael Roesslein:

I could be a doctor.

Dr. Felice Gersh:

Yeah, you know the solution for every female problem. You got it.

Michael Roesslein:

Yeah, yeah. Yeah. Have them be quiet too, while we’re at it. That’s where the conventional medicine approach is. Or it’s all in their head. First it’s all in their head, then give them the pills, then cut out the ovaries.

Dr. Felice Gersh:

Right and don’t forget the Prozac. Exactly.

Michael Roesslein:

Yeah, yeah, yeah. Well it used to be… What was it before? Now it’s Prozac, what was it?

Dr. Felice Gersh:

And Valium.

Michael Roesslein:

Valium. Yeah, yeah. Valium.

Dr. Felice Gersh:

Well, you can give them both. I see many patients come in my door and that’s exactly what they’re on or their cousin.

Michael Roesslein:

They still prescribe Valium?

Dr. Felice Gersh:

Well, their cousins, Xanax.

Michael Roesslein:

Oh, okay. Yeah, yeah, yeah. Total sidetrack, but I think Valium’s actually far less harmful than Xanax in the long run. I think they’ve replaced one that… I mean, I’m not advocating either, but I’ve worked with people attempting to get off benzo addictions and it’s very, very, very, very difficult. The benzodiazepines.

Dr. Felice Gersh:

Yeah.

Michael Roesslein:

Anyways, that… Wow. So you have the pre-birth and young age factors of influencing the receptor sites and that can be toxins. I’m guessing that a high stress environment in utero and childhood would impact that, too.

Dr. Felice Gersh:

Oh. That’s actually brilliant that you brought that up because we now know that many things that are happening in utero can change how genes are expressed for the rest of the life of the child. Absolutely. We now know that mothers who are highly stressed during the pregnancy, their children tend to be more stress-prone. They actually have lower threshold to feeling anxious and that’s a big problem. Women who-

Michael Roesslein:

Which makes sense.

Dr. Felice Gersh:

Totally.

Michael Roesslein:

Because the body’s getting informed about the environment it’s about to enter into and if you’re telling it that it’s a scary, dangerous environment it’s going to be more adept at finding the danger and the fear.

Dr. Felice Gersh:

That’s right.

Michael Roesslein:

This is also true for neurotransmitters. I’ve studied infant and child development quite a bit from a psychological standpoint and mental illness and depression and things and addiction. The same thing happens with neurotransmitter receptors, as you’re talking about with hormone receptor sites, so that you’re wired to not be able to receive dopamine and endorphins and things that feel good. So you’ll always be chasing these things that give you these huge rushes because it’s really hard for you to get the response.

Dr. Felice Gersh:

Absolutely. It’s such a big deal. One of the things that happens is because infertility is so prevalent in women with PCOS they often go to the fertility centers, right? Typically they will almost immediately just put them on a three month starvation diet because the majority, 80% of women with PCOS are overweight and obese, often very-

Michael Roesslein:

So then they tell them they can’t get pregnant because they’re overweight.

Dr. Felice Gersh:

Right, but they put them on a starvation diet for three months. The women who are, they call lean PCOS, which makes up 20%, they also have a lot of the same problems, the only difference is that they are what we call… I did not make up this term. The skinny-fat. They actually have an insufficient amount of muscle mass, they’re actually… Things are not working right. Clearly, in this case, the testosterone level is not building big muscles and bone because nothing is working right. We also know that there can be testosterone receptor problems as well. Plus what is often not recognized is that in order for testosterone in a woman to work properly you need to prime the receptors with estradiol. That’s why you should never just give a bunch of testosterone by itself. These are like team players. You got to realize how all these things interact with one another.

Women who are overweight, have one set of problems, but they’re very comparable with a few exceptions in the thin ones because when you do a CAT scan you find the lean women with PCOS often have a lot of visceral fat, a lot of belly fat, and they’re highly inflamed as well and they also have a lot of fertility problems and pregnancy related complications. So they’re not home free just because they’re not severely overweight. What happens is when they go to the fertility centers they’re not ovulating, they are the most difficult ones to work with, with IVF but they usually put them pretty quickly into IVF and they put them, first, on a three month starvation diet which is not sustainable and they do…

If you starve people they lose weight, but you also alter their metabolism in a negative way so that they will just regain it. How many times do we have to try that experiment? You starve people and they lose some weight, they often lose a lot of lean body mass, like their muscle and the tissue that you don’t want to lose and they only lose some of it as fat, and they often lose the support fat, not the visceral  fat. It’s just not a good way to ultimately get healthy, but you can lose some weight and that will improve, short-term, the fertility success. But then they just do the IVF and when they’re lucky and they succeed and they don’t miscarry, which is another high risk thing for the women, they often have pregnancy related complications because they really haven’t become healthy before conceiving. They simply put them in a starvation mode and have nutrient deficiencies and so on.

Then their children… And this has been proven now many times over, that the children born to metabolically unhealthy women become, themselves, metabolically unhealthy humans. That’s why you see a family and they’re all looking unhealthy and the children, too. It can be genetically programmed, unfortunately. That’s why it’s so critical that women with PCOS, and any woman, has their health optimized prior to conception because this will not only affect the course of their pregnancy, lower the risk of all kinds of terrible complications that can be life threatening to themselves and their baby, but also affect the quality of health that their child will have for the entire life of the child. That is not being done in these fertility centers. They’re not saying, “Let’s get you really healthy, even if we delay for another three months or six months. We need to have you really healthy first before you conceive.” That’s not how it works at all.

If they’re not really obese, like severely obese, they don’t even put them on the three month starvation diet, they just go right into IVF and then when they’re successful, which is not a high, high percentage, but when they are successful they end up with so many complications for mother and baby alike. That’s why this is such an important message about the epigenetics and the modification and so on, for all women and most pointedly for women with PCOS who have such severe metabolic dysfunction. And we can’t reverse it back to perfect, but we can do so much.

We always say, let’s go for better. Because we can do a whole lot better than what is being done today for women with PCOS.

Michael Roesslein:

Man, there’s a lot to unpack here. We’ve talked about from birth to… Or, pre-birth. From in utero to… I mean, there’s exposures as adults, too. I mean, we’re focusing a lot on this carries over from childhood and this, but I mean look at all the products we put on our skin. Look at all the things we spray around our house. That little thing you plug in that sprays poison in the air every 30 seconds. All of those kind of-

Dr. Felice Gersh:

Oh my gosh. They’re the perfect storm.

Michael Roesslein:

Yeah, I can’t.

Dr. Felice Gersh:

The perfect storm. Well, this is so interesting because we now know that because children are born modified, through their genetics and through the exposures to these chemicals in utero… They did a study, many years ago now, where they took cord blood of babies and they studied them and found well over 200 toxic chemicals in their cord blood. This is showing you that these things get into mothers. In fact, the chemical that’s been most studied in utero, in terms of PCOS, has been bisphenol A which, as you probably know and many of your listeners, that BPA has often been replaced with BPS which is probably even more toxic than BPA. There’s no such thing as safe plastic.

Michael Roesslein:

But then they can put, “No BPA on the label.”

Dr. Felice Gersh:

Exactly, but there’s no such thing as safe plastic.

Michael Roesslein:

I was trying to find something with plastic to hold up but I don’t even have anything that’s plastic in here.

Dr. Felice Gersh:

Yeah-

Michael Roesslein:

I’m winning. I don’t have any BPA in here.

Dr. Felice Gersh:

I have a urine collection cup [crosstalk 00:30:51]-

Michael Roesslein:

Nobody’s drinking out of that.

Dr. Felice Gersh:

No. That’s why we have plastic. But nobody’s drinking out of my urine collection cup, exactly.

Michael Roesslein:

Yeah and receipts, too. My wife is a nurse and-

Dr. Felice Gersh:

Yes, BPA.

Michael Roesslein:

Before COVID… I mean, nurses are often wearing gloves, but before COVID it wasn’t always gloves all the time and all the little tickets that the little machine prints out all day at the hospital, thousands and thousands of tickets that anybody who works in retail and cash registers all of those little… And every time they hand you one-

Dr. Felice Gersh:

And the interesting thing is if you use the alcohol hand sanitizers-

Michael Roesslein:

Doesn’t it increase the-

Dr. Felice Gersh:

Yes. It increases the absorption. So all this through COVID you keep putting on the alcohol, the Purell kind of stuff, and then you’re touching this.

Michael Roesslein:

And then touching the tickets.

Dr. Felice Gersh:

Oh my gosh. It’s terrible. I tell people that you should take a Ziploc baggy, if you have to get the receipts, keep a Ziploc baggy and then-

Michael Roesslein:

Have them put it right in there.

Dr. Felice Gersh:

Yeah, right. And tell them they should wear gloves and then just put it directly in the Ziploc baggy.

Michael Roesslein:

I’ve seen more of that. I don’t know if that was me moving to Northern California where people were more conscientious of it, but I saw more checkout people, when I lived in the Bay Area, wearing a glove on the hand that they use to take the tickets than I’ve ever seen anywhere.

Dr. Felice Gersh:

Good. [crosstalk 00:32:14]

Michael Roesslein:

And it was always really encouraging to see that.

Dr. Felice Gersh:

Yeah. What they found… They used to say… Well, they still do. When they tested the mother’s blood they said the BPA levels are below a threshold which is made up anyway, right? Below some critical negative threshold that it would create harm. Well, it turns out, number one, there is no critical level that anyone really knows. Number two, this is the ultimate in horribleness, that is that now we know that BPA actually concentrates in the fetus. The level in the fetus is multiple times higher than what is in the maternal blood. How’s that for insult to injury there? So they were saying, “Oh, look, it’s okay in the mother’s blood,” without realizing that it was concentrating in the baby at much higher levels.

They’ve actually shown, as well, and I’m looking at it as well, that women with the worst manifestations of PCOS… Those would be women who have the worst irregular cycles, they’re the most obese, they have the most hirsutism. Androgen excess, when you have excess amounts of testosterone, will manifest with growing a beard, so that they have to shave and do a lot of laser and electrolysis. They can grow a significant amount of facial hair, but it can also be on their chest, on their back. And they can get cystic recalcitrant, really hard to treat deep cysts, predominantly along the jaw line. And then they lose hair. So they have what’s called androgenic alopecia where it’s the female version of male pattern baldness which is beyond distressing.

You have this young woman who’s in her early 20s and she’s seriously overweight, she has a beard to deal with and all this other body hair, she has terrible acne that isn’t… Even when they use things like Acutance there’s a seriously high rate of recurrence. So it clears up and then six months later it comes back. It’s a real problem. And they’re going bald. And then of course they have many other problems because they often have depression, anxiety, low libido, and they often have Hashimoto’s, because they have leaky gut so they’re going to have more Hashimoto’s so they have hypothyroidism. They have more arthritis. And then they have insulin resistance or very inflamed, chronically low level inflammation is like the name of the game and that breeds insulin resistance.

Now people know, but not mostly the people taking care of the patients, but scientists know that estrogen actually regulates what are called the glucose transport system. The GLUT, G-L-U-T, the glucose transport system, that allows glucose to be transported into cells. Not having enough estrogen creates insulin resistance. You have higher levels of sugar and you’re not going to have proper transport of sugar into the cells, so now you can’t even get the energy source, the glucose, into the cells. They can’t properly use the fat, then they have higher levels of insulin.

This is another… Talk about insult to injury. When you have high levels of circulating insulin, which is classic for women with PCOS, insulin increases another hormone called IGF1, insulin-like glucose peptide 1, so GLP-1. What happens is when you have… I’m sorry. Insulin-like glucose factor 1, IGF1. When you have that increased that goes into the cell in the ovary and then increases testosterone production even more. When you don’t have enough estrogen, the other one, the GLP-1… All these initials sound so alike. The glucagon-like peptide 1, which is a little type of a hormone that’s made by lining cells in the gut. When you don’t have the right gut microbiome that is decreased and that helps regulate your appetite and also contributes to maintaining proper weight and energy production.

That goes down so then they have dysregulated appetite and many women with PCOS will have binge eating disorder because of dysregulated appetite as well. That’s why GLP-1 agonists, which are drugs that are used now for both weight loss and for diabetes are now slowly being incorporated… That’s one of the pharmaceuticals that can sometimes, short-term, help women with PCOS to sort of get them going and sort of to help them to get started on the right track, to lose some of that weight, which could be like 100 pounds excess. And so-

Michael Roesslein:

It’s like a hunger suppressant.

Dr. Felice Gersh:

It is. It does. It really works very well and people can lose weight. The problem is, in the real world, in the real world of conventional medicine, not my world hopefully, there is no exit strategy to these drugs. In other words you can put a woman on this drug and then what do you do? If you stop it and they’re doing the same lifestyle stuff you just end up back where you started, right? The studies always go out like six months and then it showed all this weight loss and then the study’s over. Like, what’s your long-term strategy here, guys? Oh, there isn’t. Well, that’s where, really, you use it… I call it a jumpstart or a bridge to health, not a lifetime-

Michael Roesslein:

Which a lot of pharmaceuticals can be used as.

Dr. Felice Gersh:

Exactly.

Michael Roesslein:

I used to be very typical within the functional medicine world of line in the sand, like all pharmaceuticals are evil and you should never take any of them and if you take any of them you’re failing and all of those kinds of things, until my wife had a really severe auto-immune flare and the only thing that she responded to was Prednisone and nothing else touched it. It was either being in excruciating pain or being on a steroid and then figuring out, “Okay, now we have the pain down, we can think clearly.” Because when somebody’s in tons of pain, you’re not thinking clearly.

Dr. Felice Gersh:

The brain is inflamed.

Michael Roesslein:

Yeah, yeah, yeah. So getting that and then work from there. Or I’ve also learned that through working with the doctor that we’ve worked with, with [inaudible 00:38:32], Dr. Eric Gordon in the Bay Area. He uses certain immunosuppressant drugs that are used for auto-immunity at, say, usually 300mg as a dose, he’ll us them at like 15mg. So there’s ways to use pharmaceuticals… And this is for the people out there who are staunchly against all pharmaceuticals.

Dr. Felice Gersh:

Oh.

Michael Roesslein:

There are ways to use pharmaceuticals in a, like you said, like a kick start or a putting our the fire or as an aid or as in addition to. I think where the problem comes in is when they’re the only thing that’s being used.

Dr. Felice Gersh:

Right.

Michael Roesslein:

And nobody’s changing anything, nobody’s doing anything differently with their food or their lifestyle or their stress or whatever, and then they’re on this pill, then they got to take that pill, then it has to be this other pill also to negate that pill’s side effects. And then you go down these rabbit holes. I think when used in a responsible way with, like you said, what’s your exit strategy? With an exit strategy and a cohesive, like, “Yes, we’ll take this to help suppress the appetite now and we’ll do X, Y, Z things so that by the time you get off of this your life is different and you won’t need it.”

Dr. Felice Gersh:

Right.

Michael Roesslein:

I just want to… I’m a converted rabid anti-medication at all costs person and I try to drop that in anytime that I see that it’s relevant is that-

Dr. Felice Gersh:

Well, I’m so glad-

Michael Roesslein:

These things are not evil, they’re tools.

Dr. Felice Gersh:

Well, I’m very pro-science and I feel that the conventional medical world has forgotten about the lifestyle issues that we talk about so much. Food as medicine, which goes back to Hippocrates, who has gotten forgotten. Targeted evidence based supplements. Working with, now, time restricted eating and various types of fasting. Eliminating, as best we can, environmental toxicants and understanding the role of low-grade chronic infections. Those pathogens that now we’re finding have come back into the picture that just when we thought they were gone now we know that chronic low-grade infections can have a tremendous role in terms of auto-immunity, in terms of cancer, and all kinds of things. It’s really a fascinating world when you combine all evidence based modalities.

That’s what I call integrative medicine, which I practice. We have just a larger therapeutic toolbox. We don’t eliminate science. We don’t eliminate amazing drugs that have changed the course of cancers with immunotherapies and immunomodulators and all kinds of things that have changed the course of diseases in so many ways. Once again, I’m in total alignment with you, that they’re not standalones, that you look at them in the context of all the other things you’re doing. You think of the mechanisms, that’s functional medicine. We don’t just throw things at people and not think about, “What is it really doing in the body?” We want to understand mechanisms in the body so we are being smart, right? So that we think, “This has this effect and this has a downstream effect and collateral issues,” and so on so that we can sort of put together a holistic, meaning the whole picture, kind of an approach and always evidence based and always starting with the safest and most efficacious way to approach.

With PCOS, to me, in 99% of cases it’s always start with lifestyle. Now, sometimes lifestyle alone is not quite sufficient and then we may have to add estrogen. As an MD I can prescribe estradiol. Instead of giving birth control chemicals, which are actually endocrine disruptors, if you go to toxicology.gov all the ingredients in a birth control pill are listed as endocrine disruptors and you can’t forget their original purpose in this world was to create havoc and chaos in the female body so she can’t be fertile. Like it or not, fertility is a vital sign of health of a female. It’s like one body and-

Michael Roesslein:

What an inconvenient thing that is in our society.

Dr. Felice Gersh:

It’s very inconvenient.

Michael Roesslein:

Yeah.

Dr. Felice Gersh:

I know. It’s like, well fertility is integral into the whole female body so that’s why I consider estrogen, in the form of estradiol, it’s like the glue that links all metabolic functions of the body so you have an optimally functioning brain and cardiovascular system and musculoskeletal system and every system in the body is optimally functioning when you have optimal estrogen along with all the other nutrients and everything else that goes into healthy lifestyle. And that coordinates with an optimal reproductive system. All of these systems are replicated. The enzyme systems and so on are replicated in the reproductive organs and in the peripheral systems of the body. When you see it as a whole then you realize you can’t, like it or not, it just is what it is. You can’t poison the reproductive system and not, at the same time, poison the entire system.

Michael Roesslein:

Another inconvenient thing.

Dr. Felice Gersh:

I know. I’m not for women having uncontrolled reproductive functions, but we need to be honest. I always say, you can’t solve a problem if you haven’t first defined the problem. We need to be honest about things. Nothing can be so big it cannot fail. When the solution that’s being offered is, really, a slow poison by putting endocrine disruptors into women’s bodies that have effects. Women, now, are getting put on birth control pills, especially women that are trending towards. You can’t really diagnose PCOS in a young teen, but you can say they’re trending towards PCOS.

Michael Roesslein:

There’s so many. I’m in a lot of health groups and practitioner forums and so many people post in there, “My 14 year old daughter’s been put on birth control because of [crosstalk 00:44:35].”

Dr. Felice Gersh:

Exactly. Exactly.

Michael Roesslein:

And it’s just like, “Oh my god.”

Dr. Felice Gersh:

Because they have every… Because when you go through puberty it becomes really clear that you’re unhealthy when the first thing that happens in a female body is she has messed up cycles. They’re irregular, they’re painful, she has PMS, they’re too heavy and so on.

Michael Roesslein:

Yeah.

Dr. Felice Gersh:

Instead of recognizing that as a red flag that this young girl, who’s like 13/14, that she has issues with her health and [crosstalk 00:45:03]-

Michael Roesslein:

We just shut the alarm off.

Dr. Felice Gersh:

We just shut the whole system down, like we talked about, and that is a false approach that we need to help her. I mean, it could be as simple as she has aa magnesium deficiency. It could be multiple deficiencies. It could be endocrine disruptors. In fact, they’ve now shown that young girls, as young as seven years of age, that you can predict that they’re going to have PCOS because they’re a little pudgy. They already can’t burn fat properly and they still have their so-called “baby fat” around their belly, but it’s cute. When you’re seven, not really. They’re already metabolically unhealthy as a little kid. If you measure a hormone that’s made by adipose tissue called adiponectin… So adiponectin…

We now know fat tissue is like a hormone producer, okay? It’s a very complex system in fat tissue, what’s going on in there, and they make a variety of hormones. They make leptin, which helps regulate appetite, which is also controlled by estrogen, and it makes adiponectin which helps to control burning of fat which is also controlled by estrogen. Women who are… Kids, I should say, they’re like, seven years old, if you measure their adiponectin it is substantially lower than what it should be. So you could actually recognize as a pediatrician, or a mom of a young child, a girl who’s, like seven, even younger, six, seven, eight years of age, that things are already going wrong metabolically. What can you do about that? Well, you can do a lot.

You can make sure that they’re exercising. That they’re sleeping. That they’re eating the right foods and so forth. There’s a ton that you can do to not have the severe manifestations of PCOS actually occur. I call it realized destiny. Your destiny doesn’t have to be bad. You can change that by taking proactive steps. I mean, that’s what preventive medicine is all about. I’m trying to educate pediatricians to recognize that this is a pediatric condition… Well, it really starts in utero, and then it’s interesting.

So, looking at it I’ve found… I’m sure a lot of people have heard of methylation. We do that by checking a gene, MTHFR. What happens? I found that women who have some of the worst manifestations of PCOS, when you check MTHFR they’re homozygous. In other words they have two genes for not being a very good methylator. Their ability to do this process is down about 70% or so from what could be optimal. They, therefore, have lesser capability to eliminate endocrine disruptors and when they measure BPA in their bodies they’re higher than it is in the average woman. That could mean, but doesn’t necessarily mean, that they’re exposed to more BPA, because we’re all exposed all the time, but what it can mean, and most likely means, is that they’re less capable of eliminating it, which they were also when they were little teeny fetuses and babies, too.

They’ve had higher total body loads of endocrine disruptors because they’re not as good at detoxifying and getting rid of these chemicals. That’s the perfect storm where you’re taking other genes, that weren’t even involved in PCOS per say, and they are just the perfect storm of exacerbating this condition. That can just make, really, wipe out for women when they have even higher, higher levels of endocrine disruptors in a body that can’t really manufacture and utilize the estrogen that they do have.

But we can deal with this because you can give methylated b-products, right? You can give methylcobalamin. We can give tetramethyl folate. We can give pre-methylated B vitamins to these women once we identify them. We can educate on plastics. I was so proud of you. You couldn’t find any plastic. How great was that?

Michael Roesslein:

Yeah. I really wanted to grab something. [crosstalk 00:49:17]

Dr. Felice Gersh:

I know. Well, that’s great. People need to know how do they get exposed to endocrine disruptors? Pesticides. Sadly, my mom, who ended up getting a type of cancer that’s involving the immune system, and they now have linked this to use of pesticides. Well, she grew up and she didn’t know anything about the dangers of pesticides. They sold Raid in cans. The spray. She didn’t like having bugs in her house so she thought it was perfectly fine to just go around with this bug spray and just spray everything. Including herself. It was like… In fact, they did that to young women when they were on the beach, like at Jones Beach in New York, and they would spray for mosquitoes with terrible like DDT and different other terrible pesticides that are endocrine disruptors. And then they found that those young girls, they were 13/14, when they were in their 30s they were getting breast cancer.

Well, they were being epigenetically modified with these endocrine disruptors that increased cancers, the hormonally based cancers, later in life. These are all things that people can be aware of. At least you can not buy that stuff. Don’t do it. There are better ways to deal with ants and mosquitoes. We can have more natural ways. You want to not buy a lot of plastic. Like, I got rid of all my Tupperware. Remember Tupperware?

Michael Roesslein:

Yeah, yeah.

Dr. Felice Gersh:

I had this huge collection before I knew anything and I had those Teflon lining in my pots.

Michael Roesslein:

Yeah, the black. The black pans, right?

Dr. Felice Gersh:

Oh my god. They would scrape off and it’s like, “Oh that’s still usable.” Not realizing it’s in my food.

Michael Roesslein:

Yeah, just scrape off into the food and you literally eat the Teflon.

Dr. Felice Gersh:

Oh my god. That’s right. [crosstalk 00:51:05]

Michael Roesslein:

Some of those chemicals even were… They’re so bad, the non-stick stuff, that some of those companies voluntarily pulled the stuff of the market before they got in trouble and that… If anybody knows anything about chemical companies, they don’t do that. If-

Dr. Felice Gersh:

Well, [crosstalk 00:51:23]-

Michael Roesslein:

If 3M pulls something off the market, that means that their internal people said, “We’re going to lose more money on lawsuits over this thing than we’re going to make selling it, so we got to pull it.” That’s how those decisions are made. Don’t think it was altruistic at any point, ever, that they do anything.

Dr. Felice Gersh:

No, no.

Michael Roesslein:

It’s totally a math equation and they have an actuary somewhere that’s like, “Oh, this is going to lose us more money than we’ll make,” but yeah. We had the black pans. We had the Tupperware’s. Ours were all stained red because in an Italian family it was all pasta sauce in there.

Dr. Felice Gersh:

Tomato, right.

Michael Roesslein:

You put that in a Tupperware one time and then it’s red.

Dr. Felice Gersh:

That’s right and then you wonder… Well, you didn’t wonder. In those days-

Michael Roesslein:

The deet bug sprays.

Dr. Felice Gersh:

Oh yeah, the deet. Right, the bug sprays all over the place. You spray your house and then you spray your body and you spray your clothes and-

Michael Roesslein:

Then Febreze and the scented sprays came out and the scented candles and the scented-

Dr. Felice Gersh:

And the Glade. Oh yeah, yeah, yeah. The scent. Right, right. All the phthalates. Now we know that shower curtains that are made out of vinyl that they release-

Michael Roesslein:

Oh, when they’re heated from the heat from the hot water.

Dr. Felice Gersh:

Yeah, the hot showers, right. It causes a release of the vinyl fumes which is really toxic. And then if you have a vinyl floor. So the whole bathroom becomes poison zone. Who knew? And then you can throw-

Michael Roesslein:

And people are wondering how they get sick.

Dr. Felice Gersh:

Yeah, so it’s like you have to… We’re trying to educate, right?

Michael Roesslein:

Yeah.

Dr. Felice Gersh:

And then like I say, the most important thing is to buy the healthiest food that you can. I don’t care if you have to buy used tables. Actually, I-

Michael Roesslein:

[inaudible 00:52:56] furniture a whole nother story.

Dr. Felice Gersh:

Call it antique. That’s right. I have patients that they have sick house syndrome because they have so much off gassing of formaldehyde from cabinetry which are also endocrine disruptors. These are things that-

Michael Roesslein:

Carpets, couches, glues.

Dr. Felice Gersh:

Oh yeah. Right. Carpet is, like poison, unfortunately.

Michael Roesslein:

It’s all the chemicals they put on it so that it doesn’t stain or it doesn’t burn.

Dr. Felice Gersh:

That’s right.

Michael Roesslein:

That’s the stuff that’s usually… [crosstalk 00:53:26]

Dr. Felice Gersh:

Right. And they always put-

Michael Roesslein:

Or we could-

Dr. Felice Gersh:

[crosstalk 00:53:28]

Michael Roesslein:

I’m going to actually have Laura Adler on the podcast soon, who’s an environmental toxins… She’s going to bring the doom and gloom so we will go into thousands of chemicals in that show.

Dr. Felice Gersh:

Well, and women who have PCOS should watch that show because part of the reason that infertility, in males and females… Sperm counts are plummeting, fertility among women is really [crosstalk 00:53:52]-

Michael Roesslein:

Like plummeting, plummeting.

Dr. Felice Gersh:

Plummeting.

Michael Roesslein:

I’ve seen statistics that are like, “At this rate there won’t be new people two or three generations from now.”

Dr. Felice Gersh:

That’s right and it’s very scary for those of us who are in this arena. Women with PCOS are really the poster child condition of how endocrine disruptors can combine with genes that were good for us and actually helped with survival in so many beneficial ways in ancient times and turned everything on it’s head, and combined with the crazy circadian rhythm dysfunctions and also the crazy food… I used to travel, before COVID, all over the world. That was so fun.

Michael Roesslein:

Yeah, remember that?

Dr. Felice Gersh:

Yeah, it was so fun. I used to travel. The last time I had an out of the country trip was the end of February 2019 and it was like, I got back and two weeks later we had the shut down all over the US and I just sneaked in that trip to India. I was all over the place lecturing with the Indian Menopause Society. It was so fun.

But I used to sit a lot in airports, of course, because that’s what happens, you sit around in airports. And I would people watch and I would see people eating what I thought looked like garbage, so I said, “Is this even food?” I had to go to dictionary.com and, of course, I found out it’s not food. By definition food has to have nutritional value. People are eating stuff that doesn’t even qualify as food. So I said, “Would you lick the floor? I’m hungry, I’ll lick the floor.” Of course you wouldn’t, but why are you putting this in your mouth? Look at the label. What the heck is all that stuff you’re putting in your mouth? And your kids and so on. It’s terrible.

This stuff wreaks havoc on our gut microbiome. It’s what you eat and what’s not in the food. What’s in it and what’s not in it. So you’re eating toxins that are crazy bad for you and you’re not getting the nutrients you need to run the machinery of yourselves. And then you combine that with women who have an innate problem with the conversion of testosterone into estrogen and they explode with testosterone and then that leads… Everything has downstream effects. When you have really high levels of testosterone it then, in turn, has an alteration of the gut microbiome and creates a more testosterone producing environment.

It’s really interesting. Men have a very different gut microbiome than women. If you actually did a fecal transplant from a man into a woman, guess what happens to her? She starts to produce more testosterone.

Michael Roesslein:

Yeah, you mentioned that when we did the MasterClass presentation and it blew my mind.

Dr. Felice Gersh:

Exactly.

Michael Roesslein:

And I brought it up to a microbiologist we interview quite often, because people are always grilling him about, “Should I get a fecal transplant? Should I get a fecal transplant?” Because they heard a story about someone got one and then their Crohn’s disease cleared up or something. There are instances with fecal transplants where it’s really successful and it’s fantastic and life changing.

Dr. Felice Gersh:

Oh, it can be lifesaving. Life saving, yeah.

Michael Roesslein:

But he started to name some different, really weird stuff, that they’ve seen happen. Not just men making more estrogen or women… But he heard a story about someone’s eye color started to change and all kinds of different, really weird stuff. He goes, “The potential for a miraculous outcome is there with it and there’s a ton we don’t know. We don’t really understand how it works and there’s really unexpected things that can happen.” Which he thinks is fascinating, because he’s a microbiologist, but it would be less fascinating if it were you.

Dr. Felice Gersh:

Absolutely. Right. So in women with PCOS they have alterations of all their microbiomes and this has been shown. Not only their gut microbiome, but their oral microbiome. So they’re more prone to gingivitis and the microbes in our mouth are key to the production of this critical important signaling agent and antioxidant gas called nitric oxide. We get half of our nitric oxide through manufacturing in our arteries, using estrogen that triggers an enzyme called endothelial nitric oxide synthase which isn’t going to work properly in an absence of adequate estrogen, and through the foods we eat. The nitrate containing vegetables that are converted through the microbes in our mouth that have enzymes, called reductase, converting the nitrates into nitrites which, down in the stomach and further in the gut, is converted form nitrites into nitric oxide.

Well, you need the right microbiome in your mouth and women with PCOS don’t have that, as a lot of other people don’t because they use toxic toothpaste and mouthwash, another whole story. But they don’t have it because you need hormones and that’s what happens after menopause. Women often have a lot of tooth loss and gingivitis and things. And women have that at a young age with PCOS, so not only do they have all those problems but in addition they have, now, a double whammy. They can’t make nitric oxide and nitric oxide is critically important for vascular health. Without it you’re more prone to high blood pressure which is very prevalent at a younger and women with PCOS. And as well, nitric oxide regulars t-regulatory lymphocytes that help the body to maintain a sense of self so that our immune system doesn’t attack ourselves.

You need those… They call them Tregs and nitric oxide is really critical. Women without this adequate amount, like women with PCOS, they’re more prone to getting auto-immune conditions like Hashimoto’s and so forth. I mean, there’s so many levels that these things are… That’s why you could talk for days on once you don’t have one thing what the downstream effects on this and this and this… How it is so critically important. And then we know women with PCOS don’t have the normal skin microbiome.

It turns out the microbes on our skin are… All the good microbes they’re actually at war with the bad ones. So there’s always this war going on that we don’t see where the good microbes, that we call the commensals, our friendly ones, are putting out chemicals and toxins that kill the invading microbes that are trying to take over. When you don’t have the right microbes on your skin you can’t fend of certain types of bacteria that can then create all these acne breaks out and so on. In order to have proper microbial populations everywhere in the body, including the vagina. The vagina of women with PCOS, are more prone to having yeast infections and BV, bacterial vaginosis, because they don’t have the right microbiome there.

You require the proper hormonal balance, and that’s why often if I can’t trigger the right hormone production it’s… I call it you can’t heal without the hormones and until you have the hormones you can’t heal. So you need the hormones to heal and you just won’t heal without the hormones. So I have to give the hormones, the human bio-identical hormones first, and then… I call them my training wheels. And then I can help their microbial populations throughout their body to become more normalized and then I can take away the training wheels. I can take away the hormones and then they can actually make their own hormones and then they can be more healing.

Because estrogen is required for healing. Estrogen regulates the entire immune system in so many ways. It’s like a modulator. It helps turn on the inflammatory process and it also turns off the inflammatory process. If we don’t have the right amount you go into that default state which is pro-inflammatory.

Anyway, that’s why you need to have so many tools. You need all the lifestyle approach with proper diet and stress control, meditation, all the mind-body medicine, and work on sleep and sleep hygiene and toxic reduction and all of these… Exercise. Fitness is so key for women with polycystic ovary syndrome. And then sometimes we have to give pharmaceuticals like GLP-1 agonists to help with regulating fat burning and appetite and glucose regulation and sometimes we need to give human bio-identical hormones so that the body can actually heal and then re-establish the healthy microbial populations throughout the body.

It’s complex but the solution is never, in my opinion, you just permanently, for decades often, put these young girls and women on oral contraceptives, endocrine disruptors, and sometimes they throw in metformin and sometimes spironolactone. I’m not anti-spironolactone as that’s another drug that can sometimes be very helpful over time, a short time. Maybe even a couple of years to help modulate the testosterone receptors and so on, just to sort of turn down the fire a bit. That shouldn’t be forever.

And then metformin has never been very good for weight loss and it’s never done better than lifestyle. When they’ve done studies comparing lifestyle to metformin, lifestyle always wins and the solution, they always say, is, “Well, people won’t do lifestyle so we put them on metformin.” I don’t buy that. People care. If you motivate them and educate them they will do what’s in their own best interest, especially women who want to have a baby because they are highly motivated. When they understand that their health determines their child’s health for life. How important is that? So we can do this. We can have a tremendous impact on changing.

Just giving metformin, spironolactone, and birth control pills for ages, ongoing, indefinitely, is not a solution because it’s not helping the body heal

Michael Roesslein:

Until they cut out their uterus.

Dr. Felice Gersh:

That’s often done. That is correct.

Michael Roesslein:

Yeah I know. That’s step one. Step two is cutting out the parts when that doesn’t work anymore. I’m sorry, I’m agitated.

Dr. Felice Gersh:

Me, too.

Michael Roesslein:

I can’t imagine because I don’t work in the field so it’s got to be 10 times for you. But you help women heal from the damage done from that approach, so that’s great and we need more doctors that are educated in these to be able to help reverse that because I can’t even… I’m sure there’s statistics of it but I can’t even imagine how many women under 18 are on those medications or…

Dr. Felice Gersh:

Well, in India, because I was there before the COVID… They actually estimate, because nobody keeps track and the women there don’t even want to ever admit that they have PCOS because it’s a heinous thing to have a fertility problem. But they think it could be between 35% and 39% of women now, in India. And in the US… Because nobody keeps track of any of this either, because they would have to look at diagnosis codes and often that’s not what’s coded. PCOS is not coded. They may code irregular cycles or some other symptom. They’re not coding PCOS. They think it’s anywhere from 10% to 25% of American women now have some… It’s a spectrum so there’s all degrees. They’re somewhere on the spectrum of PCOS.

I mean, this is an epidemic, guys, and the solution isn’t shut down the ovaries and give metformin. Come on.

Michael Roesslein:

Yeah, and you mentioned so much there, too. The diet, the circadian rhythm is huge, and that’s huge with every single health condition. You mentioned the microbiome and drugs that can be helpful for short periods of time. The estrogen, eating the highest quality food possible, getting the poisonous stuff out of your house and off your body and out of the air and out of your area as much. People always want to know-

Dr. Felice Gersh:

As much as possible.

Michael Roesslein:

“What do I do to detox?” I say, well, take away all the poison first.

Dr. Felice Gersh:

That’s absolutely true.

Michael Roesslein:

That’s the first thing.

Dr. Felice Gersh:

I’d say the same thing. If you’re in a house on fire, the first thing is put on the fire before you start redecorating.

Michael Roesslein:

Yeah. They always want, “What supplements can I take to detox?” And I say, “Well, throw out all the stuff that’s in your bathroom and then we’ll talk.” Or, “Get air purifiers or air filters.” Or, “Do these things…” The things that remove the exposure first. That’s the lowest hanging fruit.

Dr. Felice Gersh:

Absolutely.

Michael Roesslein:

Inventory the stuff you’re putting in your mouth, on your body, in the air in your house, and all of that first. You gave a huge list there, there’s a lot that can be done. I encourage people to look into this further. There’s so much more. I mean, your book I’m sure is… We’ve been talking for an hour, I’m sure your book has five times more stuff in it. If people do want to learn more, because we’re about out of time so I’m going to send people to where there’s more information. We’ll have links down below. She provided links for us. We’ll have everything down below for Instagram, Twitter, Facebook. I have a YouTube channel and links to your books and you mentioned-

Dr. Felice Gersh:

That’s it.

Michael Roesslein:

We’re going to do a promotion where people can get first chapter from the book PCOS SOS, we’ll get connected with you to get that set up. We’ll have all the links right below. Where would you recommend they start if PCOS is their main concern with all of your various places on the internet they can go?

Dr. Felice Gersh:

Well, I would say to get my first, I call it my fundamental book on everything that you should know and do. It’s like a seven step what to do for PCOS. It explains it, it has hundreds and hundreds of references. So my original book, PCOS SOS, is where you should start, okay? Of course, I am here. I’m actually speaking to you from one of my exam rooms. I have a brick and mortar practice. I’m kind of old fashioned. I still see patients in person. I also can do telemedicine, but I love to see people in my office if possible. I’m here five days a week in my office working and seeing patients, so come to me at Integrative Medical Group of Irvine, if you can. We’re in, typically, although not today, sunny Southern California, and we have tons of… Everything’s open so you can come and have great restaurants and beaches and recreation here. You can combine it. See me and have a great time.

Michael Roesslein:

Highly recommend it. I can vouch for the sunniness, normally, of Southern California. I spent five years in San Diego. Beautiful weather, great clinic, excellent book. Love all the links below. Please follow, check it out, look up all the rest of her work. So much to learn. And like you said at the beginning, so much that applies to everyone. It’s not just women with PCOS. These are the same root causes that I’ve heard over and over and over and over. It’s just how does it manifest in each individual can be different.

Dr. Felice Gersh:

Exactly.

Michael Roesslein:

Thank you so much for sharing all of this great information and for all the work you’re doing and I always enjoy connecting, so let’s do more stuff.

Dr. Felice Gersh:

My pleasure.

Michael Roesslein:

All right.