"The Most Critical Factor" of PCOS [Expert interview] - PCOS Diva
“The Most Critical Factor” of PCOS [Expert interview]

Most Critical Factor" of PCOS“The most critical factor in all of the issues facing women with PCOS is systematic inflammation and its origin which is probably in the gut,” explains Dr. Felice Gersh in our most recent interview.  Dr. Gersh is a doctor of integrated medicine and a renowned expert on PCOS.  Our conversation was wide ranging as she clearly explained the origin of many of our toughest symptoms.  The gut-brain-hormone link can be a delicate balancing act, but once we get it worked out, Dr. Gersh assures, our physical and emotional health will radically improve.  Listen in and learn:

  • Why the gut is called the 2nd brain
  • What steps to take in order to calm and treat GI inflammation
  • The impact of stress, emotions and anxiety on your gut and overall health
  • The link between nutrient deficiencies, leaky gut, insulin resistance, acne, hair loss, Hashimotos and other auto immune disorders
  • How mouthwash is ruining your arteries
  • Foods and supplements that can help repair your gut and reduce inflammation
  • The extreme dangers of pharmaceuticals like Prilosec, Prevacid and Nexium

A complete transcript can be found below.

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DrGersh 2014.2Dr. Felice Gersh is one of only a small number of fellowship trained integrative gynecologists in the nation. She blends the best of the world of natural and holistic medicine with state of the art functional and allopathic medical treatment. Because of her extensive knowledge of the complex inter-relationships of the body’s organs, she recognizes the need to investigate all aspects of health, always working to re-establish a healthy gastrointestinal tract, adequate sleep,
good mood, great nutrition, high energy, and balanced hormones.

Expert in all areas of women’s health, and particularly of gynecological and reproductive matters, Dr. Gersh deals in an integrative manner with such uniquely female issues as polycystic ovary disease (PCOS).

She is currently writing a book on Polycystic Ovary Syndrome and writing a chapter on the same topic for a medical textbook.

You may contact Dr. Gersh at:

Integrative Medical Group of Irvine, 4968 Booth Circle, Suite 101, Irvine, California 92604

Website: www.integrativemgi.com

Email: mail@integrativemgi.com

Phone: 949-753-7475


Complete transcript with links: 

Amy: Hello, and welcome to another PCOS Diva podcast. This is Amy Medling. I’m a certified health coach, and I’m the founder of PCOS Diva. I’m really glad that I’ve been able to welcome back Dr. Felice Gersh. She’s a regular contributor to PCOS Diva, and she’s going to be talking to us today about inflammation and the gut.
If you’ve been a frequenter of PCOS Diva, you’ll notice some of the wonderful articles and podcasts that she shared about inflammation and one about gut biome, and we’re going to bring both of those topics together in this podcast as we talk about inflammation in the GI tract.
Welcome, Dr. Gersh.
Felice: Well, thank you so much, Amy. It’s a pleasure to be back and to talk about what is really about the most critical factor in all of the issues facing women with PCOS, and that is systemic inflammation and its origins, which probably are within the gut.
Amy: I just want to give listeners just a quick bio for you. I know your area of expertise. You are one of a very small number of fellowship-trained integrative gynecologists in the nation. You blend the best of the world of natural and holistic medicine with the state-of-the-art functional and allopathic medical treatment.
You have a real extensive knowledge of the complex interrelationships of the body’s organs, so you’re looking at all aspects of health, working to reestablish a healthy gastrointestinal tract, adequate sleep, good mood, great nutrition, high energy, balanced hormones. It really takes this holistic approach.
You also are a gynecologist, and you are working on a book about polycystic ovarian syndrome. Just wanted to give everyone that overview of where you’re approaching the topic about inflammation in the GI tract.
Felice: Oh, yes, absolutely. I became very disgruntled back quite a few years ago as I looked at what was happening in conventional medicine in most areas involving women’s health and in particular with women with PCOS, when the only thing that women were offered were birth control pills and a few pharmaceuticals which have a limited amount of impact and didn’t at all deal with the underlying issues.
I had to go and delve and research and learn mostly on my own and with making wonderful connections with people like you so that we could actually really delve deeply into what is really happening with women and what can we offer them. It became clear with PCOS that inflammation is an overriding and consistent element of this condition, and that’s why I’m so excited to really talk about it and some of its underlying ideologies which involve the GI tract and, of course, how it interplays with every other organ in the body.
Amy: Recently, I’ve been posting little snippets, I guess, info bites of information for PCOS Awareness Month, which is in September. I posted something about how leaky gut and specifically, I guess, irritable bowel syndrome, there was a 2010 study that found that women with PCOS had an increased likelihood of irritable bowel syndrome, posted that little tidbit of information and then some more information about leaky gut syndrome and how it relates to PCOS.
I was really floored by the comments and the amount of women that are affected with gastrointestinal tract distress. That’s why I was really excited that you were going to come and speak to us about that today. Maybe you can give us an overview of what the GI tract is and how we can calm some of the inflammation that’s going on there.
Felice: Well, of course. It’s definitely become a focus of attention these days, and rightly so. The GI tract is often called the second brain. We know that there’s more neurotransmitters produced, for example, serotonin, in the gut than in the brain itself. As well, there’s a very intimate connection between the gut, which includes the entire GI tract, and the brain, which is now known as the gut-brain axis. In addition to many, many ways of communication between the brain and the GI tract, there’s a nerve, the vagus nerve, which is like a direct conduit, avoiding and not even requiring use of the spinal cord to communicate very directly to the GI tract.
Whenever a woman, we’ll say we’re talking about women, has any sort of emotional feelings like anxiety or depression, the vagus nerve suddenly transmits that information to the GI tract, which will then respond and become altered in term of its motility, and then as well inflammation develops, the wrong types of bacteria can overgrow and set up a whole cascade of events which can lead to things that are the grab-bag label of irritable bowel syndrome, which of course is just a symptomatic label. There are really things that are going on beneath the surface that are really very critical to the function of the GI tract, which of course relates to every other organ in the body.
Women with PCOS are particularly vulnerable to GI issues, and I would say that close to 100% of women who have PCOS have some sort of GI problem even if they are not even aware of it. Women with PCOS have distinctly abnormal mouth microbiota. The bacteria that grow in their mouths, they’ve actually checked, and they’re different from another woman who’s matched in the same age group.
Then when you talk about irritable bowel syndrome and people have emotional issues and women with polycystic ovary syndrome, they tend to be what we call sympathetically upregulated. Their sympathetic nervous system is sending out more signals than it should, and so they’re upregulated. Sympathetic nervous system is involved in the fight or flight, when women are feeling anxious. Their heart will beat faster, they’ll sweat, they’ll have GI symptoms which usually are acid reflux and sometimes diarrhea and have to go to the bathroom to urinate more frequently.
All the things that you think about with anxiety, they’re related to upregulation of sympathetic nervous system, and we now know that women with PCOS tend to have more of that happening in them, which then translates to more GI issues. They tend to have more irritable bowel syndrome, which is often now recognized as related to having what we call “SIBO” or small intestinal bowel overgrowth.
Because of reduced stomach acid production and the sphincter between the colon and the small intestine not really working well, you have the bacteria coming up into the small intestine from the colon and from the stomach down into the small intestine, so you have bacteria overgrowing in the small intestine where it doesn’t belong. This creates inflammation as this bacteria overgrows.
Then as you eat food that has fiber, healthy fiber, the bacteria in the small intestine start to ferment it, which should not happen until it reaches the colon because you have too many of these bad bacteria growing in the small intestine. Then they get bloating and gas, and depending on what the different products of fermentation are, if it’s methane, then they get diarrhea. If it’s hydrogen sulfite, then they get constipation, and it can alternate between the two depending on what the foods are that they eat and the bacteria overgrowing.
Then they get an overgrowth of mucus in the small intestine, which then prohibits proper digestion and absorption of nutrients. Many women with polycystic ovary syndrome will have nutrient deficiencies that are critical to different B vitamins such as magnesium, which of course have a big role in how they work with their metabolisms and glucose transport, so you can see how this is like a snowball effect.
Then they get the wrong bacteria overgrowing in their colons or they don’t even have what they call “good diversity,” which is another whole big area that they don’t have the right bacteria, they don’t have enough different species of bacteria, so they don’t do the proper fermenting of the fibrous products that they eat in their food in their colon and then they get different problems down the line as well.
It’s from top, from the mouth, all the way down. Of course, if they have reduced stomach acid which is also very common, especially with stress and nutrient deficiencies, because it’s, once again, with the snowball effect, if you don’t absorb the nutrients and you don’t have enough zinc and you don’t have enough thiamine which is vitamin D1, then you don’t produce enough stomach acid. Then when you don’t have enough stomach acid, the sphincter between the stomach and the esophagus doesn’t close, and then you get reflux and then you get inflammation in both the stomach and then the esophagus.
Then, of course, you mentioned leaky gut. When you have inflammation in the gut, the little single-celled barrier that keeps the contents of the intestine from transferring and crossing into the body itself proper is no longer intact. You can have particles of partially digested protein, which we call peptides, can cross over into the regular part of the human body where 70% of the immune system resides, lining the gut, and that’s called the GALT, the gut associated lymphatic tissue.
Then you’re starting to upregulate inappropriately the immune system, creating cytokines, these inflammatory products, and also the immune system can then get disregulated and start making antibodies against these protein peptides. Over time, the body gets confused and starts making antibodies against yourself, and that’s why so many women with polycystic ovary syndrome also have autoimmune conditions like Hashimoto’s thyroiditis. That’s very, very common, and they get passage of these other things called LPS, lipopolysaccharide, which are products from the Gram-negative bacteria that overgrow also in the intestinal tract. These also upregulate the production of inflammatory particles called inflammatory cytokines.
The cascade just continues. These cause insulin resistance and upregulation of production of IGF1 and insulin, which then causes in the self more testosterone production, and then we know where that goes, when you have too much testosterone, and then they get acne and hair loss. You can see where at the center of all of this, it comes down to what’s going on in the gut, and that’s where you and I come into play, because we can give advice to try to help stop this overwhelming cascade snowball effect of things that are happening that are starting within the GI tract.
Amy: Yeah, and I think, after listening to that, I think a lot of us just say, okay, I’m just going to throw up my hands. What is there to do? It seems like the chips are stacked against me, but I think that there are a lot of things we can do.
Felice: Oh, absolutely, Amy.
Amy: Please educate us.
Felice: It is overwhelming to hear “this” then “that” and it goes to “this,” but if you break it down one by one, what can we do? Well, number one, honestly, start with stress reduction, because the sympathetic upregulation is controlled through your moods, and there are wonderful things that you can do, whether it’s guided imagery, meditation, progressive relaxation, just taking a walk on the beach in your bare feet. There’s so many things that you can do to start to downregulate, subdue that sympathetic tone, and get that vagus nerve quieted down to really … because if you don’t deal with emotions, I’m telling you, it’s going to be very difficult to really override a lot of the other things.
Really, start with your attitude and say, you know what, yeah, there’s a lot of stuff. I don’t need to know all of the science. All that stuff I just threw out, all you need to know is, we’re going to work on your emotions, you stress, your sleep, your circadian rhythms, like working with nature, see the sunset every day, go to bed at a reasonable time between 10:00-11:00, don’t do a lot of computer work, don’t suppress your melatonin and trigger more cortisol.
I didn’t mention this, but when you have stress you have more cortisol, which creates more inflammation in the gut. That’s why you’ve got to control this stress and the emotions and recognize that if you’re indoors all the time, you’re not going to get enough vitamin D, which is also very important. Get out in nature and just take a lot of deep breaths and say, you know what, I am in control over this, I can handle this. You can, and we know, I have so many patients who have taken their lives back.
The next thing after you deal with the whole emotional thing is what you put in your mouth, because you know that we’ve talked about the inflammatory diet. How often has that come up? You don’t want to eat foods that are going to create inflammation, and you don’t want to eat foods that are nutrient-deficient. You want to eat nutrient-dense foods. You want to eat foods that are going to heal your body, and you want to definitely not put in anything that is not a food. We don’t want to eat chemicals. We don’t want to eat a lot of sugars.
I always say, if you couldn’t have eaten it 500 years ago, don’t even consider eating it, because no one has improved upon food from 500 years ago, I can tell you. Eat natural food. Eat from the color of the rainbow and nourish your body. Think of food as more than just entertainment, right? We’re getting to basics. Food is survival. Food is how you nourish your body. Every cell in your body needs the right nutrients in order for it to function properly.
You want to eat nourishing foods and you have to do a little experimentation, because if you do have small intestinal bowel overgrowth, the very high fiber foods may not agree with you at first because you’re fermenting in your small intestine. That’s where you need to work with a doctor who is understanding of these things, because sometimes we have to do other dietary maneuvers first and actually give you lower-fiber foods initially and then deal with doing herbals and such to kill out the bacteria in the small intestine before we then feed a lot of fiber.
These are things that have to be managed professionally if you have a lot of serious GI symptoms. We don’t want to, I don’t want you to micromanage yourself, but I want you to understand what can be done and start with the foundational things of eating real food and foods that are not containing chemicals and such.
Amy: I do think that that is a real issue for a lot of women. They’ve been eating the standard American diet and now they have a PCOS diagnosis or they’re ready to start taking control over their PCOS. They start eating a densely whole-foods-based diet like you were just mentioning, nutrient-dense, but most of those foods are high in fiber, and then they have gastrointestinal distress.
Felice: Right.
Amy: You mentioned finding a doctor that understands these things.
Felice: A challenge, I know.
Amy: Yeah, so what kind of … Is it a GI doctor? A functional medicine doctor? What would you advise?
Felice: I would always say, if possible, find a functional medicine doctor. Of course, if people can travel to me, we do have an away program for people that don’t live in my neighborhood and I can work with them to get them started. Really, I hate to say it, but many of the conventional gastroenterologists, they really are not looking below the surface. They do a lot of scopes. They’re very good at detecting cancer and giant ulcers, but they’re not very good at managing and fine-tuning the gut function. That’s not really what they were trained to do.
You’re much better off finding a functional medicine doctor or a naturopathic doctor if you can’t come in, say, to see me, because they are much more geared towards the function of the GI tract and healing the GI tract. There is no magic bullet, and you really have to look at each individual. Like I said, if you start eating really healthy foods and lots of roots vegetables and beets and things and then you feel worse, that’s really clear-cut evidence that you have small intestinal bowel overgrowth or SIBO and you’re fermenting in your small intestine where you shouldn’t be.
You really have to get that cleared up, and that is not something that you should be working on on your own, truthfully. You really need to get a functional medicine doctor to work with you on cleaning up your gut and getting the bad bacteria out of your small intestine.
Amy: Okay, so once you’ve done that, how do you keep, I guess, feeding your gut the good stuff? How can you move forward to create optimal gut health?
Felice: Well, one thing is, and we had talked about this a little bit, which was starting with the mouth. The mouth is the forgotten part of the GI tract. People just don’t think about it, but the idea of cleaning up your mouth in terms of getting rid of harmful bacteria without killing the good bacteria, 99% of the bacteria in the mouth are the good guys.
One thing, never use mouthwash. That stuff is poison. I know they say, “kills germs on contact,” but, remember, the germs are our friends. They are doing amazing things. If you do not have the right bacteria in your mouth, you can’t make a critical substance called nitric oxide, which is made in the stomach, which is a gas which diffuses out of the stomach and it goes into the arteries and it’s what maintains artery health, which is a problem for women with PCOS. They often have what they call “endothelial dysfunction” or the lining of the arteries are not healthy, and you need to have nitric oxide but you need to have stomach acid and you need to have proper bacteria in the mouth. Get rid of all mouthwashes that are chemicals. We don’t want chemical mouthwashes.
Now, you can use sometimes natural things, like we had talked about, like the sesame seed oil. Organic sesame seed oil can be helpful, and I actually went on PubMed and looked it up and there are quite a few published articles. There are some other things like bilberry extracts and other natural phytonutrients that can be swished around in your mouth and between your teeth that are actually very good for cleaning up the gut and the mouth microbiome and helping with healing the gums.
It turns out, women with polycystic ovary syndrome often have very inflamed gums. They actually have, there are issues with the mouth that are very unique in polycystic ovary syndrome. Definitely, you want to have regular tooth cleanings and gum … Make sure your gums are clean and get rid of plaque where bacteria can accumulate and proliferate. You want to take care of your mouth.
The other thing that I advocate is, for as much as possible, eat food and chew it as opposed to drinking your food. I’m not against drinking green smoothies. However, recognize that you’re missing the whole benefit of the mouth when you drink your food. I much prefer if possible to chew your food and chew it well like your mother said. Chew it 32 times before you swallow it and mix it with your saliva. Saliva has digestive enzymes.
Remember, digestion starts in the mouth, and it’s a very critical part of the GI tract, and take care of your gums and your teeth. We won’t even go into this on this one, maybe another time we can talk about dental amalgams and toxicities and all, because we can’t go into everything in just a little bit of time, but environmental toxins have a big role in also gut inflammation. Our poor mouths are often filled with chemicals, and our teeth and such.
The other thing is choose a very good natural toothpaste as well. You don’t want to put chemicals and you don’t want to put little beads of plastic in your mouth. You’ve probably been reading about that. Some of the toothpaste have in them triclosan, which is like a chemical antimicrobial which also kills all the good bacteria. Don’t get a toothpaste that has triclosan in it. They actually sell these little particle …
Amy: It’s an endocrine disruptor as well.
Felice: What? Sorry?
Amy: It’s an endocrine disruptor as well.
Felice: Oh, my God. Yes, it’s an endocrine disruptor, absolutely. These are terrible things and we’re putting them in our mouths and they’re being absorbed and going right down into our intestines. Be very picky about what you put in your mouth as far as things to clean up your mouth. You’re destroying all the good stuff and you’re poisoning your endocrine system as well.
In terms of the esophagus, if you have burning and so on, if you have acid reflux, there are many natural herbal products that include things like slippery elm and a certain form of chewable licorice that they call DGL that can be very coating. These are what we call demulcents, they can coat, and then you can also get marshmallow root.
There’s a number … aloe vera juice. If you buy aloe vera juice, be very careful, though. Make sure it says “fillet only” or “aloin free” or you get the component of aloe vera which is a very, very potent laxative, and you will definitely notice the effects. Make sure that any aloe vera juice you get says “aloin free” or “fillet only,” but aloe is also a wonderful demulcent as well. These are all things that you can, you can go to a health food store to get some of these, or I think you have some of these products as well. Don’t you, Amy?
Amy: Yeah, I have berberine, which is an antimicrobial …
Felice: Oh, yeah, and I didn’t get into it, like berberine. Berberine, if you have issues with gastritis and you have H. pylori, overgrowth of H. pylori, that’s a whole other big topic, but berberine is excellent, along with some of these other demulcents that I just mentioned, the chewable licorice and the slippery elm and the marshmallow root and bismuth and so on.
All these things can be very helpful for getting rid of the H. pylori, along with certain pro-biotics that are very, very helpful. If you take various strains, particularly of the lactobacillus and some of the bifidobacterium, these are very helpful for getting rid of H. pylori. In fact, in studies now they’ve show that they do as well and actually often better than the traditional antibiotic and PPI treatment that they use for H. pylori.
Recognize, too, that H. pylori is not a bad guy. It’s a good guy. It’s supposed to be often in the stomach. In fact, there’s some data that show that it’s actually protective against stomach cancer. The problem is when you have everything going wrong in the stomach and you have the wrong types of bacteria and you don’t have the right nutrients and you don’t have enough stomach acid that you don’t have the proper amount of mucus coating in the stomach, and then the H. pylori comes right up close against the tissue of the stomach and then creates ulcerations.
In a healthy stomach, H. pylori should not be treated. There’s been a lot of change in the thinking about H. pylori, so just having H. pylori in a perfectly healthy asymptomatic person should not be treated. That’s really important in case you ever go to a doctor and they say, you have H. pylori. Well, if you’re feeling fine, leave it alone, because H. pylori is not a bad guy. It’s only when you have a sick stomach that then you have, these are what we call, and this is really a very important concept, what are called the “commensal bacteria.”
These are normal inhabitants of our intestinal tract, but when you have an abnormal environment, the friendly guys, the commensals, become unfriendly. It’s kind of like if you have a friendly dog but you put them in a really scary environment and suddenly he acts up, right? It’s really your friendly dog, but you just do the wrong things and then he acts up. You take all your friendly bacteria, but then you do everything to create a bad environment to live in and then they start turning on you and acting up. The bacteria themselves may not be the problem. It’s all the other stuff that’s changing the environment that they’re living in.
It’s a whole different view, a whole world that’s changing in how we’re looking at the whole GI tract. In fact, we’re looking, for the colon, we’re not just looking at what types of bacteria you have. What we’re looking at is overall diversity rather than individual species. What we want is lots and lots and lots of different types of bacteria.
They’ve looked at primitive societies that eat on average 100-150 grams of fiber a day. The typical American has like 5-10 grams. It’s like almost nothing of fiber. They find that the typical American has at least one-third fewer types of bacteria growing in their large intestine, in the colon, and this is really critical because each particular species has a special job in terms of how they digest and ferment the fiber that you eat.
It’s like the poor planet earth where we have different species going extinct on us. What do we do? What happens when they’re gone? What do we do? We can’t replace the carrier pidgeon, right? What happens if they’re gone? They’re gone. Well, the only thing with humans that gives us hope, and there’s research coming down the pipeline, is fecal transplants. If you get tested, I recommend that everyone with PCOS get their GI tested to look at what their microbiome is, we’ve been using what’s been called polymerase chain reaction, PCR. We can actually do DNA assays, and you can actually test your microbiome.
There’s a whole big program going on in the nation that’s called the Microbiome Project that people may have heard of, where they’re looking at typing microbiomes, the bacteria in all different parts of people, in their mouth, in their sinuses, vagina, and in their intestine, to see what is normal, what is typical. You can not be part of that project. You can just get it through labs, and they’re not that expensive, and see what’s really going on inside of you and see if you have overgrowth of bacteria, see if you have low diversity.
In the future, there may be fecal capsules and fecal transplants and things, so that if you have low diversity, you can find a healthy person, and there are still a few of them out there but fewer and fewer unfortunately, and take their fecal microbiome and transplant it into you. In the meantime, there are other things that are being researched like probiotic enemas, but certainly what I recommend and I’m sure you do, too, is if once the small intestinal bowel overgrowth is cleared, to eat a lot of high-fiber foods, natural foods, and also eat fermented foods.
That’s not part of our diet, but in traditional societies eating fermented foods is really a daily event, like the Koreans have their kimchi and there is kombucha tea and then there’s some different types of fermented, of course, yogurts which can be helpful when they’re organic. Real kind, you know, we don’t want processed yogurts with all kinds of chemicals in them and artificial sweeteners and sugars and things.
You can get sauerkraut, and you can make your own. A lot of people I know are fermenting their own vegetables, and it’s not very difficult. Any vegetable that has a crunch you can ferment, and then if you eat it it’ll really help to repopulate your intestinal tract and then you’ll have a much healthier gut.
Amy: I completely agree with the adding the fermented foods. I’ve seen that’s made a tremendous improvement in my digestion. I had Summer Bock, she’s the fermentation expert, on the podcast about a year ago now, and she advocated eating two forkfuls of, it’s really important, raw sauerkraut. Not the stuff that you eat out of a can …
Felice: Oh, yeah, don’t eat it out of a …
Amy: Yeah, don’t heat it up.
Felice: No, heat it up and put it on a hot dog. That’s not going to do you any good.
Amy: Right, right, and there’s a wonderful local, here in New Hampshire, it’s called Micro Mama’s, a local company that makes delicious fermented vegetables, and they sell at Whole Foods. I buy a jar of that and have like a forkful a day almost like a supplement.
Felice: That’s probably, yeah, but I’d say a couple of ounces, but that’s probably about the same as two forkfuls. Mm-hmm (affirmative).
Amy: Yeah, a couple forkfuls, and you can put it on your salad or just eat it as is. It’s really easy, and I think it just makes a tremendous difference.
Felice: It does. Oh, it’s such a wonderful thing to heal the gut. These are steps that can change a person’s life. By the way, I find that when people do this and they have cystic acne, it dramatically improves because, remember, the skin is a reflection of your underlying inflammation. Heal the gut, and you’ll heal your skin dramatically.
The other thing is, the brain-gut axis is a two-way street. If you have anxiety and depression and a lot of the mental things that are going in your life, it’ll upset your GI tract, but as you heal your GI tract by doing all these wonderful things with your nutrition and herbs and such, then it’ll feed back on your brain and it’ll be brain-calming. It’s a two-way directional event, the brain-gut axis, which is so good, and that’s why there should be tremendous optimism. There’s so much that we can do to make women with PCOS healthier through healing their gut and then healing their emotions, because they go together, and then healing systemic inflammation.
Amy: Yeah, and the other thing I was going to mention, I was wondering your thoughts on it, is homemade bone broth.
Felice: Oh, I love it. I’m so glad you brought that up. I have it every day myself, just about every day. I use chicken bones, because I just happen to love the taste and it’s always free-range organic chicken, of course, that’s our goal, but you can use any healthy animal bones to make bone broth. Do you have a recipe? I can go over it, but if you have an easy-access recipe …
Amy: Yeah, no, I have an easy-access recipe on the site.
Felice: Wonderful.
Amy: Just add … I always like to add a couple teaspoons of apple cider vinegar to leech the nutrients out of the bone.
Felice: That’s right. It leeches all the good stuff out of the bones, absolutely.
Amy: Yeah, and it’s something, now that we’re getting into the cooler weather, I always buy an organic chicken every week and roast it, and then you can use that. I roasted mine yesterday and now I’m making Thai chicken chowder for dinner after we get off the call.
Felice: Wonderful. Are we all invited over? It sounds so good.
Amy: Yeah, I know. My stock is actually simmering right now, and it’s just so easy.
Felice: Oh, I can almost smell it here in California. It’s wonderful.
Oh, I forgot to mention, also along the lines of what you can do with just foods and such, I love a lot of teas, and when you give herbals as a tea, it doesn’t feel like you’re using a medicine, right? Just things like ginger tea is very good for digestion, and ginger is naturally antimicrobial as well, and chamomile, which no one in the past understood how chamomile can be good for the GI tract and it’s emotionally calming. Well, now of course we understand because what’s good for the gut is good for the brain and vice versa.
Chamomile is a wonderful tea, so I encourage people to drink regularly ginger tea, chamomile tea. They’re really wonderful to have. Those are, I think, musts for women with PCOS. Also, if they like peppermint tea, because peppermint also and spearmint tea particularly can lower their testosterone. You can get the benefits of those types of teas as well.
Amy: Yeah, and I have a couple articles on my site about tea and the ritual of tea.
Felice: Great. I love rituals, so that is also wonderful.
Amy: I believe, especially for me, my kids come home from school around 3:00 and I usually go and make a pot of tea before they get home and make sure I sit very mindfully and have a cup and center myself before the craziness of the evening begins.
Felice: I love that.
Amy: Yeah, you have this really fragrant tea and you put it in your, I have a pretty little teapot that I treated myself to. You have to wait for the water to boil and then the tea to steep and you smell the fragrance.
Felice: It is. I think that it’s fantastic to do that. I think there’s a reason why in the British societies they had their 3:00 afternoon tea. Of course, high tea, but skip the crumpets and those …
Amy: Yeah, right?
Felice: The idea of having a late- to mid-afternoon tea rejuvenation time. It’s wonderful, and if you can have the time to listen to a little bit of pleasant music and even go outside. I’m always big on earthing. I don’t know if we’ve talked about the issues with electromagnetic radiation which are pervasive now in our society and really not healthy to say the least.
If you can get outside and even take your shoes off while it’s still warm, and you have a limited time now in New Hampshire, but while it’s still warm and just put your feet, run it through grass and so on, and look at the sky and drink your tea. Even if you can’t look out the window and just take in a little … They’ve shown that looking at nature will lower your sympathetic tone and make you feel calmer right there.
I just wanted to also mention before we finish that for women who have irritable bowel syndrome, the pharmacological agents are bad for you. Drugs that block the ability of the GI tract to have motility, drugs like Lomotil, drugs that paralyze the GI tract because you have diarrhea, they’re not getting to the root cause at all and they’re harming you. Please don’t take those things. Go find a functional medicine doctor who understands that you have to heal the gut, not paralyze the gut. That’s not the solution.
PPI’s are evil. They’re so evil if you have acid reflux. Stomach acid is critical. I’ve mentioned that it’s essential to making nitric oxide. Without stomach acid, you don’t trigger the pancreas to secrete its digestive enzymes properly. You don’t get the gall bladder to contract, to release its bile, so you’re going to have increased risk of gallstones. You’re not going to digest your proteins, you’re not going to digest your fats, and you’re not going to get your fat-soluble vitamins. I can’t tell you how terrible it is to take chronic PPI’s. Those are drugs like Prilosec, Prevacid, Nexium, and so on. They are terrible, and you can’t just stop them, though, because I call them the “crazy-maker” drugs. They actually give you the problem they’re designed to treat.
In fact, they have studies where they gave totally healthy 25-year-olds these drugs for three months, and at the end of three months most of them, when they just suddenly discontinued the drugs, they had acid reflux because they paralyze the sphincter. It stays open, because it’s the stomach acid that triggers the sphincter to close. For three months these people had no stomach acid, so their sphincters got stuck in the open position, but they’re still capable of making stomach acid when you take the drug away, so you get this gigantic rebound of stomach acid production, the sphincter doesn’t close, and so they get this horrendous rush of acid up into their esophagus and they feel horrible.
People who have been on these drugs and they suddenly stop it and then they have this overwhelming burning and horrible heartburn, they think, oh, my God, I really need that drug. The drug caused the problem. You can do that to totally healthy people. You can’t just stop it. You have to once again have a functional medicine doctor who knows how to slowly wean you off of these drugs, which is 100% of the time doable by the way, but then you also have to look at, why did you have a problem with heartburn or reflux in the first place, and that’s where you get to the emotions, the foods, people can have food sensitivities.
Obviously, this goes way beyond one little podcast, but certain foods, if you get leaky gut, you may have developed allergies to specific foods that you have to avoid for several months while you heal your gut. It’s complex, and some of these things you can do on your own, and you can always do the right things like drinking tea and making bone broth and taking some of these very safe herbal things, but if you’re really having significant problems with your GI tract, you can’t do all this stuff on your own. You need to find someone that will be an ally with you and work with you but without these really, really harmful pharmaceuticals.
Amy: Dr. Gersh, can you tell us if somebody is interested in working with you, how can they connect with you, and what’s the protocol?
Felice: Oh, sure. Well, we have several different programs that are available, depending on what people want and so on. They can call my office. I can give you the number. That is 949-753-7475, and they would ask for my Amy, so that’s easy to remember because I have an Amy here who is in charge of that, or if it’s attached to the podcast, to my email, and they can email to me and I would be happy to respond.
We have programs that involve myself. We try to do the total picture, so depending on what people are open to, I have a naturopathic doctor that works, we work very much as a team. As well, I have Chinese medicine, we have fitness, we do all kinds of stress reduction, we have massage. We have a variety of tools, I’d say. We have an expanded toolbox, but we work with people and try to make it very affordable.
By law in California, I can’t treat people in another state. I can treat people in California with never seeing them, but if they’re in another state I have to at least see them to begin with. I don’t have to see them all the time, but I can’t just treat people specifically dealing with their issues without seeing them at least initially in person. That’s just the law right now. Of course, telemedicine laws may change, but by law I have to see them in person.
People would have to come and fly to Southern California, which fortunately is an easy place to get to because we’re right by John Wayne Airport here in Orange County. I’ve had people come from all around the world, and then they combine it with a vacation to Disneyland or Newport Beach and so on.
It’s very doable, because I’ve tried, and I have to be honest, it’s really hard to find people who have niched as I have in learning about this condition. It’s overwhelming for most doctors, and most gynecologists really haven’t gotten into it to the degree that we have and they still reflexively just prescribe birth control pills and some metformin and then tell everyone to go see different doctors.
You can end up seeing five different specialists for every symptom you have, but each one just prescribes their own separate pharmaceutical. Before you know it, you’re on all these different drugs and not really getting better at all, because none of those drugs ever address the root cause of the problems as we know. They’re all about cover-up and symptoms, and the problem is, even if they help initially, they’re not going to help long-term.
In fact, interestingly enough, an article was just published looking at women who have IVF who’ve had PCOS and they found that pretreatment with birth control pills which has been a standard is actually harmful. When you actually start doing studies, and I have a lot of great concerns about women being on birth control pills, especially long-term, because we now know that birth control pills actually disrupt the gut. They alter the gut mucosa, they alter the gut microbiome. Birth control pills are harmful to your GI tract, and they’re not so good for your brain, either, and they do increase your risk about 24% of breast cancer. Somehow these things are not getting talked about.
Amy: Women with PCOS are double the risk of blood clots.
Felice: Oh, my gosh, yes, and blood clots go way up in PCOS women because they all have the thrombophilia, the increased clotting. Of course, we know that we don’t give birth control pills to women with high cardiovascular risk like smokers, and women with PCOS do have elevated cardiovascular risk. I had mentioned, their endothelial lining, their arteries tend to be less healthy.
Birth control pills are not hormones. It’s really a very important take-home message. They’re chemicals that actually disrupt the normal hormones of your body. That’s their whole point, so you don’t get pregnant. They are not hormones. They talk about them as hormones. They are not hormones. They’re chemical endocrine disruptors that combine to hormone receptor sites. We have to call a spade a spade. That is what it is.
Amy: Mm-hmm, and there’s more information about the pill on PCOS Diva and the downsides, so definitely check that out if that’s a topic you’re …
Felice: Great. Well, you are such a wonderful resource, Amy. I just love it.
Amy: Oh, well, I love you. You’re like a breath of fresh air coming on to share your knowledge with us. I will be posting some, you have information about your practice, under this podcast, as well as links to some of the things that we talked about as well. We mentioned oil pulling, when Dr. Gersh was talking about the sesame oil. I have an article about that as well as the bone broth, and perhaps Dr. Gersh could post some info about the types of tests women should advocate for if they’re experiencing gastrointestinal issues. You had mentioned …
Felice: Oh, sure. Do you want me to email that yo you?
Amy: Yeah, sure, and then we’ll post that.
Felice: Oh, absolutely. I can get that to you. I think that I’m a big believer, that’s what I am, I’m an MD, in doing the testing that I can access so that I can understand the specifics of what each individual person has going on in her. There’s so much that you can do without being tested, but by the time someones sees me, obviously, they need more intervention. If they’re going to be seeing me, I’m going to be doing testing.
Amy: Right, and it’s important, women with PCOS need to be knowledgeable and advocate for themselves. That would be great if you can post that. We’ll post that information for listeners. I just want to thank you, Dr. Gersh, for taking your time to explain these really complex issues to us in a way that we can understand and then take action on.
Felice: Yes, the reality is that the human body is the most complex creature that exists, and they’ve now discovered that the microbiome, the bacteria that reside within the human intestinal tract, is the most complex ecosystem on the entire planet. It’s so overwhelming even for doctors to try to master all of this.
Basically, my goal is just to let people understand that this is a very involved situation, but that it can be managed and that there’s so much hope and so much that you can do to make your GI tract healthier, and then that sets the stage for all the rest of you to be healthier and happier and have the life you deserve.
Amy: Well, wonderful. What a wonderful message of hope to leave us with. Thank you all for listening, and I look forward to being with you again next time.


  • Emma

    Hi Amy! I just came across this podcast and it gave me so much hope – I feel seen and understood ( I have PCOS, IBS, and am battling SIBO) and this helped me piece together many of the puzzle pieces of my health. Seeing how these are connected makes me feel like I can work to solve all of them together, rather than having too many battles to fight. So a million thank you’s to you and Dr. Gersh! I cannot find the links you refer to about tests women should get for GI issues – did those get posted elsewhere? (or maybe i’m just missing them.) Thanks for pointing me in the right direction, and thanks again for this post!

  • Jane

    I love reading posts where the ‘expert’ actually has the expertise in both conventional and so called alternative medicine. Dr Felice Gersh seems to know so much more than most and it’s so good to know people like her are researching PCOS and disseminating her findings to the public.
    Thanks Amy for all your efforts in enabling this process. Much appreciated!

    • Amy Anderson Medling

      You are so welcome. Dr. Gersh is a gem! What else would you like to hear from her about?

  • Sarah McIlvaine

    This was full of great information, thank you!