PCOS S.O.S. - A New Guide to PCOS [Podcast] - PCOS Diva
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PCOS S.O.S. – A New Guide to PCOS [Podcast]

PCOS Podcast No. 115 Gersh“We women with PCOS, we’re very special. We’re actually winners in the big picture of life if you look over the thousands of years of humans being on earth.” – Dr. Felice Gersh


PCOS expert and integrative physician, Dr. Felice Gersh has published a brilliant new book called “PCOS S.O.S., A Gynecologist’s Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness”. It is best described as a complete guide addressing the symptoms of PCOS and how women with the disorder can lead happy and healthier lives. Dr. Gersh is dedicated to educating women and health care providers about how to best discover and treat the underlying causes of PCOS. Listen in (or read the transcript) as we discuss her book and much more including:

  • The family connection of PCOS
  • Why PCOS is on the rise
  • Impact of sleep, timed eating, fitness, and stress
  • Importance of regulating light and the circadian rhythm
  • How birth control changes a woman’s circadian rhythm

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Mentioned in this podcast:

Felice Gersh, MD, Medical Director, The Integrative Medical Group of Irvine

Double Board Certified – Obstetrics and Gynecology and Integrative Medicine

www.integrativemgi.com (practice)

www.felicelgershmd.com (educational site)

Author, with her daughter, Alexis Perella: PCOS SOS – A Gynecologist’s Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness (Available on Amazon)

Complete Transcript:

Amy:                                     Today, I have back on the PCOS Diva Podcast one of my favorite experts on PCOS, and that is Dr. Felice Gersh, and if you haven’t already checked out our other two podcasts together, I want you to do that. It’s podcast number 15. We talked about inflammation. In podcast number 26, we talked about gut health, but, today, we’re going to be talking about Dr. Felice’s brand new book, which I read last night, and I absolutely love it. It’s just really a complete guide addressing the symptoms of PCOS and how women with the disorder can lead happy and healthier lives.

Dr. Gersh is an award-winning OB/GYN. She specializes in all aspects of women’s health. She’s a founder and director of Integrative Medical Group of Irvine in Irvine, California, and her practice provides comprehensive healthcare for women, combining the best evidence-based therapies from conventional, naturopathic and holistic medicine, so welcome, Dr. Gersh.

Felice Gersh:                      Thank you, Amy. It’s wonderful to be back and join you here today.

Amy:                                     I just want everybody to know that the name of your book is “PCOS SOS, A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness,” and that is available in Kindle and softcover on Amazon.

Felice Gersh:                      That’s right. Thank you.

Amy:                                     As I mentioned, I loved your book. It’s truly a complete guide, and I think what I like about it so much is you approach it from that integrative functional approach, and, also, I don’t know if people know, but you also have PCOS, and you’ve been able to overcome your PCOS with many of the lifestyle recommendations that you give us in your book.

Felice Gersh:                      Yes. Absolutely. I always try to walk the talk. I never want to be full of hot air. I, like everyone, is something of a self-hacker, so I do try everything I recommend, and I have had my own journey like all of us have had our own very complex and sometimes heartwarming and sometimes heartbreaking journeys as PCOS women, and my own started way back when I was a teenager, and my periods were very irregular and into my 20’s, and then I went a couple of years, when I was in medical school, I didn’t have a single period and I had terrible acne. I didn’t understand why I had this acne because I thought I’m just not cleaning my face well enough. I thought it was about dirt. I didn’t understand anything, and I scrubbed my face so hard, and I used alcohol because I thought that will kill whatever is bad or something. It will sterilize my face.

My skin was cracking around the pimples, and I went to one of the most respected and very renowned gynecologists at my university-based medical school and I said, “Dr. so-and-so, I think something is really wrong. I haven’t had a period in two years, and I can’t get rid of my acne,” and he said, “I don’t know what you’re complaining about, because no women like having periods, and so just go on birth control pills,” and I said, “I want to have kids sometime,” and he said, “Worry about it then.” It’s like, okay, so I had to go on my own journey. I self-diagnosed myself with PCOS at one point, and it became a passion of mine especially as I saw in my practice the increasing prevalence in the population of women of PCOS and, also, it seemed to be more severe. It’s like I was the front runner of this crowd of women behind me coming with terrible cases of PCOS, which I didn’t really see in the very beginning years of my training and practice.

It seemed, over the years, more and more women were suffering. It’s like, okay, what is going on here? More women are really having the worst cases of PCOS. Something is happening, and so it set me on my other journey of figuring it out, of finding out what is happening, what’s the story behind all of this PCOS and then what can we do to really help myself, my patients, and my relatives, because we know that there’s a familial kind of incidence of PCOS.

Amy:                                     Yeah, and we’re going to get into your thoughts about why PCOS is such a crisis right now, but, first, I want to talk a little bit about the… You had just mentioned the family connection, and you wrote this book with your daughter, and I love… I’m going to pull out this little quote which I love. She says, “Dr. Gersh may not be your mom, but now you have all of her advice here in one place.”

Thank you. I read the electronic version or the Kindle version last night, and, honestly, I can’t wait to get the book in my hand so that I do have everything at my fingertips because there’s just so much fantastic information, but tell us about how your daughter got involved.

Felice Gersh:                      In terms of her PCOS, she realized that she had PCOS when she couldn’t get pregnant and her periods were somewhat irregular, and she’s a lean PCOS, so she was very thin, but she was always battling acne. She was definitely my offspring and… because I’m also one of the lean PCOS, and so she thought she was going to have to go on a fertility drug like Clomid, but, together, we worked on her diet, and we changed some of her different lifestyle things, and she got pregnant naturally and… but had some complications, as is so common with women with PCOS, and delivered prematurely and had a big baby.

Her second baby, who’s her son, my little, adorable grandson, he weighed well over nine pounds. When she was born to me, she weighed nine pounds, and my biggest daughter weighed almost nine and a half pounds, and we were not big people. We didn’t eat tons of food, and so, clearly, there’s an insulin issue here. My dad was a diabetic at a very young age for no apparent reason because he was slim, so there clearly is a familial thing.

Fathers can also be related to the whole PCOS picture. We’re just starting to understand how that all works, but in terms of writing my book, I have been wanting her to write with me. She’s a brilliant woman, and she’s a Stanford grad. She’s won all kinds of awards, and, initially, she was a teacher, and she worked in Palo Alto in the school district, and then she moved into developing educational toys for kids, and then she went into motherhood, and so she took some time off to have her two beautiful kids, and then she was ready to get back into the workforce.

It was very challenging because she really wanted to be a full-time mother, and maybe that was a little in reaction to my not being a full-time mother, but she saw the good and the bad of having a working mom, and she wanted to be there for her kids. Also, her first, my granddaughter, had a few challenges that she’s worked through, and she’s done fabulously and… but she wanted to be there. Having childcare intermittently with the way she was working as a consultant was really challenging.

Finally, I was able to convince her, because she’s a wonderful writer, and I said, “Please write. Become a book writer.” I sent her to a wonderful course at Harvard University on becoming a medical book writer, and she loved it, and so now she is my co-writer, so… because, first of all, I need someone putting the fire under my feet to get this done, and she is very, very responsible. She worked as a product manager when she was at the toy company. She’s very organized much more so than me, and so, together, we were able to put the book together, and she’s… Now, this is her new career. She is a professional book writer, and we’re going to be hopefully putting out books on a regular basis.

Amy:                                     It really is a fabulous book, and I wanted to… for you to jump into how you frame PCOS in the book. You really talk about how it isn’t a disease. Yes, we know it’s a syndrome, but tell us how do you frame it for us in the book. I love it. It’s very powerful.

Felice Gersh:                      We women with PCOS, we’re very special. We’re actually winners in the big picture of life if you look over the thousands of years of humans being on earth. We’ve learned a lot about genetics, so we know that different people have different types of single nucleotide polymorphisms. We have variations in our genes, and so it’s not just about the genes you have. It’s also how they become expressed, and the expression of genes relates to the environment.

If we go back into prehistoric times when we had an environment where everything was organic, everything was natural, you lived with the light, we lived with the rhythm of the earth, the circadian rhythm, the rotation of the earth, so, during the day, we were active. At night, we would go to sleep. We would get up with the sun. We go down to sleep when the lights got dark, and maybe we had a fire, but that was about it. We certainly didn’t have computer screens and televisions, so it was very much living within our universe, our natural universe.

At that time, there were some women, and that’s what PCOS women are, who had a certain genetic variant that did not permit them to turn testosterone into estrogen quite as efficiently as some other women, but it wasn’t a real detriment. It was just a very mild variation, so what they ended up with was maybe slightly reduced fertility, but just mildly reduced. They were still fertile, so, maybe instead of having nine children, they would have five, and they would have time to raise them. They could nurse them longer. They had a little bit of mild built-in birth control, so that they didn’t have as many children.

Of course, women died during childbirth, and children did not survive as well if they were one of more children and their mother didn’t have as much time to spend with each child, so it was actually a survival advantage for their children and for themselves, so women with PCOS could help populate the world with more children with PCOS, their daughters, because they would carry some of these genes from the mom.

What were some of the good things in addition to having a little bit of built-in birth control? They had a little higher level of testosterone. It turns out that having a little bit of testosterone in the extra department is actually extra good. Testosterone is a hormone that all women have, and it has very, very important functions. In men, of course, we know that testosterone makes them big and muscular, with stronger bones, and it actually has brain effects as well. It has effects throughout the entire body, so women who have a little extra testosterone tend to be a little bit more muscular, stronger and then, in terms of the emotions or the brain effects, they tend to be maybe a little bit bolder, maybe braver and just more capable of exploration.

Amy:                                     I also think that, and this is just my observation working with so many women with PCOS, I think we are more highly sensitive. Our nervous systems are like tuned up a little bit more, so maybe, back in those paleo days, we were more attuned to danger and/or incoming, yeah, danger or threats. What do you think about that?

Felice Gersh:                      I think so, too. I think that there’s something that nature created to have men naturally be a little bit more protector-oriented and more attuned to potential dangers, and I think that gets built into the women who have PCOS as well. In their natural state, we’ll say without the new… we’ll say harms that have come from our society, the way things have changed, that women with PCOS had many, many advantages. They were strong. They were beautiful. They were fertile, and they were wise and they were energetic and strong, so, there were wonderful things about being a PCOS woman.

Of course, nobody called it that then. They were just strong women, maybe a little bit more dominant in their clan, in their society. Now, things, of course, have changed, and we can get into that, why PCOS has turned on its head. Now, you can take something that is wonderful and a survival advantage and then turn it into a syndrome.

Amy:                                     Dr. Azziz put together a report paper about PCOS as being an ancient disorder, and the insulin issues, too, can… were able to help us in times of famine, but now, of course, we don’t have famine, and I want you to explain how modern life has made these hormones go awry and why so many of us are dealing with really these extreme symptoms in PCOS.

Felice Gersh:                      Yeah. Absolutely. Having a little bit of insulin resistance, what does that mean? Insulin is a hormone that is very much about promoting the production and storage of fat, so think about that in ancient times when food was not always available. It was very important for women to have some extra fat storage.

In fact, we know that, in general terms, women tend to have more body fat than males because women have to be able to take care of their babies. They have to be able to withstand the rigors of being pregnant and all the demands of that, so that’s why pregnancy itself is like a stress test for women. Pregnancy is an inherently insulin resistant kind of a state of being because, women who are pregnant, they need to put on fat and store it so that they can then be able to take care of their babies and themselves.

Women who have PCOS would have a little bit in the natural state we’ll say, a little bit of extra insulin resistance, which would allow them to be a little bit more fat storage oriented, and that would be a survival advantage exactly. I mean, it’s amazing how we can take all these things and actually pick them apart and see all the pluses, and then we can turn it around and see how we can take these really wonderful attributes and turn them into harmful to our health types of situations.

Amy:                                     In your book, you talked about how we want to return to this mild variant of PCOS that maybe our great-grandmothers had if we indeed inherited our PCOS, which I think I can look at my great-grandmother and probably… She only had one child. She was… had a lot of androgenic alopecia. She carried a lot of weight around her middle. It’s funny because my daughter is doing a report on Ellis Island and immigration, and we’re using my great-grandmother as sort of the example, so I was looking at all the old pictures of her, but, anyway, how can we return to that mild variant of our great-grandmothers and be strong and powerful and not feel so afflicted by our PCOS symptoms?

Felice Gersh:                      It’s definitely a challenge in the world that we all live in, so we have to think about what were the conditions that our wonderful women ancestors lived in and that enabled them to have the PCOS genes work to their advantage. They lived in a world where they saw the sun. They had activity. They ate natural food, and they didn’t eat all the time. They did not eat around the clock, and sometimes they didn’t eat at all because there was no food available, so we have to try to think what were those conditions that our women ancestors lived in that enabled them to be healthy.

These genes were actually an advantage, so have to try to turn our world back into that ancient, wonderful, natural world, which is, like I said, not an easy thing to do, so we have to work hard to get back that natural kind of environment. We have to look at our sleep habits. We have to look at our eating habits, both not just what we eat, which is critically important, but when we eat and when we don’t eat, and then, of course, add in fitness, and we have to look at stress.

We have to look at all these different components that make up the life environment and then we have to try to return to that prehistoric natural state. We have to look at getting the light at the proper time of day, eating during the day, never eating at night, not eating snacks, trying to eat more in the morning the way people would naturally, trying to eat sometime between when you get up and a couple of hours after, trying to eat a big meal for breakfast instead of what traditional people in our day now tend to do, which is skip breakfast altogether. There’s a lot of misunderstandings about this whole concept of fasting, which I tried to clarify as well. It’s not easy, but we have to try to restore our lifestyles to that of our women ancestors.

Amy:                                     You really break this all down in your book. You talk about diet and exercise and lifestyle, but I would love in the time that we have together to talk more about the light and the circadian rhythm connection and how we can hack getting the right light at the right time of day, because I think that that can really make a profound shift, and you write about that in your book as well.

Felice Gersh:                      Right, so it turns out that we humans, actually, every life form on earth, every single life form has built into it clock genes, so we are oriented to the planet that we live on, which has a 24-hour rotation, and so we have the night and we have the day, and our bodies are metabolically different, so we have totally different bodies at night and in the day. During the day, our bodies are metabolically active, and at night everything goes into a totally different state.

Our immune system is very different between the day and night, and our bodies are timed. We have a master clock in our brain that sits atop the optic nerve so we can sense light and dark, and it also has some degree of sensing nutrition, nutrient sensors, but primarily light and dark. That’s the dominant triggers to setting our master clock is light and dark, and then we have these peripheral clocks, so the different cells of our body like cells in our liver, for example, cells in our heart, all the different cells of our body have clock genes, and they are getting messages from the master clock that sits in the brain in the hypothalamus at the top of the optic nerve, and they also can get signals from the gut, from our microbiome, the little bacteria that live in there. They also have clocks. They also have clocks that set the liver.

The light though, which goes into the master clock which senses whether it’s day or night, light or dark, that is like… That’s why they’re called the master clock, because it really sets the beat like the conductor in front of the orchestra. It’s like, in women with PCOS, because it turns out that their master clock drifts, it doesn’t stay on the beat. It’s a little bit like your conductor is there, but he’s a little bit impaired, maybe he had a little too much to drink, so he’s just a little off the beat, so all the instruments are a little bit off the beat. They’re maybe off a measure or a few notes.

We can help get our master clock back into the right beat by helping it to see light and dark, and it just drills it in. Now, recognize it’s daytime, master clock, and so we can do that by waking up in the morning to really bright light. That is a major trigger to setting that clock. Every day, even in people who don’t have PCOS, it drifts. They call it like drifting, and then you have to… The word is train. You’ve got to get it back on the beat every morning. That’s why light is so important.

We know, for example, people who live in areas where it doesn’t get light for much of the day like in the northern climes like, say, Northern Sweden and so on, there’s very high rates of depression because it turns out that everything links to the master clock. Metabolic health, mood health, everything, immune health, everything links to the master clock. We now know that the rhythm of our body sets the beat for everything for all the functions.

Seeing bright light in the morning is so critical to setting that master clock and getting it right on the beat, but some of us don’t live where I live, which is sunny, usually, Southern California, where I could just open up the blinds, and I can step outside and the bright sun is right there. A lot of use don’t have that, or we get up when it’s dark especially different times of the year. For that, we can have different dawn simulators. I think you were telling me that you have one of them, which made me so excited that you were really so tuned in to this even ahead of my book.

Amy:                                     I know. I was so happy to see that you mentioned it in the book. Yeah, I use the Philips light dawn simulator. It’s a little pricey. I think it cost me about a $150, but, honestly, it’s one of the best gifts I’ve given myself especially living up here in New Hampshire. I wake up at 5:45 in the morning, and it’s dark until… in the depths of winter until 7:00, after 7:00, so, having that has made a huge difference in the quality of my life. I mean, it just makes me feel better in the morning.

Felice Gersh:                      That’s great. You’re a perfect example of how getting that proper light into your eyes. Of course, in a natural situation, you wouldn’t have the light suddenly going from dark to bright, so that’s what I love about the gradual light. For myself, what I do is, because I’m in sunny Southern California where I can… and I usually don’t get up as early as you do. I get up a little bit later, so, usually, the light is already there. The sun is up when I get up in the morning typically, and so I use a mask, a sleep mask because I cannot get… That’s the other thing is that, when it’s night, it’s supposed to be really dark.

I can’t tell how many of my patients tell me they go to bed with the television on. They say, “I turn the volume down.” It’s like, no, the light, oh, my gosh, they don’t realize it, or they have lights from all kinds of electronic devices all over or they have bright street lights outside their window, and they… their blinds are not really blackout or they have cracks all over the place, and there’s so much ambient light.

In my bedroom, I have too much ambient light myself, so I found that using a sleep mask has been wonderful. It has dramatically improved the quality of my sleep. We know that even a little bit of light filtering through your eyelids at night can suppress your proper melatonin production even though you’re sleeping, and melatonin is critical. It’s a hormone that’s critical for so many things, not just for sleep, but it’s a potent antioxidant. We know that we need that, and women with PCOS have whole issues with melatonin.

Amy:                                     Yeah, and you go into detail about that in your book and really get some really sound recommendations, because melatonin is not something that you want to take large amounts of, and I guess I just want to leave it that I love your recommendations in your book.

Felice Gersh:                      Thanks. For me, what I do, and other people can do it, too, is I wake up and then I take… I keep my eyes closed and I take off my sleep mask, and then I let the ambient light filter through. It’s my own dawn simulator of sorts. I just take it and then the light starts coming through my eyes, and I wait about 15 minutes as the light is really filtering in, and then I open up my eyes. I don’t go from pitch black into suddenly bright light, but we have to try to make it as natural as we can, get back to that cavemen life.

They’ve talked about getting back to nature, and we know that people who go camping can just go camping for a weekend and sleep outside under the stars and get up with the sun in just one weekend of outdoor camping tremendously improve their circadian rhythm. It’s really fascinating how it wants to get back in order. It really wants to get fixed, and we can help it so much by either going out camping and living outside, or we can do these simulator types of events in our own bedroom.

Amy:                                     One thing that I found especially running my Jumpstart program is that shift work is very difficult on women with PCOS. I mean, I think it’s difficult in general, but my recommendation now is, if you can get out of shift work, if you have PCOS, you really have to do it. I was pleasantly surprised to see that that was your conclusion as well.

Felice Gersh:                      Yes, and I myself lived a very challenging lifestyle for many, many decades. Actually, I practiced obstetrics, which is love, I love taking care of pregnant women and delivering their babies, but pregnant women have their babies very often in the early morning hours and they labor through the night, and I didn’t understand it at the time. First, I thought this is just a wives’ tale, that people go into labor at night, but, of course, it isn’t.

Once you understand the critical nature of the circadian rhythm, it’s all about survival. It’s about living to maximize our ability to survive and to reproduce and to have successful reproduction. You wouldn’t want someone laboring in the middle of the day, if we could avoid it, when you’re a possible prey to every kind of wild animal out there, and what are you going to do if you’re in the middle of labor? Get up and run away? You’re so at risk. You’re so vulnerable when you’re in labor, so nature arranged it through evolution that we would labor most commonly in nature during the night under the cloak of darkness and the safety of the darkness and then deliver as the sun would rise, and then we would be able to take our babies and move to someplace safer and be able to potentially be alert at least, use our PCOS wisdom so that we could actually tell when we’re in danger, which we can’t really do when we’re in the middle of labor and pushing.

I think nature did that for us, but, on the other hand, as an obstetrician, I had to live living a life of tremendous amounts of shift work, and it really took a toll on me, and, absolutely, it’s harmful and challenging for every person, and we have about one-third of our population now that works at times of the day, basically at night, when we should really be sleeping and resting. It’s really a challenge because we have this 24-hour society, but you have to think about yourself. I mean, everyone wants to do the right thing for the world and for our community, but you have to first do the right thing for yourself.

As women with PCOS, we inherently live a life of jet lag. Because of our innate problems with endocrine disruptors that are altering the way our estrogen receptors are working, and that is very critical to the function of the master clock, we basically are programed to be jet lagged, and that is a huge problem, so, recognizing that we have this built-in handicap in terms of our circadian rhythm, it’s that much more important that we try not to work at night, we try to avoid shift work.

I’m so glad you brought that up, Amy, because I know it’s hard for people to have different careers, and you can’t just quit your job, but think about how you can possibly transition into a daytime job.

Amy:                                     The other thing that I wanted to bring up that you mentioned in your book is how birth control and being on hormonal birth control, which so many women with PCOS are, really changes the way that your body responds to light, and we haven’t had a chance to talk about sleep, which you go into detail in your book, but it also changes the way you sleep. It’s not that I’m anti-pill for everyone with PCOS. I just want women to have informed consent when they decide to go and take the pill, so I had to point those two things out, and maybe you could speak to that a little bit more?

Felice Gersh:                      I’m so glad that you brought that up because it is the conventional approach. I mean, it is totally embedded into the minds of every OB/GYN, pretty much I’ve come across and endocrinologists, that the primary treatment for women with PCOS is, first and foremost, put them on the birth control pill, and they do talk about it as hormonal contraception, and here is where I have to say there is no hormone that is present in a birth control pill.

I know that it seems to go against the wisdom of, “They’re hormones.” No, they are not hormones. If you look at the ingredients of a birth control pill, the pretend… I hate to find the word. We don’t have a real good word for it, so I’m going to say the pretend estrogen that’s in a birth control pill is ethinylestradiol. That is not estradiol. Notice they changed the name. It’s ethinylestradiol. It would be like Strawberry Jellybeans. Now, Strawberry Jellybeans have the word strawberry.

Amy:                                     Good analogy.

Felice Gersh:                      It’s not a strawberry. It’s a Jellybean. Birth control pills, their prime directive is to not let women have natural hormones, and so if you go to the Toxicology Center on the National Institutes of Health website, the toxicology site, it lists ethinylestradiol as what it is, an endocrine disruptor.

Environmental scientists are up in arms about the fact that birth control pill chemicals, these pretend hormones, are getting out into the water supply. Our water treatment plants don’t get them out. They weren’t designed for that. They were designed to kill bacteria, not get rid of pharmaceuticals, and this stuff is getting into lakes and rivers and it’s altering the function of all the wildlife, and they call it what it is. They call a spade a spade. They call ethinylestradiol an endocrine disruptor in all of their scientific literature, so women… and the other, the pretend progesterone, they’re not progesterone. They are some variant of some other chemical that can bind to progesterone receptors, but they also bind to other receptors. They may bind to other hormone receptors like testosterone, aldosterone, and do varying things.

When you talk about an endocrine disruptor, you’re talking about a chemical that can do anything to the natural function of our hormones, so it could affect the production, the distribution, the degradation, the elimination, the receptor function, so really any aspect of hormonal function can be changed by these endocrine disruptors. That means everything in the female body is going to be altered in some way when you take away your natural hormones because your ovaries won’t make any when you go on the birth control pill.

It turns out that estrogen, of course, every hormone has so many different functions, but if we just look at estrogen for a moment, estrogen has receptors everywhere all throughout the brain, including on the master clock that regulates our master… our circadian rhythm, but it also is in the gut. It’s in the heart. It’s in the blood vessels. Estrogen receptors are everywhere, and when you take away your real estrogen and you replace it with these chemicals, you’re going to have altered effects and, basically, it’s going to affect every single function.

The body makes estrogen onsite in different organs. That’s how men and children get estrogen, which is so critical to all these different functions in the body, and so some of that is continuing, but the primary source of estrogen in reproductive-aged women is from the ovary, and that is completely lost when you’re on oral contraceptives, on the birth control pill, and other things, I call them similars, can also have an impact on the production of estrogen as well. The implantables and some of the types of IUDs and such can also affect the function of the ovaries as well, and so you’ll have altered estrogen, and so we now know that it’s not even… Just like I said, it’s not just about what you eat. It’s when you eat. It’s not just about having hormones. It’s having them in the right rhythms, because it turns out that everything is rhythmic.

Estrogen is rhythmic in a lunar sense, so that we have the beautiful 28-day rhythm of the menstrual cycle, which, of course, women with PCOS often don’t have, but the solution isn’t to take a bad problem and make it worse by taking away any sense of rhythm that you have, and then there’s also the circadian rhythm. Estrogen also has a circadian rhythm as well. You have more estrogen production typically in the morning than you do later in the day, so these… and there’s ultradian rhythm that comes out in pulses, these beautiful rhythms throughout the female body when it’s functioning normally, and all of those things are completely lost when you go on birth control pills.

My analogy to giving birth control pills is like you have a wall and it’s filled with termites and molds, but it’s such a problem and so expensive to actually try to fix the wall, so you get some really pretty wallpaper and you just cover it up, and you say, “Look, the wall looks great. Everything’s fine,” but you know there’s going to be a pay day down the road because the termites and molds just keep going.

When you take women with PCOS and you give them birth control pills, sometimes short term, you get improvement in symptoms. That is true. I can never deny that, because it’s like the pretty wallpaper. It does cover up the problem, but something is happening in the body. If you’re young and you go on birth control pills, you’re going to lose your beautiful rhythms and you’re going to… and by losing your rhythms, you affect things that are already in trouble with PCOS like sleep, like mood. All these things can actually get worse, and we know that women, some women, especially younger women, when they go on birth control pills, they have exacerbation of depression, which is also often very commonly present in women with PCOS. It even can increase suicidal tendencies. There are serious things that have to be watched if you even use birth control pills short term.

The other thing that doesn’t get talked about is how all of these things link together. For example, bone is growing in young women, and you don’t get the proper bone development for life, and bone is also a metabolically active tissue, so you’re affecting the gut microbiome, you’re affecting your circadian clock and you’re affecting your sleep, you’re affecting your mood, so… and you’re not dealing with the underlying problem to resolve them. You’re just covering it up with pretty wallpaper that sometimes will work for certain amount of time, but, ultimately, you’re not addressing the real issues that women with PCOS need to deal with and should deal with.

Amy:                                     Your book, PCOS SOS really does address so many of the issues in a very eloquent way, and I think the last chapter of the book is the treat because you tease some of the exciting developments over the horizon possibly for PCOS. Maybe you could just tease a few of those as we close the podcast.

Felice Gersh:                      I don’t want to give too much away, but I want to just tell people about something that actually isn’t in the book, but… and I’ll go back, is that I’m now in new research study that’s just getting started with a group actually in Milan that’s connected to the Longevity Institute at USC, and we’re going to be doing research on fasting. I know we didn’t really get a chance to talk about fasting too much, but we’re going to be looking at the fasting, mimicking diet that is a beautiful way of doing fasting without actually having to take food out of your diet, and that is you eat for five days, but your body thinks you actually just drank water, water fasted for four days.

The thing about fasting is that it’s a reboot to your gut microbiome and your circadian master clock, so the research I think on doing intermittent fasting is really going to be a breakthrough for women with PCOS, so I want to have everyone stay tuned on that, and, really, I think that working with the circadian rhythm is going to be so key to helping women with PCOS all around the globe.

Amy:                                     Yeah, I mean, and in your book, there’s a lot of information about fasting and different ways to fast, so I just think that it’s such a great tool for your PCOS toolbox. Pick up a copy of Dr. Gersh’s book. Thank you so much. I know you’re such a busy lady. You got so many things going on, but thank you to you and your daughter for taking the time to write this book. I am so grateful, and I know that so many PCOS Divas will be grateful, too.

Felice Gersh:                      I am so pleased. It took us a while. We finally got the book out, and now we can share all of our personal experiences, and I know that you saw that we have hundreds of references. I’m very, very into evidence-based medicine, so everything that we presented is based on real, hardcore evidence-based medicine and published research, and so I hope everyone will be able to get a hold of it and really integrate a lot of the recommendations into their lifestyle so that they, too, can restore their happiness.

Amy:                                     Yeah, and that’s a great point. I mean, it really is about evidence-based research and recommendations, and that’s what you provide.

If you’ve enjoyed this podcast with Dr. Felice, please check out those other two podcasts, and she’s also been a tremendous guest blogger for PCOS Diva. She wrote a recent wonderful article about the connection between the pill and breast cancer, so definitely take a look at that and some of the other articles she’s written on gut biome and circadian rhythm.

You’re just a blessing to me, Dr. Felice, and I’m just so glad you joined us today, and congrats on your new book.

Felice Gersh:                      Thank you. It’s a pleasure.

Amy:                                     Thank you to everyone listening, and I look forward to being with you again soon. Bye-bye.

PCOS Podcast no. 114 PCOS Advocacy

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