spk_0: 0:01
I am Dr Tabatha, the functional gynecologist. I'm a board certified OBY, giant and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling, hormone imbalance, weight gain, period issues, anxiety and son, you name it, then you come to the right place. I want to be your functional gynecologist. So welcome. Today I'm honored to have Dr Felice Gersh on my podcast. She's board certified O B G Y n. She completed a fellowship in integrative medicine at the University of Arizona School of Medicine and is the director of the Integrative Medical Group of Irvine, California She's awesome, you guys. She's internationally recognized, pioneer and integrative women's health. She's the author of P. C O S S. O. S. Ah, Gynecologist Lifeline to naturally restoring your rhythm, hormones and happiness. In addition to her clinical practice, she frequently lectures on the role of the Kirk ADM Rhythm in polycystic ovarian syndrome and its relevance to the microbiome nutritional medicine, time restricted eating and fasting. We actually cover all these topics today in the podcast. So it's really awesome. You're gonna He just learned so much from her. Just some background information on PCOS. It stands for polycystic ovarian syndrome. About 10% of all women have PCOS, making it the most common endocrine disorder and the most common cause of female infertility in the world. Women with PCOS may suffer from acne, menstrual irregularity, infertility, obesity, auto, immune disease, diabetes and heart disease. Traditionally, we doctors have silenced the symptoms with different medications, but that approach doesn't really address the underlying root cause of PCOS, so women are medicated but not healed. So be watching for an upcoming episode where we discuss PCOS in depth and the ways to tackle it at the root cause, whether it's problem with insulin resistance, inflammation, post birth control syndrome or adrenal gland based PCOS. In Dr Gershon's book PCOS s. O. S, she shows women how to beat PCOS, naturally replacing pills with powerful and scientifically backed lifestyle interventions that harness the bodies capacity to heal. So, like I mentioned, she and I discussed these in detail. So let's dive in. Here we go. Welcome, Dr Gersh. Thanks for coming on The functional gynecologist. I'm so excited to be connecting with a fellow gynecologist who practices integrative medicine. I was reading your bio and I saw that after you did your traditional residency, you went on to do an integrative medicine fellow ship. Wait, you know, over a decade ago, what was the reason for that?
spk_1: 3:22
Well, I always knew that there was much more to helping women than the conventional with surgery and pharmaceuticals. So from very early on in my practice, and I started my own practice way back, I wanted to go on my own path. So I knew that there was more until I incorporated Chinese medicine practitioner have nutritionist, a psychologist biofeedback, massage therapy. So I had a variety of what I called my ancillary. But I had no specific training myself. And so there was a little disconnect. I would do all the conventional that I would just refer them on. And then it was after I gave up obstetrics. And that's now Ah, a dozen years ago. It seems so the time to slides as you know. And so But when I gave it up, it was like a revelation as I had more time maybe more sleep that I really looked at my therapeutic tool box as a gynecologist denies it. This is pretty pitiful. Mostly what I have is surgery, and I was very good at surgery. I taught surgery at USC to the residents, and I was on board with every new gizmo and gadget that came down the pipeline from the medical device manufacturers. But I also because I was right there, front line and center. I was disillusioned by a lot of these devices as well. I I saw a lot of problems right from the beginning of the use of these different products, and I reported them. Nothing happened. So I just looked at all the harm some of them had done over the years to women before they were taken off the market and were given black box warnings and that applied to pharmaceuticals as well. It's like women. My therapeutic tool boxes so tiny and there's so few pharmaceuticals that actually a very useful and I said What do I have to do? And I so I had to sort of crisis of purposes.
spk_0: 5:10
I know what I'm doing. How
spk_1: 5:12
am I helping women? This is not being very proactive, you know, I would say when it gets really bad, will cut it out, you know? So that's so That's when I went on my personal journey to try to find better solutions. I started taking functional medicine courses courses with naturopathic doctors every kind. Of course I could. And I ended up in the room at one of the courses with the only other M D. Um, M V and shoes and empty. And everybody else in that particular room was a naturopath doctor. And I went up to her was Dr Low Dog, who was the director of the Integrative Fellowship at the University of Arizona School of Medicine. And I said, I'm just like roaming. I'm a rumor just trying to find answers. And I have no real direction. No, um, no little plan. I'm just running around trying to do things on my own. And she said, after talking to me, I'm qualified, apply to come into the fellowship, and it started in two weeks. I went home, I was in Portland. I flew home that weekend. I did the application. Two weeks later, I was in Tucson and I did the two year fellowship, which I completed. Now it's in 2012. So I started it a decade ago and, of course, like you never looked back. Only look forward to gaining new skills and new abilities. New therapeutic tools to help women at every stage of life toe optimize health. Because in this world that we live in, everyone needs a lot of help.
spk_0: 6:39
Yeah, that is wonderful. I kind of had the same journey, you know, I was in the conventional medicine world and doing a lot of surgery and prescribing a lot of birth control pills for all these different diagnoses. And women were getting better. They their harmony weren't getting balanced. They weren't losing weight. They were still ripping their hair out, feeling crazy, you know? And what do you think is the biggest challenge to getting women toe? Realize that it is? There is another way. There's lifestyle. Changes in your diet is so important. What would you say? The women who have never heard a functional medicine before?
spk_1: 7:21
Well, for us to leave all your preconceptions behind And that usually includes, like you mentioned birth control pills at birth control pills, which most women have been put on for a variety of reasons, including contraception. But many other reasons says use mention that they're not hormones. It's such a shocking revelation to them when I show them that they're actually that technically and every misses by our U. S government on the National Institutes of Health website that their endocrine disruptors and they don't balance hormones, they don't help and that they're not in any way addressing the underlying issues. So the first thing is to recognize that the menstrual cycle is a vital sign of women's well being. And when something is wrong with it, something is wrong with the woman and we have to just face the fact that there were issues here and not try to sweep it under the rug, which is what your birth control pills at best would be doing. Because it's not addressing why the period is abnormal, it's simply trying to cover it up. So my analogy for that is you have a wall filled with mold and termites and you don't really want to do with it, so you just cover it with really pretty well paper. But I mean it was, you know, it's obvious you're not addressing the real problem, so we have to address the underlying problems. And so with that, I explained to women that Guess what? I am your guide. I can't fix you. I can help you to access the tools so that your body can heal itself. And that means you have to do all the hard work. So I always try to gauge level of motivation because that is a big, big hurdle for a lot of people. Just how much do you really want to be? Well, and how much work are you going to do? Because it's going to be a lot of work? You know, once you really understand the full complexity of the female body, and then you know that there is no quick fix if we live in a world where everyone is looking for the magic pill, the quick fix and when I explain that this is a journey that will probably take a year before you know you're even close to where you want to be because this is a lifetime in the making. This is pre being born, you know? So we're working on so many levels here that doesn't mean we won't see a lot of progress over the course of, say, a year. But you know, it's a plus is, you know, and there is no magic pill to address all the different issues that a woman's body can be facing and dealing with in order to try to help her to achieve what she really wants, which is to be healthy and happy and vibrant and be able to do everything she wants to do with with clarity of mind, with good mood, with energy and that is not ever going to be found in a birth control pill in an I u d or you know any and even, you know with hysterectomies. And, of course, sometimes these things are necessary. That's why I try to explain. If someone comes into my office and they have fibroids the size of two bowling balls, I can't magically make them disappear. That's why we have to be. We have to be on things early. We have to be proactive, like when someone comes in and they have horrible bone density because they have had anorexia. They've been on birth control pills most of their lives, and then there 15 years out into the men Paaske and they have had no hormone therapy and a terrible diet. I can't magically make their bones wonderful. But no matter what someone is at in terms of their level, their stage, their health degree in terms of illness or wellness, we can always do a great deal to make things better. But the earlier we get on is the better. So everybody better get started tomorrow or today. You know, it's depending on the time of day. You're watching this so that you can make your every day, every future day in your life to be a better one.
spk_0: 11:16
Yeah, that's totally the truth. And my guess is you see women in the same state that I do. They have been doctor shopping. They have been through the gamut of surgery and medications, and they're at the point where they almost are hopeless. You know, I have a lot of Kleenex in my office because they finally break down and realize that they cannot get better and they've gone every other place. And so they say, You're my last hope, and that sometimes feels overwhelming to me. But it's also an honor and I'm excited because now I have tools in my toolbox that I can actually help heal them or help guide them to hell. So I just want you toe tell these women they can have hope there. There are options out there to heal. You don't have to just not feel bad.
spk_1: 12:13
Oh, you know, if there's one thing I insist upon, that's like my mission is that every woman who walks out of my exam room walks out with incident Hoke and no knows 100% that they can do so much better. I'm always realistic, you know. I never let best be the enemy of better, you know, So we don't have to be perfectionists in everything you know. Sometimes better is the best goal, and so to feel better each day is a wonderful thing. So many women live with so much pain, physical and emotional pain, like you said that Kleenex boxes are everywhere because no one has listened. I mean, sometimes I have to spend the whole first the whole visit, the first visit, just listening and hearing the woman's story. And they often end with saying for the first person who ever asked me anything about myself. You know, whoever actually cared to ever listened to hear my story and that in itself. You know what we call that? The doctor patient relationship, the healing relationship, which I think is so critical and cannot be achieved with programs that are group, you know, group programs. I'm not against groups, things, But you know, there's something about the one on one which I hope will always stay and not be eliminated with no telemedicine, where you don't even know who's on the other end of the cold like, which is happening now rampantly right. And, um, and other kinds of things that take away that that personal connection, because just having that personal connection with someone who you know cares about you and is going to be there for you can tremendously alter the healing course because we know that the emotions can affect everything. The immune system, the neurological system, everything. So we know that pessimism is always going to take it down a bad path and optimism can can heal number. You know, I think almost every miracle healing is because that person suddenly had hoped and things in their bodies changed. It changed the way their neurological synapses worked and the production of no transmitted meters. It would alter Dick Hermie ability of their gut. You know, it changed how their immune cells reacted to inflammatory stimuli. You know, it's amazing what emotions can do. That's why I'm very big on mind body medicine because it's not woo. It's does yeah, so rial to incorporate, you know, all kinds of modalities. And you have to find the one that the person will adapt those so many different ways to help people to feel calmer, less stressed, and feel more hopeful about each to each upcoming day.
spk_0: 15:09
Right? Right now, I totally believe we have to treat the mind body spirit. I mean, you just you can't get well without addressing all three areas. You probably don't realize it, but I've been stalking you for years. I've been studying. You were watching everything. You're doing your you know, amazing gynecologists. And so you've kind of been my secret mentor. You didn't even realize it, but, um, I was super. If
spk_1: 15:35
there are more of you out there because then we can create, you know, like a mass effect, right way and you get there since you integrate a functional gynecologist sent there's, like this many
spk_0: 15:48
up. Exactly. I know. I think you said we're like unicorns. So when you came out with your book that PCOS S. O s book, that was just beautiful. I just think women need to know that there are options out there and they have so much control over getting well For my listeners, Polycystic ovarian syndrome is a complex syndrome of symptoms. And so a lot of physicians don't understand it themselves. And so they it goes undiagnosed. And I just think it's so important that you brought this toe light. What prompted you to write this book?
spk_1: 16:28
Well, it was in somewhat in the works for a very long time. I had almost completed the first version when both of my parents became very ill. And I spent the next two years actually caring for them at the end of their lives and running to nursing homes and hospitals. And my poor book just didn't get any of the many attention. And then later, you know, after that whole phase of my life was over, I just felt like I was into a new face that that book just languished and and then I just started looking at my patient population. It was so overwhelmingly growing with women with PCOS, I said to myself, OK, you know what? We're going to sweep away all the old dust and everything else that went with it because I had all the emotional, you know, overlay of, you know, I was almost finished when my parents became ill and I really started over. Only this time I brought in a different generation. I brought in my daughter and she became my teammate, and together she looked at like what you did. She looked at all of my webinars and logs that I'd written and you know, the different podcasts if she went in so lectures that had been recorded. And so she went through all that. And then we had meetings together and then using my voice together, she like she would write it, hunt on a Google, and then, you know, and and then I would be able to go. And I would edit it because we would, you know, with the holding over through the Google and, um and it was just great. We wrote it together. It took about a year, and then we decided to create the next wave, which would be the fast track books where those would be 12 week, week by week, programs exactly telling you what to do so that you would get what you want out of life. So the first book, PCOS SLS, is the foundation book. It has hundreds of references. It explains everything about PCOS, and it's a seven step program. So it does tell you very much what to do so that you can take control of your body and your health and your future without pharmaceuticals. And I do prescribed pharmaceuticals in certain cases, but every woman can access her inner health by Was anyone any woman in everyone with PCOS should be able to be helped by my foundation book PCOS s OAS and then the newest one, which just came out a two beginning of this year. 2020 is the fast track, so it's PCOS S. O s fertility fast track, and it's 12 because I said program telling a week by week exactly what to do, what to buy what to eat so that you can in just 12 weeks seriously improve your chances of becoming pregnant having uncomplicated pregnancy, which is so prevalent among women with PCOS and a healthy, uncomplicated, delivery healthy baby. So that's what it's designed to do. And the vast majority of women will, even if they can't get pregnant right away. Their chances of becoming pregnant even if because I have I'm always honest about everything. There are some women that maybe need to lose well over £100. They're not going to lose on £100 in 12 weeks. That would be terrible. That would be way too bad. Get some so the high percentage will get pregnant shortly thereafter, and some may have to repeat the program for another 12 weeks. Or, if they do go into something like assisted advance reproductive technology like IVF, their chances of success will be much greater because women with PCOS had the highest dale your rates with IVF. Yeah, and they have incredibly high rates of miscarriage and also complications during their pregnancies, and then their babies often will have medical problems. So we want to do everything toe optimize every step of the way, and that's really what the fast track is designed to do. And the main oh cold, like the The Foundation book is really, I think, should be mandatory for every woman with PCOS to get her started on her health journey, even if she decides to use pharmaceuticals. And it's just like when they do studies with diabetics. And if there's a lot of insulin resistance in women with PCOS, they did studies comparing lifestyle, diet and exercise changes with Met Foreman that sort of will say, foundation drug for diabetes and pre diabetes and which one exercising and nutrition changes. Lifestyle beat metformin. And they did a study using Barberini, one of the the supplements that I will often use for a while. And that's an extract, an alkaloid extract from certain plants like Orgun grapefruit. And they compared it in. Women with PCOS who are undergoing IVF to women who were on that foreman and the Barbarian group make the metformin group out. So there's so many studies that have shown that natural products plus lifestyle can beat pharmaceuticals. So it's it's every everything that I use on. Everything I recommend is very evidence based, So I'm very scientifically oriented. Yeah, that's what I love about what we have, hundreds of references and, you know, just talking about it's not just what you eat. Of course, that's critically important. It's also when you eat, it's also when you don't eat, you know so these air, like utilizing the newest information we have about circadian rhythm about gut microbiome and the newest information about how the immune system works, all of these things intertwined and when with PCOS so called peace us the poster child for showing the intimate and critically important interconnection between reproductive assumptions and metabolic assumptions, and how the two are totally intertwined and they're the same in one body. So reproductive health and metabolic health are really one in the same, and gynecologists don't get that endocrinologist Tokyo It's like so blatantly, easy to grasp. Of course, nature would not evolve women so that they can be incredibly fertile. While they're incredibly unhealthy, right, that would obviously not make sense. That's why fertility is a sign of help. An ancient the agent populations of this earth understood that they had fertility gods. They understood fertility was life. Fertility meant health. And now you know, we spend a lot of time and money trying to get rid of fertility without understanding the potential implications down the road as well, Like with chemical contraceptives that I'm being paraded around his home amounts when, of course, they are not there like the anti hormone right and no. So it's so important to understand the link and the biggest link, which is my favorite hormone. That I always talk about is estrogen, which is the link between reproductive functions and metabolic functions. And the reality is that when you look at everything that goes on in women with PCOS and everything that goes on in metabolic terms with women in menopause, they look the same. If you wrote a list of all the metabolic dysfunctions of women with PC West and of women and men a positive the same because they're both about this function or insufficiency decision see off estrogen in the body. And the biggest difference, of course, is why they have estrogen deficiencies that you know. The reasons are totally different, but the manifestations are very much similar. And then, of course, women with peace us have functioning ovaries that are malfunctioning and that they're producing for too much testosterone, which is not the same because the mechanisms are different in menopause. But they both show the link between estrogen and metabolic health. And that's why once you rest. But these processes are all interwoven and that estrogen is the glue that puts it all together. Then understanding what's happening becomes much easier and then understanding why certain things that are conventionally utilized are really not a good solution. Even Met Foreman, which is used now in women who are pregnant with PCOS and, of course, just a Shil diabetics as well. And it's an endocrine disruptor. And they have published articles showing that the Children born of the women who are using metformin throughout the pregnancy already by age four, show metabolic dysfunction. They have more body fat relative to other Children who had similar, you know, moms in terms of their medical history, and they have more belly fat, the more visual set, their metabolically unhealthy bond. That's because met Foreman and this is in the environmental science literature galore. Metformin is itself an endocrine disruptor, so we're actually treating pregnant women with an endocrine disruptor and in terms of benefits, the studies that have been published. So it has actually no benefit on reducing gestational diabetes, preeclampsia all the things that we thought we would be reducing, they actually do not reduce. The benefit came back a very slight difference in preterm deliveries, but it was so nominal it was hard to even believe that. But that was the one possible benefit of, like a week difference in when the babies will be born. It really did not justify using an endocrine disruptor. That's official.
spk_0: 26:05
Yeah, exactly. I couldn't agree with you more. So we work so hard to get women with PCOS balanced and be ableto populate again and get pregnant. But can you explain to my listeners why diet is so important to get PCOS under control? Can you talk about the insulin resistance that goes along with that?
spk_1: 26:29
Well, it's important on so many levels. So first I'll start by saying that back in 2012 my dear friend, Professor Kelt intra melon and is an endocrine reproductive specialist in Adelaide and that's in the southern part of Australia. He had published a hypothesis that he called the Dogma hypothesis, which was a hypothesis paper that women with PCOS have display out of gut microbiome at, in other words, the microbes of the gut of the women with PCOS or abnormal. And they're malfunctioning and it's causing leaky gut. And then inflammation is increased through this away. The end of toxins like a police Ackroyd's that we call Endo talk is Endo top since leaking out of the gut into the area surrounding the gut with the immune cells, creating an explosion of inflammatory side of kinds, which circulate through the body and create systemic overall body inflammation. Right well, that has now been proven. His hypothesis was spot on, and they've been several papers now published. The 1st 1 came out of China, where they had a lot of support to, actually, because this is an international epidemic now, PC West is a lot happening in India in all areas of Asia and China. And so it's show that 100% there is a problem with. I mean, I guess you can never say 100% but they showed in all the different published papers. There is a problem with the gut microbiome that it's despite IATA creating leaky gut and this endo toxins circulating and out into the body. So how do we help this problem? Well, we have to try to nurture those little critters, those little trillions of microbes that live in our gut. So the food that they love is fiber. So there's been this epidemic of people talking against fiber because they say, don't eat starch. Don't need starchy vegetables. Well, that's what seeds are. Microbes. It's very different if you say don't eat a bowl of candy versus you should eat a bowl of roasted root vegetables. All right. But you know how like these things were getting confused in people's minds and they start thinking carrots are dangerous, you know, like
spk_0: 28:43
Oh, I had a woman brings me a report that's well, the title was why fiber causes death or something. I was like, Oh, no, we need to have a conversation saying It's crazy.
spk_1: 28:55
No, that the reason that we didn't have issues I mean, there's so many. But one of the reasons that we didn't have issues with polycystic Ovary Central in ancient times was that women ate so much fiber. Yeah, I mean lead in primitive type communities when they've looked on, you know, around earth where we had, you know, societies where they hadn't yet been Westernized and so on. They ate so much fiber like 101 150 grams. And now many Americans eat like eight. Yeah, yeah, you know, they're basically starving their little microbes. And if the microbes starved, they can't make what are called their metabolic products. Short chain fatty acids, which do all kinds of things. They signal to the liver and they work. They go out to the vagus nerve to keep you calm. They actually couldn't be food for the lining cells. They enter sites of the gut and also for the brain. Because they are fatty assets. That's what they are. So those acetic appropriate eight in beauty rate. So we have these fatty acids that have all these multitudes of functions, but you can only make him if you eat fiber. In addition, when you have this terrible gut inflammation, no, it's that this low grade chronic inflammation and you don't have the good microbes. You don't have the short chain fatty acids, you get fatty liver, and now this is also a epidemic proportions. Women with PCOS have very high rates of fatty liver when you have a fatty liver. You haven't out of control, inflamed deliver, and it goes into a state that we call uncontrolled Laconia Genesis. So it just starts pouring out. Glucose? No, just making sugar unrelated to what the body needs. Also, try Klis roids pours out the fats. That's so and that's a big part of why women with PC was have this insulin resistance is because they have the perfect storm. They have all this inflammation because when you have all the gut, this bio sis and you have the toxins coming out that's creating total body inflammation. Inflammation causes insulin resistance. And in addition, this was shown by researcher Frank Gonzales out of university in Indiana. This was back at the just before to the year 2000. I think was like 1998 that the immune cells of women with PCOS, or, like have a lower threshold to producing inflammatory side of kind sees these inflammatory particles that circulate. And that's also we didn't know then. But now we know it's because estrogen modulates all the influence. All the inflammation and all the immune cells and women with PCOS don't make enough estrogen. So you have all this end of talks, and you have immune cells that produce Seidel toxic kinds of inflammatory products at a much lower threshold. And you have all this inflammation that leads then to fatty liver. Deliver is spewing out all this glucose, and you have insulin resistance. And, of course, this is leading that even leads down the worst past because when you have high levels of insulin, because that's what When you have high levels of sugar, you then have proportionately high levels of insulin. And then insulin leads to production of ideas one another hormone insulin like growth factor one which in turn triggers more testosterone to be made right. It's like, you know, it's like spy. It's like a spiral without control, like Snowball going down, no control, no brakes. And it's It just keeps getting worse and worse. And when you have high levels of insulin, you makes that so you have all that sugar and insulin, which is necessary for life. But when you have too much like anything too much of a good thing, you can't live without it. But too much. You just keep turning all that sugar into fat, and it turns into the worst kind of that. The visuals that the inflammatory fat around the belly because they also have high amounts of cortisol because they have so much stress going on in their bodies. So that's the stress response. So you end up with all this visceral fat, and they can't lose weight because you have all this insulin. So that's where you have to eat not just the right foods but the right timing. So it turns out that we are almost receptive to food or insulin sensitive in the really part of the day, and so many people are going out and about and spreading this wrong information that people should be fasting until the afternoon. And that's actually especially for women with PCOS. About the worst thing you could do because then, when whatever they're eating in the afternoon and into the evening there the most insulin resistant. So their body is going to maintain higher sugar levels in their bloodstream and have to produce more insulin to try to transport that sugar across the some remembering and into the cells. So there was a great study out of Israel was a small but amazing study on women with PCOS. They had them eat about 2/3 of all their food, all their calories for the day for breakfast. And then they had a medium lunch that was about 1/3 of the food for the day and then just a few bites for dinner. And it was early in one month. Their testosterone and insulin levels fell by about half. And they're 17 hydroxy progesterone, which is a precursor to cortisol, which you know women with PCOS, as I mentioned there in a state of stress. And they have high cortisol, which then promotes even more insulin resistance. That's, you know, the whole perfect storm that went down almost 40%. So how amazing is that? There's no pharmaceutical that does anything like that for women who are highly motivated. If they can eat most of their food for breakfast for the day and then have either a medium lunch light dinner, I have to be like practical. Most people are not gonna forever give up dinner, but if they have a big breakfast, a tiny lunch and then a medium early dinner, that is very good. I have patients who have lost 60 £70 by having what I call the giant breakfast salad. They have, like a salad bowl. Okay, but what would serve a family of 45? That's their bread to eat the whole thing. So not only are they getting like, really full goods are eating so much food, but they're getting tremendous amounts off fiber Polly finals Those magical ingredients,
spk_0: 35:18
the eat the rainbow
spk_1: 35:19
that's right and all that the antioxidants to help reduce their inflammation. Remember, every estate were called oxidative stress. You know, they're like internal resting of all this inflammation. So all of these plant well, that's the colors of the rainbow, like you said, and then putting in nuts and seeds and going vegan for about six months, because when you have the wrong microbiome, you don't process animal protein properly. You actually make toxins even course indigenes, so that can come a little bit of animal, but later, So if we just when people do this and I've had patients do this, it's like their body just transforms because they're living with their natural circadian rhythm and women with PCOS. Other people can maybe get away with more. They they don't they they don't have the room for any of that sort of leeway. You know that you just don't. So you have to really understand what your body is doing. And then this also will help women. We're in menopause because they also have circadian rhythm dysfunction. The master clock that sits atop the optic nerve in the brain controls the timing of everything in the body. But we have a back door way when because with women with PCOS and this has been published, a small study wasn't no. There's just such a shortage of research for women with piece of Western. And what there is is almost all related to fertility, not about metabolic health. So is no. That's what we're doing for it. Everyone out there there were non profit organizations PCOS Awareness, PCOS Challenge that are working all the time for advocacy to inform and educate our legislators and the population and doctors about PCOS so that we can get more research, more education, more helpful women so that you don't just have this ridiculous going birth control pills, which actually are metabolic toxins. I mean, everyone knows that birth control pills can increase your risk of blood clots. Well, women with PCOS have increased risk for blood clots. And there's published articles showing that if you take women with peace with and then you put on birth control pills, you're even increasing above the baseline into you know, of being on birth control pills, which is higher. You know, even higher than that, you're risking them getting blood clots. So that is a terrible thing. And then, you know, they have to accept that those are not the solution. They lower the production of what's called nitric oxide. Nitric outside is critical, so maintaining vascular health so that you don't have leaky arteries. So that's a very big problem. Or develop plaque in your arteries and birth control pills. Promote that. So we'll know that you would never give someone who is a heavy smoker, even a smoker at all, or someone who just had a heart attack or stroke. Birth control pills for women with PCOS have metabolic risk, so they really should be in that same category and not get them. And so we just have to educate on that. So when women are women, have PC West because they don't have enough estrogen and estrogen helps regulate the master clock, so they always like, sort of a little bit like they're living a life of jet black, right? So they're living like in a different time zone, and we all we know Well, in case you know, Dr sometimes, no. But not everybody knows that people who work night shifts, for example, they have circadian rhythm dysfunction. I had that you had that. But anyone who does all that obstetrics, that's it. No problem. But people who fly across time zones all the time and they're going in and out of different time zones and so forth. They have higher rates of anxiety, depression, diabetes, cancer, especially breast cancer. So these are serious risk factors. And they are inherent in women with PCOS because when, like PC was basically live a life of jet lag. So one of the things that we can do, the backdoor way is to like the gut microbiome. So the gut microbiome, they're living creatures. And every living creature works with the circadian rhythm, the beautiful 24 rotation of Earth on its axis. So every living creature has clocked James. So by speeding your microbiome as the right time and not putting them at the long time. Yeah, you're actually going to help heal your gut? Yeah, it's like, so amazing. So, like, if you're a nighttime eater, you eat in the middle of the night, which a lot of women do when they have circadian dysfunction, their appetite this so just regulated. They get the night munchies and they often feel more awake at night. If any of you feel that way, I can tell you have circadian rhythm dysfunction on. We need to work on it right away, and it takes sometimes weeks to resolve it. That's where you have to use willpower for just a while. But if you start by having a really big breakfast and then hydrating a lot with herbal teas, you get through this much faster and to get in your club back in order. So women with PCOS by I say, eating to the beat by not snacking by having a big Brexit is that actually gets the clocks of your microbial population. Your microbes clubs back in sync with your liver clocks with you all your other organ clogs, and by eating to the beat, you can help to heal your gut. So you've got to feed those little microbes. You've got to get them Regiment Teoh a back on the clock at the right time. And then you have to sleep because it's found that melatonin, which is Onley made when you're sleeping. Okay, very little bits come out in the evening before your site, but the bulk of it is made while you're sleeping, and a lot of made in the gut that this also helps to get your microbial population and your gut health. And we know that people who don't sleep well have very high rates of acid reflux. Yeah, that they have dysfunction of the what's called the interrogator nervous system that Paracelsus you know, that doesn't work properly in people who don't get adequate sleep. They don't have that wonderful melatonin, which has so many functions, and one of them is to sort of get the microbes sort of in proper alignment. And there are certain microbes that actually swarm like insects in the presence of the melatonin, and they create signals that help to signal other microbes and also signals that go to the liver as well. Because there's a really close connection there between the gut and deliver, so just getting sleep. So we talk a lot in my book about sleep, hygiene and how to sleep and how to work with circadian rhythm dysfunction. Sometimes using melatonin as a supplement, seeing the sunset, getting a light box for getting bright light in the morning and at midday. So and none of this is going to be helped by a pill. There's no magic pill for this. That's why you have to a do a lot of lifestyle adjustments. But the payoff is the nominal.
spk_0: 42:10
Yeah, so true. Yeah, your life changes drastically once you start sleeping regularly. I learned that last year when I gave up obstetrics. You know, all of a sudden I could get healthy and I had energy to exercise and moving. I think clearly,
spk_1: 42:28
let's say the other thing you know, we talk, of course, is exercise, and it's, you know, I'll take exercise any time of the day, but if you exercise in the morning, you're more prone toe losing weight. But I'll take exercise any time, probably not right before. He couldn't sleep because that does rev up your cortisol production, the exact opposite of what we want so you as much as we can. You know, we try to get people to exercise, to do everything based on our innate clocks and the timing that we evolved toe have. So we just have to sort of harness our own healing mechanisms by harnessing all right, being born clocks and getting them all set. So if you picture it like you have Consul over your body and they're all like working in different time zones, then that will make sense to why we have to get everything into a coordinated whole and that we have all these techniques to help women with PCOS Teoh to get that back together again.
spk_0: 43:20
I'm, um, thinking of it that way, and I think that's wonderful. You also do a lot of educating on intermittent fasting kind of with the same idea of feeding your microbiome the right food at the right time and and allowing your body to be able to be a Fatburger as opposed to a sugar burner. And I just think that is so important for women with PCOS and, you know, perimenopausal time. So talk about that a little bit. I think what you've been doing with that is fascinating.
spk_1: 43:52
Well, I was very fortunate to be working with Professor Walter long ago. Who is the director of Longevity Institute at USC. And I was involved with the the early development before it was marketed of their fasting mimicking diet. So my office was the 1st 1 in the whole world to actually be able to to experiment, using it with my patient population not looking for efficacy because that was already shown that what it could do but in terms of usability. So they modified some of the soup flavors. I got them to take out the gluten, and we changed the kale crisps do kale crackers, which are really delicious. They made some little modifications based on feedback, and I also learned how to implement it. One of the things I learned right off the bet is that you don't start p people on a fasting regimen right out the right out the gate. So what I do is a lot of people call this fasting, and technically, if you're not eating your fasting, but there were these terms that weaken speak the same language, so I'll just to find them. So time restricted eating is when you have periods of fasting over the 24 hour day, and that's where we do. Like I said, you know you have a big breakfast like a small or medium lunch and then a very tiny dinner. Or reverse the lunch and dinner if you have to, and you end eating early at least three hours before you go to bed, so you should go to bed at 10 optimally. But stop eating by seven at the latest and no snacking. And if you have to snack, then it should be fat because, like so, what would that be like Olives more a sliver of avocado because you want to keep your insulin down. Okay, if you really want to have low protein and because protein is what the nutrients sensors and the brain pick up the most is protein. So you really want to keep your body thinking you're fasting and you want to not increase your sugar insulin levels. So that's where you want to have something very small. They also now make what's called the fast bar, which, um has almost has very minimal impact on blood sugar and insulin levels, and it's predominantly nuts, and it's another tasty thing, and I often use that at lunchtime. Not it's not a meal replacement. I call it a fast replacement. It helps you to stay somewhat, you know, close to a fasting state and always like to just mention that. I initially worked as a volunteer with professor long ago, and now I'm so fortunate them part of their education team. So I get to a lecture with the company that was spawned from the research, which is called El Neutra, and their product is called Pro Gone for promoting longevity. And so I am on their speakers bureau and use it myself, old at the time and in terms of women, I think it can be incredibly helpful. I always start with time restricted eating and what we call my office of Reset, and it's also we call it a day tops. But you're not like getting all your toxins out of your body. But you are up regulating liver detoxification pathways and you're detoxing off of process food. Alright, high fructose corn syrup and you know, we take away the dairy and gluten and all process foods, so it's a detox in that sense. You know, people talk about detoxing off of drugs. We d talk off of the standard American diet track and help to reduce inflammation. It's also an elimination diet, so we can see if you have reactions to any foods and such. And after doing that, that's when I with into appropriate candidates, which is most most people. There's just a few exceptions, like if you're very frail, very old or very young or very ill, you know those types of things would not allow you to be on a fasting program. But then I introduced the fasting, mimicking diet the pro line, and you do for five days. If you do the fasting mimicking diets five days a month for three months in a row and the other days you eat your healthy diet with your time restricted eating. And the thing that makes it so helpful is that you're actually eating because it's a mimicking tight for fasting. I personally have never gone more than one day fasting, and then I always start eating. But when you use the fasting, mimicking diet, you get three meals a day, but it's specially formulated to fly under the radar of the nutrient sensors in your brain. So it's like mimicking a fast, but you actually get to eat, so you get the benefit of eating and the benefits of fasting. So you get about the same benefits as if you had had nothing but water for four days and you get to eat for five. So, to me, that makes it. I call it practical, because if you tell a lot of people, they should stop eating for four days every month for three months in a row, you'll have, I can tell you very low compliance.
spk_0: 48:39
Oh, yeah, yeah. People look at you like you're crazy. Like I
spk_1: 48:43
mean, there's other ways of fasting with the cold, intermittent fasting. So intermittent Fasting is where you don't eat for two days every week, so that sometimes a cult of five to so two days you do not eat in five days. You do eat. Some people have modified it. So the two days you don't you have a tiny bit of fat, just a little bit like like maybe a couple of 100 calories of that. That would not be a lot. That would be like a few olives and a sliver of avocado. So it would be much, but that would be so little that that would probably keep you somewhat in the fasting state. But there's very little data to actually prove that. So if you want to do it perfectly, would actually have the water fast for two days every week. And what has that been shown to do? Let people lose weight? Okay, so that's very good. Prepare me to wait. The problem I have with that is sustainability. How many people are going to stay with that, not eating two days every week for the foreseeable future? You probably wonder really hard to what people who are to one of those weight and they can do that. Um, that's that's gonna work because they tend actually not to overeat. The other days, people think they'll over easily double, but they actually tend not to. They sort of get into a different way of thinking about food. When you stop needing two days of the week when you do the fasting mimicking diet for five days, or if you really can do a four day water fast, which I can't, um, you will also lose weight. But there is also some data, a more mount, more data that you can really lower inflammation. And there's also data on fasting, not necessarily with the fasting mimicking but other fasting data and is, you know, I would think it's going to be applicable. But looking at up regulating be detoxification pathways, for example, of regulating cytochrome P 4 50 enzymes in the small intestine so you can actually eliminate xeno estrogens. Better time restricted eating and more fiber has been shown to help the body eliminate and O'Quinn disruptors, which are horrendous for everybody. And so this is really part of the strategy because they've done some studies on women with PCOS, and they tend to have a higher body load off his final A B p A, which is a ubiquitous plastic type of material. But it's also in the liners of cans, and, um, it's, you know, pretty much out there used to be in baby bottles. It's hard plastics, so it's really everyone has it in their bodies. It's a question of how much and women with PCOS, maybe less. Kate The ones with the most severe manifestations may be genetically not as good at detoxifying and eliminating these and I've looked at and some of most of my worst case patients with PCOS. The most severe cases have mth a far double ti, so they're like they don't methyl eight, which is a very important process for a lot of things, including eliminating a lot of toxins from the body. So there, and so people who have that need to take extra B vitamins that air pre methylated. And guess what? Eat more vegetables, right? So that's where that giant breakfast salad comes in handy in so many ways. So now there is such a thing as prolonged fast day. So that's where your fasting more than a week or so. And I actually almost never advocate for that because the body is a different creature. When you do like the fasting, mimicking diet and your or your fast water for that's five days, were you fast with water for four, you actually up regulate certain processes in the body like what's called a tasa Gee on. That happens only when you've been fasting for about three days, so you won't get that stimulated with the five to where you just fast for two separate days of the week. And what autopsy, Gee is, is where you, the body says, Oh, there's no food, so we're going to have to be recycling right that we're going to be very thrifty. So they take the good cells and they take all the internal organelles, break them down into their component parts, like amino acids, fatty acids, and then reconstruct er, new organelles. So it's like a total rehab of yourselves. They can even do that with mitochondria. That's called my Tasa Jing. So you're basically rejuvenating all yourselves from the inside. And what also happens is when you don't have food coming in for a few days, the body says, Oh, no food. We better get rid of the crappy cells. So the old sin Nessen, Maybe, you know, cells that are turning bad, they actually kill themselves. They call that program self suicide, Okay, and they just kill themselves so they're dead. And that's good, because we don't want them anyway. So of many organs in the body will actually shrink, and then they re grow. And that's because they've shown this in in animals that stem cells can be triggered. Okay, so Hopefully we'll get more human data. But there is something that's happening because they've shown with imaging studies in humans that he sells are disappearing. So they're obviously killing themselves. And then the organs are getting back to normal size. And that means that stem cells are growing yourselves. New, healthy cells. So you're not only rejuvenating the internal components of cells like so internal rejuvenation of cells. You're also rejuvenating organs now in mice that led to increased longevity. And there's no human data on that. But what we're looking for is not in increased longevity. We're looking for healthier, higher quality lives. Yeah, and so on. I have seen you know, so many so many personal stories showing how doing these fasting routines have changed. Lives really change lives, and I never do fasting when someone is actively trying to get pregnant. That's why I like in my fast track fertility, fast track. I say give may 3 months OK, do not get pregnant. Don't during those three months because we're going to increase your fertility by doing all triggering all these processes in your body for self healing, rejuvenation losing visceral fat. That's the other thing that they showed with the fasting, mimicking diet is that you preferentially burn up the bad, visceral, inflammatory fat while you conserve lean body mass. And when people are going crazy crash diets they usually lose a lot of their muscle there. Lean body mass and muscle is so critical for a 1,000,000 things, but one of the things is that it actually is the biggest uptake for glucose. If you don't have enough muscle, you're going to get more insulin resistant and you're gonna have all the sugar circulating and have higher insulin because you don't have the tissues to use it, you know, so right, use it or store it as fat. Which one you want. I think we want to use it so we do not want to burn up our muscle by doing these prolonged fast. And there are people out there recommending really long fasting and you people will lose weight. But they're going to lose the wrong kind of body tissue. It's not just losing weight. It's like it's not just what you eat. It's also when you eat, it's not just losing weight. It's what exactly are you losing? Make sure we're losing the right thing, which is the visceral set and that has been shown with fast economic and guide. So I am obviously a big fan. I've done it myself. I'm losing track. I think it's like 17 times.
spk_0: 56:10
That's wonderful. Yeah, And not only do you lose weight, but your hormones balance out because you're not doing that sugar yo yo situation anymore, right?
spk_1: 56:21
Well, once, once your body is healthier, fertility will return. That's that's why menstrual cycles and fertility or vital sign of female health. That's why when a woman is infertile, not because she had her tubes tied, you know, for natural right, not good reasons that is such a red flag. This woman is unhealthy. When we have to get women healthy, we can't just ship them off to an ivy at center, where the body is tricked into getting pregnant. Unhealthy body isn't designed at that moment. To support a pregnancy properly, we have to get women pregnant after their optimally healthy or at least better, even if we can't be best, because we now know that women who are unhealthy during the time that they're actually pregnant. They alter the way the baby's developing. But even the genes are expressed differently. The court epigenetic modifications and those Children are more prone to having a lot of problems. E have more risk for metabolic dysfunction, childhood obesity and insulin resistance. Attention deficit disorder. Even have been some papers suggesting women with PCOS or not healthy and get pregnant have higher rates of autism. And we know that that's epidemic right now. So we have to just not just try to trick the body into being pregnant. I understand people really want that baby, but you have to step back even a little bit. Older women just for three months, just three months, and it can change. You know everything so that they will have a healthier baby, that they'll be healthier. So we have to really be aware. Also want women to be off of chemical contraceptives. Your birth control pills? Are you days even any kind of beauty copper or or the one that has to progestin those types of things implantable try to be off. I mean, I wish you could be a year, but as long as possible to help rebuild the vaginal microbiome, the gut microbiome nutrient status. These a lot of these deplete the body of nutrients and they change. Microbiome is everywhere they ultra circadian rhythm sweet patterns. I mean, that's not conducive to being really healthy. And then we wonder why so many women who are having complications during pregnancy abnormal labour's high rates of C section. I mean, this is not happening in a vacuum. We're letting all these unhealthy women they're not recognized as unhealthy because no one is thinking, What's your vaginal microbiome? What's your right by him? You know, what's your circadian rhythm been like? They're not like asking the white questions. So of course, they don't even realize that these women have issues before they're getting pregnant. So there's a lot of work for us to do.
spk_0: 59:06
Yes, there is. So we need to keep educating women. What you're doing is just so important. And I'm glad that you're willing to share all of this knowledge and wisdom. It's so important, So keep doing what you're doing. It's amazing, Teoh. Thank you. Yes, you're my idol. Seven Fleet will be like you someday. So where can we find you and follow you, Doctor Girsh?
spk_1: 59:31
Well, I have my own brick and border practice in Irvine, California So that's in Orange County, Southern California firm, and I do see people from all over the country, the world. I also have an instagram that's getting pretty busy on posting very, very regularly now. And that is Dr So it's d r period police curso. I've loved for everyone to follow me on Instagram, and if you go to my website and that is integrative, so name of my practices. Integrative Medical Group of Irvine and the website is integrated m g i dot com. I am very soon, it's almost done. I'm going to have really nice e book that everyone can have for free. I wonder View all about nutrition, so that should be coming out. Well, this I don't know what people will say this, but we'll say for sure by the end of February, 2020. So probably sooner. So be sure that you go to my website and sign up, and I will give you my free brand new just off hot off the press e book.
spk_0: 1:0:38
Wonderful. Yeah, I'll put a link for that in the show notes that is so gracious of you. Thank you so much. It's been just a non er talking to you. And I really appreciate you sharing all your wisdom. So thank you, Dr Gersh. Have an awesome day.
spk_1: 1:0:55
My pleasure. Hope to see you soon,
spk_0: 1:0:58
so I hope you enjoyed that conversation. Dr. Girsh is a wealth of knowledge. That was really awesome. I do want to mention that I'll do a podcast devoted to intermittent fasting because it's such an important topic toe, understand? And it really does help us women balance our hormones, keep that belly fat off and stay healthy. So be looking for that in the future. As for now, I hope you'll hit the subscribe button. Leave me a five star review so that we can get the word out and share this with other women. So I really appreciate all your support. You know, I do this for no money. It takes quite a bit of time, but I just feel like it has to be done. This information needs to get out to women, and we need to support each other and lift each other up. So thanks for helping me in this important work and go out and have an amazing day. I'll see you next time
I am Dr Tabatha, the functional gynecologist. I'm a board certified OBY, giant and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling, hormone imbalance, weight gain, period issues, anxiety and son, you name it, then you come to the right place. I want to be your functional gynecologist. So welcome. Today I'm honored to have Dr Felice Gersh on my podcast. She's board certified O B G Y n. She completed a fellowship in integrative medicine at the University of Arizona School of Medicine and is the director of the Integrative Medical Group of Irvine, California She's awesome, you guys. She's internationally recognized, pioneer and integrative women's health. She's the author of P. C O S S. O. S. Ah, Gynecologist Lifeline to naturally restoring your rhythm, hormones and happiness. In addition to her clinical practice, she frequently lectures on the role of the Kirk ADM Rhythm in polycystic ovarian syndrome and its relevance to the microbiome nutritional medicine, time restricted eating and fasting. We actually cover all these topics today in the podcast. So it's really awesome. You're gonna He just learned so much from her. Just some background information on PCOS. It stands for polycystic ovarian syndrome. About 10% of all women have PCOS, making it the most common endocrine disorder and the most common cause of female infertility in the world. Women with PCOS may suffer from acne, menstrual irregularity, infertility, obesity, auto, immune disease, diabetes and heart disease. Traditionally, we doctors have silenced the symptoms with different medications, but that approach doesn't really address the underlying root cause of PCOS, so women are medicated but not healed. So be watching for an upcoming episode where we discuss PCOS in depth and the ways to tackle it at the root cause, whether it's problem with insulin resistance, inflammation, post birth control syndrome or adrenal gland based PCOS. In Dr Gershon's book PCOS s. O. S, she shows women how to beat PCOS, naturally replacing pills with powerful and scientifically backed lifestyle interventions that harness the bodies capacity to heal. So, like I mentioned, she and I discussed these in detail. So let's dive in. Here we go. Welcome, Dr Gersh. Thanks for coming on The functional gynecologist. I'm so excited to be connecting with a fellow gynecologist who practices integrative medicine. I was reading your bio and I saw that after you did your traditional residency, you went on to do an integrative medicine fellow ship. Wait, you know, over a decade ago, what was the reason for that?
spk_1: 3:22
Well, I always knew that there was much more to helping women than the conventional with surgery and pharmaceuticals. So from very early on in my practice, and I started my own practice way back, I wanted to go on my own path. So I knew that there was more until I incorporated Chinese medicine practitioner have nutritionist, a psychologist biofeedback, massage therapy. So I had a variety of what I called my ancillary. But I had no specific training myself. And so there was a little disconnect. I would do all the conventional that I would just refer them on. And then it was after I gave up obstetrics. And that's now Ah, a dozen years ago. It seems so the time to slides as you know. And so But when I gave it up, it was like a revelation as I had more time maybe more sleep that I really looked at my therapeutic tool box as a gynecologist denies it. This is pretty pitiful. Mostly what I have is surgery, and I was very good at surgery. I taught surgery at USC to the residents, and I was on board with every new gizmo and gadget that came down the pipeline from the medical device manufacturers. But I also because I was right there, front line and center. I was disillusioned by a lot of these devices as well. I I saw a lot of problems right from the beginning of the use of these different products, and I reported them. Nothing happened. So I just looked at all the harm some of them had done over the years to women before they were taken off the market and were given black box warnings and that applied to pharmaceuticals as well. It's like women. My therapeutic tool boxes so tiny and there's so few pharmaceuticals that actually a very useful and I said What do I have to do? And I so I had to sort of crisis of purposes.
spk_0: 5:10
I know what I'm doing. How
spk_1: 5:12
am I helping women? This is not being very proactive, you know, I would say when it gets really bad, will cut it out, you know? So that's so That's when I went on my personal journey to try to find better solutions. I started taking functional medicine courses courses with naturopathic doctors every kind. Of course I could. And I ended up in the room at one of the courses with the only other M D. Um, M V and shoes and empty. And everybody else in that particular room was a naturopath doctor. And I went up to her was Dr Low Dog, who was the director of the Integrative Fellowship at the University of Arizona School of Medicine. And I said, I'm just like roaming. I'm a rumor just trying to find answers. And I have no real direction. No, um, no little plan. I'm just running around trying to do things on my own. And she said, after talking to me, I'm qualified, apply to come into the fellowship, and it started in two weeks. I went home, I was in Portland. I flew home that weekend. I did the application. Two weeks later, I was in Tucson and I did the two year fellowship, which I completed. Now it's in 2012. So I started it a decade ago and, of course, like you never looked back. Only look forward to gaining new skills and new abilities. New therapeutic tools to help women at every stage of life toe optimize health. Because in this world that we live in, everyone needs a lot of help.
spk_0: 6:39
Yeah, that is wonderful. I kind of had the same journey, you know, I was in the conventional medicine world and doing a lot of surgery and prescribing a lot of birth control pills for all these different diagnoses. And women were getting better. They their harmony weren't getting balanced. They weren't losing weight. They were still ripping their hair out, feeling crazy, you know? And what do you think is the biggest challenge to getting women toe? Realize that it is? There is another way. There's lifestyle. Changes in your diet is so important. What would you say? The women who have never heard a functional medicine before?
spk_1: 7:21
Well, for us to leave all your preconceptions behind And that usually includes, like you mentioned birth control pills at birth control pills, which most women have been put on for a variety of reasons, including contraception. But many other reasons says use mention that they're not hormones. It's such a shocking revelation to them when I show them that they're actually that technically and every misses by our U. S government on the National Institutes of Health website that their endocrine disruptors and they don't balance hormones, they don't help and that they're not in any way addressing the underlying issues. So the first thing is to recognize that the menstrual cycle is a vital sign of women's well being. And when something is wrong with it, something is wrong with the woman and we have to just face the fact that there were issues here and not try to sweep it under the rug, which is what your birth control pills at best would be doing. Because it's not addressing why the period is abnormal, it's simply trying to cover it up. So my analogy for that is you have a wall filled with mold and termites and you don't really want to do with it, so you just cover it with really pretty well paper. But I mean it was, you know, it's obvious you're not addressing the real problem, so we have to address the underlying problems. And so with that, I explained to women that Guess what? I am your guide. I can't fix you. I can help you to access the tools so that your body can heal itself. And that means you have to do all the hard work. So I always try to gauge level of motivation because that is a big, big hurdle for a lot of people. Just how much do you really want to be? Well, and how much work are you going to do? Because it's going to be a lot of work? You know, once you really understand the full complexity of the female body, and then you know that there is no quick fix if we live in a world where everyone is looking for the magic pill, the quick fix and when I explain that this is a journey that will probably take a year before you know you're even close to where you want to be because this is a lifetime in the making. This is pre being born, you know? So we're working on so many levels here that doesn't mean we won't see a lot of progress over the course of, say, a year. But you know, it's a plus is, you know, and there is no magic pill to address all the different issues that a woman's body can be facing and dealing with in order to try to help her to achieve what she really wants, which is to be healthy and happy and vibrant and be able to do everything she wants to do with with clarity of mind, with good mood, with energy and that is not ever going to be found in a birth control pill in an I u d or you know any and even, you know with hysterectomies. And, of course, sometimes these things are necessary. That's why I try to explain. If someone comes into my office and they have fibroids the size of two bowling balls, I can't magically make them disappear. That's why we have to be. We have to be on things early. We have to be proactive, like when someone comes in and they have horrible bone density because they have had anorexia. They've been on birth control pills most of their lives, and then there 15 years out into the men Paaske and they have had no hormone therapy and a terrible diet. I can't magically make their bones wonderful. But no matter what someone is at in terms of their level, their stage, their health degree in terms of illness or wellness, we can always do a great deal to make things better. But the earlier we get on is the better. So everybody better get started tomorrow or today. You know, it's depending on the time of day. You're watching this so that you can make your every day, every future day in your life to be a better one.
spk_0: 11:16
Yeah, that's totally the truth. And my guess is you see women in the same state that I do. They have been doctor shopping. They have been through the gamut of surgery and medications, and they're at the point where they almost are hopeless. You know, I have a lot of Kleenex in my office because they finally break down and realize that they cannot get better and they've gone every other place. And so they say, You're my last hope, and that sometimes feels overwhelming to me. But it's also an honor and I'm excited because now I have tools in my toolbox that I can actually help heal them or help guide them to hell. So I just want you toe tell these women they can have hope there. There are options out there to heal. You don't have to just not feel bad.
spk_1: 12:13
Oh, you know, if there's one thing I insist upon, that's like my mission is that every woman who walks out of my exam room walks out with incident Hoke and no knows 100% that they can do so much better. I'm always realistic, you know. I never let best be the enemy of better, you know, So we don't have to be perfectionists in everything you know. Sometimes better is the best goal, and so to feel better each day is a wonderful thing. So many women live with so much pain, physical and emotional pain, like you said that Kleenex boxes are everywhere because no one has listened. I mean, sometimes I have to spend the whole first the whole visit, the first visit, just listening and hearing the woman's story. And they often end with saying for the first person who ever asked me anything about myself. You know, whoever actually cared to ever listened to hear my story and that in itself. You know what we call that? The doctor patient relationship, the healing relationship, which I think is so critical and cannot be achieved with programs that are group, you know, group programs. I'm not against groups, things, But you know, there's something about the one on one which I hope will always stay and not be eliminated with no telemedicine, where you don't even know who's on the other end of the cold like, which is happening now rampantly right. And, um, and other kinds of things that take away that that personal connection, because just having that personal connection with someone who you know cares about you and is going to be there for you can tremendously alter the healing course because we know that the emotions can affect everything. The immune system, the neurological system, everything. So we know that pessimism is always going to take it down a bad path and optimism can can heal number. You know, I think almost every miracle healing is because that person suddenly had hoped and things in their bodies changed. It changed the way their neurological synapses worked and the production of no transmitted meters. It would alter Dick Hermie ability of their gut. You know, it changed how their immune cells reacted to inflammatory stimuli. You know, it's amazing what emotions can do. That's why I'm very big on mind body medicine because it's not woo. It's does yeah, so rial to incorporate, you know, all kinds of modalities. And you have to find the one that the person will adapt those so many different ways to help people to feel calmer, less stressed, and feel more hopeful about each to each upcoming day.
spk_0: 15:09
Right? Right now, I totally believe we have to treat the mind body spirit. I mean, you just you can't get well without addressing all three areas. You probably don't realize it, but I've been stalking you for years. I've been studying. You were watching everything. You're doing your you know, amazing gynecologists. And so you've kind of been my secret mentor. You didn't even realize it, but, um, I was super. If
spk_1: 15:35
there are more of you out there because then we can create, you know, like a mass effect, right way and you get there since you integrate a functional gynecologist sent there's, like this many
spk_0: 15:48
up. Exactly. I know. I think you said we're like unicorns. So when you came out with your book that PCOS S. O s book, that was just beautiful. I just think women need to know that there are options out there and they have so much control over getting well For my listeners, Polycystic ovarian syndrome is a complex syndrome of symptoms. And so a lot of physicians don't understand it themselves. And so they it goes undiagnosed. And I just think it's so important that you brought this toe light. What prompted you to write this book?
spk_1: 16:28
Well, it was in somewhat in the works for a very long time. I had almost completed the first version when both of my parents became very ill. And I spent the next two years actually caring for them at the end of their lives and running to nursing homes and hospitals. And my poor book just didn't get any of the many attention. And then later, you know, after that whole phase of my life was over, I just felt like I was into a new face that that book just languished and and then I just started looking at my patient population. It was so overwhelmingly growing with women with PCOS, I said to myself, OK, you know what? We're going to sweep away all the old dust and everything else that went with it because I had all the emotional, you know, overlay of, you know, I was almost finished when my parents became ill and I really started over. Only this time I brought in a different generation. I brought in my daughter and she became my teammate, and together she looked at like what you did. She looked at all of my webinars and logs that I'd written and you know, the different podcasts if she went in so lectures that had been recorded. And so she went through all that. And then we had meetings together and then using my voice together, she like she would write it, hunt on a Google, and then, you know, and and then I would be able to go. And I would edit it because we would, you know, with the holding over through the Google and, um and it was just great. We wrote it together. It took about a year, and then we decided to create the next wave, which would be the fast track books where those would be 12 week, week by week, programs exactly telling you what to do so that you would get what you want out of life. So the first book, PCOS SLS, is the foundation book. It has hundreds of references. It explains everything about PCOS, and it's a seven step program. So it does tell you very much what to do so that you can take control of your body and your health and your future without pharmaceuticals. And I do prescribed pharmaceuticals in certain cases, but every woman can access her inner health by Was anyone any woman in everyone with PCOS should be able to be helped by my foundation book PCOS s OAS and then the newest one, which just came out a two beginning of this year. 2020 is the fast track, so it's PCOS S. O s fertility fast track, and it's 12 because I said program telling a week by week exactly what to do, what to buy what to eat so that you can in just 12 weeks seriously improve your chances of becoming pregnant having uncomplicated pregnancy, which is so prevalent among women with PCOS and a healthy, uncomplicated, delivery healthy baby. So that's what it's designed to do. And the vast majority of women will, even if they can't get pregnant right away. Their chances of becoming pregnant even if because I have I'm always honest about everything. There are some women that maybe need to lose well over £100. They're not going to lose on £100 in 12 weeks. That would be terrible. That would be way too bad. Get some so the high percentage will get pregnant shortly thereafter, and some may have to repeat the program for another 12 weeks. Or, if they do go into something like assisted advance reproductive technology like IVF, their chances of success will be much greater because women with PCOS had the highest dale your rates with IVF. Yeah, and they have incredibly high rates of miscarriage and also complications during their pregnancies, and then their babies often will have medical problems. So we want to do everything toe optimize every step of the way, and that's really what the fast track is designed to do. And the main oh cold, like the The Foundation book is really, I think, should be mandatory for every woman with PCOS to get her started on her health journey, even if she decides to use pharmaceuticals. And it's just like when they do studies with diabetics. And if there's a lot of insulin resistance in women with PCOS, they did studies comparing lifestyle, diet and exercise changes with Met Foreman that sort of will say, foundation drug for diabetes and pre diabetes and which one exercising and nutrition changes. Lifestyle beat metformin. And they did a study using Barberini, one of the the supplements that I will often use for a while. And that's an extract, an alkaloid extract from certain plants like Orgun grapefruit. And they compared it in. Women with PCOS who are undergoing IVF to women who were on that foreman and the Barbarian group make the metformin group out. So there's so many studies that have shown that natural products plus lifestyle can beat pharmaceuticals. So it's it's every everything that I use on. Everything I recommend is very evidence based, So I'm very scientifically oriented. Yeah, that's what I love about what we have, hundreds of references and, you know, just talking about it's not just what you eat. Of course, that's critically important. It's also when you eat, it's also when you don't eat, you know so these air, like utilizing the newest information we have about circadian rhythm about gut microbiome and the newest information about how the immune system works, all of these things intertwined and when with PCOS so called peace us the poster child for showing the intimate and critically important interconnection between reproductive assumptions and metabolic assumptions, and how the two are totally intertwined and they're the same in one body. So reproductive health and metabolic health are really one in the same, and gynecologists don't get that endocrinologist Tokyo It's like so blatantly, easy to grasp. Of course, nature would not evolve women so that they can be incredibly fertile. While they're incredibly unhealthy, right, that would obviously not make sense. That's why fertility is a sign of help. An ancient the agent populations of this earth understood that they had fertility gods. They understood fertility was life. Fertility meant health. And now you know, we spend a lot of time and money trying to get rid of fertility without understanding the potential implications down the road as well, Like with chemical contraceptives that I'm being paraded around his home amounts when, of course, they are not there like the anti hormone right and no. So it's so important to understand the link and the biggest link, which is my favorite hormone. That I always talk about is estrogen, which is the link between reproductive functions and metabolic functions. And the reality is that when you look at everything that goes on in women with PCOS and everything that goes on in metabolic terms with women in menopause, they look the same. If you wrote a list of all the metabolic dysfunctions of women with PC West and of women and men a positive the same because they're both about this function or insufficiency decision see off estrogen in the body. And the biggest difference, of course, is why they have estrogen deficiencies that you know. The reasons are totally different, but the manifestations are very much similar. And then, of course, women with peace us have functioning ovaries that are malfunctioning and that they're producing for too much testosterone, which is not the same because the mechanisms are different in menopause. But they both show the link between estrogen and metabolic health. And that's why once you rest. But these processes are all interwoven and that estrogen is the glue that puts it all together. Then understanding what's happening becomes much easier and then understanding why certain things that are conventionally utilized are really not a good solution. Even Met Foreman, which is used now in women who are pregnant with PCOS and, of course, just a Shil diabetics as well. And it's an endocrine disruptor. And they have published articles showing that the Children born of the women who are using metformin throughout the pregnancy already by age four, show metabolic dysfunction. They have more body fat relative to other Children who had similar, you know, moms in terms of their medical history, and they have more belly fat, the more visual set, their metabolically unhealthy bond. That's because met Foreman and this is in the environmental science literature galore. Metformin is itself an endocrine disruptor, so we're actually treating pregnant women with an endocrine disruptor and in terms of benefits, the studies that have been published. So it has actually no benefit on reducing gestational diabetes, preeclampsia all the things that we thought we would be reducing, they actually do not reduce. The benefit came back a very slight difference in preterm deliveries, but it was so nominal it was hard to even believe that. But that was the one possible benefit of, like a week difference in when the babies will be born. It really did not justify using an endocrine disruptor. That's official.
spk_0: 26:05
Yeah, exactly. I couldn't agree with you more. So we work so hard to get women with PCOS balanced and be ableto populate again and get pregnant. But can you explain to my listeners why diet is so important to get PCOS under control? Can you talk about the insulin resistance that goes along with that?
spk_1: 26:29
Well, it's important on so many levels. So first I'll start by saying that back in 2012 my dear friend, Professor Kelt intra melon and is an endocrine reproductive specialist in Adelaide and that's in the southern part of Australia. He had published a hypothesis that he called the Dogma hypothesis, which was a hypothesis paper that women with PCOS have display out of gut microbiome at, in other words, the microbes of the gut of the women with PCOS or abnormal. And they're malfunctioning and it's causing leaky gut. And then inflammation is increased through this away. The end of toxins like a police Ackroyd's that we call Endo talk is Endo top since leaking out of the gut into the area surrounding the gut with the immune cells, creating an explosion of inflammatory side of kinds, which circulate through the body and create systemic overall body inflammation. Right well, that has now been proven. His hypothesis was spot on, and they've been several papers now published. The 1st 1 came out of China, where they had a lot of support to, actually, because this is an international epidemic now, PC West is a lot happening in India in all areas of Asia and China. And so it's show that 100% there is a problem with. I mean, I guess you can never say 100% but they showed in all the different published papers. There is a problem with the gut microbiome that it's despite IATA creating leaky gut and this endo toxins circulating and out into the body. So how do we help this problem? Well, we have to try to nurture those little critters, those little trillions of microbes that live in our gut. So the food that they love is fiber. So there's been this epidemic of people talking against fiber because they say, don't eat starch. Don't need starchy vegetables. Well, that's what seeds are. Microbes. It's very different if you say don't eat a bowl of candy versus you should eat a bowl of roasted root vegetables. All right. But you know how like these things were getting confused in people's minds and they start thinking carrots are dangerous, you know, like
spk_0: 28:43
Oh, I had a woman brings me a report that's well, the title was why fiber causes death or something. I was like, Oh, no, we need to have a conversation saying It's crazy.
spk_1: 28:55
No, that the reason that we didn't have issues I mean, there's so many. But one of the reasons that we didn't have issues with polycystic Ovary Central in ancient times was that women ate so much fiber. Yeah, I mean lead in primitive type communities when they've looked on, you know, around earth where we had, you know, societies where they hadn't yet been Westernized and so on. They ate so much fiber like 101 150 grams. And now many Americans eat like eight. Yeah, yeah, you know, they're basically starving their little microbes. And if the microbes starved, they can't make what are called their metabolic products. Short chain fatty acids, which do all kinds of things. They signal to the liver and they work. They go out to the vagus nerve to keep you calm. They actually couldn't be food for the lining cells. They enter sites of the gut and also for the brain. Because they are fatty assets. That's what they are. So those acetic appropriate eight in beauty rate. So we have these fatty acids that have all these multitudes of functions, but you can only make him if you eat fiber. In addition, when you have this terrible gut inflammation, no, it's that this low grade chronic inflammation and you don't have the good microbes. You don't have the short chain fatty acids, you get fatty liver, and now this is also a epidemic proportions. Women with PCOS have very high rates of fatty liver when you have a fatty liver. You haven't out of control, inflamed deliver, and it goes into a state that we call uncontrolled Laconia Genesis. So it just starts pouring out. Glucose? No, just making sugar unrelated to what the body needs. Also, try Klis roids pours out the fats. That's so and that's a big part of why women with PC was have this insulin resistance is because they have the perfect storm. They have all this inflammation because when you have all the gut, this bio sis and you have the toxins coming out that's creating total body inflammation. Inflammation causes insulin resistance. And in addition, this was shown by researcher Frank Gonzales out of university in Indiana. This was back at the just before to the year 2000. I think was like 1998 that the immune cells of women with PCOS, or, like have a lower threshold to producing inflammatory side of kind sees these inflammatory particles that circulate. And that's also we didn't know then. But now we know it's because estrogen modulates all the influence. All the inflammation and all the immune cells and women with PCOS don't make enough estrogen. So you have all this end of talks, and you have immune cells that produce Seidel toxic kinds of inflammatory products at a much lower threshold. And you have all this inflammation that leads then to fatty liver. Deliver is spewing out all this glucose, and you have insulin resistance. And, of course, this is leading that even leads down the worst past because when you have high levels of insulin, because that's what When you have high levels of sugar, you then have proportionately high levels of insulin. And then insulin leads to production of ideas one another hormone insulin like growth factor one which in turn triggers more testosterone to be made right. It's like, you know, it's like spy. It's like a spiral without control, like Snowball going down, no control, no brakes. And it's It just keeps getting worse and worse. And when you have high levels of insulin, you makes that so you have all that sugar and insulin, which is necessary for life. But when you have too much like anything too much of a good thing, you can't live without it. But too much. You just keep turning all that sugar into fat, and it turns into the worst kind of that. The visuals that the inflammatory fat around the belly because they also have high amounts of cortisol because they have so much stress going on in their bodies. So that's the stress response. So you end up with all this visceral fat, and they can't lose weight because you have all this insulin. So that's where you have to eat not just the right foods but the right timing. So it turns out that we are almost receptive to food or insulin sensitive in the really part of the day, and so many people are going out and about and spreading this wrong information that people should be fasting until the afternoon. And that's actually especially for women with PCOS. About the worst thing you could do because then, when whatever they're eating in the afternoon and into the evening there the most insulin resistant. So their body is going to maintain higher sugar levels in their bloodstream and have to produce more insulin to try to transport that sugar across the some remembering and into the cells. So there was a great study out of Israel was a small but amazing study on women with PCOS. They had them eat about 2/3 of all their food, all their calories for the day for breakfast. And then they had a medium lunch that was about 1/3 of the food for the day and then just a few bites for dinner. And it was early in one month. Their testosterone and insulin levels fell by about half. And they're 17 hydroxy progesterone, which is a precursor to cortisol, which you know women with PCOS, as I mentioned there in a state of stress. And they have high cortisol, which then promotes even more insulin resistance. That's, you know, the whole perfect storm that went down almost 40%. So how amazing is that? There's no pharmaceutical that does anything like that for women who are highly motivated. If they can eat most of their food for breakfast for the day and then have either a medium lunch light dinner, I have to be like practical. Most people are not gonna forever give up dinner, but if they have a big breakfast, a tiny lunch and then a medium early dinner, that is very good. I have patients who have lost 60 £70 by having what I call the giant breakfast salad. They have, like a salad bowl. Okay, but what would serve a family of 45? That's their bread to eat the whole thing. So not only are they getting like, really full goods are eating so much food, but they're getting tremendous amounts off fiber Polly finals Those magical ingredients,
spk_0: 35:18
the eat the rainbow
spk_1: 35:19
that's right and all that the antioxidants to help reduce their inflammation. Remember, every estate were called oxidative stress. You know, they're like internal resting of all this inflammation. So all of these plant well, that's the colors of the rainbow, like you said, and then putting in nuts and seeds and going vegan for about six months, because when you have the wrong microbiome, you don't process animal protein properly. You actually make toxins even course indigenes, so that can come a little bit of animal, but later, So if we just when people do this and I've had patients do this, it's like their body just transforms because they're living with their natural circadian rhythm and women with PCOS. Other people can maybe get away with more. They they don't they they don't have the room for any of that sort of leeway. You know that you just don't. So you have to really understand what your body is doing. And then this also will help women. We're in menopause because they also have circadian rhythm dysfunction. The master clock that sits atop the optic nerve in the brain controls the timing of everything in the body. But we have a back door way when because with women with PCOS and this has been published, a small study wasn't no. There's just such a shortage of research for women with piece of Western. And what there is is almost all related to fertility, not about metabolic health. So is no. That's what we're doing for it. Everyone out there there were non profit organizations PCOS Awareness, PCOS Challenge that are working all the time for advocacy to inform and educate our legislators and the population and doctors about PCOS so that we can get more research, more education, more helpful women so that you don't just have this ridiculous going birth control pills, which actually are metabolic toxins. I mean, everyone knows that birth control pills can increase your risk of blood clots. Well, women with PCOS have increased risk for blood clots. And there's published articles showing that if you take women with peace with and then you put on birth control pills, you're even increasing above the baseline into you know, of being on birth control pills, which is higher. You know, even higher than that, you're risking them getting blood clots. So that is a terrible thing. And then, you know, they have to accept that those are not the solution. They lower the production of what's called nitric oxide. Nitric outside is critical, so maintaining vascular health so that you don't have leaky arteries. So that's a very big problem. Or develop plaque in your arteries and birth control pills. Promote that. So we'll know that you would never give someone who is a heavy smoker, even a smoker at all, or someone who just had a heart attack or stroke. Birth control pills for women with PCOS have metabolic risk, so they really should be in that same category and not get them. And so we just have to educate on that. So when women are women, have PC West because they don't have enough estrogen and estrogen helps regulate the master clock, so they always like, sort of a little bit like they're living a life of jet black, right? So they're living like in a different time zone, and we all we know Well, in case you know, Dr sometimes, no. But not everybody knows that people who work night shifts, for example, they have circadian rhythm dysfunction. I had that you had that. But anyone who does all that obstetrics, that's it. No problem. But people who fly across time zones all the time and they're going in and out of different time zones and so forth. They have higher rates of anxiety, depression, diabetes, cancer, especially breast cancer. So these are serious risk factors. And they are inherent in women with PCOS because when, like PC was basically live a life of jet lag. So one of the things that we can do, the backdoor way is to like the gut microbiome. So the gut microbiome, they're living creatures. And every living creature works with the circadian rhythm, the beautiful 24 rotation of Earth on its axis. So every living creature has clocked James. So by speeding your microbiome as the right time and not putting them at the long time. Yeah, you're actually going to help heal your gut? Yeah, it's like, so amazing. So, like, if you're a nighttime eater, you eat in the middle of the night, which a lot of women do when they have circadian dysfunction, their appetite this so just regulated. They get the night munchies and they often feel more awake at night. If any of you feel that way, I can tell you have circadian rhythm dysfunction on. We need to work on it right away, and it takes sometimes weeks to resolve it. That's where you have to use willpower for just a while. But if you start by having a really big breakfast and then hydrating a lot with herbal teas, you get through this much faster and to get in your club back in order. So women with PCOS by I say, eating to the beat by not snacking by having a big Brexit is that actually gets the clocks of your microbial population. Your microbes clubs back in sync with your liver clocks with you all your other organ clogs, and by eating to the beat, you can help to heal your gut. So you've got to feed those little microbes. You've got to get them Regiment Teoh a back on the clock at the right time. And then you have to sleep because it's found that melatonin, which is Onley made when you're sleeping. Okay, very little bits come out in the evening before your site, but the bulk of it is made while you're sleeping, and a lot of made in the gut that this also helps to get your microbial population and your gut health. And we know that people who don't sleep well have very high rates of acid reflux. Yeah, that they have dysfunction of the what's called the interrogator nervous system that Paracelsus you know, that doesn't work properly in people who don't get adequate sleep. They don't have that wonderful melatonin, which has so many functions, and one of them is to sort of get the microbes sort of in proper alignment. And there are certain microbes that actually swarm like insects in the presence of the melatonin, and they create signals that help to signal other microbes and also signals that go to the liver as well. Because there's a really close connection there between the gut and deliver, so just getting sleep. So we talk a lot in my book about sleep, hygiene and how to sleep and how to work with circadian rhythm dysfunction. Sometimes using melatonin as a supplement, seeing the sunset, getting a light box for getting bright light in the morning and at midday. So and none of this is going to be helped by a pill. There's no magic pill for this. That's why you have to a do a lot of lifestyle adjustments. But the payoff is the nominal.
spk_0: 42:10
Yeah, so true. Yeah, your life changes drastically once you start sleeping regularly. I learned that last year when I gave up obstetrics. You know, all of a sudden I could get healthy and I had energy to exercise and moving. I think clearly,
spk_1: 42:28
let's say the other thing you know, we talk, of course, is exercise, and it's, you know, I'll take exercise any time of the day, but if you exercise in the morning, you're more prone toe losing weight. But I'll take exercise any time, probably not right before. He couldn't sleep because that does rev up your cortisol production, the exact opposite of what we want so you as much as we can. You know, we try to get people to exercise, to do everything based on our innate clocks and the timing that we evolved toe have. So we just have to sort of harness our own healing mechanisms by harnessing all right, being born clocks and getting them all set. So if you picture it like you have Consul over your body and they're all like working in different time zones, then that will make sense to why we have to get everything into a coordinated whole and that we have all these techniques to help women with PCOS Teoh to get that back together again.
spk_0: 43:20
I'm, um, thinking of it that way, and I think that's wonderful. You also do a lot of educating on intermittent fasting kind of with the same idea of feeding your microbiome the right food at the right time and and allowing your body to be able to be a Fatburger as opposed to a sugar burner. And I just think that is so important for women with PCOS and, you know, perimenopausal time. So talk about that a little bit. I think what you've been doing with that is fascinating.
spk_1: 43:52
Well, I was very fortunate to be working with Professor Walter long ago. Who is the director of Longevity Institute at USC. And I was involved with the the early development before it was marketed of their fasting mimicking diet. So my office was the 1st 1 in the whole world to actually be able to to experiment, using it with my patient population not looking for efficacy because that was already shown that what it could do but in terms of usability. So they modified some of the soup flavors. I got them to take out the gluten, and we changed the kale crisps do kale crackers, which are really delicious. They made some little modifications based on feedback, and I also learned how to implement it. One of the things I learned right off the bet is that you don't start p people on a fasting regimen right out the right out the gate. So what I do is a lot of people call this fasting, and technically, if you're not eating your fasting, but there were these terms that weaken speak the same language, so I'll just to find them. So time restricted eating is when you have periods of fasting over the 24 hour day, and that's where we do. Like I said, you know you have a big breakfast like a small or medium lunch and then a very tiny dinner. Or reverse the lunch and dinner if you have to, and you end eating early at least three hours before you go to bed, so you should go to bed at 10 optimally. But stop eating by seven at the latest and no snacking. And if you have to snack, then it should be fat because, like so, what would that be like Olives more a sliver of avocado because you want to keep your insulin down. Okay, if you really want to have low protein and because protein is what the nutrients sensors and the brain pick up the most is protein. So you really want to keep your body thinking you're fasting and you want to not increase your sugar insulin levels. So that's where you want to have something very small. They also now make what's called the fast bar, which, um has almost has very minimal impact on blood sugar and insulin levels, and it's predominantly nuts, and it's another tasty thing, and I often use that at lunchtime. Not it's not a meal replacement. I call it a fast replacement. It helps you to stay somewhat, you know, close to a fasting state and always like to just mention that. I initially worked as a volunteer with professor long ago, and now I'm so fortunate them part of their education team. So I get to a lecture with the company that was spawned from the research, which is called El Neutra, and their product is called Pro Gone for promoting longevity. And so I am on their speakers bureau and use it myself, old at the time and in terms of women, I think it can be incredibly helpful. I always start with time restricted eating and what we call my office of Reset, and it's also we call it a day tops. But you're not like getting all your toxins out of your body. But you are up regulating liver detoxification pathways and you're detoxing off of process food. Alright, high fructose corn syrup and you know, we take away the dairy and gluten and all process foods, so it's a detox in that sense. You know, people talk about detoxing off of drugs. We d talk off of the standard American diet track and help to reduce inflammation. It's also an elimination diet, so we can see if you have reactions to any foods and such. And after doing that, that's when I with into appropriate candidates, which is most most people. There's just a few exceptions, like if you're very frail, very old or very young or very ill, you know those types of things would not allow you to be on a fasting program. But then I introduced the fasting, mimicking diet the pro line, and you do for five days. If you do the fasting mimicking diets five days a month for three months in a row and the other days you eat your healthy diet with your time restricted eating. And the thing that makes it so helpful is that you're actually eating because it's a mimicking tight for fasting. I personally have never gone more than one day fasting, and then I always start eating. But when you use the fasting, mimicking diet, you get three meals a day, but it's specially formulated to fly under the radar of the nutrient sensors in your brain. So it's like mimicking a fast, but you actually get to eat, so you get the benefit of eating and the benefits of fasting. So you get about the same benefits as if you had had nothing but water for four days and you get to eat for five. So, to me, that makes it. I call it practical, because if you tell a lot of people, they should stop eating for four days every month for three months in a row, you'll have, I can tell you very low compliance.
spk_0: 48:39
Oh, yeah, yeah. People look at you like you're crazy. Like I
spk_1: 48:43
mean, there's other ways of fasting with the cold, intermittent fasting. So intermittent Fasting is where you don't eat for two days every week, so that sometimes a cult of five to so two days you do not eat in five days. You do eat. Some people have modified it. So the two days you don't you have a tiny bit of fat, just a little bit like like maybe a couple of 100 calories of that. That would not be a lot. That would be like a few olives and a sliver of avocado. So it would be much, but that would be so little that that would probably keep you somewhat in the fasting state. But there's very little data to actually prove that. So if you want to do it perfectly, would actually have the water fast for two days every week. And what has that been shown to do? Let people lose weight? Okay, so that's very good. Prepare me to wait. The problem I have with that is sustainability. How many people are going to stay with that, not eating two days every week for the foreseeable future? You probably wonder really hard to what people who are to one of those weight and they can do that. Um, that's that's gonna work because they tend actually not to overeat. The other days, people think they'll over easily double, but they actually tend not to. They sort of get into a different way of thinking about food. When you stop needing two days of the week when you do the fasting mimicking diet for five days, or if you really can do a four day water fast, which I can't, um, you will also lose weight. But there is also some data, a more mount, more data that you can really lower inflammation. And there's also data on fasting, not necessarily with the fasting mimicking but other fasting data and is, you know, I would think it's going to be applicable. But looking at up regulating be detoxification pathways, for example, of regulating cytochrome P 4 50 enzymes in the small intestine so you can actually eliminate xeno estrogens. Better time restricted eating and more fiber has been shown to help the body eliminate and O'Quinn disruptors, which are horrendous for everybody. And so this is really part of the strategy because they've done some studies on women with PCOS, and they tend to have a higher body load off his final A B p A, which is a ubiquitous plastic type of material. But it's also in the liners of cans, and, um, it's, you know, pretty much out there used to be in baby bottles. It's hard plastics, so it's really everyone has it in their bodies. It's a question of how much and women with PCOS, maybe less. Kate The ones with the most severe manifestations may be genetically not as good at detoxifying and eliminating these and I've looked at and some of most of my worst case patients with PCOS. The most severe cases have mth a far double ti, so they're like they don't methyl eight, which is a very important process for a lot of things, including eliminating a lot of toxins from the body. So there, and so people who have that need to take extra B vitamins that air pre methylated. And guess what? Eat more vegetables, right? So that's where that giant breakfast salad comes in handy in so many ways. So now there is such a thing as prolonged fast day. So that's where your fasting more than a week or so. And I actually almost never advocate for that because the body is a different creature. When you do like the fasting, mimicking diet and your or your fast water for that's five days, were you fast with water for four, you actually up regulate certain processes in the body like what's called a tasa Gee on. That happens only when you've been fasting for about three days, so you won't get that stimulated with the five to where you just fast for two separate days of the week. And what autopsy, Gee is, is where you, the body says, Oh, there's no food, so we're going to have to be recycling right that we're going to be very thrifty. So they take the good cells and they take all the internal organelles, break them down into their component parts, like amino acids, fatty acids, and then reconstruct er, new organelles. So it's like a total rehab of yourselves. They can even do that with mitochondria. That's called my Tasa Jing. So you're basically rejuvenating all yourselves from the inside. And what also happens is when you don't have food coming in for a few days, the body says, Oh, no food. We better get rid of the crappy cells. So the old sin Nessen, Maybe, you know, cells that are turning bad, they actually kill themselves. They call that program self suicide, Okay, and they just kill themselves so they're dead. And that's good, because we don't want them anyway. So of many organs in the body will actually shrink, and then they re grow. And that's because they've shown this in in animals that stem cells can be triggered. Okay, so Hopefully we'll get more human data. But there is something that's happening because they've shown with imaging studies in humans that he sells are disappearing. So they're obviously killing themselves. And then the organs are getting back to normal size. And that means that stem cells are growing yourselves. New, healthy cells. So you're not only rejuvenating the internal components of cells like so internal rejuvenation of cells. You're also rejuvenating organs now in mice that led to increased longevity. And there's no human data on that. But what we're looking for is not in increased longevity. We're looking for healthier, higher quality lives. Yeah, and so on. I have seen you know, so many so many personal stories showing how doing these fasting routines have changed. Lives really change lives, and I never do fasting when someone is actively trying to get pregnant. That's why I like in my fast track fertility, fast track. I say give may 3 months OK, do not get pregnant. Don't during those three months because we're going to increase your fertility by doing all triggering all these processes in your body for self healing, rejuvenation losing visceral fat. That's the other thing that they showed with the fasting, mimicking diet is that you preferentially burn up the bad, visceral, inflammatory fat while you conserve lean body mass. And when people are going crazy crash diets they usually lose a lot of their muscle there. Lean body mass and muscle is so critical for a 1,000,000 things, but one of the things is that it actually is the biggest uptake for glucose. If you don't have enough muscle, you're going to get more insulin resistant and you're gonna have all the sugar circulating and have higher insulin because you don't have the tissues to use it, you know, so right, use it or store it as fat. Which one you want. I think we want to use it so we do not want to burn up our muscle by doing these prolonged fast. And there are people out there recommending really long fasting and you people will lose weight. But they're going to lose the wrong kind of body tissue. It's not just losing weight. It's like it's not just what you eat. It's also when you eat, it's not just losing weight. It's what exactly are you losing? Make sure we're losing the right thing, which is the visceral set and that has been shown with fast economic and guide. So I am obviously a big fan. I've done it myself. I'm losing track. I think it's like 17 times.
spk_0: 56:10
That's wonderful. Yeah, And not only do you lose weight, but your hormones balance out because you're not doing that sugar yo yo situation anymore, right?
spk_1: 56:21
Well, once, once your body is healthier, fertility will return. That's that's why menstrual cycles and fertility or vital sign of female health. That's why when a woman is infertile, not because she had her tubes tied, you know, for natural right, not good reasons that is such a red flag. This woman is unhealthy. When we have to get women healthy, we can't just ship them off to an ivy at center, where the body is tricked into getting pregnant. Unhealthy body isn't designed at that moment. To support a pregnancy properly, we have to get women pregnant after their optimally healthy or at least better, even if we can't be best, because we now know that women who are unhealthy during the time that they're actually pregnant. They alter the way the baby's developing. But even the genes are expressed differently. The court epigenetic modifications and those Children are more prone to having a lot of problems. E have more risk for metabolic dysfunction, childhood obesity and insulin resistance. Attention deficit disorder. Even have been some papers suggesting women with PCOS or not healthy and get pregnant have higher rates of autism. And we know that that's epidemic right now. So we have to just not just try to trick the body into being pregnant. I understand people really want that baby, but you have to step back even a little bit. Older women just for three months, just three months, and it can change. You know everything so that they will have a healthier baby, that they'll be healthier. So we have to really be aware. Also want women to be off of chemical contraceptives. Your birth control pills? Are you days even any kind of beauty copper or or the one that has to progestin those types of things implantable try to be off. I mean, I wish you could be a year, but as long as possible to help rebuild the vaginal microbiome, the gut microbiome nutrient status. These a lot of these deplete the body of nutrients and they change. Microbiome is everywhere they ultra circadian rhythm sweet patterns. I mean, that's not conducive to being really healthy. And then we wonder why so many women who are having complications during pregnancy abnormal labour's high rates of C section. I mean, this is not happening in a vacuum. We're letting all these unhealthy women they're not recognized as unhealthy because no one is thinking, What's your vaginal microbiome? What's your right by him? You know, what's your circadian rhythm been like? They're not like asking the white questions. So of course, they don't even realize that these women have issues before they're getting pregnant. So there's a lot of work for us to do.
spk_0: 59:06
Yes, there is. So we need to keep educating women. What you're doing is just so important. And I'm glad that you're willing to share all of this knowledge and wisdom. It's so important, So keep doing what you're doing. It's amazing, Teoh. Thank you. Yes, you're my idol. Seven Fleet will be like you someday. So where can we find you and follow you, Doctor Girsh?
spk_1: 59:31
Well, I have my own brick and border practice in Irvine, California So that's in Orange County, Southern California firm, and I do see people from all over the country, the world. I also have an instagram that's getting pretty busy on posting very, very regularly now. And that is Dr So it's d r period police curso. I've loved for everyone to follow me on Instagram, and if you go to my website and that is integrative, so name of my practices. Integrative Medical Group of Irvine and the website is integrated m g i dot com. I am very soon, it's almost done. I'm going to have really nice e book that everyone can have for free. I wonder View all about nutrition, so that should be coming out. Well, this I don't know what people will say this, but we'll say for sure by the end of February, 2020. So probably sooner. So be sure that you go to my website and sign up, and I will give you my free brand new just off hot off the press e book.
spk_0: 1:0:38
Wonderful. Yeah, I'll put a link for that in the show notes that is so gracious of you. Thank you so much. It's been just a non er talking to you. And I really appreciate you sharing all your wisdom. So thank you, Dr Gersh. Have an awesome day.
spk_1: 1:0:55
My pleasure. Hope to see you soon,
spk_0: 1:0:58
so I hope you enjoyed that conversation. Dr. Girsh is a wealth of knowledge. That was really awesome. I do want to mention that I'll do a podcast devoted to intermittent fasting because it's such an important topic toe, understand? And it really does help us women balance our hormones, keep that belly fat off and stay healthy. So be looking for that in the future. As for now, I hope you'll hit the subscribe button. Leave me a five star review so that we can get the word out and share this with other women. So I really appreciate all your support. You know, I do this for no money. It takes quite a bit of time, but I just feel like it has to be done. This information needs to get out to women, and we need to support each other and lift each other up. So thanks for helping me in this important work and go out and have an amazing day. I'll see you next time
