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PCOS and Fatty Liver - The link between grows stronger!

PCOS and Fatty Liver: The Link Between Grows Stronger!

The incredible link of the gut microbiome and overall gut health with the metabolic manifestations of PCOS just keeps growing more clear! A new study was just recently published, the key points shown in the attached below piece, indicating that women with PCOS do indeed carry a higher risk of developing fatty liver. The intestinal tract links directly with the liver, through a passageway called the enterohepatic circulation. Inflammatory products from the gut head right to the liver. This connecting passage exists to allow the liver, in concert with the brain, to regulate the glucose and fat levels in our blood and to regulate our appetites. Never did Mother Nature anticipate that humans would eat huge amounts of animal fats and transfats, inordinate quantities of sugar, and high fructose corn syrup in particular, eat nonstop and late into the night, and eat chemicals toxic to our intestinal microbial guests! The outcome of this unfortunate gut environment is gut dysbiosis (the wrong sorts of bacteria living in the gut) and impaired gut barrier function (also called Leaky Gut). Leaky gut occurs when the wrong gut composition of bacteria develops and toxic particles are produced by them, called Lipopolysaccharides (LPS) - also called endotoxin - which pass through the gut lining and into the adjacent immune cells, called the Gut Associated Lyphoid Tissue (the GALT). These immune cells feel that they must defend the body against these toxins, as they are assuming the body is undergoing a serious infection, and a severe inflammatory reaction develops in the liver and a chronic state of inflammation develops throughout the body. This occurs as the immune cells release their own inflammatory products, designed to protect us from invading bacteria, fungus, parasites, and such, but in this case, these "helpful" immune cells are actually furthering the damage being done by creating an unremitting state of chronic inflammation in the liver and throughout the body. This also manifests are severe inflammatory acne! The occurrence of this inflammation in the liver worsens insulin resistance, causing more testosterone to be made and further interfering with the natural hormonal functions of the ovary. The first thing all women with PCOS must do is to change the diet to help heal and restore a healthy gut. Food can and indeed should, be thy medicine!! And that will be the topic of my next PCOS blog!
7 different ways to look absolutely fabulous

7 Different Ways to Look Absolutely Fabulous

As an integrative medical practice, we take a broad view of beauty. Though seen on the outside, beauty is truly a reflection of the physiological processes taking place throughout the body, on both the outside and from deep within our bodies. Skin problems result from hormonal imbalances, deep-seated inflammation, and oxidative stress, manifesting outwardly on the body’s surface. Our recommendations begin with healing from within and working from there to the part of you that’s visible to the whole world - your skin. Here’s what you can do to look absolutely fabulous:
  1. Eat an anti-inflammatory diet. The very same nutrients that support cardiovascular, metabolic, and cognitive health help the skin shine. Focus on choices that are organic, with lots of fruits and vegetables. Everything that goes in your mouth should be real, whole food, and, most importantly, everything you eat should taste fabulously delicious.
  2. Heal the gut. Your intestinal tract’s job is to absorb the good nutrients, while keeping the bad stuff (artificial and natural toxins) out. Eating a good diet helps, but sometimes you need extra supplementation to get the job done and lower system-wide inflammation. A detox program can help with this.
  3. Avoid environmental exposures. None of us can escape living in the 21st Century with its abundance of chemical pollutants virtually everywhere. But you must do all you can to minimize your exposures and their terrible harms.
  4. Never use cosmetics and personal care products made with toxic and carcinogenic chemicals. Find good alternatives and toss out the harmful ones.
  5. Have a daily skincare regimen. Don’t wait until the last moment before the big event and then try to hide blemishes under a layer of caked-on cosmetics. Come to our presentation on April 20, and Karen will show you how a daily routine can make your skin radiant every day of the week.
  6. Use organic - or as close to organic as possible - skincare products that have no toxic ingredients.
  7. Consider being proactive by addressing the unwanted effects of age and nature. Aesthetic treatments can make a big difference. And you can make the effects last longer with a daily skincare routine that nourishes the skin and reduces inflammation and oxidative stress. We provide free aesthetic consultations and all that we offer will be discussed - with no pressure to make any purchases.
Hormonal contraceptives and hair dyes increase breast cancer risk

Hormonal Contraceptives and Hair Dyes Increase Breast Cancer Risk | University of Helsinki

I'm anti the use of Progestin embedded IUDs (intrauterine devices), and have been for a long time. Here is now another reason, based on a just published study from Finland. There are several such IUDs, which are different from the copper containing ones. The progestin containing IUD was found to increase the risk of breast cancer by 52% in postmenopausal women. Granted this is a retrospective observational study ... but it makes sense to me!! With such an IUD, you're putting into the uterus a progesterone endocrine disruptor! Progestins (phony progesterone) block the natural and protective effects of real progesterone!! These IUDs do not contain hormones ... but rather contain "anti-hormones," toxic substances which interfere with real hormones. After all, that's their purpose - to prevent the natural hormones of the female body from being produced and working in the ways intended for females to work! I'm also anti oral, and otherwise delivered, chemical endocrine disruptors, known as birth control pills!! These apparently increase the risk of breast cancer by about a third. I've been opposed to them for some time as well. It's especially horrifying that we place these acknowledged toxins into the bodies of young teen girls, whose bodies have not yet fully matured ... including their brains! It's no wonder that in the USA that over a quarter of adult women use SSRI's for depression! Of course there are other toxins entering the brains of women, and lots of other issues as well, but often women are kept, unaware of the risks, on those disgusting BCP chemicals for decades!! I know I'm full of venum on this topic ... but why on earth is no one questioning this practice and thinking about the true ramifications of such a thing? Well ... at least in Finland there are some who feel as I do!! And we won't go over the issue of mammography right now! That was also mentioned in the study. That's another giant topic for another day! I know I'm an outlier on the use of chemical endocrine disruptors as contraceptives. I am universally opposed to the intentional placement of endocrine disruptors in humans. As for the hair dye issue - at the very least, those who do dye their hair should know what the risks are. That's the entire point of informed consent - to understand the opening and make choices intelligently, with full awareness of the options and risks! https://www.helsinki.fi/en/news/hormonal-contraceptives-and-hair-dyes-increase-breast-cancer-risk PS: I'm on the fence now ... as I do dye my hair ... in this regard I'm a phony! I will immediately look into natural wash-in hair coloring. I want to be true to my pronouncements!
B’s Block Smog’s Damaging Effects

B’s Block Smog’s Damaging Effects

Air pollution is bad for you, and while most of us think in terms of coughing, wheezing, and watery eyes; the effects go way beyond this. In fact, exposure to high levels of air pollution are associated with significantly increased rates of obesity, diabetes, heart disease, asthma, dementia, and cancer. According to the World Health Organization (WHO) air pollution kills approximately 3 million people per year and is considered the greatest environmental risk to health. While we may not know how air pollution does all its damage on the cellular and molecular levels, we are beginning to understand how it does some of its dirty work – and we’re finding ways to fight back! A case in point is a new study just published by researchers at Columbia University's Mailman School of Public Health. It showed that at least some of pollution’s harmful effects are the result of inflammation and oxidative stress induced by epigenetic changes made to genes involved in mitochondrial oxidative energy metabolism. (Epigenetics refers to the “turning on and off” of specific genes through the methylation process, and not the mutation, or changing, of the underlying DNA.) Basically, they exposed ten healthy adults to three different levels of air quality for 2-hour stretches of time while also giving them sham or vitamin B supplementation. First, the subjects breathed clean air and received supplementation placebos. Next, they were exposed to “hazardous” levels of polluted air and again given supplementation placebos. Lastly, the subjects were instructed to breathe polluted air, but this time were given supplements containing three different B vitamins – folic acid, B6, and B12. So, what did they find out? First, they confirmed that breathing polluted air increased epigenetic changes to the genes controlling mitochondrial oxidative energy metabolism. It seems that compromising mitochondrial function in this way leads to inflammation and oxidative stress. Second, they discovered that giving B vitamins was an effective way to prevent and, in fact, reverse this epigenetic damage. What does this mean for you? While it’s certainly true that most of us don’t live in areas with hazardously high levels of pollution, over 90% of the world’s population lives in areas where pollution exceeds the WHO’s recommended level for healthy air. We start from a base of bad quality – Southern California is no exception – and things get worse. If you get stuck in traffic on the freeway, if your office building (or your children’s’ school) backs up to a highway, if you fire up the grill this summer, or if you decide to visit cities in India, China, or Iran (just to name a few); you’re probably way over the limit of safe exposure. What should you do? While the best advice is to eat a healthy diet with lots of B vitamins - leafy green vegetables and beans are rich in folic acid, B6 can be found in fish, beef liver and starchy vegetables, and B12 is abundant in fish, meat, eggs and milk – sometimes this isn’t enough. To be on the safe side, especially if you have genetic issues with methylation – you may want to take a high-quality B vitamin supplement. Check with us to see which one suits your specific needs best.
The Two Flavors Of PCOS

The Two Flavors Of PCOS

Until relatively recently, I was of the understanding that Polycystic ovary syndrome (PCOS) was simply one condition, with many different degrees of severity. Some women had very irregular cycles, while others were fairly normal. Some had terrible facial hair, some cystic acne, some thinning hair, some were obese while some couldn't put on a pound. Variety abounded! While all of that remains true, it turns out that there really are two quite different conditions, with many similarities, yet with foundational differences. The two distinct types of PCOS are the type with high levels of testosterone, and the other type, characterized by high levels of DHEA-S. This is not "new" news. We've known for a long time that different androgens can be elevated in different women with PCOS. But all were still lumped together under the single umbrella of PCOS. Here are my observations. Please understand that these are generalizations. Women with high testosterone PCOS are easier to treat regarding their acne and weight issues compared with the elevated DHEA-S group. The women I see with very high DHEA-S tend to have recalcitrant cystic acne, often very severe. And their excessive fat tissue is very difficult to burn. Though I am opposed to the use of oral contraceptives in general, I've had women with high DHEA-S go on oral contraceptives and in general they do poorly. Their skin doesn't improve and they gain more weight. Similarly with Spironolactone, it simply doesn't help. I've treated the high DHEA-S women group in the same ways I treated the high testosterone group, and I now think that may not be the best approach. They are indeed different. I believe that the women with the high DHEA-S need to work on reducing stress and improving sleep more than the high testosterone group. Getting to bed by 10:30 PM, getting some sun most days, and controlling stress should be very beneficial and high priorities. The DHEA-S comes from the adrenal glands, not the ovaries, and it's the adrenal glands which respond so dramatically to stress. It's so essential for those women to keep stress levels low. Exercise would be even more important for the women with high DHEA-S, in part to lower stress and also to increase metabolism. Getting on a diet with low amounts of animal meats and high amounts of varied vegetables, should be a mainstay of treatment as well. I've also found a high percentage of women with elevated DHEA-S levels to be poor detoxifiers. Emphasizing cruciferous vegetables and taking a great B vitamin complex, with methylated B's, should be tried. And be sure the levels of Vitamin D are around 50. Getting genetics checked is also reasonable. I'd like to end by saying that much more needs to be learned about these two quite different types of PCOS. But one thing which has been found out is that women with high DHEA-S have no higher risk for diabetes and heart disease than does the general population. This is amazing and encouraging news! The unpleasantness of today will be the anti aging foundation of the future. There is indeed much to celebrate and to look towards. There is, to put it simply, much hope and much happiness ahead.

Veggies and Fruits are Magical!

It's been scientifically proven a significant number of times - vegetables and fruits are magical! They contain an array of amazing ingredients which perform amazing things for our bodies and our health. The magical phytonutrients found in these plants can turn on and off genes, as do hormones, and do special things to help our microbiota, the trillions of bacteria within our colons and intestines, to thrive. In turn, the healthy microbiota, known collectively as the gut microbiome, can perform their magic to optimize our health. Autoimmune disease has been reversed, cancers placed into remission, and Alzheimer's Disease reversed, solely with lifestyle programs. The foundational ingredient of each program is and must be - nutrition. So aim to eat a dozen vegetables daily and 2-3 fruits ... and see your body truly thrive! Read more: High Fruit and Vegetable Intake Linked to Reduced Risk for CVD, Cancer, and Mortality

Losing weight – and keeping it off!

In a previous blog, we discussed how difficult it is to maintain weight loss, and that one of the key strategies used most successfully by long-term weight losers is to exercise about an hour per day. The same, by the way, goes for losing weight in the first place. You need to exercise for about an hour per day to burn enough calories to have a significant impact on weight loss. Of course, the more elements of a healthy lifestyle you add to your daily routine – good sleep, reduced stress, healthy diet, avoidance of toxic exposures, and others – the more effective your weight loss efforts will be. But, you may ask, how practical is it to spend an hour every day “working out?” Don’t you already have way too much to do without adding even more “chores,” especially ones you don’t particularly look forward to doing? Well, without diving too deeply into the motivation discussion – how important is living long and well to you really? – let’s focus, instead, on how practical it is to exercise for that hour each day. First off, exercise doesn’t have to be a knock-down, drag-out affair to be effective. Walking at a moderate pace – 3.0 to 3.5 mph (about a mile in 20 minutes or a little less) – is enough for most people. Your heart rate quickens a little, and you breathe a little harder. You probably won’t want to do this in high heels; but you also don’t need a sweat suit, running flats, and a shower afterwards. So, it doesn’t have to be a “big deal” or annoyingly disruptive to a normal life. But the question then is: when do you do it? Not surprisingly, the answer varies according to the specifics of the life you lead. Some people like to set aside an hour during the day, and get their exercise done and over with. For some, early in the morning, before getting swept up in the day’s activities, works best. Others prefer late in the afternoon in the slot between the end of the workday and dinner. If you happen to be retired, then you have even more flexibility in your choices. An effective alternative to the all-in-one-shot approach is to break up your exercise into three 15-20 minute walks following breakfast, lunch, and dinner. If you do this within 15 minutes of finishing your meals, you get the additional benefit of cutting your after-meal insulin spike in half and giving your weight-loss efforts a significant boost. It’s also an incredibly pleasant experience, whether you do it alone or share your walk with someone who can share your thoughts. Try it, you’ll like it!

Detoxing and Weight Loss

The obesity epidemic is still increasing, but the efforts to lose weight are declining. Weight loss is rarely successful when done in the traditional manner of trying to simply consume fewer calories, and many are simply giving up hope! Obesity is associated with an increase in all health problems, and is a very serious matter. It's now becoming apparent that gaining a healthy gut microbiome - having a healthy balance of bacteria in the intestines - is essential for the successful and permanent loss of excess body fat. As well, dealing with the high body burden of environmental toxicants is equally important for permanent weight management. Environmental pollutants actually alter metabolism so that fat is accumulated, which is why they are now labeled "obesegens." Successful weight loss and maintenance of a healthy weight requires detoxing the body, improving gut health, getting proper sleep to nurture our Circadian Rhythm, managing stress, increasing physical activity, and having all essential nutrients onboard so as to enable the body's metabolic machinery to function optimally - to successfully burn fat! This isn't a simple process, but it is worth the effort - as living a life of optimized health brings with it a level joy and exuberance otherwise unattainable! Read more here:  http://time.com/4692274/americans-lose-weight-obesity/

Helpful Hints to Ward Off the Flu: Your Flu Shot Alone Isn’t Going to be Enough to Keep You Healthy

It’s here—flu season. Scientists do their best job trying to anticipate which variants of influenza will strike and they create the flu shots for the upcoming onslaught of germs. However, they don’t know how effective it is until the first cases of flu start showing up and they can compare reality to their predictions. The statistics are in, and the vaccine has been deemed 48% effective. Don’t despair, however, there are additional measures you can take to boost your immunity and help keep you healthy. Take N Acetyl Cysteine (NAC) daily in the dose of 600-900 mg twice a day, and three time a day if you're exposed! NAC has been repeatedly shown to assist in preventing flu by reducing the virus’ ability to replicate inside of your body. Additionally, NAC also reduces an inflammatory response once you are exposed. This results in less severe symptoms should you become ill. Be sure to eat a whole foods diet with lots of vegetables! Get enough sleep! Try a diffuser with orange oil; it is quite useful at killing airborne viruses. As always, wash your hands if touching surfaces which may be contaminated. (Door handles, light switches, countertops, etc) And think positive thoughts! If you do get sick - come see us right away for additional therapeutic modalities!! We've many suggestions to help you recover faster!

Flu Vaccine 48 Percent Effective This Year, CDC Says

Bloomberg News (2/16, Cortez) reports the flu vaccine has been 48% effective so far this season, according to a report from the Centers for Disease Control and Prevention. Brendan Flannery, an epidemiologist at the CDC’s influenza division, said, “The 48 percent overall is not as good as we would like to see for flu vaccine, but the protection we see is significant.”

       Medscape (2/16, Brooks) reports CDC officials said that “elevated” influenza activity is expected to continue for several more weeks in some parts of the US. Lenee Blanton of the CDC’s Influenza Division said in the report that influenza activity began to pick up in mid-December and has been “elevated” since February 4.

Why Breastfeeding is Good for You and Your Baby

A wonderful article was published last week in the Journal of Women's Health, relating the most obvious, yet not recognized fact - breastfeeding is really good for the woman doing the nursing. This particular article states that women who breastfeed for at least a year, significantly lower their risk for cardiometabolic diseases. Considering that February is Heart Awareness month, that's especially welcome news. As you may know, heart attacks and strokes are the leading killers of women, by far, and at aged we really don't wish to contemplate. Women so often think they are "bullet proof" for cardiovascular problems, and that is so far from the truth. So ... why do you think that doing a lot of breast feeding would lower your chance of having a stroke or heart attack anyway? I guess that the answer may not strike you as obvious. Well ... the article doesn't touch on the subject, so here are my thoughts. I'll number them!
  1. Women who breastfeed have lower stress hormones
  2. Women who breast feed tend to lose the weight gained during pregnancy better
  3. The hormones of breastfeeding, prolactin and oxytocin do wonderful things for your heart, your immune system, and your mood
  4. Women who breastfeed have less overall inflammation
  5. Women who breast feed tend to eat a healthier diet, as they are eating for the baby as well
  6. Genes are turned on and off by breast feeding in such a way to give the woman a better overall health status
Well... Let me know what you think are the reasons that breastfeeding lowers cardiovascular risk! The one thing I do know for absolute sure is that we are destined to be healthier when we live in accordance with nature's laws for us. If we live in tune with our female rhythms, we will live better lives ... healthier, happier, and likely longer! We are what we are ... we are designed and programmed to make babies and breastfeed. You don't have to do that, but be aware that your female body was designed for that! Just recognize that we are genetically programmed to be reproductive females ... like it or not ... at least know inside that is nature's plan! And at the very least ... chose food from nature to eat!! Enjoy!!

How Much Exercise is Needed to Maintain Weight Loss?

I have some bad news and some good news. But, as always, the bad news comes first. If you have lost a significant amount of weight, it will undoubtedly be harder for you to maintain your new weight than it is for someone of the exact same weight and body composition who was never overweight. What do I mean by this? Let’s assume that you’ve just lost 50 pounds and now weigh 150 pounds with 30% body fat – a reasonably “good” percentage for someone your age. Your friend, who may or may not have PCOS, also weighs 150 pounds with the same percent body fat. For ease of comparison, we will assume that you also do the same amount of daily physical activity – you sit, you walk, you sit some more – pretty typical for the twenty-first century. Let’s guesstimate that your resting metabolic rate (the number of calories you burn, if you’re sitting at rest all day) is around 1500 – we multiply your bodyweight in pounds by 10 for a rough estimate. Then we multiply that by 1.6 to account for the additional calories you burn from a day’s worth of average physical activity for a total of 2400 calories per day. Here’s the problem. Your friend can eat her 2400 calories per day and her weight bounces up and down the normal 2-3 pounds, but long term it stays the same. You, on the other hand, for reasons we don’t fully understand, can only eat 1900 calories per day to keep from gaining weight. If you eat the same diet as your friend, you’ll gain an extra pound every week (500 calories per day x 7 days = 3500 calories, which is the energy content of a pound of fat) and within a year will have regained every pound you lost. You didn’t overeat; your body has simply become super-efficient and now under-burns calories. This is exactly what the Persistent metabolic adaptation 6 years after “The Biggest Loser” competition study showed us. Contestant metabolic rates averaged 500 calories per day lower than similar sized people who had never lost weight. It doesn’t seem fair, but that’s the way it is. This problem is further compounded by the fact that when you’re only eating 1900 calories per day, you will most likely be hungry almost all the time. Except in rare cases, your appetite center doesn’t adjust well to this fact and still expects to consume 2400 calories to maintain your 150-pound body. This is absolutely, unequivocally unfair, right? So, what can you do? What’s the “good” news promised at the beginning? It turns out that you can exercise the 500-calorie daily deficit away, rather than starving for the rest of your life. How much? Roughly an hour per day at moderate intensity – oh, come on, it’s not that bad! And the only side effect is that you’ll be even healthier than you ever imagined. In a future post, I’ll show you just how easy this can be.

Risks of Conventional Hormone Replacement Therapy

This is data from rats but shows that periodic, as opposed to continuous, treatment with estradiol, is protective for the brain from ischemic damage. This article urges research be done in human females to investigate a more physiological approach to estrogen therapy than what is currently being done. This is what I absolutely believe - hormones must be replaced in a physiological manner for there to be maximum benefit and minimal negatives. The conventional manner in which female hormones are given to menopausal women simply makes no sense, as it is not consistent with physiology. Women are cyclic, beautifully rhythmic creatures ... not static ones ... and must receive hormones consist with how they were designed for them. I know I'm an outlier now, but time will bear me out. The functions of estrogen are well known and highly protective ... and after menopause women suffer in varying degrees from hormonal deprivation. Yes ... It is natural ... but it is so very negative to a woman's very being. After menopause ... women simply dry up! They can get dry eyes, dry bladders, dry vaginas, dry skin, dry arteries, dry brains, dry muscles, dry hearts, dry mouths, dry guts, dry bones, and on and on ... And yes ... I use the word dry a bit loosely ... but it's really quite close to the truth!! Women must demand that proper research be done for them! Women are wondrous and rhythmic and should live their lives in harmony with nature! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625208/

Artificial Sweeteners Absolutely do not Belong in Your Food!

Most women with PCOS suffer with being overweight or obese, living in a constant battle with their weight and food. Many have binge eating disorder, some have bulimia, and some even have anorexia nervosa. With the exception of the weight problem, lean women with PCOS have most of the same issues as their heavier "sisters," and should follow the same dietary rules, one of which is: absolutely no chemical sweeteners, or really, sweeteners of any sort! In the desire to achieve good health, weight loss, or weight maintenance, many women with PCOS choose non-caloric sweetened foods and beverages (those containing chemical sweeteners with few or no calories) in the mistaken belief that these are wise and healthy choices. Sadly, there is now clear evidence to the contrary. In fact, more and more data is clearly indicating that these nasty chemicals actually lead to further weight gain and insulin resistance, thereby increasing the risk of pre-diabetes and diabetes. Additionally, by disrupting the normal functioning of the gut microbiome (the bacteria that live in our gastrointestinal tracts) these sweeteners can foster cognitive decline, as well as increase anxiety and depression, worsen or initiate irritable bowel syndrome, and elevate the risk for problems affecting the cardiovascular and immune systems. A likely reason for these terrible effects is the negative impact artificial chemicals have on the different species of gastrointestinal bacteria, upsetting their natural balance by suppressing the growth of some populations, which then allows for the overgrowth of others. These bacteria, collectively called the microbiota, play an enormous role in our metabolic, emotional, cognitive, immune, and cardiovascular states by producing metabolites and signaling molecules that are absorbed and then circulated throughout our bodies. Altering the microbiome alters the natural balance of these chemical messengers and metabolites, resulting in a host of ill effects which no one, and certainly not women with PCOS, can afford to deal with. The take-away message is, as I see it, to avoid all processed foods, as they often contain chemicals harmful to our microbiome and other aspects of our health. Try hard to eat only real and unaltered food ... the food your great, great grandmother could and would have eaten! And though she may on occasion have had a special sweet treat, try to avoid those as well, unless and until you regain the health and vitality you seek and deserve.

What’s for Dinner?

When you sit down at the table to eat, what do you think makes for a great meal?

My first rule of thumb is quite simple – all food must taste good and be good for you! Those rules simply cannot be broken. Next, once it meets those qualifications, it is really important that it is truly scrumptious. If given a choice, why go for food you don’t really love, and who doesn’t love to eat? Eating is one of the true joys of life, and it makes me, and actually everyone, happy and satisfied when eating wonderful food. Second, we should think about nutrition – is the food we’re eating supporting our long-term health. If it isn’t, then we’re setting ourselves up for all the dangerous health consequences that plague PCOS women: obesity, pre-diabetes and type-2 diabetes, cardiovascular disease, inflammatory bowel disease, and more. And of course we will think about the toxin content of the food. Is it organic or not? What chemicals are contained in it or is it a processed food, which, by the way, I never will eat! And is it fresh and full of nutrients, or old and wilted. Rarely, however, do we think about the food we eat in terms of feeding the 30-40 trillion (that’s right, trillion!) bacteria that inhabit our GI tract, call the gut microbiome. This is a lot more important than you might think, because the latest scientific research is telling us that these little fellows – who have been part and parcel of who we are for the past several million years – have an incredibly powerful impact on virtually every organ system in our bodies. They help digest and process our food and create a vast range of metabolites that we absorb and use all over our bodies. They also produce neurotransmitters that control our feelings of anxiety and depression and also help regulate our blood glucose levels through several mechanisms – and that’s just scratching the surface. So, the bottom line is: when you sit down to eat, remember that you’re not just eating for yourself, the 20-30 trillion (yup, there we go with the trillion again) human cells that make up your body, but also for the gazillion microbial guests, who are also seated at the table. And exactly what, you may ask, would they like to eat? Fortunately, the answer to this is relatively straightforward and not at all discouraging. They like to eat high-quality, whole foods, and they like variety. They love lots of vegetables, both above ground and root vegetables, and a slightly lesser amount of fruit, especially when they are organic and not tainted by residues of herbicides and pesticides. They prefer plant-based sources of protein (beans, lentils, quinoa, and amaranth) over animal-based sources and do well with good doses of the fatty acid, Omega 3. And please avoid simple sugars and sugar substitutes, as they are quite toxic to the microbiome. It is simply much better to be focusing on carbohydrates containing lots of fiber. Fiber is the foundational food for the microbiota which dwells within our gut. If you give these single-cell companions what they want, they will reward you in spectacular ways. Your weight, blood pressure, body fat percentage, cholesterol levels, and fasting glucose level will drop, all of which will lead to substantial reductions in inflammation and oxidative stress. And, if you stay tuned to this blog, we’ll give you wonderful recipes and cooking advice that will make your new diet every bit as delicious as it is good for your health!

PCOS and Inflammation

There is a common thread which ties all women with PCOS together, whether they are over- or underweight, young or old. That link is INFLAMMATION – the driving force behind the ills afflicting all PCOS women. Let me explain a bit about inflammation, how it develops, and how it can create havoc for women with PCOS. The inflammatory process begins during pregnancy as the fetus’ developing estrogen receptors are misprogrammed by the presence of toxic chemicals, such as bisphenol A, a powerful endocrine disrupting chemical found in plastics and thermal printing papers.Since estrogen receptors are present in virtually every cell of the female body, this bodes poorly for the development of proper metabolic functions, as it is estrogen which is the master of metabolism in the female body. What does inflammation actually mean for the female body and why it is so bad? Acute inflammation is a normal response to a trauma or an infection. This type of inflammation involves the activation of the innate immune system,which protects the body from invading organisms. This acute, short term inflammation is a normal and very important part of our immune defense system. Unfortunately, there are times when inflammation becomes chronic, due to a malfunction and misdirection of the immune system. When this develops, bad things follow right behind. A key component of an acute inflammatory response is the activation of white blood cells, called macrophages. They then secrete substances called inflammatory cytokines and enzymes which act something like a natural acid. The inflammatory cytokines include substances like tumor necrosis factor alpha, which, if produced in an uncontrolled fashion, leads to insulin resistance, elevated levels of glucose and insulin-like growth factor 1, and high production of testosterone. Also produced by macrophages are special enzymes, called matrix metalloproteinases, which are substances designed to kill invading bacteria and aid in the removal of dead tissue. Chronic production of these matrix metalloproteinases causes damage to body structures, such as the interior lining of arteries, which in turn leads to severe acne. Estrogen is the ultimate controlling force behind the function of macrophages, and receptors for estrogen reside on these cells. When estrogen receptors are not properly developed, estrogen can no longer control the actions of macrophages. With control reduced in women with PCOS, macrophages run amok through the female body, doing much damage. They are perpetually in a state of high alert, ready to release inflammatory cytokines and myeloperoxidase, and they are more easily stimulated compared with immune cells in women without PCOS. Much of the stimulation to the macrophages originates in the gastrointestinal tract, also known as the gut. Studies now show for the first time that women with PCOS have a more “leaky gut,” meaning that the single-cell barrier between the internal contents of the colon and the rest of the body is compromised. This allows inflammation-inducing particles within the colon, derived from the overgrowth of predominantly gram-negative bacteria called lipopolysaccharides (LPS), to pass through the colon wall and enter into the surrounding immune system, known as the gut-associated lymphatic system (GALT). Within the GALT reside those key cells - the macrophages - which are triggered by the LPS to release their inflammatory substances. This is a short introduction to a very complex subject. In upcoming articles, I’ll explain more about what is happening within the gut, and I’ll also dive further into the story of inflammation as the driving force behind the suffering of women with PCOS and how to “tame the flames of PCOS!”

How PCOS affects Depression and Anxiety

January is a month when many feel the effects of the holiday season coming to a sudden end. The decorations must all be put away; there is often a big mess of discarded wrappings to deal with, thank you notes calling to be written, and health resolutions to write… and often times to discard quite quickly. For many, unfortunately, January is a “down-mood” month, one with long, cold days and long, dark nights, when we are often faced with a stark reality, without the joyous festivities to hide behind! And for those with PCOS, to add to the general “down-ness of January,” is the fact that mood disorders are increased in women with PCOS compared to women without this condition. In fact, all women with PCOS, at all times of the year, should have an initial evaluation to include assessment of mental health disorders. The prevalence of depression in women with PCOS is high and varies from 28 to 64%, and the prevalence of anxiety in women with PCOS ranges from 34-57% In recent years, the complex relationship between PCOS and psychosocial issues has come to the forefront, with a prominent link found between specific features of PCOS and mental well-being, including the impact of infertility, hirsutism, and acne on mood. The fact that many women with PCOS experience menstrual dysfunction, hirsutism and obesity, along with cystic acne, creates a situation which can clearly result in profound psychosocial distress. In one interesting study from South Asia, they found that in comparing hirsutism and obesity, the most depression was related to the presence of hirsutism. The scientific literature now shows clearly that anxiety levels, psychological distress, depressive feelings, and social fears are all markedly higher in the population of women with PCOS. The reasons for the increased vulnerability of depression and anxiety in women with PCOS as well as for PCOS women to develop psychiatric disorders are still unclear, but in addition to the negative mood reactions to the visible symptoms of PCOS, there are others which likely involve several pathways independent of the visible symptoms of PCOS, such as obesity, acne, and hirsutism. In one study of 300 women, nearly a third had anxiety, and quality of life was lowest in those with a combination of stress and depression. Stress is one of the common mechanisms that induce psychological disorders. This occurs via the hypothalamic-pituitary-adrenal (HPA) axis and involves circadian rhythms. With significant stress, there is alteration of the HPA axis and disruption of the circadian rhythm, altering the functional relationship of the brain with the endocrine systems, resulting in adverse impacts on health. Women with PCOS have a higher level of sympathetic output from their adrenal glands. They tend to have higher outputs of cortisol and adrenaline, and to have dysfunctional melatonin, and therefore more inflammation and poorer sleep.  The higher levels of cortisol and adrenaline make those women more prone to anxiety and sleep dysfunction, adversely affecting mood. Women with PCOS have an exaggerated response by the sympathetic nervous system, with a heightened response to negative stimuli compared with non-PCOS women. They have an abnormally increased cortisol response to physical and psychological stressors which cannot be explained by their BMI, increased percent of body fat, fasting insulin, or elevated androgen levels. Indeed, there is an independent and inherent mechanism exaggerating the stress response, in a negative way, for PCOS women. Additionally, there is evidence of an increased incidence of eating disorders and suicidal behavior among PCOS women. Sadly, they are at an increased risk of social phobia and suicide attempts. But none of this means that women with PCOS can’t have full and wonderful lives. All this means is that it must be recognized that PCOS women have an added risk for adverse reactions to normal stressors and are more prone to anxiety and depression. Therefore, more active and proactive management is necessary. Women with PCOS need to cultivate coping mechanisms, and there are many to choose from. The maintenance of the emotional well-being of women with PCOS needs more nurturing than what is needed for the average woman. But with such support, every woman with PCOS can achieve mental, emotional, and spiritual health. The ways to achieve emotional happiness are many, and all can be combined to satisfy each individual woman’s unique needs. Some of the effective methods are the varying forms of meditation, hypnosis, the Emotional Freedom Techniques, including tapping, Tai Chi, Chi Gong, yoga, massage, baths, acupuncture, cognitive behavioral therapy, essential oils, and my own personal favorite, guided imagery. I utilize several techniques for my own stress therapy, emphasizing baths, essential oils, and guided imagery, but all can be amazingly effective! Each woman must try out several and discover what works particularly well for her. If you feel especially down or stressed, be sure to seek assistance and find your personal path to emotional, spiritual, and mental wellbeing. Do not delay even a minute getting help if you have any tendencies towards self-harm!! Please contact me if you are seeking PCOS medical care and do not know where to turn. *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: Depression and Anxiety in Women with PCOS http://pcosdiva.com/2015/12/depression-and-anxiety-in-women-with-pcos/

What is the condition known as PCOS (Polycystic Ovary Syndrome)?

PCOS incorporates the word, SYNDROME! When that word is linked with a condition, it basically means that no one really knows why someone would develop it, and, as well, it has a great variety of ways it can manifest itself.  PCOS is therefore, a highly individualized condition, resulting from each woman’s unique genetic make-up, along with her mode of delivery at birth, whether or not she was breastfed, her exposures to a variety of chemicals which can act as endocrine disruptors, her nutritional status, her sleep patterns, her exposure to antibiotics and vaccines, her stress levels, and more. Essentially, it is a very complex and variable condition! Many choices you make can affect how you experience PCOS, which symptoms you get, and how severe they may be. Some women struggle with irregular or no periods at all; some have acne; most struggle with excessive weight gain, while others easily maintain very slim figures. Infertility is a common complaint while thinning scalp hair and excessive growth of facial hair plague other women. And women with PCOS all have elevated risks for developing various cancers, diabetes, irritable bowel syndrome, cardiovascular disease, anxiety and depression, and problems with sleep. PCOS is, at its very heart, a condition characterized by universal insulin resistance and systemic inflammation, regardless of whether the woman is obese or thin. Inflammation is a driving force of the condition. In fact, since PCOS was first described by Drs. Stein and Leventhal in 1935, physicians throughout the world have debated with defining the syndrome. Today, there are three closely related sets of criteria (NIH, Rotterdam, and AE-PCOS Society) and all revolve around the following issues: infrequent or no menstrual periods, polycystic ovaries (many very small cysts surrounding the core of the ovaries), excessive production of androgens (hormones found in males such as DHEAS and testosterone), and the elimination of other known causes for these symptoms. PCOS is by far the most common endocrine disorder suffered by women around the world, affecting up to 25% of all reproductive-aged women. Lest you become too distraught over all of these realities, there is a brighter side.  There are things you can and should do, along with choices you can make, all of which will ameliorate your symptoms and transform your life for the better. And that will be the focus and driving force for this blog – transforming lives such as yours, and creating happiness. The dialogue we will have together will focus on concrete ways to make your life as wonderful and rewarding as it should be, despite your PCOS!

Diagnosis and Treatment of PCOS in Young Girls

Most doctors and patients alike believe that PCOS is a condition which appears in the teen years or with young adulthood, following the advent of puberty and the onset of periods. In reality, shocking as it may seem, PCOS begins with birth!! Now how, you may ask, can that happen? Doesn’t puberty herald the onset of the all the medical challenges faced by young women with PCOS? The answer to that question is…. mostly so… but there are signs and symptoms early on, and there can be early detection! Here is the story of the beginnings of PCOS, and with this knowledge comes the capability to predict with reasonable, if not perfect, accuracy whether or not your daughter will develop PCOS. With that knowledge comes the power to begin treating it BEFORE all the misery that you know all too well ensues, following the completion of puberty. While in utero, because of the ubiquitous toxins surrounding us all, everyone becomes exposed to numerous chemicals, including ones which act as endocrine disruptors, particularly Bisphenol A (BPA). Such exposures alter the very foundational development and function of hormone receptors. What happens is that these chemicals enter the pregnant woman’s body through various means and then cross the placenta, thereby entering  the baby’s body, where it actually concentrates in greater quantity than in the mom’s body! This sad fact has only been recently realized! Researchers, measuring the chemical levels in the moms, often found low levels and concluded they were below the threshold to cause problems, while being unaware that the levels of that chemical were actually much higher within the baby. Chemical endocrine disruptors are like cheap knock-off imitations of real hormones. They can attach to receptors and act in one of many ways-mimicking the real hormone, blocking the action of the hormone, or something in between. And estrogen has three different kinds of receptors, so the end result can be hormone chaos and the various organs of the developing baby’s body simply do not get the right exposure to hormones, particularly estrogen.  The baby is born with a “confused” hormonal system, unable to respond properly to the hormones due to the abnormal function of their receptors, as well as the inability to manufacture them properly. When there is a problem with the functioning of the estrogen receptors, systemic inflammation occurs. This occurs because estrogen functions as the master of metabolic homeostasis. What that means is that estrogen controls a female’s appetite, energy usage, metabolic rate, location of fat deposits, and how fat functions. Estrogen is truly the mastermind of all that is female and metabolic! Young girls born to PCOS moms have about a 50% chance of developing PCOS themselves. Given those odds, it is really imperative for us to diagnose, with some reasonable probability, which of those daughters will and which won’t have to deal with PCOS. And there are ways to reasonably identify young girls as having a high predilection to develop PCOS. From a physical point of view, here are the suspicious symptoms. If a very young girl, from approximately age 4 to 12 years of age, has an unusual amount of waist and belly fat, yet she eats quite well… that is a powerful clue. Estrogen regulates where fat is deposited and how it functions, so young girls destined to get PCOS may be showing signs of abnormal fat deposition and already have difficulty maintaining a healthy weight, well before puberty sets in. There is also a blood test which has good predictability for detecting PCOS prone girls and which can be administered as early as age 6 to make a likely diagnosis! This test is called Adiponectin. I order it through the Cleveland HeartLab, a very prestigious cardiovascular laboratory, affiliated with the renowned Cleveland Clinic. Adiponectin is a type of hormone made by adipose (fat) tissue, called an Adipokine. Adiponectin is an extremely important and vital hormone to prevent inflammation, insulin resistance, and obesity. It is involved in managing how fat tissue functions, the level of inflammation in the body, how energy is produced and stored, and the transport of glucose from the blood into cells, impacting insulin resistance. Estrogen controls the production of Adiponectin. In girls prone to develop PCOS, the Adiponectin levels will be unusually low. The finding of low Adiponectin levels raises a big red flag that the girl is at high risk to develop PCOS. The potential for Adiponectin to be used as an early screening tool means that girls at high risk to develop PCOS can be identified as young as age 6! Once identified, proactive therapies can be initiated to lower the chance of PCOS becoming severe. Lifestyle changes involving diet, sleep, stress, exercise, and nutrition can all be implemented to greatly soften the blow to health which occurs with the passage through puberty. I would be happy to assist any who have daughters they would like evaluated for PCOS risk status. I can see and examine them and order Adiponectin, as well as all indicated inflammation testing. I strongly advocate for a proactive approach to all diseases in order to prevent the devastating effects of an advanced disease state. This philosophy is particularly applicable to PCOS to ameliorate the suffering so many with the condition must endure. *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:  http://pcosdiva.com/2015/11/diagnosis-and-treatment-of-pcos/

PCOS Diet: 7 Tips for Timed Eating, Weight Loss Gut Health and Better Sleep

We are “what” we eat, that remains true. But just as correct, is the very new notion that we are “when” we eat!  The newest data now shows that when you eat can determine how long and how strongly your heart will beat. Incredibly, the timing of meals may be as important for health as is diet composition and amounts of calories. Research now shows that there are clocks in our bodies which are very involved in cardiovascular function and risk, and that this relates to the time of eating. One research study with fruit flies showed that limiting their eating to only 12 hours of 24 led to healthier hearts compared with allowing fruit flies to eat whenever they wanted to eat. The body’s master clock is located in the brain, in the section called the hypothalamus, and sits atop the optic nerve so it can glean whether it is day or night, based on the light received to the retina. But there are other peripheral clocks located in all the cells of the body which are regulated by the master clock, the only clock which sees light and dark. Although the peripheral clocks cannot see light or dark, they can sense when there is feeding happening, and that is an important component of how they can be set! Previous research has shown that timed eating, limiting all food intake to a maximum of 12 hours per day, can protect mice from obesity and other metabolic problems. Mice’s hearts do not easily get altered, and so studies with fruit flies were done, with dramatic results. Two groups of fruit flies were used. They both ate the same amount of food, but one group ate for only 12 hours a day and the other group had 24 hour access to the food and snacked at night. Both groups had the same amount of activity, but the flies who did all of their feeding within 12 hours did most of their moving during the day and slept better at night. The hearts of the flies were examined at different times. At 3 weeks of age, the flies in both feeding groups had similar regularly beating, healthy hearts. At 5 weeks, which is the fly’s middle age, the 12 hour eaters had hearts which maintained a steady rhythm of one beat per second. The other group which ate at any hour of the day or night, had hearts with irregular beats, sometimes skipping a beat, and sometimes quivering. By 7 weeks, the anytime eaters had hearts which beat with badly damaged heart function. In other studies, restricted timed eating helped stave off the harmful impact of high-fat diets.  And also interesting, when the researchers disabled the clocks throughout their bodies, restricting the feeding times did not help the hearts of the flies, suggesting that functioning clocks are important for heart health. The researchers also looked at the effects of timed eating on gene expression and activity. Circadian rhythms are powerfully expressed in genes, which peak in activity at certain times of the day. The flies which ate only during 12 hours had peaks of gene activity which maximized right before breakfast and just before the final bite. The flies which could eat around the clock had several smaller peaks of gene activity throughout the day, suggesting that timed eating led to better coordination of gene activity. Tightly controlled gene activity may permit more efficient energy use and prevent the build-up of metabolic byproducts which can damage tissues. Additionally, it is now recognized that the bacteria within our colons have their own clocks, and when eating is done properly, their clocks are perfectly synchronized with the clocks in our own cells. The only way for the bacteria to synchronize their clocks with our own, is through timed feeding. And we clearly know that it is necessary for the microbiome to be happy and healthy if we are likewise to be happy and healthy. My advice is easy. Begin with this simple plan:
  • Eat no more than three meals a day
  • Avoid snacking
  • Stop eating at 7 pm, but at least by 8 pm
  • Have at least a 12 hour fast between dinner and breakfast
  • Eat mostly plants with many vegetables, beans, lentils, and whole grains
  • Avoid or limit grains which have been pulverized (aka-bread and crackers)
  • Eat at the same times every day
By eating the timed way, you will lose weight and feel better, even if you consume the same number of calories. I am not going to say that calories don’t count, but they count far less than once was thought. Eating at the right times matters as much, and likely more. The gut microbiome requires timed eating to properly care for them. Focus on caring for the microbiome with lots of fiber and plant based foods. By finally nurturing the microbiome with the right food choices and with timed/restrictive eating, it will take care of you. *This is a repost of a guest post Dr. Gersh originally posted on PCOS Diva at: http://pcosdiva.com/2016/06/pcos-and-circadian-rhythm-part-2/

Acne and PCOS

Just thinking about “acne” makes my stomach churn, since it is one of the most hated of all the PCOS symptoms. Acne affects a large percentage of women with PCOS and is something you simply cannot ignore. It stares at you with every glance at your reflection. I am fully aware of the pain experienced by those with acne; I suffered for much of my adult life with it. I want to up-front tell you that I cannot give you a magic pill to clear your acne, but I will share my most effective approaches, and let you know of some exciting up-coming research. The sad thing is that there are many dermatologists who believe they have the magic pill in the form of Isotretinoin (Accutane), a drug originally formulated as a chemotherapeutic agent. I must issue a serious warning concerning this medication for PCOS women. The success rate in this group is much lower than for others; only about one in three has long term benefit. Some see short-term improvement, followed by the acne’s return with a vengeance a short time later. Isotretinoin also has many side-effects such as headaches, dry eyes, cracked lips, bleeding gums, and fatigue. Among the more serious ones are birth defects, increased suicidal feelings and suicides, liver injury, elevation of blood lipids (fats), and permanent irritable bowel syndrome. The other issue I want to address immediately is the use of oral contraceptives for PCOS acne. Oral contraceptives do sometimes help reduce acne in PCOS women, though often it does not. Oral contraceptives are chemical hormone mimics and are not good for the gut health. They deplete the body of B vitamins as well. They increase blood clot formation, which can be life-threatening. Long term use can increase breast cancer risk. They also can increase headaches and depression. These effects make me hesitant to prescribe them, though I will at times. Spironolactone is another conventional drug often prescribed for acne, with mixed results. Although technically approved as a diuretic, it seems to work by blocking the action of testosterone in the skin. My patients have had less than stellar results with this treatment, but it can be tried. I’d like you to understand why you have such stubborn acne. Your acne is the outward manifestation of inner inflammation combined with an elevated level of androgens (male type hormones)! Those of you who have read my previous article on PCOS and inflammation understand that a cardinal issue with PCOS is systemic (generalized) inflammation. This inflammation is also occurring in your skin, and so you must tackle this problem for what it truly is - a terrible SYMPTOM of an underlying inflammatory situation. The high levels of inflammation trigger still higher systemic levels of testosterone and DHEA (adrenal androgen), further aggravating the acne in an emotionally aggravating feed-forward scenario. In PCOS women, the bacteria on the skin have been demonstrated to be different from that of “normal” women. Additionally, the sebum, or oily material which protects our skin, is also unique in PCOS women; its constituent fatty acid components are not the same and have reduced capability to fight off infection, hence the development of cystic, recalcitrant acne. So what shall we do? We must douse those fires! We first must measure your inflammatory status and then must lower it. Your acne will dramatically improve once the flames are out. Start by getting your inflammatory lab tests performed. Contact me if you need help on this. Over the past few months, I’ve worked out a system to help all get these important tests performed at a network of draw sites. Next, we must get that inflammation down. As this is a short article on a very complex problem, I can only provide an overview of my program. If desired, I am happy to help you individually, simply contact me. The treatment of PCOS related acne starts with your food choices. You must eat an anti-inflammatory diet. Avoid all dairy, in all forms! Dairy increases levels of IGF-1, which increases testosterone, increasing acne! Also, avoid all wheat and gluten, all sugars and sweeteners, alcohol, white rice and corn, and all chemical and processed foods. There is no diet which is perfect for all PCOS women, so please feel free to do some experimentation to discover what works best for you. We are all unique in our immune systems, our toxic load, and genetics. The unifying theme must, however, be a diet to reduce inflammation! For those who enjoy it and can handle it, I suggest trying initially, for three to six months only, an organic vegan diet consisting of 10 servings (1/2 cup each) of vegetables, including at least 4 servings of a variety of root vegetables such as beet roots, turnips, rutabagas, parsnips, and carrots. Add in 2 fruits, particularly tart apples and berries. The other vegetables should consist of many different varieties of vegetables - all the colors of the rainbow! The phytonutrients and anti-oxidants in these foods fight inflammation and the resistant starch fibers in the vegetables, particularly in the root vegetables, provide nourishment to those critically important bacteria living in your intestinal tract. Add in organic beans, lentils, a handful of organic raw seeds and nuts, small amounts of whole grains such as millet, buckwheat, quinoa, and brown rice, along with lots of green and spearmint tea. This diet is high in nutrients, anti-oxidants, and gut-nourishing fiber. A healthy gut lowers generalized inflammation, which in turn lowers circulating testosterone and DHEA levels, which then reduces inflammation in the skin and improves acne! But if not eating animal products is more than you can handle, go ahead and add in some organic eggs, chicken, red meat, and fish. Another option exists for women without disordered eating. Published data has revealed that testosterone and inflammation can be reduced by eating most of the day’s calories at breakfast, a third at lunch and fewer than a hundred calories at dinner. In one study, testosterone and insulin levels were reduced quickly by 50%! Although this was an incredible achievement, please recognize that this regimen was only tested in one study, and this way of eating is definitely neither suitable nor feasible for everyone! You also must control stress! High stress causes increased output of cortisol, and that causes more acne! I hope to write an article on stress and PCOS in the upcoming months, but for now I would recommend buying guided imagery CDs for stress, take a course in meditation, learn progressive relaxation or tapping, get massages, or all of the above! There are studies showing that hypnosis can actually improve acne. The mind controls your stress level and your immune system’s responses, and YOU can control your mind with practice! Sleep is a critical element related to inflammation. Just one night of sleep deprivation results in elevated markers of inflammation. Maintaining your Circadian Rhythm is a key element of health and the management of your acne. Wake and sleep consistently and get 7-8 hours of sleep nightly. There are a few key supplements I recommend to reduce acne. They work by improving detoxification functions in the liver and by improving the metabolic functions of the body. In turn, generalized inflammation is reduced. Myo-Inositol, resveratrol, N-Acetyl Cysteine, and berberine are all very helpful. Taking a high potency B complex, containing methylated B vitamins is important. There are also published studies showing benefit from taking Vitamin B5, at a dose of 2 grams, 3 times daily, along with CoQ10, and L-Carnitine at a dose of 1 gram twice daily. Spearmint tea has been shown to lower testosterone levels and reduce acne. Healing acne is slow going, so expect it to take 6 months to see very significant improvement. In terms of topicals, several are helpful. Organic essential oils can help to control the skin bacteria. Blends with Thyme and Tea Tree are great. We use an excellent blend called Clear Skin by Simplers Botanicals. I recommend an organic acne line from Sophyto. In a study pitting ProActiv against Sophyto, Sophyto won! It incorporates antioxidants from organic fruits and vegetables grown on a farm on the British Isles. There are also several prescription topicals I have made up at my local compound pharmacy which I utilize. I have also found that acne peels can be very beneficial by exfoliating the skin. I have had success with a peel called ViPeel, designed specifically for acne skin. I also want to emphasize that I am vehemently against the use of antibiotics for the treatment of acne. Actually, they rarely work for PCOS patients anyway, and from a long-term view, they are incredibly harmful to the GUT microbiome. Remember, there are supposed to be bacteria all over our bodies and within our bodies. The “right” bacteria in our guts reduce inflammation, and hence, reduce acne. Bacteria also typically grow resistant in time to the antibiotics and cease working at all, and so the antibiotics can create more harm by killing off our GOOD bacteria, those which are actually protective! In terms of future hope, I am currently working to begin a study of the effects of a five-day diet which mimics the effects of fasting on the state of acne in PCOS women. It has been shown that this program reduces markers of inflammation, IGF-1, and insulin levels, all of which are associated with acne. The hope is that this dietary program will substantially reduce acne. In summary, as you have seen, there clearly is no magic bullet for the treatment of PCOS acne, whether cystic or not. As my imperative is always to do no harm, I avoid Accutane and antibiotics, and prescribe oral contraceptives judiciously. My ultimate hope is to reduce the underlying generalized inflammation and lower androgen levels (testosterone and DHEA levels), while also healing the gut of PCOS women. Then the fire in the skin will be calmed, and the acne will finally fade away.  

PCOS and Gallbladder Issues

PCOS and Gallbladder Issues As if women with PCOS don’t have enough on their plates to deal with already, add another to the list-gallbladder dysfunction and gallstones! Yes… it’s true… many women with PCOS also have problems with the workings of their gallbladders. But please…don’t despair as there are many options to help your gallbladders function better…and when they work better…all of you will work and feel better! Let’s begin with some gallbladder basics. Do you even know why you have one? And is it even important, as many women have their gallbladders removed and no one seems to bat an eye! There reality is that, like all organs we were are born with, the gallbladder serves a very important purpose. Should yours have been removed already or truly must be removed in the future, please don’t think that it doesn’t matter and then make no accommodations for its loss. The gallbladder is a very important part of digestion … don’t part with it lightly or readily. The gallbladder is a storage vehicle. It holds cholesterol and bile, secreted by the liver. Bile is truly a fascinating creature. It, like many things in the human body, is an amazing multitasker! Bile is vile! Well… just sort of. Bile is the toxic waste material created by the liver in the process of detoxification, also known as biotransformation, of your body’s own old hormones and neurotransmitters, and of environmental toxins and pharmaceuticals. It really is toxic waste!! But it’s amazing stuff. It is also an emulsifier. When you eat fat, you need to break it down into its little component pieces and then digest and absorb it. Please don’t think fat is evil. Actually it is essential to life, which is why fats are called essential fatty acids. You truly cannot live without fats in your diet. You need a proper balance of the different types of fats, and many are deficient in the type called Omega 3, which is primarily obtained from fish and somewhat from plants like flax seeds and walnuts. And many of you have probably heard that olive oil and coconut oil are healthful fats. And so is the fat in the yolk of organic eggs. We will talk more about fat another time…for now take me at my word that fat is essential to life and you need bile to help you digest it. Back to bile… it is a natural emulsifier. That means it can take a fat and turn it into being water soluble, so it can mix with water! This is truly like a miracle. You probably know that if you have greasy hands and simply run them under the water faucet, the hands stay oily. If, however, you rub in soap, the grease will be able to be washed off your hands without a problem! Soap is an emulsifier-it makes fat able to be washed off with water. Without bile, you simply can’t digest fats, and with the fats come the fat soluble vitamins… like Vitamin E, A, K, and D! These vitamins are essential to proper functioning! If you don’t have a gallbladder or the one you have doesn’t work well, you will naturally have difficulty with your digestion of fats and of fat soluble vitamins!! If that’s the case, you need to actually take bile at the beginning of each meal. This bile comes from an ox! It’s the closest we have to human and it works well. You also need to take digestive enzymes as well as that nearly always becomes a problem when the gallbladder is gone or malfunctioning. The gallbladder triggers the pancreas to release it digestive enzymes. It is very important that you do this or you’re quite simply not going to digest your food properly! Women with PCOS have enough issues…malnutrition shouldn’t be one of them! So why do women with PCOS have problems so often with their gallbladders? It’s related to gastrointestinal problems in general, and women with PCOS are renowned for what we term “gut problems.”  Many have irritable bowel syndrome (IBS) with constipation or diarrhea and general gut issues, acid reflux (GERD), dysbiosis (the wrong gut bacteria), and sometimes even more serious inflammatory bowel disease. There are quite a few theories as to why PCOS women how so many gastrointestinal problems, but it is known for sure that many have what is called “leaky gut” and  small intestinal bowel overgrowth, along with many food allergies, sensitivities, and autoimmune states as well. Because of these issues, the proper signals to the gallbladder don’t occur and it becomes sluggish, and can actually get sludge in it, and it can even progress to gallstones. Just because you have sludge or stones does not mean the gallbladder must go! Only if you’ve had recurrent pain, pancreatitis, or infection, is it then absolutely necessary to have it removed… but remember you’ll absolutely need a bile and digestive enzyme supplement. Some PCOS women get gallstones or sludge because she goes on a low fat diet for a long time. I don’t recommend a woman go on such a diet!! That is not the way to get healthy! You already know that fat is essential to life!! I believe strongly that all women with PCOS should have their GI tracts checked out for overgrowth of bad bacteria, small intestinal bowel overgrowth (SIBO), issues with low levels of stomach acid and digestive enzymes, constipation or diarrhea, stomachaches, and the like. And please…do not go on a low fat diet…nor go on a prolonged very low calorie diet…as that too will make you more prone to gallstones. If you do have gallstones and you haven’t had severe pain, infection or pancreatitis, get another opinion before having your gallbladder removed. Often women can live a long and normal life with gallstones. With gallstones, you’ll want to do a liver detox regularly, eat a healthy amount of good fats, work on stress as that is so unhealthy for the gut, and you can even consider medication to try to dissolve your gallstones, if you meet the criteria. In general though, my first choice, as always, is to try to work with you simply with a lifestyle approach. The key take-home points are that we should try hard to maintain good gallbladder health by eating healthy fats and getting the GI tract checked out by a good doctor who understands what is needed for PCOS women, and if you have gallbladder issues already or have had yours removed, get on bile and digestive enzymes right away!! And remember, stay positive and focused on doing the right things to maintain your health, at most of the time!!! Good luck and give your gallbladder a virtual hug today!!  

PCOS: Resetting Your Circadian Rhythms

All living creatures throughout evolution have developed biological clocks to better adapt to the 24 hour day called the Circadian Rhythm. These are called Circadian Clocks and they regulate physiology, metabolism, and behavior. In humans, many aspects of physiology are subject to circadian regulation. These include sleep-wake cycles, cognitive performance, cardiac and renal functions, digestion and detoxification. Overall, about 10% of all genes express in a Circadian manner. These peripheral genes, sometimes referred to as peripheral oscillators, are controlled by the master clock located in the brain. It has been known for over 40 years that all humans have such a master clock built into their bodies, controlling numerous functions, such as when hormones are released, the level of one’s appetite, metabolic functions, mood, and cardiovascular health. The master clock regulates a myriad of cellular, physiological, and behavioral 24 hour rhythms. This master clock is located in the hypothalamus of the brain, at a spot called the superchiastmatic nucleus (SCN). This location is on top of the optic nerves, allowing it to sense light and dark! There are also clocks in most of the cells of our bodies called peripheral clocks, and all are regulated by our genetics by what are called clock genes! The discovery of clock genes has led to a revolution in our understanding of how Circadian Rhythms are generated in individual cells. Light signals detected by the eyes are interpreted by the SCN which then sends out synchronization signals to other cells of the body via hormone secretion, sympathetic innervation, and indirect cues such as body temperature, feeding times , and activity rhythms. The regulation of these clock genes is extraordinarily complex, involving many types of receptors and proteins for signaling, and also include hormone receptors such as glucocorticoids (like cortisol), thyroid, and estrogen. Women with PCOS have documented dysfunction of their Circadian Rhythm systems. They simply do not keep proper time by the master clock in the brain, nor synchronize all the cells of the body as they should. Circadian disruption is associated with insulin resistance and obesity, as well as with intestinal problems, and mood and cognitive issues. A broken clock increases one’s risk for cancer, a heart attack, a stroke, and dementia. But do not get all stressed out! Over the upcoming months, I will take you through the issues of the Circadian Rhythm as they relate specifically to PCOS, discuss the special clocks within us all, and explain  in-depth how they relate to gut health, sleep, mood, the immune system, the cardiovascular system and more! So stay tuned! We have a great journey ahead of us, as we explore the nature of our biological rhythms, how we can work to get them working properly again, and aid you in your quest to return to a state of optimal health and happiness! *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:  http://pcosdiva.com/2016/05/resetting-clock-series-part-1-circadian-rhythm/

How Much Calcium is Necessary for Your Health?

Calcium is the most abundant mineral in the human body and is a crucial factor in numerous body functions and structures. But what should a woman do to ensure she is consuming the correct amount of calcium to maintain a healthy body? Does a woman with PCOS need to drink milk? Until recently, the dogma of consuming large amounts of calcium went unchallenged, but it is now recognized that the studies used to create that advice were poorly done, and the data is less than clear on the value of calcium supplements. Most data are now not in support of calcium supplements, or at least suggest consuming them only in small amounts!

The Pros and Cons of Calcium

Previously, it was thought that calcium supplements provided a large array of metabolic benefits: improving cardiovascular wellbeing, lowering blood pressure, and reducing diabetes risk. Of course, it was also thought that it would help bones stay strong. Certainly, calcium itself is important for those functions. The current state of knowledge is that calcium supplementation in small amounts may be beneficial, but larger quantities of calcium supplements do not seem to provide those desired benefits after all and actually may increase the incidence of kidney stones! There is even concern that excessive calcium supplementation may cause calcium deposits to develop in the artery walls.

What is the Best Source of Usable Calcium?

It turns out that the best way to get calcium into your body, to ensure a healthy set of bones and a healthy cardiovascular system, is through the diet. The dairy industry has made it seem absolutely necessary that large amounts of dairy products be consumed daily, and the newest US nutrition guidelines also advise a glass of milk with each meal! Not only is this unnecessary, it is downright harmful, most particularly for women with PCOS. Dairy is an acid producing food, and calcium will not get into bones if the blood is acidic, making dairy products an inferior source of calcium. Calcium is a natural antacid. Removing it from the blood would make the blood even more acidic, and calcium cannot move out to the tissues from an acidic environment. Only in an alkaline situation can calcium leave the blood to move into tissues. The only foods which alkalize the blood are vegetables! Did you know that there is much more usable calcium in a cup of collard greens than in a cup of milk? Most people don’t realize the calcium content of greens is so high. Best of all, the calcium in greens is usable by the body and doesn’t just pass out with the urine or cause stones!

So what do I recommend?

Eat large quantities of green vegetables and lots of greens. As a side note- chard and spinach are very healthy, but the oxalates in them bind with the calcium and preclude their use, so be sure to include a variety of vegetables each day. I also recommend only a small amount of calcium as a supplement in most cases. Keeping the supplement dose to 500 mg daily is safe and may help. Women over 50 or those with low stomach acid should avoid calcium carbonate. It is poorly absorbed. In general, keep calcium carbonate to a minimum and choose other forms. Remember that calcium, like all minerals and vitamins, doesn’t work in isolation. Be sure to get plenty of sunlight for Vitamin D production and magnesium from walnuts and sunflower seeds, and include supplements for them as well, if needed. In summary, fresh green vegetables should remain your primary source of calcium. And please avoid dairy, it is inflammatory, increases acne, and it is associated with weaker (not stronger) bones. That is truly what the data shows! Now go eat a wonderful green salad and some sautéed greens! Good luck and good food choices always! *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2016/04/step-away-from-the-calcium-supplement/

3 Simple Tips for a Healthier Gallbladder

As if women with PCOS don’t have enough on their plates to deal with already, add another to the list- gallbladder dysfunction and gallstones! Yes,  it’s true… many women with PCOS also have problems with the workings of their gallbladders. But please, don’t despair. There are many options to help your gallbladders function better, and when they work better, all of you will work and feel better! Let’s begin with some gallbladder basics. Do you even know why you have one? And why is it even important, as many women have their gallbladders removed and no one seems to bat an eye! There reality is that, like all organs we were are born with, the gallbladder serves a very important purpose. Should yours have been removed already or truly must be removed in the future, please don’t think that it doesn’t matter and then make no accommodations for its loss.

What is a gallbladder and why do you have one?

The gallbladder is a very important part of digestion … don’t part with it lightly or readily. The gallbladder is a storage vehicle. It holds cholesterol and bile, secreted by the liver. Bile is truly a fascinating creature. It, like many things in the human body, is an amazing multitasker! Bile is vile! Well… just sort of. Bile is the toxic waste material created by the liver in the process of detoxification, also known as biotransformation, of your body’s own old hormones and neurotransmitters, and of environmental toxins and pharmaceuticals. It really is toxic waste!! But it’s amazing stuff. It is also an emulsifier. When you eat fat, you need to break it down into its little component pieces and then digest and absorb it. Please don’t think fat is evil. Actually, it is essential to life, which is why fats are called essential fatty acids. You truly cannot live without fats in your diet. You need a proper balance of the different types of fats, and many women are deficient in the type called Omega 3, which is primarily obtained from fish and somewhat from plants like flax seeds and walnuts. Many of you have probably heard that olive oil and coconut oil are healthful fats. So is the fat in the yolk of organic eggs. We will talk more about fat another time…for now, take me at my word that fat is essential to life and you need bile to help you digest it. Back to bile… it is a natural emulsifier. That means it can take a fat and turn it into being water soluble, so it can mix with water! This is truly like a miracle. You probably know that if you have greasy hands and simply run them under the water faucet, the hands stay oily. If, however, you rub in soap, the grease will be able to be washed off your hands without a problem! Soap is an emulsifier-it makes fat able to be washed off with water. Without bile, you simply can’t digest fats, and with the fats come the fat soluble vitamins… like Vitamin E, A, K, and D! These vitamins are essential to proper functioning! If you don’t have a gallbladder, or the one you have doesn’t work well, you will naturally have difficulty with your digestion of fats and of fat soluble vitamins!! If that’s the case, you need to actually take bile at the beginning of each meal. This type of bile comes from an ox! It’s the closest we have to human bile, and it works well. You also need to take digestive enzymes as well because that nearly always becomes a problem when the gallbladder is gone or malfunctioning. The gallbladder triggers the pancreas to release it digestive enzymes. It is very important that you do this, or you’re quite simply not going to digest your food properly! Women with PCOS have enough issues…malnutrition shouldn’t be one of them!

What goes wrong?

So why do women with PCOS have problems so often with their gallbladders? It’s related to gastrointestinal problems in general, and women with PCOS are renowned for what we term “gut problems.”  Many have irritable bowel syndrome (IBS) with constipation or diarrhea and general gut issues, acid reflux (GERD), dysbiosis (the wrong gut bacteria), and sometimes even more serious inflammatory bowel disease. There are quite a few theories as to why PCOS women how so many gastrointestinal problems, but it is known for sure that many have what is called “leaky gut” and  small intestinal bowel overgrowth, along with many food allergies, sensitivities, and autoimmune states as well. Because of these issues, the proper signals to the gallbladder don’t occur and it becomes sluggish, can actually get sludge in it, and it can even progress to gallstones. Just because you have sludge or stones does not mean the gallbladder must go! Only if you’ve had recurrent pain, pancreatitis, or infection, is it then absolutely necessary to have it removed, but remember you’ll absolutely need a bile and digestive enzyme supplement.

What can you do?

Some PCOS women get gallstones or sludge because she goes on a low fat diet for a long time. I don’t recommend a woman go on such a diet!! That is not the way to get healthy! You already know that fat is essential to life!! I believe strongly that all women with PCOS should have their GI tracts checked out for overgrowth of bad bacteria, small intestinal bowel overgrowth (SIBO), issues with low levels of stomach acid and digestive enzymes, constipation or diarrhea, stomachaches, and the like. Please…do not go on a low fat diet…nor should you go on a prolonged very low calorie diet…as that too will make you more prone to gallstones. If you do have gallstones and you haven’t had severe pain, infection or pancreatitis, get another opinion before having your gallbladder removed. Often women can live a long and normal life with gallstones. With gallstones, you’ll want to do a liver detox regularly, eat a healthy amount of good fats, work on stress as that is so unhealthy for the gut, and you can even consider medication to try to dissolve your gallstones if you meet the criteria. In general though, my first choice, as always, is to try to work with you simply with a lifestyle approach. The key take-home points are that we should:
  1. try hard to maintain good gallbladder health by eating healthy fats,
  2. getting the GI tract checked out by a good doctor who understands what is needed for PCOS women, and
  3. if you have gallbladder issues already or have had yours removed, get on bile and digestive enzymes right away!
Remember, stay positive and focused on doing the right things to maintain your health, at least most of the time!!! Good luck and give your gallbladder a virtual hug today!
Here are some supplements that Dr. Gersh recommends for gallbladder support.  All from Pure Encaspulations.  1. Digestion GB  1-2 with each meal Contains gall bladder digestive enzymes, bike salts, taurine, and herbal extracts to promote healthy gall bladder function and fat utilization. 2. Digestive Enzymes Ultra with Betaine HCl   This is for those women who have additional issues with digestion, and can use the addition of stronger digestive enzymes and some stomach acid to facilitate digestion. I normally recommend that women be seen by a physician such as I to embark on these sorts of supplements, as I think Gut Healing should involve healthcare professionals. 3. Heartburn Essentials or DGL Plus  These are great products for those who have heartburn and indigestion. Take one at the start of meals and for symptoms should they occur.  4. GI Fortify  Great product to support a healthy GI environment, bowel regularity, colon cell function, and detoxification and support production of short chain fatty acids.  I prefer the powder but the capsules are great if powder not preferred. For a great gallbladder cholegogue, try Vitanica’s Bitters Extra-it helps stimulate the gallbladder to contract.
*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2016/03/pcos-and-gallbladder-issues/

Flagship Project on Precision Medicine

March 1, 2016 Flagship Project on Precision Medicine for Underserved Women Will Advance Learning Health System Washington, D.C. - On February 25th , President Obama participated in a panel discussion at the White House Precision Medicine Summit Initiative (PMI), marking the one year anniversary. The panel featured remarks from inspiring patients, researchers and others working in the PMI field. More than 40 private-sector organizations and a variety of federal agencies are making commitments to new actions and principles that are spearheading the Precision Medicine Initiative. One such flagship project, "Precision Medicine for Underserved Women with Polycystic Ovary Syndrome (PCOS)," aims to align precision medicine with the vision embodied by the Learning Health System (LHS) Core Values. The PCOS genetic disorder causes infertility that eventually ends up in a disease state of diabetes, heart disease or cancer creating an enormous cost to the healthcare system. The Learning Health Community, a grassroots, multi-stakeholder movement aimed at transforming our nation's health system into one that is capable of engendering learning from every experience of every consenting patient, and rapidly feeding back lessons learned to empower better decisions that improve people’s health. President Obama said, "The (PMI) goal is to create a common database of ultimately a million people that is diverse. Ultimately we can take a disease that may be rare and start seeing patterns we may not have seen before.” Marc Wine, a supporter of the LHS - Precision Medicine PCOS Project and participant in Learning Health Community initiatives, who attended the summit hosted by the president said, “One goal is to seek collaboration with underserved communities in genomics, open data and integrative medicine. This will result in engaging individual patients in ways that will move them from dependency on fragmented healthcare to the point where patients can use their own evidence-based genetic information to make the very best health decisions.” The Precision Medicine PCOS Project is aimed at developing a protocol for women with PCOS while employing an integrative medicine approach to treatment based on the participant’s molecular makeup, clinical data and available scientific knowledge. The PMI includes ongoing efforts through the Department of Veterans Affairs (VA), the Department of Defense (DOD), the Food and Drug Administration (FDA), the Office of the National Coordinator for Health IT and the Office for Civil Rights, all in line with Vice President Biden’s Cancer Moon-shot initiative. “The LHS is the fabric that weaves together and enables various use cases aimed at improving health including precision medicine, Patient-Centered Outcomes Research (PCOR), public health surveillance, patient engagement, quality improvement, patient safety, and further uses not yet envisioned,” said Joshua C. Rubin, JD, MBA, MPH, MPP, a leader in the LHS movement. The LHS vision has been the subject of over 16 reports of the Institute of Medicine since 2007, and now represents the pinnacle goal of federal health IT strategic planning for the coming decade. Through aligning the LHS - Precision Medicine PCOS project with this larger vision, the project team is working to ensure that infrastructure and key components created to advance this flagship project will support future use cases. The Precision Medicine PCOS Project was recently launched in Atlanta at Medici Medical Arts Clinic, with Chief Medical Officer, Dr. Sonny Dosanjh and a group of 37 women who have PCOS, a complex and chronic syndrome that affects 7 million women in America. Ten of these initial women will form the Patient Advisory Team resulting in ongoing involvement in systems design, learning and education systems and participating in the use of their molecular data. This provides unique involvement so women with PCOS will have access to not only their data, but also how the clinical support and care is delivered individually. By building such efforts upon a sturdy foundation of Learning Health Systems “Core Values,” this Precision Medicine PCOS Project will collaboratively build the big data, Artificial Intelligence infrastructure large enough to include all individuals and populations through open knowledge sharing. The Precision Medicine PCOS Project with LHS, aligning with the president’s PMI and the underserved, has taken the initiative to launch its innovation in Atlanta, phasing-in a large cohort of women with PCOS which is the number one cause of infertility in women. As a complicated endocrine and metabolic disease, PCOS has received limited attention by the medical community. Of the estimated 7 million women with PCOS, less than 0.1% of the NIH budget is focused on research to help these women. This Precision Medicine PCOS Project was started in December 2015 and may be the largest ever project to use state of the art genetic and molecular research, science, evidence-based integrative medicine and technology to help this growing underserved community of women. The Precision Medicine PCOS Project is acting to build a nationwide collaborative to empower women with PCOS to manage this complex genetic disease throughout their lifetime. The project’s leader and Founder of Open Source Health, Inc., Sonya Satveit, said, “As women, we have been underserved in healthcare for too long, if I can make a difference, I have accomplished my life-long dream. To have such an incredible team, that shares my passion, come together around this critically underserved area of women’s health, gives me confidence that we will make a difference and give hope to women with genetically caused infertility. “ The project expects to see the first results in late 2016. For more information see: Open Source Health, Inc.: http://opensourcehealth.com/ Learning Health Community: http://www.learninghealth.org The White House Precision Medicine Summit: https://www.whitehouse.gov/blog/2016/02/25/precision-medicine-health-care-tailored-you

Research News: PCOS and Autism Risk

The very word…AUTISM… Brings deep fear to the hearts of every mother and future mother. We all envision having a beautiful and healthy baby, fully capable of interacting with us on all levels. Having an autistic child is a one of a mother’s greatest fears. When the story hit the news a few months back that women with PCOS have a higher chance of having a baby with autism, it was one more dagger into the hearts of women with PCOS, who already have some much to deal with. Just having fertility problems isn’t enough!? Before we all panic, let’s look for a moment at what the study actually said, even assuming its message was correct. It said that the overall incidence in Sweden of a baby with autism is 1.5%. If a woman had ever been given a label of PCOS, the risk rose by 59%, based on the registries for children diagnosed with autism between 1984 and 2007. That would mean is that for every 100 children, the chance of one having autism would rise by about .8 children per 100. That would mean that for every 100 children born to women with PCOS, there would be less than 1 additional child born who has autism per the 100 children. So though the statistics said the risk rose 59% for a woman with PCOS to have an autistic child, in absolute terms, the overall increased chance of having a child with autism was still quite slight. Statistics are a funny game, and one can play with the numbers to make risks appear dramatic when they are minimal. There are terms used… absolute risk and relative risk. Relative risk can inflate the appearance of risk dramatically while the absolute risk remains small. For example, the chance of something is 1 in 10,000 and with an intervention rises to 2 in 10,000. That is a doubling of risk… so high! But in real, or absolute terms, the risk still remains very tiny. As well, reviewing data from years ago based on records, can be very misleading since a teenager with acne may have been labeled as PCOS incorrectly… realize that all that was needed was one chart notation on one occasion to give the label of PCOS to a woman. So the take home message here is that even if this study is accurate in its conclusion, which is not necessarily true, the real risk of a woman with PCOS having a baby with autism is still very low. Let’s talk a bit about why autism may occur and what you can do to actually lower your risk. The human brain is amazingly complex and is created during the fetal development in utero and continues after birth. What is critical to proper brain development is clear… you need the full array of nutrients and the avoidance of brain toxins. The first thing a woman must do to increase the odds of having a baby with a healthy brain is to get fantastic nutrition before conception…. high levels of omega 3, Vitamin D, folate and all the B vitamins, plenty of phytonutrients antioxidants like Vitamins C, A, and E. Avoid exposure to toxins as much as possible… get a water and air purifier, buy all organic food, avoid plastic contacting your food, use organic skincare products and makeup. Also… control stress, get exercise, and plenty of sleep at night, and reduce exposures to electromagnetic radiation. Get to a healthy weight by eating mostly fresh vegetables, some fruit, raw nuts and seeds, and avoid all processed foods and added sweeteners… real or synthetic.  Space meals throughout the day. Get outside if possible and walk barefoot on grass or sand when weather permits, and take up meditation or guided imagery. Use a far infrared sauna pre-conception if possible, and do a supervised detox. All I’ve suggested will likely make you healthier and a healthy you creates a healthy baby. Try to breast feed for at least one year, preferably two, and give yourself and the baby probiotics to help the gut microbiome stay healthy as well. The topic of vaccines is a sensitive one, but there are some experts who advise higher risk individuals to delay all vaccinations for at least the first year of life, a critical time for the baby’s immune system to develop. It’s a challenging political issue, so that’s about all I’ll say on the topic at this time. Women with PCOS have many challenges to deal with, but as we are learning more and more about the intricacies of the human body, these challenges can be met and you can overcome them and live the life you desire and deserve. *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2016/02/pcos-and-autism/

Depression and Anxiety in women with PCOS

Depression and Anxiety in women with PCOS December 25, 2015 January is a month when many feel the effects of the holiday season coming to a sudden end. The decorations must all be put away; there is often a big mess of discarded wrappings to deal with, thank you notes calling to be written, and health resolutions to write - and often to discard just as quickly. For many, unfortunately, January is a “down-mood” month, one with long, cold days and long, dark nights; when we are often faced with a stark reality, without the joyous festivities to hide behind! And for those with PCOS, to add to the general “down-ness of January,” is the fact that mood disorders are increased in women with PCOS compared to women without this condition. In fact, all women with PCOS, at all times of the year, should have an initial evaluation to include assessment of mental health disorders. The prevalence of depression in women with PCOS is high and varies from 28 to 64%, while the prevalence of anxiety in women with PCOS ranges from 34-57%. In recent years, the complex relationship between PCOS and psychosocial issues has come to the forefront, with a prominent link found between specific features of PCOS and mental well-being. The fact that many women with PCOS experience menstrual dysfunction and infertility, hirsutism and obesity, along with cystic acne, creates a situation which can clearly result in profound psychosocial distress. In one interesting study from South Asia, researchers found that in comparing hirsutism and obesity, more depression was related to the presence of hirsutism. The scientific literature now shows clearly that anxiety levels, psychological distress, depressive feelings, and social fears are all markedly higher in women with PCOS. The reasons for this increased vulnerability to depression and anxiety and for women with PCOS to develop psychiatric disorders are still unclear. But in addition to the negative mood reactions to the visible symptoms of PCOS, there are others which likely involve pathways independent of these visible symptoms. In one study of 300 women, nearly a third had anxiety, and quality of life was lowest in those with a combination of stress and depression. Stress is one of the common mechanisms that induce psychological disorders. This occurs via the hypothalamic-pituitary-adrenal (HPA) axis and involves circadian rhythms. With significant stress, there is alteration of the HPA axis and disruption of the circadian rhythm, altering the functional relationship of the brain with the endocrine systems, resulting in adverse impacts on health. Women with PCOS have a higher level of sympathetic output from their adrenal glands. They tend to have higher outputs of cortisol and adrenaline, and to have dysfunctional melatonin, and therefore more inflammation and poorer sleep.  The higher levels of cortisol and adrenaline make those women more prone to anxiety and sleep dysfunction, adversely affecting mood. Women with PCOS have an exaggerated response by the sympathetic nervous system, with a heightened response to negative stimuli compared with non-PCOS women. They have an abnormally increased cortisol response to physical and psychological stressors which cannot be explained by their BMI, increased percent of body fat, fasting insulin, or elevated androgen levels. Indeed, there is an independent and inherent mechanism exaggerating the stress response, in a negative way, for PCOS women. Additionally, there is evidence of an increased incidence of eating disorders and suicidal behavior among PCOS women. Sadly, they are at an increased risk of social phobia and suicide attempts. But none of this means that women with PCOS can’t have full and wonderful lives. All this means is that it must be recognized that PCOS women have an added risk for adverse reactions to normal stressors and are more prone to anxiety and depression. Therefore, more active and proactive management is necessary. Women with PCOS need to cultivate coping mechanisms, and there are many to choose from. The maintenance of the emotional well-being of women with PCOS needs more nurturing than what is needed for the average woman. But with such support, every woman with PCOS can achieve mental, emotional, and spiritual health. The ways to achieve emotional happiness are many, and all can be combined to satisfy each individual woman’s unique needs. Some of the effective methods are the varying forms of meditation, hypnosis, the Emotional Freedom Techniques, including tapping, Tai Chi, Chi Gong, yoga, massage, baths, acupuncture, cognitive behavioral therapy, essential oils, and my own personal favorite, guided imagery. I utilize several techniques for my own stress therapy, emphasizing baths, essential oils, and guided imagery, but all can be amazingly effective! Each woman must try out several and discover what works particularly well for her. If you feel especially down or stressed, be sure to seek assistance and find your personal path to emotional, spiritual, and mental well-being. Do not delay even a minute getting help if you have any tendencies towards self-harm! Please contact me if you are seeking PCOS medical care and do not know where to turn.  

Attention PCOS Moms : Diagnosis and Treatment of PCOS in Young Girls

Most doctors and patients alike believe that PCOS is a condition which appears in the teen years, following the advent of puberty and the onset of periods. In reality, shocking as it may seem, PCOS begins at birth! Now how, you may ask, can that happen? Doesn’t puberty herald the onset of all the medical challenges faced by young women with PCOS? The answer to that question is: mostly so, but there are signs and symptoms early on, and there can be early detection! Here is the story of the beginnings of PCOS, and with this knowledge comes the capability to predict with reasonable, if not perfect, accuracy whether or not your daughter will develop PCOS. With that knowledge comes the power to begin treatment BEFORE all the misery that you know all too well ensues. While in utero, because of the ubiquitous toxins surrounding us all, everyone becomes exposed to numerous chemicals, including ones which act as endocrine disruptors, particularly Bisphenol A (BPA). Such exposures alter the very foundational development and function of hormone receptors. Here's what happens: endocrine disrupting chemicals enter the pregnant woman’s body through various means and then cross the placenta. They thereby gain entry to the baby’s body, where they actually concentrate in greater quantity than in the mom’s body! This sad fact has only been recently realized. Researchers, measuring the chemical levels in the moms, often found low levels and concluded they were below the threshold to cause problems, while being unaware that the levels of that chemical were actually much higher within the baby. Chemical endocrine disruptors are like cheap knock-off imitations of real hormones. They can attach to receptors and act in one of many ways - mimicking the real hormone, blocking the action of the hormone, or something in between. Since estrogen has three different kinds of receptors, the end result can be hormonal chaos, as the various organs of the developing baby’s body simply do not get the right exposure to hormones, particularly to estrogen. The baby is born with a “confused” hormonal system, unable to respond properly to certain hormones due to the abnormal function of their receptors. This is in addition to the endocrine glands' inability to manufacture these hormones properly. When there is a problem with the functioning of the estrogen receptors, systemic inflammation occurs. This occurs because estrogen functions as the master of metabolic homeostasis. This means that estrogen controls a female’s appetite, energy usage, metabolic rate, location of fat deposits, and how fat functions. Estrogen is truly the mastermind of all that is female and metabolic! Young girls born to PCOS moms have about a 50% chance of developing PCOS themselves. Given those odds, it is really imperative for us to diagnose, with some reasonable probability, which of those daughters will and which won’t have to deal with PCOS. And there are ways to reasonably identify young girls as having a high predilection to develop PCOS. From a physical point of view, here are the suspicious symptoms. If a very young girl, from approximately age 4 to 12 years of age, has an unusual amount of waist and belly fat, in spite of eating quite well, this is a powerful clue. Estrogen regulates where fat is deposited and how it functions, so young girls destined to get PCOS may be showing signs of abnormal fat deposition and already have difficulty maintaining a healthy weight, well before puberty sets in. There is also a blood test which has good predictability for detecting PCOS prone girls and that can be administered as early as age 6. This test is called Adiponectin. I order it through the Cleveland HeartLab, a very prestigious cardiovascular laboratory, affiliated with the renowned Cleveland Clinic. Adiponectin is a type of hormone made by adipose (fat) tissue and is extremely important in preventing inflammation, insulin resistance, and obesity. It is involved in managing how fat tissue functions, the level of inflammation in the body, how energy is produced and stored, and the transport of glucose from the blood into cells, impacting insulin resistance. Estrogen controls the production of Adiponectin. In girls prone to develop PCOS, the Adiponectin levels will be unusually low. The finding of low Adiponectin levels raises a big red flag that a girl is at high risk to develop PCOS. The potential for Adiponectin to be used as an early screening tool means that for these girls proactive therapies can be initiated to lower the chance of PCOS becoming severe. Lifestyle changes involving diet, sleep, stress, exercise, and nutrition can all be implemented to greatly soften the blows which occur with the passage through puberty. I would be happy to assist any who have daughters they would like evaluated for PCOS risk status. I can see and examine them and order Adiponectin, as well as all indicated inflammation testing. I strongly advocate for a proactive approach to all diseases in order to prevent the devastating effects of an advanced disease state. This philosophy is particularly applicable to PCOS to ameliorate the suffering so many with the condition must endure.

Interview: What is the Most Critical Factor of PCOS

“The most critical factor in all of the issues facing women with PCOS is systematic inflammation and its origin which is probably in the gut,” explains Dr. Felice Gersh in our most recent interview.  Dr. Gersh is a doctor of integrated medicine and a renowned expert on PCOS.  Our conversation was wide ranging as she clearly explained the origin of many of our toughest symptoms.  The gut-brain-hormone link can be a delicate balancing act, but once we get it worked out, Dr. Gersh assures, our physical and emotional health will radically improve.  Listen in and learn:
  • Why the gut is called the 2nd brain
  • What steps to take in order to calm and treat GI inflammation
  • The impact of stress, emotions and anxiety on your gut and overall health
  • The link between nutrient deficiencies, leaky gut, insulin resistance, acne, hair loss, Hashimotos and other auto immune disorders
  • How mouthwash is ruining your arteries
  • Foods and supplements that can help repair your gut and reduce inflammation
  • The extreme dangers of pharmaceuticals like Prilosec, Prevacid and Nexium
A complete transcript can be found below. Amy: Hello, and welcome to another PCOS Diva podcast. This is Amy Medling. I’m a certified health coach, and I’m the founder of PCOS Diva. I’m really glad that I’ve been able to welcome back Dr. Felice Gersh. She’s a regular contributor to PCOS Diva, and she’s going to be talking to us today about inflammation and the gut. If you’ve been a frequenter of PCOS Diva, you’ll notice some of the wonderful articles and podcasts that she shared about inflammation and one about gut biome, and we’re going to bring both of those topics together in this podcast as we talk about inflammation in the GI tract.  Welcome, Dr. Gersh.  Felice: Well, thank you so much, Amy. It’s a pleasure to be back and to talk about what is really about the most critical factor in all of the issues facing women with PCOS, and that is systemic inflammation and its origins, which probably are within the gut.  Amy: I just want to give listeners just a quick bio for you. I know your area of expertise. You are one of a very small number of fellowship-trained integrative gynecologists in the nation. You blend the best of the world of natural and holistic medicine with the state-of-the-art functional and allopathic medical treatment.  You have a real extensive knowledge of the complex interrelationships of the body’s organs, so you’re looking at all aspects of health, working to reestablish a healthy gastrointestinal tract, adequate sleep, good mood, great nutrition, high energy, balanced hormones. It really takes this holistic approach.  You also are a gynecologist, and you are working on a book about polycystic ovarian syndrome. Just wanted to give everyone that overview of where you’re approaching the topic about inflammation in the GI tract.  Felice: Oh, yes, absolutely. I became very disgruntled back quite a few years ago as I looked at what was happening in conventional medicine in most areas involving women’s health and in particular with women with PCOS, when the only thing that women were offered were birth control pills and a few pharmaceuticals which have a limited amount of impact and didn’t at all deal with the underlying issues.  I had to go and delve and research and learn mostly on my own and with making wonderful connections with people like you so that we could actually really delve deeply into what is really happening with women and what can we offer them. It became clear with PCOS that inflammation is an overriding and consistent element of this condition, and that’s why I’m so excited to really talk about it and some of its underlying ideologies which involve the GI tract and, of course, how it interplays with every other organ in the body.  Amy: Recently, I’ve been posting little snippets, I guess, info bites of information for PCOS Awareness Month, which is in September. I posted something about how leaky gut and specifically, I guess, irritable bowel syndrome, there was a 2010 study that found that women with PCOS had an increased likelihood of irritable bowel syndrome, posted that little tidbit of information and then some more information about leaky gut syndrome and how it relates to PCOS.  I was really floored by the comments and the amount of women that are affected with gastrointestinal tract distress. That’s why I was really excited that you were going to come and speak to us about that today. Maybe you can give us an overview of what the GI tract is and how we can calm some of the inflammation that’s going on there.  Felice: Well, of course. It’s definitely become a focus of attention these days, and rightly so. The GI tract is often called the second brain. We know that there’s more neurotransmitters produced, for example, serotonin, in the gut than in the brain itself. As well, there’s a very intimate connection between the gut, which includes the entire GI tract, and the brain, which is now known as the gut-brain axis. In addition to many, many ways of communication between the brain and the GI tract, there’s a nerve, the vagus nerve, which is like a direct conduit, avoiding and not even requiring use of the spinal cord to communicate very directly to the GI tract.  Whenever a woman, we’ll say we’re talking about women, has any sort of emotional feelings like anxiety or depression, the vagus nerve suddenly transmits that information to the GI tract, which will then respond and become altered in term of its motility, and then as well inflammation develops, the wrong types of bacteria can overgrow and set up a whole cascade of events which can lead to things that are the grab-bag label of irritable bowel syndrome, which of course is just a symptomatic label. There are really things that are going on beneath the surface that are really very critical to the function of the GI tract, which of course relates to every other organ in the body.  Women with PCOS are particularly vulnerable to GI issues, and I would say that close to 100% of women who have PCOS have some sort of GI problem even if they are not even aware of it. Women with PCOS have distinctly abnormal mouth microbiota. The bacteria that grow in their mouths, they’ve actually checked, and they’re different from another woman who’s matched in the same age group.  Then when you talk about irritable bowel syndrome and people have emotional issues and women with polycystic ovary syndrome, they tend to be what we call sympathetically upregulated. Their sympathetic nervous system is sending out more signals than it should, and so they’re upregulated. Sympathetic nervous system is involved in the fight or flight, when women are feeling anxious. Their heart will beat faster, they’ll sweat, they’ll have GI symptoms which usually are acid reflux and sometimes diarrhea and have to go to the bathroom to urinate more frequently.  All the things that you think about with anxiety, they’re related to upregulation of sympathetic nervous system, and we now know that women with PCOS tend to have more of that happening in them, which then translates to more GI issues. They tend to have more irritable bowel syndrome, which is often now recognized as related to having what we call “SIBO” or small intestinal bowel overgrowth.  Because of reduced stomach acid production and the sphincter between the colon and the small intestine not really working well, you have the bacteria coming up into the small intestine from the colon and from the stomach down into the small intestine, so you have bacteria overgrowing in the small intestine where it doesn’t belong. This creates inflammation as this bacteria overgrows.  Then as you eat food that has fiber, healthy fiber, the bacteria in the small intestine start to ferment it, which should not happen until it reaches the colon because you have too many of these bad bacteria growing in the small intestine. Then they get bloating and gas, and depending on what the different products of fermentation are, if it’s methane, then they get diarrhea. If it’s hydrogen sulfite, then they get constipation, and it can alternate between the two depending on what the foods are that they eat and the bacteria overgrowing.  Then they get an overgrowth of mucus in the small intestine, which then prohibits proper digestion and absorption of nutrients. Many women with polycystic ovary syndrome will have nutrient deficiencies that are critical to different B vitamins such as magnesium, which of course have a big role in how they work with their metabolisms and glucose transport, so you can see how this is like a snowball effect.  Then they get the wrong bacteria overgrowing in their colons or they don’t even have what they call “good diversity,” which is another whole big area that they don’t have the right bacteria, they don’t have enough different species of bacteria, so they don’t do the proper fermenting of the fibrous products that they eat in their food in their colon and then they get different problems down the line as well.  It’s from top, from the mouth, all the way down. Of course, if they have reduced stomach acid which is also very common, especially with stress and nutrient deficiencies, because it’s, once again, with the snowball effect, if you don’t absorb the nutrients and you don’t have enough zinc and you don’t have enough thiamine which is vitamin D1, then you don’t produce enough stomach acid. Then when you don’t have enough stomach acid, the sphincter between the stomach and the esophagus doesn’t close, and then you get reflux and then you get inflammation in both the stomach and then the esophagus. Then, of course, you mentioned leaky gut. When you have inflammation in the gut, the little single-celled barrier that keeps the contents of the intestine from transferring and crossing into the body itself proper is no longer intact. You can have particles of partially digested protein, which we call peptides, can cross over into the regular part of the human body where 70% of the immune system resides, lining the gut, and that’s called the GALT, the gut associated lymphatic tissue.  Then you’re starting to upregulate inappropriately the immune system, creating cytokines, these inflammatory products, and also the immune system can then get disregulated and start making antibodies against these protein peptides. Over time, the body gets confused and starts making antibodies against yourself, and that’s why so many women with polycystic ovary syndrome also have autoimmune conditions like Hashimoto’s thyroiditis. That’s very, very common, and they get passage of these other things called LPS, lipopolysaccharide, which are products from the Gram-negative bacteria that overgrow also in the intestinal tract. These also upregulate the production of inflammatory particles called inflammatory cytokines. The cascade just continues. These cause insulin resistance and upregulation of production of IGF1 and insulin, which then causes in the self more testosterone production, and then we know where that goes, when you have too much testosterone, and then they get acne and hair loss. You can see where at the center of all of this, it comes down to what’s going on in the gut, and that’s where you and I come into play, because we can give advice to try to help stop this overwhelming cascade snowball effect of things that are happening that are starting within the GI tract.  Amy: Yeah, and I think, after listening to that, I think a lot of us just say, okay, I’m just going to throw up my hands. What is there to do? It seems like the chips are stacked against me, but I think that there are a lot of things we can do.  Felice: Oh, absolutely, Amy.  Felice: It is overwhelming to hear “this” then “that” and it goes to “this,” but if you break it down one by one, what can we do? Well, number one, honestly, start with stress reduction, because the sympathetic upregulation is controlled through your moods, and there are wonderful things that you can do, whether it’s guided imagery, meditation, progressive relaxation, just taking a walk on the beach in your bare feet. There’s so many things that you can do to start to downregulate, subdue that sympathetic tone, and get that vagus nerve quieted down to really … because if you don’t deal with emotions, I’m telling you, it’s going to be very difficult to really override a lot of the other things.  Really, start with your attitude and say, you know what, yeah, there’s a lot of stuff. I don’t need to know all of the science. All that stuff I just threw out, all you need to know is, we’re going to work on your emotions, you stress, your sleep, your circadian rhythms, like working with nature, see the sunset every day, go to bed at a reasonable time between 10:00-11:00, don’t do a lot of computer work, don’t suppress your melatonin and trigger more cortisol.  I didn’t mention this, but when you have stress you have more cortisol, which creates more inflammation in the gut. That’s why you’ve got to control this stress and the emotions and recognize that if you’re indoors all the time, you’re not going to get enough vitamin D, which is also very important. Get out in nature and just take a lot of deep breaths and say, you know what, I am in control over this, I can handle this. You can, and we know, I have so many patients who have taken their lives back.  The next thing after you deal with the whole emotional thing is what you put in your mouth, because you know that we’ve talked about the inflammatory diet. How often has that come up? You don’t want to eat foods that are going to create inflammation, and you don’t want to eat foods that are nutrient-deficient. You want to eat nutrient-dense foods. You want to eat foods that are going to heal your body, and you want to definitely not put in anything that is not a food. We don’t want to eat chemicals. We don’t want to eat a lot of sugars.  I always say, if you couldn’t have eaten it 500 years ago, don’t even consider eating it, because no one has improved upon food from 500 years ago, I can tell you. Eat natural food. Eat from the color of the rainbow and nourish your body. Think of food as more than just entertainment, right? We’re getting to basics. Food is survival. Food is how you nourish your body. Every cell in your body needs the right nutrients in order for it to function properly.  You want to eat nourishing foods and you have to do a little experimentation, because if you do have small intestinal bowel overgrowth, the very high fiber foods may not agree with you at first because you’re fermenting in your small intestine. That’s where you need to work with a doctor who is understanding of these things, because sometimes we have to do other dietary maneuvers first and actually give you lower-fiber foods initially and then deal with doing herbals and such to kill out the bacteria in the small intestine before we then feed a lot of fiber.  These are things that have to be managed professionally if you have a lot of serious GI symptoms. We don’t want to, I don’t want you to micromanage yourself, but I want you to understand what can be done and start with the foundational things of eating real food and foods that are not containing chemicals and such.  These are things that have to be managed professionally if you have a lot of serious GI symptoms. We don’t want to, I don’t want you to micromanage yourself, but I want you to understand what can be done and start with the foundational things of eating real food and foods that are not containing chemicals and such.  Amy: I do think that that is a real issue for a lot of women. They’ve been eating the standard American diet and now they have a PCOS diagnosis or they’re ready to start taking control over their PCOS. They start eating a densely whole-foods-based diet like you were just mentioning, nutrient-dense, but most of those foods are high in fiber, and then they have gastrointestinal distress.  Felice: Right.  Amy: You mentioned finding a doctor that understands these things.  Felice: A challenge, I know.  Amy: Yeah, so what kind of … Is it a GI doctor? A functional medicine doctor? What would you advise?  Felice: I would always say, if possible, find a functional medicine doctor. Of course, if people can travel to me, we do have an away program for people that don’t live in my neighborhood and I can work with them to get them started. Really, I hate to say it, but many of the conventional gastroenterologists, they really are not looking below the surface. They do a lot of scopes. They’re very good at detecting cancer and giant ulcers, but they’re not very good at managing and fine-tuning the gut function. That’s not really what they were trained to do.  You’re much better off finding a functional medicine doctor or a naturopathic doctor if you can’t come in, say, to see me, because they are much more geared towards the function of the GI tract and healing the GI tract. There is no magic bullet, and you really have to look at each individual. Like I said, if you start eating really healthy foods and lots of roots vegetables and beets and things and then you feel worse, that’s really clear-cut evidence that you have small intestinal bowel overgrowth or SIBO and you’re fermenting in your small intestine where you shouldn’t be.  You really have to get that cleared up, and that is not something that you should be working on on your own, truthfully. You really need to get a functional medicine doctor to work with you on cleaning up your gut and getting the bad bacteria out of your small intestine.  Amy: Okay, so once you’ve done that, how do you keep, I guess, feeding your gut the good stuff? How can you move forward to create optimal gut health?  Felice: Well, one thing is, and we had talked about this a little bit, which was starting with the mouth. The mouth is the forgotten part of the GI tract. People just don’t think about it, but the idea of cleaning up your mouth in terms of getting rid of harmful bacteria without killing the good bacteria, 99% of the bacteria in the mouth are the good guys. One thing, never use mouthwash. That stuff is poison. I know they say, “kills germs on contact,” but, remember, the germs are our friends. They are doing amazing things. If you do not have the right bacteria in your mouth, you can’t make a critical substance called nitric oxide, which is made in the stomach, which is a gas which diffuses out of the stomach and it goes into the arteries and it’s what maintains artery health, which is a problem for women with PCOS. They often have what they call “endothelial dysfunction” or the lining of the arteries are not healthy, and you need to have nitric oxide but you need to have stomach acid and you need to have proper bacteria in the mouth. Get rid of all mouthwashes that are chemicals. We don’t want chemical mouthwashes.  Now, you can use sometimes natural things, like we had talked about, like the sesame seed oil. Organic sesame seed oil can be helpful, and I actually went on PubMed and looked it up and there are quite a few published articles. There are some other things like bilberry extracts and other natural phytonutrients that can be swished around in your mouth and between your teeth that are actually very good for cleaning up the gut and the mouth microbiome and helping with healing the gums. It turns out, women with polycystic ovary syndrome often have very inflamed gums. They actually have, there are issues with the mouth that are very unique in polycystic ovary syndrome. Definitely, you want to have regular tooth cleanings and gum … Make sure your gums are clean and get rid of plaque where bacteria can accumulate and proliferate. You want to take care of your mouth.  The other thing that I advocate is, for as much as possible, eat food and chew it as opposed to drinking your food. I’m not against drinking green smoothies. However, recognize that you’re missing the whole benefit of the mouth when you drink your food. I much prefer if possible to chew your food and chew it well like your mother said. Chew it 32 times before you swallow it and mix it with your saliva. Saliva has digestive enzymes. Remember, digestion starts in the mouth, and it’s a very critical part of the GI tract, and take care of your gums and your teeth. We won’t even go into this on this one, maybe another time we can talk about dental amalgams and toxicities and all, because we can’t go into everything in just a little bit of time, but environmental toxins have a big role in also gut inflammation. Our poor mouths are often filled with chemicals, and our teeth and such. The other thing is choose a very good natural toothpaste as well. You don’t want to put chemicals and you don’t want to put little beads of plastic in your mouth. You’ve probably been reading about that. Some of the toothpaste have in them triclosan, which is like a chemical antimicrobial which also kills all the good bacteria. Don’t get a toothpaste that has triclosan in it. They actually sell these little particle … Amy: It’s an endocrine disruptor as well.  Felice: Oh, my God. Yes, it’s an endocrine disruptor, absolutely. These are terrible things and we’re putting them in our mouths and they’re being absorbed and going right down into our intestines. Be very picky about what you put in your mouth as far as things to clean up your mouth. You’re destroying all the good stuff and you’re poisoning your endocrine system as well.  In terms of the esophagus, if you have burning and so on, if you have acid reflux, there are many natural herbal products that include things like slippery elm and a certain form of chewable licorice that they call DGL that can be very coating. These are what we call demulcents, they can coat, and then you can also get marshmallow root. There’s a number … aloe vera juice. If you buy aloe vera juice, be very careful, though.  Make sure it says “fillet only” or “aloin free” or you get the component of aloe vera which is a very, very potent laxative, and you will definitely notice the effects. Make sure that any aloe vera juice you get says “aloin free” or “fillet only,” but aloe is also a wonderful demulcent as well. These are all things that you can, you can go to a health food store to get some of these, or I think you have some of these products as well. Don’t you, Amy? Amy: Yeah, I have berberine, which is an antimicrobial … Felice: Oh, yeah, and I didn’t get into it, like berberine. Berberine, if you have issues with gastritis and you have H. pylori, overgrowth of H. pylori, that’s a whole other big topic, but berberine is excellent, along with some of these other demulcents that I just mentioned, the chewable licorice and the slippery elm and the marshmallow root and bismuth and so on. All these things can be very helpful for getting rid of the H. pylori, along with certain pro-biotics that are very, very helpful. If you take various strains, particularly of the lactobacillus and some of the bifidobacterium, these are very helpful for getting rid of H. pylori. In fact, in studies now they’ve show that they do as well and actually often better than the traditional antibiotic and PPI treatment that they use for H. pylori. Recognize, too, that H. pylori is not a bad guy. It’s a good guy. It’s supposed to be often in the stomach. In fact, there’s some data that show that it’s actually protective against stomach cancer. The problem is when you have everything going wrong in the stomach and you have the wrong types of bacteria and you don’t have the right nutrients and you don’t have enough stomach acid that you don’t have the proper amount of mucus coating in the stomach, and then the H. pylori comes right up close against the tissue of the stomach and then creates ulcerations.  In a healthy stomach, H. pylori should not be treated. There’s been a lot of change in the thinking about H. pylori, so just having H. pylori in a perfectly healthy asymptomatic person should not be treated. That’s really important in case you ever go to a doctor and they say, you have H. pylori. Well, if you’re feeling fine, leave it alone, because H. pylori is not a bad guy. It’s only when you have a sick stomach that then you have, these are what we call, and this is really a very important concept, what are called the “commensal bacteria.”  These are normal inhabitants of our intestinal tract, but when you have an abnormal environment, the friendly guys, the commensals, become unfriendly. It’s kind of like if you have a friendly dog but you put them in a really scary environment and suddenly he acts up, right? It’s really your friendly dog, but you just do the wrong things and then he acts up. You take all your friendly bacteria, but then you do everything to create a bad environment to live in and then they start turning on you and acting up. The bacteria themselves may not be the problem. It’s all the other stuff that’s changing the environment that they’re living in.  It’s a whole different view, a whole world that’s changing in how we’re looking at the whole GI tract. In fact, we’re looking, for the colon, we’re not just looking at what types of bacteria you have. What we’re looking at is overall diversity rather than individual species. What we want is lots and lots and lots of different types of bacteria.  They’ve looked at primitive societies that eat on average 100-150 grams of fiber a day. The typical American has like 5-10 grams. It’s like almost nothing of fiber. They find that the typical American has at least one-third fewer types of bacteria growing in their large intestine, in the colon, and this is really critical because each particular species has a special job in terms of how they digest and ferment the fiber that you eat.  It’s like the poor planet earth where we have different species going extinct on us. What do we do? What happens when they’re gone? What do we do? We can’t replace the carrier pidgeon, right? What happens if they’re gone? They’re gone. Well, the only thing with humans that gives us hope, and there’s research coming down the pipeline, is fecal transplants. If you get tested, I recommend that everyone with PCOS get their GI tested to look at what their microbiome is, we’ve been using what’s been called polymerase chain reaction, PCR. We can actually do DNA assays, and you can actually test your microbiome.  There’s a whole big program going on in the nation that’s called the Microbiome Project that people may have heard of, where they’re looking at typing microbiomes, the bacteria in all different parts of people, in their mouth, in their sinuses, vagina, and in their intestine, to see what is normal, what is typical. You can not be part of that project. You can just get it through labs, and they’re not that expensive, and see what’s really going on inside of you and see if you have overgrowth of bacteria, see if you have low diversity.  In the future, there may be fecal capsules and fecal transplants and things, so that if you have low diversity, you can find a healthy person, and there are still a few of them out there but fewer and fewer unfortunately, and take their fecal microbiome and transplant it into you. In the meantime, there are other things that are being researched like probiotic enemas, but certainly what I recommend and I’m sure you do, too, is if once the small intestinal bowel overgrowth is cleared, to eat a lot of high-fiber foods, natural foods, and also eat fermented foods.  That’s not part of our diet, but in traditional societies eating fermented foods is really a daily event, like the Koreans have their kimchi and there is kombucha tea and then there’s some different types of fermented, of course, yogurts which can be helpful when they’re organic. Real kind, you know, we don’t want processed yogurts with all kinds of chemicals in them and artificial sweeteners and sugars and things.  You can get sauerkraut, and you can make your own. A lot of people I know are fermenting their own vegetables, and it’s not very difficult. Any vegetable that has a crunch you can ferment, and then if you eat it it’ll really help to repopulate your intestinal tract and then you’ll have a much healthier gut.  Amy: I completely agree with the adding the fermented foods. I’ve seen that’s made a tremendous improvement in my digestion. I had Summer Bock, she’s the fermentation expert, on the podcast about a year ago now, and she advocated eating two forkfuls of, it’s really important, raw sauerkraut. Not the stuff that you eat out of a can …  Felice: Oh, yeah, don’t eat it out of a …  Amy: Yeah, don’t heat it up. Felice: No, heat it up and put it on a hot dog. That’s not going to do you any good.  Amy: Right, right, and there’s a wonderful local, here in New Hampshire, it’s called Micro Mama’s, a local company that makes delicious fermented vegetables, and they sell at Whole Foods. I buy a jar of that and have like a forkful a day almost like a supplement.  Felice: That’s probably, yeah, but I’d say a couple of ounces, but that’s probably about the same as two forkfuls. Mm-hmm (affirmative).  Amy: Yeah, a couple forkfuls, and you can put it on your salad or just eat it as is. It’s really easy, and I think it just makes a tremendous difference.  Felice: It does. Oh, it’s such a wonderful thing to heal the gut. These are steps that can change a person’s life. By the way, I find that when people do this and they have cystic acne, it dramatically improves because, remember, the skin is a reflection of your underlying inflammation. Heal the gut, and you’ll heal your skin dramatically. The other thing is, the brain-gut axis is a two-way street. If you have anxiety and depression and a lot of the mental things that are going in your life, it’ll upset your GI tract, but as you heal your GI tract by doing all these wonderful things with your nutrition and herbs and such, then it’ll feed back on your brain and it’ll be brain-calming. It’s a two-way directional event, the brain-gut axis, which is so good, and that’s why there should be tremendous optimism. There’s so much that we can do to make women with PCOS healthier through healing their gut and then healing their emotions, because they go together, and then healing systemic inflammation. Amy: Yeah, and the other thing I was going to mention, I was wondering your thoughts on it, is homemade bone broth.  Felice: Oh, I love it. I’m so glad you brought that up. I have it every day myself, just about every day. I use chicken bones, because I just happen to love the taste and it’s always free-range organic chicken, of course, that’s our goal, but you can use any healthy animal bones to make bone broth. Do you have a recipe? I can go over it, but if you have an easy-access recipe …  Amy: Yeah, no, I have an easy-access recipe on the site.  Felice: Wonderful.  Amy: Just add … I always like to add a couple teaspoons of apple cider vinegar to leech the nutrients out of the bone.  Felice: That’s right. It leeches all the good stuff out of the bones, absolutely.  Amy: Yeah, and it’s something, now that we’re getting into the cooler weather, I always buy an organic chicken every week and roast it, and then you can use that. I roasted mine yesterday and now I’m making Thai chicken chowder for dinner after we get off the call.  Felice: Wonderful. Are we all invited over? It sounds so good.  Oh, I forgot to mention, also along the lines of what you can do with just foods and such, I love a lot of teas, and when you give herbals as a tea, it doesn’t feel like you’re using a medicine, right? Just things like ginger tea is very good for digestion, and ginger is naturally antimicrobial as well, and chamomile, which no one in the past understood how chamomile can be good for the GI tract and it’s emotionally calming. Well, now of course we understand because what’s good for the gut is good for the brain and vice versa.  Chamomile is a wonderful tea, so I encourage people to drink regularly ginger tea, chamomile tea. They’re really wonderful to have. Those are, I think, musts for women with PCOS. Also, if they like peppermint tea, because peppermint also and spearmint tea particularly can lower their testosterone. You can get the benefits of those types of teas as well.  Amy: Yeah, and I have a couple articles on my site about tea and the ritual of tea.  Felice: Great. I love rituals, so that is also wonderful.  Amy: I believe, especially for me, my kids come home from school around 3:00 and I usually go and make a pot of tea before they get home and make sure I sit very mindfully and have a cup and center myself before the craziness of the evening begins.  Felice: I love that.  Amy: Yeah, you have this really fragrant tea and you put it in your, I have a pretty little teapot that I treated myself to. You have to wait for the water to boil and then the tea to steep and you smell the fragrance.  Felice: It is. I think that it’s fantastic to do that. I think there’s a reason why in the British societies they had their 3:00 afternoon tea. Of course, high tea, but skip the crumpets and those …  Amy: Yeah, right?  Felice: The idea of having a late- to mid-afternoon tea rejuvenation time. It’s wonderful, and if you can have the time to listen to a little bit of pleasant music and even go outside. I’m always big on earthing. I don’t know if we’ve talked about the issues with electromagnetic radiation which are pervasive now in our society and really not healthy to say the least. If you can get outside and even take your shoes off while it’s still warm, and you have a limited time now in New Hampshire, but while it’s still warm and just put your feet, run it through grass and so on, and look at the sky and drink your tea. Even if you can’t look out the window and just take in a little … They’ve shown that looking at nature will lower your sympathetic tone and make you feel calmer right there.  I just wanted to also mention before we finish that for women who have irritable bowel syndrome, the pharmacological agents are bad for you. Drugs that block the ability of the GI tract to have motility, drugs like Lomotil, drugs that paralyze the GI tract because you have diarrhea, they’re not getting to the root cause at all and they’re harming you. Please don’t take those things. Go find a functional medicine doctor who understands that you have to heal the gut, not paralyze the gut. That’s not the solution.  PPI’s are evil. They’re so evil if you have acid reflux. Stomach acid is critical. I’ve mentioned that it’s essential to making nitric oxide. Without stomach acid, you don’t trigger the pancreas to secrete its digestive enzymes properly. You don’t get the gall bladder to contract, to release its bile, so you’re going to have increased risk of gallstones. You’re not going to digest your proteins, you’re not going to digest your fats, and you’re not going to get your fat-soluble vitamins. I can’t tell you how terrible it is to take chronic PPI’s. Those are drugs like Prilosec, Prevacid, Nexium, and so on. They are terrible, and you can’t just stop them, though, because I call them the “crazy-maker” drugs. They actually give you the problem they’re designed to treat.  In fact, they have studies where they gave totally healthy 25-year-olds these drugs for three months, and at the end of three months most of them, when they just suddenly discontinued the drugs, they had acid reflux because they paralyze the sphincter. It stays open, because it’s the stomach acid that triggers the sphincter to close. For three months these people had no stomach acid, so their sphincters got stuck in the open position, but they’re still capable of making stomach acid when you take the drug away, so you get this gigantic rebound of stomach acid production, the sphincter doesn’t close, and so they get this horrendous rush of acid up into their esophagus and they feel horrible.  People who have been on these drugs and they suddenly stop it and then they have this overwhelming burning and horrible heartburn, they think, oh, my God, I really need that drug. The drug caused the problem. You can do that to totally healthy people. You can’t just stop it. You have to once again have a functional medicine doctor who knows how to slowly wean you off of these drugs, which is 100% of the time doable by the way, but then you also have to look at, why did you have a problem with heartburn or reflux in the first place, and that’s where you get to the emotions, the foods, people can have food sensitivities.  Obviously, this goes way beyond one little podcast, but certain foods, if you get leaky gut, you may have developed allergies to specific foods that you have to avoid for several months while you heal your gut. It’s complex, and some of these things you can do on your own, and you can always do the right things like drinking tea and making bone broth and taking some of these very safe herbal things, but if you’re really having significant problems with your GI tract, you can’t do all this stuff on your own. You need to find someone that will be an ally with you and work with you but without these really, really harmful pharmaceuticals.  Amy: Dr. Gersh, can you tell us if somebody is interested in working with you, how can they connect with you, and what’s the protocol?  Felice: Oh, sure. Well, we have several different programs that are available, depending on what people want and so on. They can call my office. I can give you the number. That is 949-753-7475, and they would ask for my Amy, so that’s easy to remember because I have an Amy here who is in charge of that, or if it’s attached to the podcast, to my email, and they can email to me and I would be happy to respond.  We have programs that involve myself. We try to do the total picture, so depending on what people are open to, I have a naturopathic doctor that works, we work very much as a team. As well, I have Chinese medicine, we have fitness, we do all kinds of stress reduction, we have massage. We have a variety of tools, I’d say. We have an expanded toolbox, but we work with people and try to make it very affordable.  By law in California, I can’t treat people in another state. I can treat people in California with never seeing them, but if they’re in another state I have to at least see them to begin with. I don’t have to see them all the time, but I can’t just treat people specifically dealing with their issues without seeing them at least initially in person. That’s just the law right now. Of course, telemedicine laws may change, but by law I have to see them in person. People would have to come and fly to Southern California, which fortunately is an easy place to get to because we’re right by John Wayne Airport here in Orange County. I’ve had people come from all around the world, and then they combine it with a vacation to Disneyland or Newport Beach and so on.  It’s very doable, because I’ve tried, and I have to be honest, it’s really hard to find people who have niched as I have in learning about this condition. It’s overwhelming for most doctors, and most gynecologists really haven’t gotten into it to the degree that we have and they still reflexively just prescribe birth control pills and some metformin and then tell everyone to go see different doctors.  You can end up seeing five different specialists for every symptom you have, but each one just prescribes their own separate pharmaceutical. Before you know it, you’re on all these different drugs and not really getting better at all, because none of those drugs ever address the root cause of the problems as we know. They’re all about cover-up and symptoms, and the problem is, even if they help initially, they’re not going to help long-term.  In fact, interestingly enough, an article was just published looking at women who have IVF who’ve had PCOS and they found that pretreatment with birth control pills which has been a standard is actually harmful. When you actually start doing studies, and I have a lot of great concerns about women being on birth control pills, especially long-term, because we now know that birth control pills actually disrupt the gut. They alter the gut mucosa, they alter the gut microbiome. Birth control pills are harmful to your GI tract, and they’re not so good for your brain, either, and they do increase your risk about 24% of breast cancer. Somehow these things are not getting talked about.  Amy: Women with PCOS are double the risk of blood clots.  Felice: Oh, my gosh, yes, and blood clots go way up in PCOS women because they all have the thrombophilia, the increased clotting. Of course, we know that we don’t give birth control pills to women with high cardiovascular risk like smokers, and women with PCOS do have elevated cardiovascular risk. I had mentioned, their endothelial lining, their arteries tend to be less healthy.  Birth control pills are not hormones. It’s really a very important take-home message. They’re chemicals that actually disrupt the normal hormones of your body. That’s their whole point, so you don’t get pregnant. They are not hormones. They talk about them as hormones. They are not hormones. They’re chemical endocrine disruptors that combine to hormone receptor sites. We have to call a spade a spade. That is what it is.  Amy: Mm-hmm, and there’s more information about the pill on PCOS Diva and the downsides, so definitely check that out if that’s a topic you’re …  Felice: Great. Well, you are such a wonderful resource, Amy. I just love it.  Amy: Oh, well, I love you. You’re like a breath of fresh air coming on to share your knowledge with us. I will be posting some, you have information about your practice, under this podcast, as well as links to some of the things that we talked about as well. We mentioned oil pulling, when Dr. Gersh was talking about the sesame oil. I have an article about that as well as the bone broth, and perhaps Dr. Gersh could post some info about the types of tests women should advocate for if they’re experiencing gastrointestinal issues. You had mentioned …  Felice: Oh, sure. Do you want me to email that yo you?  Amy: Yeah, sure, and then we’ll post that.  Felice: Oh, absolutely. I can get that to you. I think that I’m a big believer, that’s what I am, I’m an MD, in doing the testing that I can access so that I can understand the specifics of what each individual person has going on in her. There’s so much that you can do without being tested, but by the time someones sees me, obviously, they need more intervention. If they’re going to be seeing me, I’m going to be doing testing. Amy: Right, and it’s important, women with PCOS need to be knowledgeable and advocate for themselves. That would be great if you can post that. We’ll post that information for listeners. I just want to thank you, Dr. Gersh, for taking your time to explain these really complex issues to us in a way that we can understand and then take action on.  Felice: Yes, the reality is that the human body is the most complex creature that exists, and they’ve now discovered that the microbiome, the bacteria that reside within the human intestinal tract, is the most complex ecosystem on the entire planet. It’s so overwhelming even for doctors to try to master all of this.  Basically, my goal is just to let people understand that this is a very involved situation, but that it can be managed and that there’s so much hope and so much that you can do to make your GI tract healthier, and then that sets the stage for all the rest of you to be healthier and happier and have the life you deserve.  Amy: Well, wonderful. What a wonderful message of hope to leave us with. Thank you all for listening, and I look forward to being with you again next time.    *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/10/gut-biome-pcos/ 

Does it Make Sense for a Woman with PCOS to Use Progesterone Cream?

Many women with PCOS realize that they have significant hormonal dysfunctions, manifesting in many ways, including menstrual irregularities, thyroid problems, insulin resistance and glucose dysregulation, weight loss resistance, sleep problems, and infertility. Among the many hormones which can be dysfunctional is progesterone.  In fact, women with PCOS do have serious progesterone “issues.” The concerns involving progesterone can result in an increased risk for miscarriages, pregnancy complications and preterm delivery, irregular cycles, PMS and mood swings, and significantly elevated risk for uterine lining (endometrial) overgrowth (hyperplasia) and uterine cancer!! The elevated uterine (endometrial) cancer risk arises from infrequent and irregular ovulation and from progesterone receptor resistance.  The continuous estrogen production results in an imbalanced situation in which there is chronic, unopposed exposure of the uterine lining (endometrium) to estrogen, without the balancing effects of progesterone. The progesterone receptor resistance issue compounds the problem by not allowing the progesterone which is produced to have the desired effects upon the progesterone receptors throughout the body. And of course, by not properly impacting the receptors on the uterine lining, the effects of estrogen dominate; increase the cancer risk, with the result being frank endometrial cancer developing, in some cases.  Shockingly, such cancers can occur at surprisingly young ages! Progesterone receptors reside throughout the female body. Among the other progesterone receptors which have received much attention are those in the breasts. In fact, there is now much written that in the event of radiation exposure, both large and small, progesterone can possibly affect certain breast stem cells, now known as cancer stem cells, stimulating them to develop into florid cancer cells. Of great interest in our evolving understanding of progesterone as a critical regulator has been the research into the functioning of the progesterone receptor. As inferred above, several studies in humans have indicated that, in women with PCOS, there is receptor resistance to progesterone in the cell nucleus within those organs which possess progesterone receptors.  Progesterone resistance means there is a reduced responsiveness of target tissues to the available progesterone. Gene expression analysis of PCOS endometrium reveals progesterone resistance, but the mechanisms and sensitivity are not yet completely understood. It is clear, though, that PCOS women with endometrial hyperplasia are more likely than non-PCOS women to proceed further into trouble and have a higher likelihood to develop endometrial carcinoma. There are two forms of the progesterone receptor, A and B, and they are not functionally equivalent. Some animal studies suggest that the A receptor may be key to normal uterine function. Most likely, however, both the A and B forms contribute to the diverse and indispensable actions of progesterone involving cellular events in humans. Progesterone in human females also acts through another set of receptors; these are different from the nuclear receptors. They are membrane-bound progesterone receptors, and these receptors appear to be regulated in normal human endometrium in a cycle-dependent manner, but the precise mechanisms of each membrane progesterone receptor also has yet to be determined. With the widespread dissemination of information now available, affording a degree of understanding by many women with PCOS that they have significant issues with their progesterone, some have wondered if adding progesterone cream into their PCOS treatment regimen makes sense. Perhaps this could reduce their risk for endometrial (uterine) cancer? Perhaps such hormone use would aid proper sleep, and improve mood and fertility? Perhaps so!! There are progesterone products which can be readily purchased over the counter (OTC), without any medical supervision. Does it make sense for a woman with PCOS to buy and use them? These are excellent questions, and the answer is: maybe yes to the use of progesterone as a therapeutic modality, but a resounding no to the use of any OTC versions of progesterone. The biological effects of progesterone depend on the dose, the duration of the stimulus, and the presence, levels, and function of other hormones such as 17 Beta Estradiol, testosterone, thyroid, melatonin, DHEA-S, cortisol, and oxytocin. The woman’s age can also play a role. The application of progesterone as a therapeutic modality is complex and is absolutely not one which should be undertaken without medical supervision. The prescription should be individualized as far as its dose, and absolutely should be formulated by a quality pharmacy. Additionally, the goals involved with its use should be clearly delineated, and the woman using the progesterone must be closely followed and monitored. Depending on the specific needs and situation of the patient, other hormones may be indicated to be prescribed as well. We live in a world filled with toxins, and some behave as endocrine mimics or so-called endocrine disruptors. Such ubiquitous chemicals play additional havoc with our endocrine systems, creating individualized needs and responses. This adds another layer of complexity which must be considered as therapies are planned. Often a several week detox program is warranted. It should always be acknowledged that progesterone is an important and powerful hormone with many effects throughout the body. An over the counter product is not able to provide a consistent and therapeutic dose of progesterone, as the actual dosing is truly unknown when such products are utilized and reproducibility does not exist. I would urge all of you who read this who suffer from PCOS to locate a qualified and caring doctor to work with you, one who will carefully measure your hormone levels and your inflammation markers, and truly look at your total medical picture. If I can personally help any of you on your quest for health, please let me know, as I have created special programs for women who live a distance from my practice in Southern California. Happily, through lifestyle changes, detoxification, and nutraceutical use, one’s intrinsic hormones can often be improved and this may happily negate the need for prescription hormones. Should that goal not be attainable, it truly is essential that you use only quality, commercially prescribed or compounded progesterone, and not an OTC product, containing unknown ingredients and dosage, and without the critical supervision of a caring and knowledgeable physician. Progesterone can be a part of the treatment plan for PCOS women, but, please, promise not to undertake this on your own with products not standardized for such a critical application. Remember… I am talking about YOUR WELFARE!!! *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/09/pcos-treatment-progesterone-cream/

Progesterone Cream for PCOS: Is it Right for You?

Many women with PCOS realize that they have significant hormonal dysfunctions, manifesting in many ways, including menstrual irregularities, thyroid problems, insulin resistance and glucose dysregulation, weight loss resistance, sleep problems, and infertility. Among the many hormones which can be dysfunctional is progesterone. Of particular concern are an increased risk for miscarriages, pregnancy complications and preterm delivery, irregular cycles, PMS and mood swings, and significantly elevated risk for uterine lining (endometrial) overgrowth (hyperplasia) and uterine cancer! The elevated uterine (endometrial) cancer risk arises from infrequent and irregular ovulation and from progesterone receptor resistance. The continuous estrogen production characteristic of PCOS results in an imbalanced situation in which there is chronic, unopposed exposure of the uterine lining (endometrium) to estrogen, without the balancing effects of progesterone. The progesterone receptor resistance issue compounds the problem by not allowing the progesterone which is produced to have the desired effects upon progesterone receptors throughout the body. And of course, by not properly impacting the receptors on the uterine lining, the effects of estrogen dominate; increase the cancer risk, with the result being frank endometrial cancer developing, in some cases. Shockingly, such cancers can occur at surprisingly young ages! Progesterone receptors reside throughout the female body. Among the other progesterone receptors which have received much attention are those in the breasts. In fact, there is now much written that in the event of radiation exposure, both large and small, progesterone can possibly affect certain breast stem cells, now known as cancer stem cells, stimulating them to develop into florid cancer cells. Of great interest in our evolving understanding of progesterone as a critical regulator has been research into the functioning of the progesterone receptor. As inferred above, several studies in humans have indicated that, in women with PCOS, there is receptor resistance to progesterone in the cell nucleus within those organs which possess progesterone receptors. Progesterone resistance means there is a reduced responsiveness in target tissues to the available progesterone. Gene expression analysis of PCOS endometrium reveals progesterone resistance, but the mechanisms and sensitivity are not yet completely understood. It is clear, though, that PCOS women with endometrial hyperplasia are more likely than non-PCOS women to proceed further into trouble and have a higher likelihood of developing endometrial carcinoma. There are two forms of the progesterone receptor, A and B, and they are not functionally equivalent. Some animal studies suggest that the A receptor may be key to normal uterine function. Most likely, however, both the A and B forms contribute to the diverse and indispensable actions of progesterone involving cellular events in humans. Progesterone in human females also acts through another set of receptors; these are different from the nuclear receptors. They are membrane-bound progesterone receptors, and these receptors appear to be regulated in normal human endometrium in a cycle-dependent manner, but the precise mechanisms of each membrane progesterone receptor also has yet to be determined. With the widespread dissemination of information now available, affording a degree of understanding by many women with PCOS that they have significant issues with their progesterone, some have wondered if adding progesterone cream into their PCOS treatment regimen makes sense. Perhaps this could reduce their risk for endometrial (uterine) cancer? Perhaps such hormone use would aid proper sleep, and improve mood and fertility? Perhaps so! There are progesterone products which can be readily purchased over the counter (OTC), without any medical supervision. Does it make sense for a woman with PCOS to buy and use them? These are excellent questions, and the answer is: maybe "yes" to the use of progesterone as a therapeutic modality, but a resounding "no" to the use of any OTC versions of progesterone. The biological effects of progesterone depend on the dose, the duration of the stimulus, and the presence, levels, and function of other hormones such as 17 Beta Estradiol, testosterone, thyroid, melatonin, DHEA-S, cortisol, and oxytocin. The woman’s age can also play a role. The application of progesterone as a therapeutic modality is complex and is absolutely not one which should be undertaken without medical supervision. The prescription should be individualized as far as its dose, and absolutely should be formulated by a quality pharmacy. Additionally, the goals involved with its use should be clearly delineated, and the woman using the progesterone must be closely followed and monitored. Depending on the specific needs and situation of the patient, other hormones may be indicated to be prescribed as well. We live in a world filled with toxins, and some behave as endocrine mimics or so-called endocrine disruptors. Such ubiquitous chemicals play additional havoc with our endocrine systems, creating individualized needs and responses. This adds another layer of complexity which must be considered as therapies are planned. Often a several week detox program prior to the start of progesterone therapy is warranted. It should always be acknowledged that progesterone is an important and powerful hormone with many effects throughout the body. An over-the-counter product is not able to provide a consistent and therapeutic dose of progesterone, as the actual dosing is truly unknown when such products are utilized and reproducibility does not exist. I would urge all of you who read this who suffer from PCOS to locate a qualified and caring doctor to work with you, one who will carefully measure your hormone levels and your inflammation markers, and truly look at your total medical picture. If I can personally help any of you on your quest for health, please let me know, as I have created special programs for women who live a distance from my practice in Southern California. Happily, through lifestyle changes, detoxification, and nutraceutical use, one’s intrinsic hormones can often be improved and this may happily negate the need for prescription hormones. Should that goal not be attainable, it truly is essential that you use only quality, commercially prescribed or compounded progesterone, and not an OTC product, containing unknown ingredients and dosage, and without the critical supervision of a caring and knowledgeable physician.

How to Treat PCOS Related Acne Effectively

Just thinking “acne” makes my stomach churn….it is one of the most hated of all the PCOS symptoms.  Acne affects a large percentage of women with PCOS and is something you simply cannot ignore. It stares at you with every glance at your reflection. I am fully aware of the pain experienced by those with acne; I suffered for the much of my adult life with it. I want to up-front tell you that I cannot give you a magic pill to clear your acne, but I will share my most effective approaches, and let you know of some exciting up-coming research. The sad thing is that there are many dermatologists who believe they have the magic pill… in the form of Isotretinoin (Accutane), a drug originally formulated as a chemotherapeutic agent. I must issue a serious warning concerning this medication for PCOS women. The success rate in this group is much lower than for others; only about one in three has long term benefit. Some see short-term improvement, followed by the acne’s return with a vengeance a short time later.  Isotretinoin also has many side-effects such as headaches, dry eyes, cracked lips, bleeding gums, and fatigue. Among the more serious ones are birth defects, increased suicidal feelings and suicides, liver injury, elevation of blood lipids (fats), and permanent irritable bowel syndrome. The other topic I want to address immediately is the use of oral contraceptives for PCOS acne. Oral contraceptives do sometimes help reduce the acne in PCOS women, though often it does not. Oral contraceptives are chemical hormone mimics and are not good for the gut health. They deplete the body of B vitamins as well.  They increase blood clot formation, which can be life-threatening. Long term use can increase breast cancer risk. They also can increase headaches and depression. These effects make me hesitant to prescribe them, though I will at times. Spironolactone is another conventional drug often prescribed acne, with mixed results. Although technically approved as a diuretic, it seems to work by blocking the action of testosterone in the skin. I have had less than stellar results, but it can be tried. I’d like you to understand why you have such stubborn acne. Your acne is the outward manifestation of inner inflammation combined with an elevated level of androgens (male type hormones)!! Those of you who have read my previous article on PCOS and inflammation understand that a cardinal issue with PCOS is systemic (generalized) inflammation. This inflammation is also occurring in your skin, and so you must tackle this problem for what it truly is….a terrible SYMPTOM of an underlying inflammatory situation. The high levels of inflammation trigger still higher systemic levels of testosterone and DHEA (adrenal androgen), further aggravating the acne in an emotionally aggravating feed-forward scenario. In PCOS women, the bacteria on the skin have been demonstrated to be different from that of “normal” women. Additionally, the sebum, or oily material which protects our skin, is also unique in PCOS women…its constituent fatty acid components are not the same and have reduced capability to fight off infection, hence the development of cystic, recalcitrant acne. So what shall we do? We must douse those fires! We first must measure your inflammatory status and then must lower it. Your acne will dramatically improve once the flames are out. Start by getting your inflammatory lab tests performed. Contact me if you need help on this. Over the past few months, I’ve worked out a system to help all get these important tests performed at a network of draw sites. Next, we must get that inflammation down. As this is a short article on a very complex problem, I can only provide an overview of my program. If desired, I am happy to help you individually… simply contact me. The treatment of PCOS related acne starts with your food choices. You must eat an anti-inflammatory diet. Avoid all dairy, in all forms!! Dairy increases levels of IGF 1, which increases testosterone, increasing acne! Also, avoid all wheat and gluten, all sugars and sweeteners, alcohol, white rice and corn, and all chemical and processed foods. There is no diet which is perfect for all PCOS women, so please feel free to do some experimentation to discover what works best for you. We are all unique in our immune systems, our toxic load, and genetics. The unifying theme must, however, be a diet to reduce inflammation! For those who enjoy it and can handle it, I suggest trying initially, for three to six months only, an organic vegan diet consisting of 10 servings (1/2 cup each) of vegetables, including at least 4 servings of a variety of root vegetables such as beet roots, turnips, rutabagas, parsnips, and carrots. Add in 2 fruits, particularly tart apples and berries. The other vegetables should consist of many different varieties of vegetables… all the colors of the rainbow!! The phytonutrients and anti-oxidants in these foods fight inflammation and the resistant starch fibers in the vegetables, particularly in the root vegetables, provide nourishment to those critically important bacteria living in your intestinal tract. Add in organic beans, lentils, a handful of organic raw seeds and nuts, small amounts of whole grains such as millet, buckwheat, quinoa, and brown rice, along with lots of green and spearmint tea. This diet is high in nutrients, anti-oxidants, and gut nourishing fiber. A healthy gut lowers generalized inflammation, which in turn lowers circulating testosterone and DHEA levels, which then reduces inflammation in the skin and improves acne!!  But if not eating animal products is more than you can handle, go ahead and add in some organic eggs, chicken, red meat, and fish. (See archived article on the gut microbiome for more info on this topic.) Another option exists for women without disordered eating. Published data has revealed that testosterone and inflammation can be reduced by eating most of the day’s calories at breakfast, a third at lunch and fewer than a hundred calories at dinner. In one study, testosterone and insulin levels were reduced quickly by 50%!! Although this was an incredible achievement, please recognize that this regimen was only tested in one study and this way of eating is definitely neither suitable nor feasible for everyone! You also must control stress! High stress causes increased output of cortisol, and that causes more acne! I hope to write an article on stress and PCOS in the upcoming months, but for now I would recommend buying guided imagery CD for stress, take a course in meditation, learn progressive relaxation or tapping, get massages, or all of the above! There are studies showing that hypnosis can actually improve acne. The mind controls your stress level and your immune system’s responses and YOU can control your mind with practice! Sleep…. a critical element related to inflammation. Just one night of sleep deprivation results in elevated markers of inflammation. Maintaining your Circadian Rhythm is a key element of health and the management of your acne. Wake and sleep consistently and get 7-8 hours of sleep nightly. There are a few key supplements I recommend to reduce acne. They work by improving detoxification functions in the liver and by improving the metabolic functions of the body. In turn, generalized inflammation is reduced. Myo-Inositol, resveratrol, N Acetyl Cysteine, and berberine are all very helpful. Taking a high potency B complex, containing methylated B vitamins is important. There are also published studies showing benefit from taking Vitamin B5, at a dose of 2 grams, 3 times daily, along with COQ10, and L Carnitine at a dose of 1 gram twice daily. Spearmint tea has been shown to lower testosterone levels and reduce acne. Healing acne is slow going, so expect it to take 6 months to see very significant improvement. In terms of topicals, several are helpful. Organic essential oils can help to control the skin bacteria. Blends with Thyme and Tea Tree are great. We use an excellent blend called Clear Skin by Simplers Botanicals. I recommend an organic acne line from Sophyto. In a study pinning ProActiv against Sophyto, Sophyto won! It incorporates antioxidants from organic fruits and vegetables grown on a farm on the British Isles. There are also several prescription topicals I have made up at my local compound pharmacy which I utilize. I have also found that acne peels can be very beneficial by exfoliating the skin. I have had success with a peel called ViPeel,  designed specifically for acne skin. I also want to emphasize that I am vehemently against the use of antibiotics for the treatment of acne. Actually, they rarely work for PCOS patients anyway and from a long-term view, they are incredibly harmful to the GUT microbiome. Remember, there are supposed to be bacteria all over our bodies and within our bodies. The “right” bacteria in our guts reduce inflammation, and hence, reduce acne. Bacteria also typically grow resistant in time to the antibiotics and cease working at all, and so the antibiotics can create more harm by killing off our GOOD bacteria, those which are actually protective! In terms of future hope, I am currently working to begin a study of the effects of a five day diet which mimics the effects of fasting on the state of acne in PCOS women. It has been shown that this program reduces markers of inflammation, IGF 1, and insulin levels, all of which are associated with acne. The hope is that this dietary program will substantially reduce acne. If you have an interest in being a volunteer for this or future studies of this sort, please email me. In summary, as you have seen, there clearly is no magic bullet for the treatment of PCOS acne, whether cystic or not. As my imperative is always to do no harm, I avoid Accutane and antibiotics, and prescribe oral contraceptives judiciously. My ultimate hope is to reduce the underlying generalized inflammation and lower androgen levels (testosterone and DHEA levels), while also healing the gut of PCOS women. Then the fire in the skin will be calmed… and the acne will finally fade away. *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/08/acne-and-pcos-the-symptom-you-cry-about-daily/

Microbiome and PCOS

Until fairly recently, you could look at yourself in a mirror and believe that the reflection was the real “you.” No longer is that the case! It is now recognized that more DNA exists within us, derived from our Microbiome, than from our own genetic tissues. The Microbiome consists of the trillions of bacteria which live both on and in us. And what is now understood is that those little critters are not freeloaders! To the contrary, they are key players in all aspects of our health, and unfortunately for those of us suffering from PCOS, the bacteria comprising our Microbiome are unlikely to be the right ones, nor to be present in the correct amounts, for our maximal well-being. The particular areas of the Microbiome I’ll touch on in this article will include the mouth, along with the rest of the gastrointestinal system, and the female reproductive system. Next month, I will deal with acne, so I’ll touch on the skin Microbiome at that time. The topic of the Microbiome is truly “hot!” New information is coming out about the enormous significance of these bacterial colonies on a weekly basis. In fact, along with a colleague of mine, I am currently preparing a study of the Microbiome of PCOS women. Let’s start our review of the Microbiome by beginning at the top, with the mouth. I would say that virtually no one has been thinking of the mouth bacteria as important except as an annoyance, as something to wipe out as much as possible with mouthwash. Let’s kill all those germs on contact! Well, unfortunately, it turns out that the bacteria in our mouths are actually critical to making nitric oxide, a necessary ingredient for the proper function of our cardiovascular system. It is now realized that when we eat certain vegetables which contain nitrates, the bacteria in our mouths, after being swallowed with our saliva, work with our stomach acid to create nitric oxide. Without the right bacteria, nitric oxide quite simply will not be made. Nitric oxide is an essential part of our health. Unfortunately, we have done a great job of killing off the essential bacteria within our mouths through the use of mouthwash, antibiotics, toothpastes, and numerous bacteria-killing chemicals in foods. Also, drugs such as Nexium and Prilosec, which block stomach acid production, prevent proper nitric oxide production in the stomach. Even without the things we do to kill off our bacteria, it seems from several small studies, that women with PCOS have different bacteria in their mouths than do “normal” woman. What that means is still unclear, but most probably, PCOS women do not, as a group, produce nitric oxide properly. One thing that is clear is that women with low nitric oxide have higher pregnancy complications, which we know is true of PCOS women, and more cardiovascular conditions. Moving down the GI tract, we come to the Microbiome of the Gut. These bacteria are critical to every function of our bodies and the wrong Microbiome results in increased risk of cardiovascular disease, autoimmune disease, depression and anxiety, cognition issues, and cancer. It is beyond the scope of this small article to go into great detail on all aspects of the Microbiome, but it is important that you at least know it exists and is critically important to your health. The analogy I like to use is the following: there is a complex society - an advanced civilization of microscopic people living in our intestinal tract, and they perform many critical functions necessary for our well-being. By not realizing their importance, we’ve systematically gone about trying, inadvertently, to destroy them. We’ve dropped bombs on them (antibiotics), starved them (inadequate fiber in our diets), and tortured and killed them (additives and chemicals in foods). Most of us weren’t even given the best start to the formation of our Microbiomes, since we weren’t breast fed for at least a year. For all of these reasons and more, our Microbiomes have reduced diversity and absolute numbers and may include many wrong players as well. When the conditions within our Gut are not right and the Microbiome is “wrong,” there is typically inflammation of a low grade in the Gut, resulting in inflammation throughout our bodies. Systemic (body-wide) inflammation leads to increased insulin levels, insulin resistance, weight loss resistance, elevated levels of IGF-1, and higher levels of testosterone. Now, with this new knowledge, evaluating my patients’ Microbiome has become commonplace for me and healing the inflamed Gut and remediating the Microbiome is an essential part of my treatment plan. Lastly, I want to mention the Microbiome of the female genital tract. The bacteria in the vagina are essential to the health of the organs which lie above - the uterus, fallopian tubes, and ovaries. We’ve known that there are bacteria within the vagina, but the essential functions they perform for the health of the reproductive tract and their role in fertility was minimally comprehended. What is now coming to light is that the vaginal Microbiome is related to the proper function of the sperm, facilitating proper motility and ultimate fertilization of the egg. Additionally, in the past we believed that the environments within the uterus and fallopian tubes were sterile, but in fact, that is not true. The bacteria within those spaces are critical to having normal fertility. Even the ovary can contain some bacteria, and they must be of the right sort for all to work properly. So what can you do today? Do not use mouthwash or chemical toothpaste-use a natural one. Do not take a drug to lower stomach acid production. If you are on one, work with a doctor who knows how to wean you off. I can help, if necessary. Do not take antibiotics unless it is absolutely essential - and I mean that! Don’t put chemicals in or near your vagina. Use organic aloe vera gel or coconut oil as a lubricant. Use Vitamin E suppositories or oil for irritations. In general, use natural products for all treatments of the vulva and vagina. Recognize that oral contraceptives are bad for nitric oxide production and the Microbiome. If you use them, there are risks and benefits which must be considered. This is, unfortunately, one of the risks. Eat lots of root vegetables (all vegetables from below the surface), as well as beans and lentils, buckwheat and millet. Those items contain resistant starch - hard for you to digest but great for the bacteria to ferment! Eat above ground vegetables, too. Avoid all sweeteners, soft drinks, bread, processed foods, dry and instant cereal, alcohol, and please try to eat all organic. Eat fermented foods. Work with a doctor who can test your Microbiome and treat it. Also work with a doctor who understands nitric oxide. These are all really important items. Treat your Microbiome like the important complex civilization it is. You need them as much as they need you! It is the ultimate symbiotic relationship!

PCOS Update: The Latest Research on Microbiome and PCOS

The Microbiome and PCOS: An Evolving Area of Research of Huge Importance

Until fairly recently, you could look at yourself in a mirror and believe that the reflection was the real “you.” No longer is that the case! It is now recognized that more DNA exists within us that derives from our Microbiome than from our own genetic tissues. The Microbiome consists of the trillions of bacteria which live both on and in us. And what is now understood is that those little critters are not freeloaders! To the contrary, they are key players in all aspects of our health, and unfortunately for those of us suffering from PCOS, the bacteria comprising our Microbiome are unlikely to be the right ones, nor to be present in the correct amounts, for our maximal wellbeing. The particular areas of the Microbiome I’ll touch on in this article will include the mouth, along with the rest of the gastrointestinal system, and the female reproductive system. Next month, I will deal with acne, so I’ll touch on the skin Microbiome at that time. The topic of the Microbiome is truly “hot!” New information is coming out about the enormous significance of these bacterial colonies on a weekly basis. In fact, along with a colleague of mine, I am currently designing a study of the Microbiome of PCOS women. If you’re interested in being a part of it, I may actually be soliciting your help in the near future! Let’s start our review of the Microbiome by beginning at the top, with the mouth. I would say that virtually no one has been thinking of the mouth bacteria as important except as an annoyance, as something to wipe out as much as possible with mouthwash. Let’s all kill those germs on contact!! Well….unfortunately, it turns out that the bacteria in our mouths are actually critical to making nitric oxide, a necessary ingredient for the proper function of our cardiovascular system. It has been realized that when we eat certain vegetables which contain nitrates, the bacteria in our mouths, after being swallowed with our saliva, works in the stomach with our stomach acid, on the food, to create nitric oxide. Without the right bacteria, nitric oxide quite simply will not be made. Nitric oxide is an essential part of our health. Unfortunately, we have done a great job of killing off the essential bacteria within our mouths through the use of mouthwash, antibiotics, toothpastes, and numerous bacteria-killing chemicals in foods. Also, drugs such as Nexium and Prilosec, which block stomach acid production, prevent proper nitric oxide production in the stomach. Even without the things we do to kill off our bacteria, it seems from several small studies, that women with PCOS have different bacteria in their mouths than do “normal” woman.  What that means is still unclear, but most probably, PCOS women do not, as a group, produce nitric oxide properly. One thing that is clear is that women with low nitric oxide have higher pregnancy complications, which we know is true of PCOS women, and more cardiovascular conditions. Moving down the GI tract, we come to the Microbiome of the Gut. These bacteria are critical to every function of our bodies and the wrong Microbiome results in increased risk of cardiovascular disease, autoimmune disease, depression and anxiety, cognition issues, and cancer. It is beyond the scope of this small article to go into great detail on all aspects of the Microbiome, but it is important that you at least learn that it exists and its critical import to your health. The analogy I like to use is the following: there is a complex society-an advanced civilization of microscopic people living in our intestinal tract, and they perform many critical functions necessary for our wellbeing. By not realizing their importance, we’ve systematically gone about trying, inadvertently, to destroy them. We’ve dropped bombs on them (antibiotics), starved them (inadequate fiber in our diets), and tortured and killed them (additives and chemicals in foods). Most of us weren’t even given the best start to the formation of our Microbiomes since we weren’t breast fed for at least a year. For all of these reasons and more, our Microbiomes have reduced diversity and absolute numbers and may include many wrong players as well. When the conditions within our Gut are not right and the Microbiome is “wrong,” there is typically inflammation of a low grade in the Gut, resulting in inflammation throughout our bodies. Systemic (body-wide) inflammation leads to increased insulin levels, insulin resistance, weight loss resistance, elevated levels of IGF 1, and higher levels of testosterone. Now, with this new knowledge, evaluating my patients’ Microbiome has become commonplace for me and healing the inflamed Gut and remediating the Microbiome is an essential part of my treatment plan. Lastly, I want to mention the Microbiome of the female genital tract. The bacteria in the vagina are essential to the health of the organs which lie above-the uterus, fallopian tubes, and ovaries. We’ve known that there are bacteria within the vagina, but the essential functions they perform for the health of the reproductive tract and their role in fertility was minimally comprehended. What is now coming to light is that the vaginal Microbiome is related to the proper function of the sperm, facilitating proper motility and ultimate fertilization of the egg. Additionally, in the past we believed that the environments within the uterus and fallopian tubes were sterile, but in fact, that is not true. The bacteria within those spaces are critical to having normal fertility. Even the ovary can contain some bacteria, and they must be of the right sort for all to work properly. So what can you do today? Do not use mouthwash or chemical toothpaste-use a natural one. Do not take a drug to lower stomach acid production. If you are on one, work with a doctor who knows how to wean you off. I can help, if necessary. Do not take antibiotics unless it is absolutely essential…. and I mean that! Don’t put chemicals in or near your vagina. Use organic aloe vera gel or coconut oil as a lubricant. Use Vitamin E suppositories or oil for irritations. In general, use natural products for all treatments of the vulva and vagina. Recognize that oral contraceptives are bad for nitric oxide production and the Microbiome. If you use them, there are risks and benefits which must be considered. This is, unfortunately, one of the risks. Eat lots of root vegetables (all vegetables from below the surface), as well as beans and lentils, buckwheat and millet. Those items contain resistant starch-hard for you to digest but great for the bacteria to ferment! Eat above ground vegetables too. Avoid all sweeteners, soft drinks, bread, processed foods, dry and instant cereal, alcohol, and please try to eat all organic. Eat fermented foods. Work with a doctor who can test your Microbiome and treat it. Also work with a doctor who understands nitric oxide. These are all really important items. Email me if you need help, and I will see what I can do: mail@integrativemgi.com Treat your Microbiome like the important complex civilization it is! You need them as much as they need you!! It is the ultimate symbiotic relationship! *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/07/hot-new-pcos-research-the-microbiome-and-pcos/

Three Little Letters That Put You and Your Baby at Risk

The world we live in is quite different from the one inhabited by our grandmothers. Our world is filled with well over 85,000 different chemicals, most of which have no safety data whatsoever. Others are recognized as dangerous by leading scientists, yet no alterations are recommended by our government for their continued and widespread use. One chemical found widely in our world is Bisphenol A (BPA). It is produced in huge quantities and is used in the production of plastics intended to have a direct contact with food, including plastic packaging and plastic kitchenware, and it is also present in the inside linings of cans and jar lids. Humans can get exposed to BPA by ingesting it through the mouth, breathing it in, and absorbing  it through the skin. The main sources of BPA include food packaging, dust, dental materials (including dental sealants), healthcare equipment, thermal paper (receipts and boarding passes), and children’s toys and other articles. BPA has a chemical structure with some similarities to real estrogen, and therefore, it can interact with estrogen receptors in strange and various ways; acting in some cases as if it were a powerful estrogen (agonist) and on other organs acting as an estrogen blocker (antagonist). BPA is one of many chemicals now known to be endocrine disruptors. It basically creates hormonal chaos throughout the body. Strangely, its initial existence was as a “synthetic estrogen,” proposed for use as a drug. BPA has been shown to play a role in the development of several endocrine disorders of women (and men). These include precocious (early onset) puberty, breast tumors, and, of course, our very own Polycystic Ovary Syndrome! We all experience continual exposure to BPA on a daily basis, and it bio-accumulates - meaning its amount in the body grows steadily, and during pregnancy, BPA accumulates in the fetus more so than in the mother! In rodents, levels of BPA which are comparable to the levels many women are actually exposed to, affect the brain, liver, gut, adipose tissue, insulin producing pancreas tissue, breast tissue, and the reproductive tract structurally and functionally. High levels are associated with obesity, diabetes, and cardiovascular disease, in addition to PCOS. Exposure to BPA while in the womb, can alter the very structure of the ovary, increasing the number of cysts and can actually disrupt the development of those critical eggs within the ovaries! Exposure can alter how the genes actually work, allowing them to be reprogrammed and resulting in reduced fertility and alteration of the very development of the baby. BPA has been shown to directly cause higher levels of testosterone to be produced, higher rates of implantation failure, reduced ovarian response to hormonal signals, altered development of the embryo, defective uterine response to hormones, alterations in the function and production of hormones by the pituitary gland, recurrent miscarriage, decreased estrogen response to fertility drug treatments, and premature births! Given this knowledge of the enormous effects which BPA and the likely effects of many other endocrine-disrupting chemicals in the development of PCOS, what is one to do? First off, avoid plastic like the plague! Don’t store food in it, use plastic utensils, or microwave in it. Remember that the chemicals are most likely to leach out and into the food when the food is warm, so if you must use plastic, only use it with cold food. Try not to touch receipts, don’t buy food from cans (unless they are BPA-, BPF- and BPS-free), and place water in glass or stainless steel containers as much as possible! Get your BPA levels checked. There are labs which do that testing. And eat a high-fiber diet, low in protein and with moderate amounts of healthy fats. Keep stress under control and use supplements to control inflammation and assist proper metabolic functioning. Consider supplementation with bio-identical hormones. Though we cannot change your in-utero and childhood exposures to BPA and other endocrine disruptors, there is so much we can do to ameliorate the damage which they did and continue to inflict. Stay optimistic and true to your cause - stay on the path towards optimal wellness!

How to Protect Yourself from BPA Exposure While Pregnant

The world in which we all live is quite different from the one inhabited by our grandmothers. Our world is filled with well over 80,000 different chemicals, most of which have no safety data whatsoever. Others are recognized as dangerous by leading scientists, yet no alterations are recommended by our government for their continued and widespread use. One chemical found widely in our world is Bisphenol A (BPA). It is produced in huge quantities and is used in the production of plastics intended to have a direct contact with food, including plastic packaging and plastic kitchenware, and it is also present in the inside linings of cans and jar lids. Humans get exposure through the ingestion of BPA through the mouth, by breathing it in, and through the skin by absorption. The main sources of BPA include food packaging, dust, dental materials (including dental sealants), healthcare equipment, thermal paper (receipts and boarding passes), and children’s toys and other articles. BPA has a chemical structure with some similarities to real estrogen, and therefore, it can interact with estrogen receptors in strange and various ways, acting in some cases as if it were a powerful estrogen (agonist) and on other organs it acts as an estrogen blocker (antagonist). BPA is what is known as an endocrine disruptor. It basically creates hormonal chaos throughout the body. Strangely, its initial existence was as a “synthetic estrogen,” proposed to be used as a drug. BPA has been shown to play a role in the development of several endocrine disorders of women (and men). These include precocious (early onset) puberty, breast tumors, and, of course, our very own Polycystic Ovary Syndrome. We all experience continual exposure to BPA on a daily basis and it bio-accumulates (meaning it’s amount in the body grows steadily), and during pregnancy, BPA accumulates in the fetus more so than in the mother! In rodents, levels of BPA which are comparable to the levels many women are actually exposed to, affects the brain, liver, gut, adipose tissue, insulin producing pancreas tissue, breast tissue, and the reproductive tract structurally and functionally. High levels are associated with obesity, diabetes, and cardiovascular disease, in addition to PCOS. Exposure to BPA while in the womb can alter the very structure of the ovary, increasing the number of cysts and can actually disrupt the development of those critical eggs within the ovaries. Exposure can alter how the genes actually work. The genes can be reprogrammed, resulting in reduced fertility and alteration of the very development of the baby. BPA has been shown to directly cause higher levels of testosterone to be produced, higher rates of implantation failure, reduced ovarian response to hormonal signals, altered development of the embryo, defective uterine response to hormones, alterations in the function and production of hormones by the pituitary gland, recurrent miscarriage, decreased estrogen response to fertility drug treatments, and premature births! Given this knowledge of the enormous effects which BPA (and likely many other endocrine disrupting chemicals) have and their potential role in the development of PCOS, what is one to do?
  1. Avoid plastic like the plague! Don’t store food in it, use plastic utensils, or microwave in it. Remember that the chemicals are most likely to leach out and into the food when the food is warm, so if you must use plastic, only use it with cold food. Try not to touch receipts, don’t buy food from cans, and place water in glass or stainless steel containers as much as possible!
  2. Get your BPA levels checked. There are labs which do BPA testing.
  3. Eat a high fiber diet, low in protein and with moderate amounts of healthy fats. 
  4. Keep stress controlled.
  5. Use supplements advocated by myself and PCOS Diva to control inflammation and assist proper metabolic functioning.
  6. Consider supplementation with bio-identical hormones. 
Though we cannot change your in-utero and childhood exposures to BPA and other endocrine disruptors, there is so much we can do to ameliorate the damage which they did and continue to inflict. Stay optimistic and true to your cause to stay on the path towards optimal wellness! Feel free to contact me at my office website for further information on bio-identical hormones and how to get your BPA level tested. *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/06/bpa-exposure-during-pregnancy/

Chronic Inflammation and PCOS

PCOS is the most common endocrine dysfunction of women, now affecting, in varying degrees, up to 20% of all women across the world! There is now no area of the globe in which women are not impacted by this condition. It is widely recognized that women affected by PCOS have many medical troubles - obesity with weight loss resistance, pre-diabetes and diabetes, increased risk for strokes and heart attacks, menstrual dysfunctions, infertility, pregnancy complications, recalcitrant cystic acne and excessive facial hair, sleep problems, irritable bowel syndrome, arthritis, mood swings, and thyroid problems. There is a powerful concept at the very core of PCOS, which is often neglected, and that is the essential fact that inflammation is the driver of ALL of these problems! Amazingly, the majority of scientific and medical researchers in this field remain unaware of this powerful connection, yet the recognition of the relationship between PCOS and inflammation is critical to the proper approach to managing and treating it! It goes beyond the scope of this article to explain the entire array of factors underlying the chronic and unremitting inflammation present in all PCOS women, including the 20% who are lean, but I want you to understand the very basics of this issue and why it is so critical that YOUR level of inflammation get measured, monitored, and as best it can be…..remediated! So here is a brief overview of inflammation and PCOS. Women with PCOS live in a chronic state of physical stress (and often emotional stress) with an up-regulated adrenal system, giving rise to elevated levels of the hormone cortisol. Chronic over-production of cortisol results in a lowered level of metabolic activity, with reduced thyroid functioning, elevated levels of blood glucose, and intestinal abnormalities. This creates a state of inflammation in the intestines and insulin resistance throughout the body. This chronic, low level intestinal inflammation damages the intestinal lining, impairing the function of a critical barrier, a barrier designed to prevent transport of toxins and bacteria across the intestinal wall. When this barrier no longer functions properly, the result is “leaky gut.” Intestinal contents actually cross into the body proper, inappropriately stimulating the immune system, and further inciting inflammation!! As well, women with PCOS have adipose tissues (fat) which function abnormally, with low production of a hormone made by fat tissue called Adiponectin. This hormone is very anti-inflammatory and promotes fat burning, along with the transport of glucose across cell membranes. When the levels of Adiponectin are too low, insulin resistance grows and the body cannot burn fat properly! The combined effects of low Adiponectin and elevated cortisol levels, result in abnormal fat accumulation and distribution, and high levels of circulating glucose. This then leads to a “snow ball” effect. High blood sugar induces more inflammation; excessive fat tissue elevates levels of inflammation; low Adiponectin further increases inflammation; leaky gut augments inflammation, and high cortisol levels perpetually fuel the fires of PCOS inflammation. So, what is the sum result of all of this? This results in the perfect storm of inflammation producing factors! These factors create a persistent and constant up regulation of macrophages - the white blood cells of the body which produce what are called inflammatory cytokines, chemical messengers of the body designed to enable us to fight and fend off invaders, like bacteria. But in women with PCOS, this defensive mechanism is being activated inappropriately and persistently with the potential for dire results. Inflammation is now universally recognized as a factor contributing to the development of cancers, dementia, cardiovascular disease, depression, arthritis, tendinitis, autoimmune disease, and more! Unattended, PCOS women have a lifetime elevated risk of all of those outcomes. Now comes the good news! Although all PCOS women are impacted, we can dramatically lower this state of chronic inflammation, promote weight loss, reduce insulin resistance, improve acne and facial hair, as well as improve the large array of additional maladies suffered by PCOS women around the world! The journey to health begins by measuring your personal level of inflammation, evaluating your initial inflammatory state and monitoring its subsequent improvement following the institution of appropriate therapies. To provide my patients with the ultimate in excellent healthcare, I utilize the services of a specialty cardiovascular laboratory. By utilizing a unique panel of inflammatory biomarkers, in addition to other cardiovascular and hormone tests, the progress towards restitution of health can be measured and monitored. If you would like to learn more about the special inflammatory lab panel I utilize and how you can get these tests drawn on yourself, no matter where you live, please email me at mail@integrativemgi.com. My team will contact you, so you can get your needs met!

PCOS: How to Manage Chronic Inflammation

PCOS and it’s Smoldering Driver: Chronic inflammation

PCOS is the most common endocrine dysfunction of women, now affecting, in varying degrees, up to 20% of all women across the world! There is now no area of the globe in which women are not impacted by this condition. It is widely recognized that women affected by PCOS have many medical troubles….obesity with weight loss resistance, pre-diabetes and diabetes, increased risk for strokes and heart attacks, menstrual dysfunctions, infertility, pregnancy complications, recalcitrant cystic acne and excessive facial hair, sleep problems, irritable bowel syndrome, arthritis, mood swings, and thyroid problems. There is a powerful piece of foundational understanding of PCOS, which is often neglected, and that is the essential fact that inflammation is the driver of ALL of these problems!! Amazingly, the majority of scientific and medical researchers in this field remain unaware of this powerful connection, yet the recognition of the relationship between PCOS and inflammation is critical to the proper approach to managing and treating it! It goes beyond the scope of this article to explain the entire array of factors underlying the chronic and unremitting inflammation present in all PCOS women, including the 20% who are lean, but I want you to understand the very basics of this issue and why it is so critical that YOUR level of inflammation get measured, monitored, and as best it can be…..remediated! So here is a brief overview of inflammation and PCOS….. Women with PCOS live in a chronic state of physical stress (and often emotional stress) with an up-regulated adrenal system, giving rise to elevated levels of the hormone cortisol. Chronic over-production of cortisol results in a lowered level of metabolic activity, with reduced thyroid functioning, elevated levels of blood glucose, and intestinal abnormalities. This creates a state of inflammation in the intestines and insulin resistance throughout the body. This chronic, low level intestinal inflammation damages the intestinal lining, impairing the function of a critical barrier, a barrier designed to prevent transport of toxins and bacteria across the intestinal wall. When this barrier no longer functions properly, the result is “leaky gut.” Intestinal contents actually cross into the body proper, inappropriately stimulating the immune system….inciting inflammation!! As well, women with PCOS have adipose tissues (fat) which function abnormally, with low production of a hormone made by fat tissue called Adiponectin. Adiponectin is a very anti-inflammatory hormone which promotes fat burning and the transport of glucose across cell membranes. When the levels of Adiponectin are too low, insulin resistance grows and the body cannot burn fat properly! The combined effects of low Adiponectin and elevated cortisol levels, result in abnormal fat accumulation and distribution, and high levels of circulating glucose. This then leads to a “snow ball” effect.  High blood sugar induces more inflammation; excessive fat tissue elevates levels of inflammation; low Adiponectin further increases inflammation; leaky gut augments inflammation, and high cortisol levels perpetually fuel the fires of PCOS inflammation…..So what is the sum result of all of this? This results in the perfect storm of inflammation producing factors! These factors create a persistent and constant up regulation of macrophages-the white blood cells of the body which produce what are called inflammatory cytokines-chemical messengers of the body designed to enable us to fight and fend off invaders, like bacteria. But in women with PCOS, this defensive mechanism is being activated inappropriately and persistently…with the potential for dire results. Inflammation is now universally recognized as a factor contributing to the development of cancers, dementia, cardiovascular disease, depression, arthritis, tendinitis, autoimmune disease, and more!!!  Unattended, PCOS women all have a lifetime elevated risk of all of those outcomes. Now comes the good news! Although all PCOS women are impacted, we can dramatically lower this state of chronic inflammation, promote weight loss, reduce insulin resistance, improve acne and facial hair, as well as improve the large array of additional maladies suffered by PCOS women around the world! The journey to health begins by measuring your personal level of inflammation, evaluating your initial inflammatory state and monitoring its subsequent improvement following the institution of appropriate therapies. To provide my patients with the ultimate in excellent healthcare, I utilize the premier, specialty cardiovascular laboratory in the U.S., Cleveland HeartLab. By utilizing their unique panel of inflammatory biomarkers, in addition to other cardiovascular and hormone tests, the progress towards restitution of health can be measured and monitored. If you would like to learn more about the special inflammatory lab panel I utilize and how you can get these tests drawn on yourself, no matter where you live, please email me at mail@integrativemgi.com. My team will contact you, so you can get your needs met! To learn more, please access an excellent educational website at www.chlcme.com. You can view, at no charge, a webcast I did last month. It’s entitled, “Tame the Flames of PCOS: A Unique Integrative Approach.” As you all know from working with this wonderful resource, PCOS Diva, there is much that you can do! With lifestyle changes, adequate sleep, exercise, stress reduction, proper nutrition, reduced toxin exposures, and select nutraceuticals, although the flames of PCOS may not be completely quenched, they can be very well controlled to such a degree that you really can live the life you deserve! *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/05/pcos-and-inflammation-transform-from-inflamed-to-tamed/

Can a Hysterectomy Cure your PCOS?

As an integrative gynecologist, I talk to and care for women seeking a second opinion on a variety of medical issues. One of the most common questions I’m asked is “Will a Hysterectomy Cure My PCOS?” Even the organization which “governs” my specialty, the American College of OB/GYN, has acknowledged that about 70% of hysterectomies are not indicated, and it is documented that approximately 45% of hysterectomies performed on premenopausal women do not have pathology findings which match the preoperative diagnosis. As bad as that all sounds, I’d like to share additional concerns. Some gynecologists are recommending to women with PCOS that they have a hysterectomy to treat their condition. In some cases, the recommendation includes removing both ovaries as well. And these recommendations are to remove organs which do not contain cancerous or precancerous cells. First and foremost, many gynecologists have little to no foundational knowledge of PCOS. If your physician is one of them, I highly and emphatically urge women to become armed with the facts to protect themselves from medically induced harm. PCOS is fundamentally a problem of intra-body hormonal communication, not of structural or anatomic issues. The development of multiple tiny cysts on the ovaries, giving the condition its name, is a consequence of the hormonal dysfunction, not the cause. The remedies can involve major lifestyle changes, detoxification, various nutraceuticals, pharmaceuticals, and possibly hormones. Unless the unfortunate development of cancer occurs or advanced endometriosis or problematic fibroids develop, surgery is not indicated. Removing the uterus has potential consequences in premenopausal women. Such surgery has a small association with increased incontinence and some women feel it changes their sexual responses, but the biggest issue is that it can accelerate the onset of menopause by reducing the blood supply to the ovaries. And of course, pregnancy is no longer a possibility. Removing the ovaries is horrific for women with PCOS, from a metabolic perspective. Estrogen is essential to the proper metabolic functioning of the female body and women with PCOS have dysfunctional estrogen receptors and need the estrogen produced by their ovaries. With lower levels of estrogen, disorders such as hypertension and diabetes escalate in frequency, and obesity can worsen! For some women, there is a benefit of reduced levels of testosterone and improved acne, but for others it does nothing for their skin as their acne stems primarily from the high levels of DHEA and the pervasive systemic (body-wide) inflammation. Many women with PCOS have menstrual dysfunctions-heavy periods, cramps, and irregularity. In virtually all women, these symptoms can be greatly reduced through the utilization of the treatment modalities mentioned above. Therefore, it would be the rare woman who should resort to surgery as a treatment for PCOS. If surgery is suggested to you as the treatment of choice, please get another opinion. And of course, as a practicing integrative gynecologist, this is an essential part of my job. I’m here for women; to listen to them, care for them, particularly when it comes to a misunderstood, often times misdiagnosed and poorly treated PCOS. *This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/2015/04/will-a-hysterectomy-cure-your-pcos/

PCOS: How to Reduce Your Symptoms and Inflammation

If you have polycystic ovarian syndrome (PCOS), you have chronic body-wide inflammation. Recently, Dr. Felice Gersh, M.D., a leading expert on the subject share her views on this topic.  Dr. Gersh is one of the top integrative gynecologists in the United States and an expert in the field of PCOS.  Her philosophy involves looking at a patient’s whole being in order to help them achieve optimal health.  She believes that doctors don’t heal people; they merely help patients resource their own healing abilities and find the right balance in their bodies, ideally through the right mix of exercise, nutrition and lifestyle.  In our recent interview, she delivered cutting edge information about PCOS and its causes as well as practical advice on how to begin healing. Listen and you will learn:
  • How gut inflammation is the root of many of your toughest PCOS symptoms
  • The 5 steps you need to take today to reduce inflammation
  • How to protect your children from PCOS starting even before birth
  • Whether a hysterectomy will cure your PCOS
  • How to monitor your inflammation levels
*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at: http://pcosdiva.com/podcast/15-reduce-inflammation-and-your-pcos-symptoms/

New Pharmaceutical Warnings Placed on Proton Pump Inhibitors (PPIs)

Greetings!

This month’s Pharmaceutical Alert highlights the ongoing problems with PPIs, the Proton Pump Inhibitors. We wrote to you about the problems with these drugs more than a year ago, and finally the FDA is taking action, issuing a Warning Alert. We hope you will read through the following story and then take the appropriate action.
 drgersh
Sincerely, Felice L. Gersh, M.D. Medical Director Integrative Medical Group of Irvine

FDA Warning Alert on Proton Pump Inhibitors

The FDA issued a warning alert yesterday, Wednesday, February 8th, that the risk of serious intestinal infections is increased in persons using the class of nexiumdrugs known as proton pump inhibitors. These include Nexium, Prevacid, Prilosec (Omeprazole), Aciphex, Protonix, and Dexilant. The increased risk involves the development of diarrhea due to Clostridium difficile. This is particularly worrisome, since new strains of this bacteria are both more virulent and anti-biotic resistant than were previous ones. The bacteria is also more widely dispersed than before, so exposure is far more likely. C. difficileinfection is a potentially life-threatening event.The warning comes after a review of data from the agency’s Adverse Event Reporting System (see below). Medical literature has suggested such a link for quite some time, as indicated by a meta-analysis reported at the 2010 meeting of the American College of Gastroenterology. pillsPPIs block nearly all production of stomach acid. Although stomach acid has been vilified by the pharmaceutical companies, it is actually essential for the proper digestion and absorption of food nutrients. In addition, it protects the body from infections caused by pathogenic bacteria carried on the food we eat.At IMGI, we have been talking about the dangers of PPIs for several years and have successfully weaned many of our patients off these drugs.

FDA Warnings

Less than a year ago, the FDA issued several other warnings concerning this class of pharmaceuticals and declared that fully 70% of patients placed on these medications were done so inappropriately. prilosecPPIs are associated with osteoporosis, Vitamin B12 deficiency, severe total body magnesium deficiency, and other nutrient deficiencies. Additionally, they are associated with higher levels of pneumonia and the development of gastrointestinal dysfunctions. Barrett’s Esophagus, considered a significant risk factor for esophageal cancer, is actually not reduced by these drugs, as the elimination of stomach acid does nothing to decrease the reflux problem and the fluids, minus the acid, which continue to reflux can be damaging to the esophagus.

What should you do?

One should never, ever just stop taking these drugs. Because of the severe reduction in stomach acid, the body compensates by putting out great quantities of the hormone gastrin in an attempt to stimulate the stomach into making more of the necessary acid. If the drug is suddenly stopped, the high quantities of this hormone will stimulate huge amounts of acid to be produced, resulting in great discomfort. Additionally, there are a small number of people who should not be taken off these medications or have never had their symptoms properly diagnosed.
Dr. Yoojin LeeDr. Gersh has been extensively trained in all aspects of this important medical condition at her Integrative Fellowship at the University of Arizona. She works closely in this with Dr. Lee, our expert naturopathic doctor, whose training focused in great detail on the function and therapies of the digestive system. In addition, we have teamed with a highly qualified gastroenterologist who will be available to perform upper GI endoscopies when clinically indicated prior to the weaning-off process. Once a patient is off these dangerous drugs, we can offer many natural and safe ways to alleviate, or even eliminate, heartburn, gastritis, and other such conditions.Please share this information with your many friends and family who are using these medications. And if you are interested in getting off of your drug, please contact the office.

Adverse Event Reporting System

The Adverse Event Reporting System (AERS) is a computerized information database designed to support the FDA’s post-marketing safety surveillance program for all approved drug and therapeutic biologic products. The FDA uses AERS to monitor for new adverse events and medication errors that might occur with these marketed products. Participation in this system is voluntary for doctors, patients and hospitals. For more information on AERS, click here.

Dietary Supplements and Mortality Rate in Older Women

Greetings!

Approximately two weeks ago, we were all shocked by a story appearing in the national news media warning that women taking vitamins had a higher mortality than women not taking vitamins. Subsequent to this, many patients called our office, concerned that their use of vitamins and supplements might be dangerous. In response to these concerns, we are forwarding one of the many well-reasoned rebuttals that appeared after this story was published. Our take on this matter is no different from the position we have always held. We believe that good lifestyle choices – based on sound principles of good nutrition, exercise, stress reduction, minimizing exposure to environmental toxins, adequate amounts of sleep, and an upbeat emotional attitude – are the mainstays of a long, healthy, and happy life. Nevertheless, obtaining adequate vitamins and minerals on a daily basis is a challenge for many people. Fast foods, processed foods, and our continued exposure to high levels of environmental toxins combine to make high-quality vitamin/mineral supplements a good idea. Of course, all vitamins and supplements should be of the highest quality – low quality, hard-pressed vitamin tablets filled with suspect binders and synthetic (not bio-identical) vitamins are not a good choice. Although the study could not appropriately draw any conclusions due to its poor design, the best conclusion one could draw from this flare-up of silly science and media headline mongering would be that it is best to avoid substandard quality in supplements. Below is an excerpt from the rebuttal written by an expert on supplements, Dr. Alan Miller, Director of Medical Education and Research at Thorne Research, Inc. felice-gersh-md1Sincerely, Felice L. Gersh, M.D. Medical Director Integrative Medical Group of Irvine
A recent study, “Dietary Supplements and Mortality Rate in Older Women,” published in the Archives of Internal Medicine, 2011, Volume 171(18):1625-1633, has caused some concern among the public about the safety of dietary supplements. We have thoroughly reviewed this study and share the following analysis in order to help you better understand the study’s design and its findings, and to help allay any concerns you may have.

The Study’s Design

This study is an analysis of data gleaned from 38,772 postmenopausal Caucasian women enrolled in the then-ongoing Iowa Women’s Health Study. The data for the study is based on the responses obtained through a self-administered questionnaire initially distributed in 1986, with two follow-up questionnaires distributed over the next 18 years, in 1997 and 2004. The questionnaires inquired about lifestyle practices, food intake, dietary supplement use, weight, smoking status, hormone replacement therapy, and the presence of diabetes or heart disease. Although study participants were asked about their intake of dietary supplements, the study did not report how much of any specific nutrient was consumed. Nor was information elicited from the women regarding the chemical form of the supplement (e.g., picolinate versus sulfate) or the quality of the supplements that were taken. Furthermore, although the women were asked whether they took a “multivitamin,” the study does not define this term; i.e., the mineral, vitamin, and botanical content of the study’s universal “multivitamin” cannot be determined. Finally, no attempt was made to verify the accuracy of the answers provided in the questionnaires, nor were any of the participating women asked why they were taking supplements, and no attempt was made to determine the impact of taking-or not taking-supplements on any specific individual. One possible flaw to consider: it is well known that when an individual is diagnosed with a serious disease, such as cardiovascular disease or cancer, beginning or increasing the use of dietary supplements occurs commonly. If the new or increased supplement use were reported on a questionnaire and then subsequent mortality resulted because of the underlying disease, the situation could very possibly exist such that the individual’s death, while properly attributed to the disease, would also be “associated” with the use of a dietary supplement. Such an erroneous scenario is a highly likely flaw in the study’s design.

The Study’s Findings

The results of the study’s analysis claim to show a slightly higher risk of all-cause mortality associated with the use of multivitamins, iron, and copper. In weighing the pills3-150x102 study’s findings, however, it must be emphasized that the Iowa Women’s Health Study is a retrospective study of already collected data. It is not a prospective, controlled intervention study, i.e., it is not a “clinical trial,” in which participants would be given a specific dietary supplement or a placebo and then followed closely over time to observe not only the specific outcomes but also the factors possibly contributing to those outcomes. As can only be surmised retrospectively, individual circumstances change over time, and a significant number of the women participants likely either changed or began new dietary supplement regimens over the course of the 18 years they were studied. And since there was no direct contact with the participants outside of the mailed questionnaires, general information surrounding individual deaths had to be obtained from public records; it was not ascertained by direct medical investigation. With regard to iron and copper, it has been known for decades that both metals can be potentially toxic, as exemplified by the multi-system disease states that can result from hemochromatosis and Wilson’s disease, respectively. For this reason, many postmenopausal women, like men, probably should not take an iron supplement in the absence of anemia or a documented deficiency. At the very least, iron and copper supplements should be taken concurrently with antioxidants and/or antioxidant-rich foods to prevent a potential increase in oxidative stress. Each of these circumstances points to the merits of dietary supplements being recommended and overseen by medical professionals. With regard to multivitamins, there is simply insufficient data that can be gleaned from the study to make any serious conclusion about the impact of multivitamins on mortality. This is due to the fact that there are literally thousands of different combinations of vitamins, minerals, and botanicals that can be considered a “multivitamin,” as well as a whole host of considerations such as quality, potency, dosage, protocol, and indications for use, among others.

Practitioner and Patient Concerns

We believe there are serious flaws in the methodology, analysis, and findings on which this study is based. Retrospective surveys such as this-in which people are asked to recall years of dietary habits or supplement use-are notoriously inaccurate. The only conclusion that can realistically be drawn is that a slight statistical association was found based on a limited data set of questionable reliability-and a simple association does not reflect causation. The study’s authors do not disagree, stating the following in their commentary to the study: “It is not advisable to make a causal statement of excess risk based on these observational data…” We heartily agree with this advice. When made by a quality manufacturer, when recommended by a knowledgeable health-care practitioner, and when taken for the appropriate indication, dietary supplements promote, enhance, support, and help maintain overall good health and well-being. The “results” of the recent study do not diminish this conclusion. Additional commentaries on this study are available at: The Alliance for Natural Health The Council for Responsible Nutrition

Why Eating Gluten Can Be Reproductive Suicide for Women

The incidence of infertility is rising and innumerable women are experiencing menstrual dysfunction of varying types while their OB/GYN doctors scratch their collective heads and send them off to get IVF treatments or just put them on birth control pills when pregnancy is not desired. Sadly, most of these women will never be properly diagnosed with the real cause of their problems-gluten sensitivity. Gluten sensitivity is now recognized as a very common genetic condition, capable of developing at any age. It is acknowledged in learned circles as a significant cause of reproductive and hormonal problems in both men and women. It is my opinion that EVERY SINGLE WOMAN with chronic menstrual dysfunctions, otherwise unexplained infertility and any autoimmune condition should be considered as possibly gluten sensitive and thoroughly evaluated and tried on a gluten-free diet.