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/

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/

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/

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