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/

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/ 

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