Conquering PCOS Through Genetics & Fasting With Dr. Felice Gersh

Welcome to Episode 6 of Season 7 of The PCOS Revolution Podcast:

Conquering Your PCOS Through Genetics and Fasting With Dr. Felice Gersh

Is PCOS linked to genetics? The answer is yes. Learn more about genetics and fasting and the role they play in PCOS during this important episode.

This week on PCOS Revolution Podcast, I am having a conversation with Dr. Felice Gersh. She is a double board-certified OBGYN and integrative medicine practitioner. Dr. Gersh completed her undergrad at Princeton University and her medical degree at the Southern California School of Medicine. She went on to complete her residency as an OBGYN. Most recently she spent two years in a fellowship program in integrative medicine.

Dr. Gersh specializes in all aspects of female health. She participates in many national and international speaking engagements. Additionally, she has published her first book “PCOS SOS”.

During this episode, Dr. Gersh and I talk about a variety of topics. She provides great insights and recommendations for living with PCOS. We talk about the environment and the impact it has on how genes are expressed. From BPA to clock genes and time restricted feeding, we cover a lot of ground.

We also dive into a discussion around altered hormone reception disfunction, chronic inflammation, the impact inflammation has on insulin and so much more. Dr. Gersh highly encourages individuals to get outside to significantly help reduce stress. She also recommends getting a little sun every day and avoiding sunscreen if possible. 

A main topic of our discussion is eating and how to best fuel your body. It’s not about food deprivation, it’s about food timing. Dr. Gersh encourages individuals to eat all they want, just don’t eat all the time. If you’re going to skip a meal, skip dinner – don’t skip breakfast. If you’re looking to make changes, start by working with the rhythms of your life. Try to set a routine and do things such as going to bed, getting up, working out and eating at the same times each day.

READ the entire transcript here:

Read Full TranscriptFarrar Duro

Hi everyone and welcome back to the PCOS Revolution Podcast. I am honored today to have Dr. Felice Gersh here who is a double board certified OB-GYN and integrative medicine practitioner, she received her undergraduate degree from Princeton University and her medical degree from the University of Southern California School of Medicine. Now, this was followed by a four year internship and residency in OB-GYN at Kaiser Hospital at Los Angeles. And more recently, she completed a two year fellowship program and Integrative Medicine at the University of Arizona School of Medicine. Now, she specializes in all aspects of female health, with a particular focus on managing female hormonal dysfunctions. And in addition to her many national and international speaking engagements, she works full time as a medical director of the integrative medical group of Irvine.

Farrar Duro

Along with all of her accomplishments, she’s also published her first book “PCOS SOS, a Gynecologist Lifeline To Naturally Restoring Your Rhythms, Hormones And Happiness”, which is now available for purchase on Amazon. And we’re definitely going to link that book in our show notes. I have been reading it and it’s a wonderful, wonderful resource. It really falls along the line of a lot of things that we see in our practice, and that we discuss with our patients. It’s kind of like having you there inside the book. I think that’s just so nice. If not everybody can come and see you physically, I think so. So this is a great resource for our listeners. So welcome, Dr. Gersh, thank you for being here.

Dr. Felice Gersh

Well, I’m so happy to be here. And I’m so excited that you have this wonderful podcast that allows women with PCOS all over the world to really access information that they need.

Farrar Duro

Thank you. The best part about this is actually to put all this information together, because there’s a lot of misinformation out there, too. And then it’s just a lot of confusion. So I thought that what we could talk about today is a topic that is near and dear to my heart and yours as well, a little bit about genetics, because there’s so many pieces now coming out about that. I think that we can really learn a lot just from looking back a little bit in the past. Can you tell us a little bit about what your piece of advice is regarding the genetic research that is coming out and kind of the origin of that?

Dr. Felice Gersh

Well, they searched for a very long time for the exact genes that would cause PCOS, and they have yet to find it. But there’s actually a lot of interest in that area, what we do know is that there is definitely a genetic link, even if we haven’t identified exactly what genes they are. If a woman has PCOS, she has a 50% chance of having a sister or a daughter that will have PCOS. Even if a woman doesn’t have PCOS herself, but her daughter has PCOS, she has a dramatically increased risk of developing diabetes and other metabolic syndrome issues. So there’s definitely a genetic link. And if we look back, way way back into history, like 20,000 or more years ago, it turns out that PCOS existed then as well. But it looked very differently than it looks today.

Dr. Felice Gersh

Because at that time, it was actually a survival advantage that women who had PCOS had a very slight defect genetically in their ability to convert testosterone to estrogen, the form estradiol in their ovaries, that’s where the estrogen that the ovary makes is formed in the ovary from testosterone. And there’s an enzyme called aromatase that controls that conversion, and they just don’t do it as well. So they have a little extra testosterone, a tiny bit less estrogen, but they still are fertile, they still would have cycles, they may be a little less fertile. Maybe if you went back 20,000 years ago, instead of having eight children, they had four or five. So it wasn’t sterility, it was just slightly reduced fertility. And they had this extra testosterone, just a little bit not enough to give them all the manifestations that we have today with severe cystic acne or alopecia, or the extra hair growth, they didn’t have it to that degree at all. So what was that that was good about that? Well, having fewer children was a survival advantage, because every time a woman had a pregnancy, that was a potentially life threatening event, because of hemorrhage, infection, and so on.

Dr. Felice Gersh

Plus, she had more time to be with each child. Each child would get more time with the mom, they would have a better survival advantage for themselves as well. And having that little extra testosterone was the little extra special sauce, that little bit extra. They were the stronger women, the braver women, they were more inventive, they were a little bit different. And a little bit more of the leaders, they’ve actually done studies of women who win Olympic gold medals. And they found that a very significant percentage of them actually have a mild version of PCOS, but they have PCOS, they have that I’ll call it this very special gene that gives you PCOS. What happened to this advantage, this condition that allowed women to be more super women and to have more survival advantage to well, we have our modern environment, which has really changed everything. It’s not just about the genes you have, it’s about how they express themselves, they call that epigenetic modification, the environment has a big influence on how our genes are expressed. And we live in a very different environment than we did 20,000 years ago. So by understanding this, we can then go back and harness our innate mechanisms to heal, and then actually have that advantage, again, to turn the clock back.

Farrar Duro

That is really inspiring, because I think a lot of people look at PCOS as kind of a bleak sentence here. And I think that we can really use some of these. I’ve always said that this gives us so much insight into our bodies, and in the future, how we respect our body and treat our bodies, and a lot of times just recognizing that. I think it’s so important to have that information and know that there is some advantages as well. And like you said, it’s easier to build muscle mass I’ve found like working out of the gym, I seem to sometimes, have a little bit easier time, getting through workout plans and that sort of thing and have building strength, a little faster than some of my friends. I think that’s an advantage. But definitely we need to use some of these. How can women with PCOS use this information to their advantage?

Dr. Felice Gersh

Well, what happened is, in our current environment, we have a lot of factors that are working against women with PCOS, because I too, am a PCOS woman. I wrote the book with my daughter who also has PCOS. Okay, I am part of this tribe. As we know, probably 25% of women are part of this tribe. It’s pretty, not an exclusive group. It turns out that in an environment where you’re exposed to endocrine disruptors, and the one that has had the most research is BPA, Bisphenol A, that’s ubiquitous, it’s found everywhere. It’s in cash register, cash register receipts, the inside lining of cans, it’s in all the plastic water bottles, that’s why you don’t microwave in plastic sick because it will leach out into the food. So everyone has BPA in their bodies, unfortunately.

Dr. Felice Gersh

But if you get it at a certain time of life, like in utero, when you’re actually creating your hormone receptors, when your body is being developed, that can actually alter the way your hormone receptors are made, and is actually now published data that showed that women with PCOS have altered hormone receptor function for our critical hormone estradiol that’s the key estrogen made by the ovary. If you don’t have the right amount of receptor function, it says you don’t have enough of the hormone, as well, it turns out that the aroma, taste enzyme that I mentioned, that converts testosterone to estrogen works even less well in women with PCOS. It’s like a double whammy, they have estrogen receptors that aren’t working as well. And they don’t make as much estrogen. A lot of people think that PCOS is estrogen dominance, they keep talking about estrogen dominance, and a lot of women think, “Oh, I make too much estrogen”. That’s actually the opposite. They don’t make enough progesterone, because they’re not ovulating regularly. But they definitely have lower levels of estrogen. Well, it turns out that estrogen, I call it the hormone of metabolic homeostasis. It’s like the hormone that keeps every function in the body humming, how we make energy, for example.

Dr. Felice Gersh

That’s a very common problem for women with PCOS, they’re very good at storing fat and making fat and not too good at burning fat. And that’s hugely a function related to estrogen. That’s why women when they go and transition into menopause, often see their body morphing in front of their eyes, they often lose their cute little waistline, they start getting belly fat, that type of thing happens when your estrogen is low. So women with PCOS have to recognize that they have this lower level of estrogen in their body. And then they have more testosterone for a couple of reasons. And one is that testosterone is the precursor to estrogen, the brain says give me more estrogen. And so it produces through the pituitary gland, the hormone, Lh, lutenizing hormone, which stimulates the ovary to make testosterone. But the testosterone isn’t converted as well to estrogen. It’s like an assembly line where you’re missing one of the stations, so you get a backup of what comes before. You get this buildup of testosterone and not enough conversion into estrogen.

Dr. Felice Gersh

Then the other big whammy that happens with women with PCOS is that estrogen is very key to maintaining the healthy gut microbiome, which I’m sure you’ve talked about. And women now they have published articles, the first research came out of China, that women with PCOS have altered microbiome of their gut and not for the better, it is for the worse, unfortunately. That leads to impaired gut barrier function because you don’t have the right bacteria to help create the mucus protective lining. Then you get what they call leaky gut, and the bacteria makes particles, which we call endo toxins, which actually can pass through the lining into the surrounding immune cells that we call the gut associated lymphoid tissue, and then create a big inflammatory response. Inflammation causes more insulin resistance, which most women with PCOS have insulin resistance, and then insulin resistance causes higher levels of insulin and insulin drives, set development, production and storage and drives up IGF one another hormone insulin like growth factor, one, which drives up testosterone production. It’s this real cycle thing. So we have to start at the beginning by acknowledging and recognizing what the problem is. So then we can develop solutions.

Farrar Duro

Interesting. I guess as to backtrack, and to say, how do we use this to our advantage? Would you recommend fasting for someone that does have excessive adipose tissue or excessive weight to actually try to get that insulin resistance lowered? What’s the first step to kind of start utilizing some of this information and helping with how the body is reacting to all these hormonal cascades?

Dr. Felice Gersh

Actually, I do incorporate fasting all the time. In fact, we’re formulating a study that will actually look at utilizing the fasting mimicking diet that was developed at the longevity Institute at USC, for women with PCOS. I’ve been using it in my practice. But now we’re hopefully going to actually have hard data, I have my own anecdotal data. And it’s been excellent. Now we’re going to have the real published data, hopefully, that will support what I’m doing successfully in my practice. But if I backtrack, just one moment, and I’ll show you how I use fasting is that it turns out that estrogen, another key factor, is that it helps to keep the master clock in the brain on the beat. And that’s the key for our circadian rhythm. We know that all of our organs in the body have to work in unison, like with a special timing, and women with PCOS, it says, they’re living a life of jetlag.

Dr. Felice Gersh

And because their circadian rhythm is off. And we know that when women work night shifts, women are crossing time zones all the time, they tend to have waking metabolic syndrome, insulin resistance, mood disorders, weight gain, insomnia, a lot of women with PCOS have all of those symptoms. So what we have to do is work with our circadian rhythm through a different light called the backdoor way, because it turns out that ourselves also have clocks. They’re called clock genes, and even our bacteria that live in our gut, they also have clock genes, every living creature, even plants on this planet have clock genes. And by using the backdoor through time restricted feeding, which then leads into fasting. So by eating at very fixed times of the day, and having a big breakfast, not snacking and stopping eating early, because your pancreas actually goes to sleep around seven, eight o’clock at night. So if you eat after that, you’re going to stress out your pancreas, and you’re going to have more tendency towards diabetes and insulin resistance. So by timing your eating, and then incorporating fasting, we have a real incredible change.

Dr. Felice Gersh

I’ve seen this over and over in my practice of helping to reset the circadian rhythm, and also to help modulate the gut microbiome, to get it back into a healthier type of consistency and diversity and composition. So there’s an excellent but very small study of Israel that showed women with PCOS, most people won’t do this. But it’s good to know. And it can be a goal, if they ate two thirds of their calories for breakfast, and one third for lunch, and then had virtually like no dinner. After one month, their insulin and testosterone levels dropped by around 50%. There’s no drug that does that. And they also lowered their 17 Hydroxy-progesterone, which is a precursor into cortisol. And cortisol is such a driver of insulin resistance and mood disorder and gut this biosystems. So it’s phenomenal. And then what else happened, they started eating. So time restricted eating is an incredible tool for women with PCOS.

Dr. Felice Gersh

I say, well say you don’t want to like skip dinner, that’s just not going to happen. That’s not realistic. Eat a big breakfast, if you can, a very tiny or skip lunch. And by the way, if you eat a really big breakfast, you’re usually not very hungry at lunch, then it takes sometimes a few weeks and your appetite will start to get properly regulated, because estrogen regulates the appetite centers of the brain as well. That’s why so many women with PCOS have binge eating disorder just regulated appetite, this will get back on track, when you start doing time restricted eating, this is sort of like the backdoor way into getting things right again. And then after you try the time restricted eating, where you have like a big breakfast, no lunch, or very tiny lunch. And if you do have lunch, try to make it predominantly a fatty food, because that will keep the insulin level down.

Dr. Felice Gersh

You don’t want your insulin to go up, you want to keep in a fasting type of state. I utilize what’s called the fast bar, that’s actually a bar that was developed also to the research that came out of the longevity Institute, then they commercialized it. Now they make it as a bar that has been shown to keep the insulin very low. It’s kind of like a nut bar, but that you can buy called the fast bar, or you could do and that’s the company’s el Neutra, which I actually do work with now. I just love that they’re doing all the research on fasting, or you could just eat like seven olives, or have a small, like maybe a quarter of an avocado, something predominantly Fatty, a few macadamia nuts, something like that. And then have just a moderate early dinner, forks down by 7pm. No food after 7pm and fast for 13 hours until breakfast. So have breakfast at eight, finished dinner at seven. Or you can move it back an hour, you know, you can play with that time just by one hour give you a little flexibility.

Dr. Felice Gersh

It’s amazing, it’ll take about a month, your appetite will start to be incredibly regulated, the testosterone level drops, insulin drops, things start to get back on track, you start to ovulate. And then after a month or two of that, then you incorporate the fasting. There’s a couple of ways to do that. I love the fasting mimicking diet, which was developed, as I mentioned at the longevity Institute, and then they made it into a company and now they have a product. It’s called “PROLON” for promoting longevity, because it came out of the longevity Institute. And that’s a product that you can buy online or from your practice sooner, once they get up to speed on it. I have it in my practice, I keep boxes in my office so that I can give to patients. It’s a five day program where you have food every day laid out for you in a box. It’s all minimally processed, like freeze dried. There’s no preservatives, no chemicals, and you get a nut bar for breakfast. And then for lunch and dinner, you get a soup.

Dr. Felice Gersh

They have a bunch of new soup SAP and little extras like some olives, or kale crackers, or like a little, it looks like a little brownie, they call it like a cocoa crisp, and to get little extras. Then you get like the energy drink and you also get teased to drink. And you do that for five days. You don’t deviate, you don’t eat anything else, just what they give you. And you get the same benefit as if you water fasted for four days. Those benefits are incredible. The studies show it lowers the markers of inflammation. And inflammation is what drives so much of the troubles that women with PCOS experience is chronic inflammation, so it gets down that inflammation. It helps normalize blood pressure, glucose insulin, the insulin resistance improves. And there’s data with other types of fasting because they don’t have it’s all new. But using other forms of fasting, they’ve shown that it can help modulate the circadian rhythm, that it can help restore the healthy gut microbiome, sort of like a reboot. It also helps crappy cells to kill themselves. And one of the things I love is that it increases brain derived neurotrophic factor. So many women with PCOS have mood disorders, anxiety and depression. And brain growth factors help women to feel better. Bby the end of my Well, I’ve done it sixteen times, so I’m a total believer, you know, by the end, when I’m on day five, I feel super smart, because I have all those brain growth factors. And I feel really happy and calm. And really the more you do it, the more it stays with you. And the recommendation is to do it just five days, every month for three months.

Dr. Felice Gersh

Then quarterly, so it’s not overwhelming at all, it’s just five days. And on other days, if someone is very, very overweight and very determined to lose weight, you can also add in on the other times of the month, the intermittent fasting, that’s where one or even two days of the week, you eat no more than 500 calories. That’s maximum. And it has to be predominantly or virtually all fat calories, but very, very little. It would be like you have a few olives for breakfast and a few olives for dinner, that’s pretty much it, or you have, half an avocado, and you divided up over the breakfast, lunch and dinner. It’s not very much food at all, but you can have a little bit of fat. And you do that two days a week, not consecutive days, like Monday, Thursday, something like that. It’s not the easiest thing for people to do.

Dr. Felice Gersh

But people can get into that routine that has been shown to significantly helped weight loss. If you combine that with the benefits of the five day fasting mimicking diet, which has been shown to do more than just lose weight, which is critical, but also it helps with really reducing inflammation, and helping with all these other factors, increasing brain derived neurotrophic factor and stimulating stem cells. It’s really rejuvenating, it actually kills off crappy cells. And the other thing that there’s data now showing that it can help with fatty liver. Fatty liver is epidemic in women with PCOS. And we have very few ways to get rid of fatty liver. One is exercise, which is like the miracle medicine, and the other is fasting. By incorporating fasting with the fasting mimicking diet and then getting into an exercise program, if you have a fatty liver, which can only really be checked by ultrasound, I do that on all my patients, so that I can know if they have fatty liver and you can’t monitor what you never measure. This way I know who has what, and I can then follow their progress. I have documentation of resolution of fatty liver on ultrasound, and when you have fatty liver, you have this regulated glucose production from your liver, what they call glucose, Neo Genesis. A fatty liver is an out of control liver, it doesn’t detoxify well, it puts out fats and sugar with no control. That is the exact opposite what of what everyone with PCOS needs is their livers spewing up triglycerides, fats, cholesterol, and glucose. This helps get that under control. These are some micro key weapons for helping women with PCOS to get back to that beautiful state that they had when they live 20,000 years ago as PCOS women.

Farrar Duro

Wow, we need to clone you and put you in Florida. I always say gosh, pretty key place, please ask your primary provider or your gynecologist, I’m going to do an ultrasound because when you get blood work back and you see that fatty liver coming out, it’s like, well, their liver enzymes are elevated. But Has anybody done an ultrasound? No. It seems like there’s a big missing link there. But it’s so common now we just see. I expect to see high cholesterol now in patients which is coming in.

Dr. Felice Gersh

Yes, it’s an epidemic such as low vitamin D, this is also another bottom, which actually that is the perfect lead into my next thing, which is Sunlight, sunlight as medicine, vitamin D is very most women with PCOS, and vitamin D is not only critical in itself, low vitamin D is also a marker for low sunlight exposure. So it’s bad in itself. It’s also indicative that this woman is not getting enough sun. One of the things that helps set that circadian rhythm, which is a little offbeat in women with PCOS, is bright sun in the morning, and then bright sun in mid day.

Dr. Felice Gersh

And then watching the sunset at night, the colors of the sunset, help to lower the cortisol level and bring up the melatonin production. It’s so important for the circadian rhythm to get sun. In addition, sunlight is not just about making vitamin D, which is so so important, now we are learning that there are other antioxidants that are made in the skin that circulate through the body and reduce that. That horrible insidious inflammatory state that women with PCOS develop, we’ve got to get inflammation down. Because inflammation drives up insulin, you have to get that inflammation down to lose weight, and to be healthy and get all those metabolic processes back in order. Sunlight is an amazing tool. It’s a great therapy for helping women with PCOS. So every morning when you wake up, you should get bright sun. And if you can’t get bright sun, you can buy a dawn stimulator to help bring the morning into your room. If you’re waking up in the real dark, you can also get a lightbox where you can get exposed to 10,000. Lux every morning, and then take a walk after lunch.

Dr. Felice Gersh

Or if you don’t have lunch, because you’re getting advanced like me, then you can just skip the lunch because you had such a big breakfast and get out in the sun and take a nice walk. It not only gets you the sun, but getting outside lowers stress hormones, those cortisol levels will go down, which is so key to being healthy and restoring your metabolic health. Sunlight has been shown to help with so many facets. When people are exposed to sunlight, it actually improves their immune function. So there’s actually reduction in a whole slew of cancers in people who get adequate sunlight, we don’t want to get a burn, it’s really important not to get a burn. But unfortunately, we’ve swung the pendulum from one extreme to the other, where so many people think that sunlight is evil.

Dr. Felice Gersh

And then I have to defend healthy carbs. And now I have to defend the sun. It’s like I have to defend estrogen. It’s like, there’s so many people are not are so confused about what is good and what is bad. So the sun is good, but you like everything that’s good. You don’t want to have an overdose, you don’t want to get a burn, but actually want to get sun every day. And that means don’t put on sunscreen. By the way, sunscreens are typically endocrine disruptors, that’s been a lot in the news. I would not recommend using those chemical sunscreens if you have to use something because you’re really going to be out for so many hours, then you should use zinc oxide, the mineral based sunblock. You don’t want to wear sunglasses all the time, because you need some of that light actually getting in and hitting the special receptors in the retina of the eye that actually helped to regulate the circadian rhythm and actually help trigger all these other really wonderful benefits. Wwe don’t want to get a burn, we don’t want to go crazy out in the sun. But we don’t want to go crazy avoiding the sun either. So everyone should get this, is my prescription, your dose of sunlight every day.

Farrar Duro

Well, yeah, definitely. And even I’m saying in Florida, it’s been raining for a month straight and you would think we would have plenty of sunshine. But all of our cars have UV coatings. And our windows and our office windows are also UV coated. And we do our best in not get any sunlight.

Dr. Felice Gersh

Talking about Windows, they actually did a study that after surgery, when patients were put on the sunny side of the hospital, I guess they didn’t have UV windows. So they will put on the sunny side or they had like a sunroom that patients after surgery that got a lot of sunlight. They healed much faster. recovery was faster. They used far fewer pain pills, pain drugs. So it was you reduce pain, and you speed healing. That’s how magical sunlight is when you get it. But it’s awesome. You can overdo anything. So yes, there’s always just being prudent.

Farrar Duro

That’s true. We’ve gotten away from tanning beds thinking. And I think that when we think about going back in time, like we talked about with the ancestral link, and looking at women who were the gathers, I guess, was never readily available year round. Their bodies were meant to actually kind of store fat for survival. I believe that the women who could do that the best were the ones that survived. Right. And so absolutely, survivors, we have the survivor gene. And we’re, definitely like you said, the athletes out there, who are the female athletes showing this. I feel like the fasting comes into play as kind of our evolutionary way of utilizing that fat, instead of just storing and storing and storing.

Dr. Felice Gersh

The thing you can’t, we’ve had lots of conversations about multitasking. The body cannot multitask and burn fat and make fat at the same time it’s doing one or the other insulin drives, making and storing fat. Now, when you eat that will even if no matter what you eat, you’re going to have some elevation of insulin. That’s where if you eat all the time, if you never stop eating, you’re always going to trigger proliferation. That’s one of the nutrients sensors, it’s called em tour. We definitely want this beautiful balance of build and burn, build and burn, like you said, we had food, then we didn’t have food. This idea that somebody came up with it, you eat all the time that grazing is good, grazing is bad, okay, we do not want to eat constantly, all day long, we want to have no more than three meals a day. And like I said, breakfast and just lunch or dinner is even better when you get a whole lot more advanced, as long as you get all your food.

Dr. Felice Gersh

It’s not about food deprivation, it’s about food timing, okay, that’s what it’s all about. And in fact, I don’t do any calorie counting with my patients, I don’t do any measurements, I just say, as long as it’s healthy food plant, I emphasize a plant based diet. No one odd, no one got diabetes, because they ate too much salad, it just doesn’t happen. And our bodies just say I’ve had enough at a certain point. So you can’t get sick because you ate too many vegetables at one meal. I mean, I’ve never heard of that, I guess you could, there’s always somebody could do something crazy. But that is will say a remote possibility that you actually overdosed on some vegetables. I just say eat, get a big plate, you know how they had this whole thing towards get little plates, and then put your food on a little plate. So look like a little plate is full? Well, that’s it, I go the opposite, I say get a serving bowl, get a big serving bowl, and just fill it with vegetables, nuts, and seeds, beans, and lentils, you know all these plant based foods and eat all you want, okay, but just don’t eat all the time, just eat breakfast, and then, maybe a small lunch or a small dinner, and then one or the other as a moderate meal. But don’t eat all day long.

Dr. Felice Gersh

And don’t eat every day. That’s the other thing. That’s where there’s time restricted eating. Of course, anytime you’re not eating, you can say you’re fasting, but we have these definitions. Time restricted eating is dividing how you eat during the 24 hour day. You don’t want to eat all the time and you want to get a good 13 hour fast at night, you could fast for longer at night if you want to. But the return on investment is very low. That is from research at the longevity institute that you know, like fasting for 16 hours will not do a whole lot of good compared to fasting for 13 hours. So why are you doing that, you want to put your effort into things that are actually going to give you better results. The whole idea is don’t fast through breakfast, a lot of people are very confused. So they say “I’m going to do the 8-16” and what they do is they eat kind of late at night, and then they don’t eat until two o’clock in the afternoon.

Dr. Felice Gersh

Bad idea, because we now know that you get more atherosclerosis plaque in your arteries. And the studies show for women, especially PCOS women, they do far better if they eat breakfast. If you’re going to skip a meal, skip dinner, don’t skip breakfast, I have to keep telling people, because when people are not hungry in the morning, by the way, that’s a sign that they probably have circadian rhythm dysfunction. Because if you’re healthy, you should be hungry in the morning, you haven’t eaten, presumably for a lot of hours. And if you get munchies at night, that’s another sign of circadian rhythm disorder, because your appetite centers are very confused, because everything in the body is finally regulated. And finally time. That’s why animals in the wild are never obese, they never overeat.

Dr. Felice Gersh

They do everything on time, everything like they are fertile at certain times of the year. So they tend to have babies at the right time. Everything is geared for survival. Every life form on planet earth evolved for maximum survival. And as you said, women survived on this planet by being better at storing fat than men. We are the fat stores of the genders, right. So if you take a man and a woman, and you put them into some sort of weight loss program, the men will always lose more weight than the woman because it’s designed into our genes that we hold on to fat more, because we’re the ones who have to survive, we have to be able to be there to have babies and raise children, whether we want to or not. That’s just how we’re made. I mean, everyone should have kids or not have kids based on what they want.

Dr. Felice Gersh

But our bodies were designed for making babies raising babies. And we have very different immune systems and men were designed to hold on to our fat better, we are also better at living without food we don’t because we can keep our metabolism really low, which people can watch, like, why is my metabolism so low, because that is a survival mechanism. And our immune systems are such that we are better able to fight off infections. If you have an epidemic, and you’re a female, you’re more likely to survive than a male testosterone is not the same as estrogen on the immune system. And women have more capability of making antibodies, we have more immune cells to fight infections, nature designed males and females, for the needs that survival would dictate based on reproduction and raising children. We shouldn’t be hard on ourselves because we have a bigger thigh but should offend a man because we’re supposed to.

Dr. Felice Gersh

And by the way, fat that’s in our thighs and butts is not harmful, they’ve actually shown it’s the fat that’s really inflammatory and harmful is the belly fat. If you have like a nice little waist and you have a bigger, you know, curve, that’s okay, that’s not dangerous. What’s dangerous is a lot of visceral fat and belly fat, that’s one of the things that also when you do fasting, and fasting mimicking diets, it doesn’t just burn fat, it burns this really bad fat, this belly fat nature knows to get rid of that stuff. First, when you do fasting mimicking diets, because who wants to keep, the worst thing that happens when you see I’m sure everyone has seen someone who’s gone on some kind of crazy starvation, long term diet, which we’re not in favor of at all. And they end up with skinny arms and legs, and they still have a big belly.

Dr. Felice Gersh

That’s not the goal, we want to lose that belly and maintain our lean muscle mass, we want to keep all our muscles in place, because we need those muscles. That’s when you do things right, when you don’t go on starvation diets, when you eat really well and you get lots of nutrients. And then you do very clear programs where you do intermittent fasting, and you do like pro on the fasting mimicking diet and it’s all orchestrated properly, you will maintain your lean body mass, and you will lose that belly fat, because the worst thing a woman can do is lose her muscle, that’s why we do body competitions in my office, because I want to know, as much as I can about my patients, I want to know when they’re losing weight, are they losing muscle? Are they losing fat? where is the fat they’re losing? But we know from data that was done at the longevity Institute, that when you do the fasting mimicking diet prolon, you maintain your lean body mass, and you lose the visceral fat, that is so key. Even if you don’t have a body composition machine available to you, at least from the data that was studied, that you will not lose your lean body mass, if you do that type of testing.

Farrar Duro

So many light bulbs are going off in my head right now I’m like looking for a piece of paper and like I need to write all this down. But I actually, was thinking that a lot of this information goes contradictory to how we are socialized in this environment where we can skip breakfast and be fine. I believe that the most important thing you can do with PCOS is eat breakfast, I really do. And to the point of, a lot of women are told as you get older PCOS is no longer an issue. I feel like the opposite is true. And so what we see as, you are at risk, 50% chance of having diabetes, heart disease increases so many things.

Farrar Duro

And we see it in our office over and over again, women who are never diagnosed, and they’re 45. And they’re at risk for stroke. And they have that Apple presentation as far as body fat goes. And that’s what we’re taught in pre med and medical. Yes, just always look for the fat distribution. If you have a pear shaped patient versus an apple, then the apple patient is going to have more issues usually, insulin resistance and all that. I feel like we’re not really putting as much emphasis on women in their 40s and 50s that have PCOS presentations, because, oh, well we don’t need, the pregnancies out the window and all that. But this is a serious, serious issue. If you’re having low estrogen on top of all these issues, forget about the cardio protective effects and that sort of thing. So to your point, I think that, the fasting is even more important to get a handle on and to get your body acclimated to that before any of that inflammation takes hold. Do you agree with that?

Dr. Felice Gersh

Oh, absolutely. And I’m so glad you brought up like we’ll call it the middle aged and older women with PCOS, because they’re almost completely ignored 100% because in this country, in the US, almost all the research, which is miniscule to begin with on PCOS is based on fertility issues. There’s almost none that’s on metabolic health and long term health. And then they spew out this data that well, it doesn’t matter when they hit menopause. Because it’s all the same. And what happens is menopause is really bad for women metabolically. So it all blends in and they just really lose track of the women with PCOS. By the time they even hit menopause, like you said, 50% are already diabetic. So what are you talking about, it doesn’t matter, of course, it matters.

Dr. Felice Gersh

And as estrogen goes down, I’ve seen this, when they lose their estrogen production from their ovaries, they’re like hanging on by a thread. And when we lose that, that’s when they often develop really serious hypertension. And then they go from pre diabetes into diabetes, or they suddenly put on even more weight. And they have more mood disorders and sleep disorders. And if they didn’t have it before, then they develop sleep apnea, which is also highly prevalent and should be screened for in all this battle with the PCOS. Because it’s so it’s such a common problem. And the women in their 40s and 50s and beyond are completely ignored with PCOS. I’m so glad you brought that up, because of course, there’s no reason that it heals itself, that all the metabolic issues are still there.

Dr. Felice Gersh

What dissipates is the elevated testosterone, because of the reproductive cycling goes away, because the body is no longer trying to get women to ovulate, when the ovaries can no longer make estrogen, the whole system drops down. And they still may have elevated testosterone, um, but it’s not to the same degree as it was when they were when they were younger. Some of the manifestations actually improved. But the metabolic problems persist. So their skin may be better, they may have less testosterone, and maybe their facial hair is not growing as much, but their metabolic problems have not gone away the hypertension, risk of stroke with a heart attack risk, all of those things are still right there.

Farrar Duro

So wonderful to speak to an OB-GYN who really gets PCOS and all the different life stages because it is true, we just get overwhelmed with the pregnancy and the fertility issues. And what about postpartum? What about as we get into menopause? and all those things. We try to really emphasize that no matter what age you are, you do need to have the right care, the appropriate screen. And the way that you do it is to educate yourself, because unfortunately, a lot of the providers out there are not going to be as comprehensive as we just talked about, they’re not going to talk about fasting to you or any of that. So the fact that you’re listening to this right now means that you’re taking it seriously. And if you have friends that have PCOS, or that probably had fertility issues and that sort of thing and struggled with their weight, and now they’re in their 40s, and 50s, definitely let them know that this is not going to just go away, it’s really important to address this, and get your fasting program, exercise program and nutritional program in place. It’s never too late either, that’s the good news. I really think that, if we could just, end with a parting piece of guidance for audience, and also the best way to connect with you. I think we could talk probably for another hour, I guess we have so much talk about but I would love to get your take on something that someone in our audience could really, start to move the needle with right away?

Dr. Felice Gersh

Well, I think if you’re going to start with something, it’s really working with your beautiful rhythms of your body, which are really off when you have PCOS. Ttry to go to bed, just try to get a very routine in your day with you, try to get up at the same time, don’t do what we call social jetlag where you do crazy stuff on the weekend, staying up till three o’clock in the morning, try to have a set routine, try to eat at the same times every day, go to bed at the same time every day, get into a routine exercise program, because exercise is so important. Try to just organize your life so that you can actually start by planning your day. Every day you start with breakfast, you have your regular meals, you get out in the sun, just kind of create a schedule. My recommendation is crazy. I have daily and weekly, which will hopefully be repetitive every day of the week schedule, so you can actually do these things. Because if you think about it, and then you never planned for it, and you don’t do it, it won’t happen. Write down a schedule, you’re going to do this at this time, visit this time, visit the sun, and then live it.

Farrar Duro

Awesome, wonderful piece of advice. And if you guys ever have any questions, I would encourage you to seek out Dr. Gersh’s website. She has a blog in there as well. And then also the new book that she has coming out or is already out “PCOS SOS”. It actually contains her protocols and so much information summit that we talked about. It will be a great resource as well. I have my own collection in my office and this is definitely going in there because I really think that it can make a difference. Just little changes that you can implement every day starting with when you wake up tomorrow, for sure. Thank you so much Dr. Gersh. And thank you guys for listening and I will see you here. Same time next week. Have a great week, everyone. Thank you.

Episode Spotlights:

  • Origin of genetic research ([2:37])
  • Survival advantage ([5:05])
  • How women with PCOS can use genetic information to their advantage ([7:10])
  • Altered gut microbiomes ([11:04])
  • Fasting and first steps ([12:30])
  • Estrogen impact on circadian rhythm ([13:17])
  • Dysregulated appetite and time restricted eating ([16:42])
  • Exercise is the miracle medicine ([23:10])
  • Sunlight and vitamin D importance ([25:08])
  • The body cannot multitask ([30:42])
  • Differences in male and female body and function ([34:28])
  • No matter what age you are, you need the appropriate care ([42:05])

Resources Mentioned In This Episode:

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