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...