Ep.114: Naturally Restore Your Rhythms, Hormones and Happiness with Dr. Felice Gersh

 

Robyn: Hey everyone, it’s Robyn Openshaw. Welcome back to The Vibe Show.

I am talking today with Dr. Felice Gersh. She is a medical doctor, and I sought her out because she qualified in our “Learn From Our Elders” series. She’s 65 years old, and she’s actually publishing her first book.

She is an expert in women’s hormone issues, and she went back to school and did a fellowship and became double board certified shortly before she turned 60 years old. She’s a perfect example of someone who is still learning, growing, very mentally sharp; you will find her very articulate in this interview.

I’m very excited to have her back for a second interview, because we got to the end and I realized that I was so mesmerized by everything she was saying that I didn’t ask her about part of her bio where she is a forensic expert in gynecological matters.

She’s been involved in some very high profile, pretty famous cases. You’ll recognize some of them. She’s promised to come back on the show soon and talk about why an OBGYN takes the stand in high profile legal cases to testify about gynecological matters. Pretty interesting, right?

She really is a rockstar doctor. She’s been in the top five percent of medical students. She’s been the outstanding volunteer faculty for the OBGYN Department at USC School of Medicine. She’s been named a super doctor in southern California. She’s named in the top doc list.

I’m really excited for you to hear this interview because I felt like it could have gone on for three hours and I would have been just completely mesmerized. I think you’re going to enjoy this.

Welcome to the Vibe show, Dr. Felice Gersh.

Dr. Gersh: Thank you so much Robyn for inviting me. It’s a pleasure to join you.

Robyn: I am really excited about this interview, because it’s remarkable when we find someone who’s over 65 and still going hard, still contributing in a big way, which you are obviously doing.

Some really interesting things are in your bio, including being a forensic OBGYN. I hope to get a minute on that – that’ll be a little side tangent – but you’re doing great work and you’re a woman, so of course we love that around here. We are looking for role models. We’re looking for who is rocking it still, at 20 years past where I am; and I don’t have a whole lot of role models so I might just attach myself to your ankle.

Let’s just start at the high level, and then I want to dive into some of the things in your super fascinating introduction to yourself that you sent me. What have you learned in your life and in your medical practice that now, at over the age of 65 (you’re welcome to share your age or not) that would you love to go back and tell your 35 year old self?

Dr. Gersh: Well, I actually had the most amazing mentor, who was my dad. I mean, my mom was fantastic, but my dad was sort of my mentor. He lived to over 98 and he said to me – well, he gave me so much good advice – but he said, “Do what you love. The money will come along. Just find your passion and go for it and don’t look back. Just keep moving forward.”

And that’s how I have lived my life. I have many, many chapters in my life, and this is just another. I hope I’ll have more chapters, and more interesting things. I look at the timeline; it will just keep going and going as long as it will go. I’m just barely over the 65 mark; I’m 66. But I don’t see that as hampering me in any way.

I went back and I actually had an interesting event happened. I was at a conference and I was with a bunch of naturopaths, and I was the only MD in the audience. And one of the speakers was an MD. I went over to her, and it was at a time when I was kind of lost, trying to transition from a conventional practice into something else, but I wasn’t quite sure what that something else was.

I said, “You know, I don’t know what to do. I’m really lost. I don’t have any mentors myself.” And she said, “Come and do the fellowship in Integrative Medicine at the University of Arizona School of Medicine. It starts in two weeks.”

I ran home. I applied. And two weeks later I was in Tucson, and I finished that fellowship in 2012. And that really opened the door to this wonderful new chapter, sort of really helped seal the deal for me to keep moving forward and looking back only to glean what I can in terms of what I’ve learned. Not to lament, or think, “Oh, I should’ve done something differently,” but always to keep an eye on the future. Especially with the idea that I will do what I’m passionate about.

And that’s why I’m here with you, Robyn, because I am passionate about talking about everything that has to do with women’s health.

Robyn: That’s pretty fascinating.

I’m picking up on a different thing than you might’ve even intended with in sharing that story. But I’m pretty sure what you just said is, you only became a functional medicine practitioner – kind of stepping outside of the ways of standard of care –when you were getting close to 60.

I think that’s fascinating because you know how people will say, “Oh I could go back to school, but then I’ll be like 50 when I finish,” or “I’ll be 60 when I finish.” And I always think, well, you’re going to be 50 anyway. You’re going to be 60 anyway.

Did you just tell me that you decided to go back for a fellowship, and sort of reinvent your career, shortly before you turned 60?

Dr. Gersh: Right. I graduated from my fellowship and I became board certified in integrative medicine. I finished it when I was 60. I was definitely, probably, the eldest one in my class. And I felt very much aligned with people who were 10, 20 years younger than me. Actually, that’s what they always say: when you get older, make sure you have younger friends. Because if you think of yourself in the mind frame of a younger person – not that I pretend that I’m your age because I know my age – then it’s your mindset.

In fact, they’ve even done studies where they took elderly people, in their eighties, and they put them in an environment that was an exact duplicate of the type of environment, like furnishings that they had, the house, they had fwhen they were children. They put the radio shows on like it was in the 1930’s. And over time – they monitored them over a month – they actually changed their markers, their blood markers, and they actually lowered their blood pressure. They actually became younger.

So, if you think of yourself in a certain age, rather than thinking of yourself as a conventional senior, then you can actually have the body of a younger person. The mind is so powerful that you can control your aging by just how you view yourself.

Robyn: Fascinating. And you’re not the first person to tell us this.

Very recently, I think it was our first Learn From our Elders interviewee… We interviewed Mimi Kirk, who is around 80, and she told us that all her best friends are in their thirties, and some of them in their twenties. And so here we have heard it again. I guess it’s kind of like the, “you are the average of the five people you spend the most time with” thing. I guess that applies to aging as well?

Dr. Gersh: Well, it certainly matters who you keep company with. We know that, in both the good and the bad that they talk about from a health point of view, if you hang out with people who don’t care about their health, who eat junk food, who never exercise, you will become one of them.

You really have to choose your friends very wisely, because you are the company you keep.

Robyn: I love it. Well, one of the things I thought was super interesting, about the background notes you gave me, was you said, “I understand that we humans are very much a part of the animal kingdom. Though we often like to think that none of the laws of nature apply to us, of course they do. The reality is that the prime directive of life is the creation of new life, the veritable circle of life. Some species procreate, they lay eggs, and they die. Some get eaten by their mate after mating and some, like humans, have a fairly long childhood, adolescence and reproductive lifespan, and so we get to live far longer lives.”

In taking that thought, what do you have to say about women and hormones and aging, because we want to live to be 200 while perfectly healthy, still doing handstands. Right? Or should we just give that idea up? Or what?

Dr. Gersh: Well, at this point, I’m certainly not realistically thinking about 200. I’m marketing myself for 100. But of course the optimal age that you live is going to be the optimal age that you’re still healthy, right? That what we call “health span”, because living long without health span – just like you said, doing handstands, which I may not be doing, but something comparable – is really where we want to be.

We want to have that health span, and that’s really one of the things that I do in the “age management” portion of my practice. Because I understand what nature is all about. And I don’t care.

That’s the thing. I understand that nature doesn’t really care about you or me as an individual, it cares about replacing us with new little humans and then having them do the same.

The bottom line is, menopause marks a massive metabolic change for women and it’s not for the better. And I don’t believe in living in a la-la land, and pretend that it’s the opening of a new chapter that’s wonderful that you lose your hormones from your ovaries and things get better. Unfortunately, we are really a product of our hormones.

If you think about it, if you took a little boy and a little girl who were fraternal twins at age seven, and you did everything identically for them, with the same classes and food and school and everything the same, and then you fast forward a dozen years and now they’re 19, they’re not going to look alike. It doesn’t matter that they ate the same food and played the same games. They have different hormones. It’s destiny.

And when a woman loses her ovarian function, the organs that make estrogen – which is how children and men get estrogen – don’t pick up the slack like the brain. A woman’s brain does not make as much estrogen as a male brain. A man’s brain makes six to eight times as much. And after menopause, women’s brains don’t make more. They simply get less.

That’s why women have almost three times the incidence of Alzheimer’s disease as males do. What I do is I try to do everything to optimize this, often, last half of our lives; so we can actually have that health span.

I do believe in giving hormones, recognizing that it’s completely concocted, it’s completely against nature, which says, after menopause, you’ve mastered (or didn’t) your destiny for biology and had kids, or didn’t; but it’s over. It doesn’t matter. You’re done with that. And once you’re done with reproduction, well, there is no grand plan for you. You are just set loose, you know; fend for yourself, like Survivors Island or something.

So I don’t have a problem [with the hormones]. Nobody does in medicine; we have artificial joints, right? We remove cataracts, we do implanted defibrillators; we do so many things that are certainly not natural.

Why not be proactive and recognize the vast metabolic roles that hormones play in women’s bodies; just replace them as best we can, as physiologically as we can. We’re never going to actually be the same as a pair of viable 25-year-old ovaries, but at least we could be better.

But then we get into the other part. So, the way I look at it, being healthy is like putting together a thousand-piece jigsaw puzzle and the hormones are the center 400 pieces. But the other 600 pieces are the rim, and that’s your lifestyle, your diet, your exercise, your stress, your sleep, working with your circadian rhythm, all of that sort of thing.

And that’s where we start, right? When we put a puzzle together, a thousand-piece puzzle, we always start with the rim, with the little straight edges. And we have to start with lifestyle and nutrition; it’s the foundation, and then we put our puzzle together, and then we can add in hormones recognizing that it’s just one piece. It’s not the whole. It’s one piece of the puzzle that is to create our health span.

Robyn: What I hear you saying – just to touch on the whole idea of replacing our hormones, and then I want to move on to the diet that you also just touched on – you like bioidentical hormones, but you want to be qualified about it and say, “This is not going to make you perennially 25 years old. When you have your ovary [functions] cut off, there’s just only so much we can do.” Right?

But, it’s going to give us healthier aging. It’s not the fountain of youth, that we can live forever like we did when we were 25. Is that about right?

Dr. Gersh: Robyn, you hit it right on the head. That is absolutely true. And anyone who says otherwise is not being honest. Because we can’t replace exactly what the ovaries do. The more we understand about what they do, the more we realize how complex it is.

The hormones don’t come out in a bolus in the morning, and then maybe another bolus at night. They don’t come out at equal amounts all day long, seven days a week. They’re pulses of hormones that come out more in the first half of the day, and less in the later part of the day. And they also relate and interact with the other hormones, and other things that are happening.

It’s very dynamic. And when we give hormones – like if somebody has a patch – they’re getting the same amount all the time. That is not physiologic. If you put on some cream, and you put a blob on in the morning and then a blob on at night, that’s not the way the ovaries do it. And if you have a pellet – which I don’t do at all, I don’t believe in pellets as being even close to physiologic –you get this really high relief in the beginning, and then it starts degrading; but you never know at what rate. I mean, those are not anything like the way the ovaries make hormones.

We can try rhythmic hormones, and that’s actually an area that I am working on with a group that’s nonprofit, that’s a foundation. We’re trying to raise money to actually do human research in Mexico where it’s a lot more affordable, to see how close can we come to replicating the hormones of an ovary. But we know we’re not going to come that close, so we have to look elsewhere for the Fountain of Youth.

We have to be realistic, and we have to try to keep as many of those puzzle pieces of our thousand-piece puzzle together into the puzzle, because it’s not going to be just take the hormones, and, like you said, you’ll be fabulous forever.

Robyn: You mentioned a little bit about the circadian rhythm, and I know that you’re really passionate about this. I think this is a fascinating area I’d love for you to cover.

I was reading recently about some more integrative doctors who do low dose chemotherapy; they don’t do the full dose, they’re willing to get paid less to do something that’s more useful to a cancer patient. They’ve started to look at timing, the delivery of chemotherapy to the circadian rhythm. I thought that was pretty fascinating.

Tell us how it applies to your work with women and hormones.

Dr. Gersh: Absolutely, it applies to everything. And you’re right, it’s a whole new world that they called Chrono Therapeutics, which is looking at the most optimal time of the day for whatever it is, surgery or pharmaceuticals and that sort of thing.

Basically, everything in our body is timed to the 24 hour rhythm of the day, of the rotation of earth on its axis, over the 24 hours. Everything is timed. And 90% of all the genes in our body are either clock genes or related to clock genes.

Virtually every hormone [is a clock system]; there’s a 24 hour clock of insulin and testosterone and estrogen. And you know, of course everyone knows, that there’s circadian rhythm of Cortisol; that’s the one that people know the best. That you have the peak of Cortisol in the morning when you wake up, and it should be lowest during the night, and that’s when the Melatonin rises. And people know the Melatonin Circadian Rhythm.

But everything is on a rhythm. And it’s all designed for survival. And once again, survival for the purpose of successful reproduction. When I was doing thousands of deliveries, I did not understand anything about the circadian rhythm at that time. In fact, they hadn’t even discovered clock genes or anything.

We didn’t know anything about it. And I kept wondering, why is it that all these patients of mine are going into labor during the night and then I have to go in at the early morning hours and deliver them. I thought that was a wives tale, but it’s actually my life, which is one of the reasons why after 25 years I had to give it up. It was literally killing me.

And now of course I understand, because women are programmed to go into labor during the night when everything is [dark], because that’s the safest time. Because under the cloak of darkness, they’re more protected from the wild beast of 25,000 years ago than if they were laboring in the middle of the day when the wild animals and other humans are up and about and could harm them. And that when they deliver in the early morning when the sun rises, they can go to a safer place and seek shelter where they can maybe protect themselves and their new baby.

Everything about us is designed for maximum survival. And that includes every rhythm of our body. And of course, what have we done in our society? We’ve ignored that. We have one third of the population working at odd hours during the night. Of course, I was one of those people for many, many decades. And then we have people eating at odd times.

Now we have all this new information about time restricted eating. It’s not just what you eat, which really matters, but it’s also when you eat it. It’s when you do everything. You have to recognize, once again, that we’re part of the animal kingdom, and if you take an animal that’s supposed to be up at night and you try to flip its circadian rhythm, it’s not going to be healthy. It’s the same for humans.

Robyn: I go to Switzerland for three weeks every summer, and this last time I decided to really flood my body with a few different probiotic supplements that I trust, because I had the sense that I could navigate jet lag better if I did that. I had read that as a theory, and I did it. And I had absolutely no jet lag on either end.

What do you think about it? Because I know you’re an expert on these kinds of connections, of the gut and the hormone system and the female reproductive system. What do you think that’s about, having healthy probiotics as supplements when you travel and change big time zones like that. Why? Why was that useful?

Dr. Gersh: It’s so interesting. The Gut microbiome, they’re living cells as well; if we think of the microbes, they are also like every living creature on this earth; they have their own clock genes as well. And there’s actually differences in the microbes at different times of the day and night, and there are certain microbes that respond to Melatonin and swarm, just like insects swarm. And they then communicate through their production of short chain fatty acids to the other microbes.

I’m sure that what you were doing, by taking the probiotics and the way that you are timing them, is that you are helping to maintain the circadian rhythm of your microbes inside of you by helping them to stay healthy and properly timed.

That’s one of the very interesting things that’s happening when you give your gut some rest. Like maybe you weren’t eating for a while. One of the things that I do when I travel, because I do a lot of traveling and speaking, is I try to fast the day before I take a very long transcontinental trip. And then once I get on the plane, I try to go instantly into the time zone that I’m going to be in to try to help my microbes. Because if you stop eating for a while, it’s sort of like a gut reboot.

But I think that when you were taking the probiotics, you are actually helping to support them. It’s like you put your microbes on life support, and they were actually helping them to ride out the time change.

Robyn: Interesting. I wonder if we can go back to talking about bioidentical hormones. Do you think that there will be a breakthrough? Because I don’t think that the transdermal pellets are a good idea. People get infected. We don’t know what they’re doing there under the skin. I think it’s terrible.

Dr. Gersh: I’m so glad you agree.

Robyn: Everybody, on a personal level, that I’ve known have done that usually for testosterone more than estrogen, but you’re saying that’s a way to deliver estrogen. I’m not a big fan of that. Do you think there’s going to be a breakthrough to at least mimic nature better for release of bioidentical hormones?

Dr. Gersh: I don’t think it’s happening really soon and that’s really sad because there is so little interest in the conventional medical world. In fact, even though there’s tons of literature in the basic science research showing all the functions, all the benefits, that hormones do in the body. I have a lecture on every single function in the body and how it correlates with estrogen, because estrogen has receptors in every organ everywhere. So of course it has its finger in everything.

The problem is, even though the data is there, the clinical world has not embraced this at all. So it’s going to happen, I just don’t know when. That’s part of my mission, to educate people to stop vilifying our hormones. They didn’t come into our bodies to injure us. They’re there to maintain our health.

And that’s why, after women hit menopause, they have dramatic declines in their health. By the time the average woman reaches the age of 75, there’s an 85% chance that she’ll be hypertensive. And women outdo men for strokes, dementia as I mentioned, they have equal amounts of heart attacks. Women have more osteoporosis and osteoarthritis than men.

After menopause, women have much more onsets of rheumatoid arthritis and they have a lot of gut problems. And of course, breast cancer dramatically rises when they lose their estrogen. That’s why postmenopausal breast cancer far exceeds premenopausal breast cancer, and colon cancer really starts to escalate. All these problems happen after menopause and it’s not a coincidence; it’s not the age of the woman, it’s the loss of the hormones of the woman.

So absolutely, if we’re going to start really thinking about being proactive for women’s health, and men’s health too, we really have to start figuring out better ways of delivering hormones that are in line with our rhythms. Women not only have circadian rhythms, of course; they have the beautiful lunar rhythm. There’s whole lectures I give on what happens in a menstrual cycle at different phases and how that correlates with different other parts of the body.

And of course it does. It’s not just about the uterus, it’s about the breasts, for example. When women have a normal menstrual cycle and they have their period, there’s data that show that abnormal cells (probably incipient, even breast cancer cells) actually kill themselves and die in the breast when the uterine lining is sloughing. So nature took its own care to prevent creating breast cancer.

We have all these fail-safe mechanisms. The problem is if you don’t have a real rhythm, if you don’t have the peaks and troughs and so on, the ebb and flow of the hormones, you actually don’t put into play any of these beautiful functions of the body. That we eat all the time, and now we know that we have to do some intermittent fasting or periodic fasting to actually give our bodies a chance to rejuvenate. You don’t go into the rejuvenating state unless you stop eating.

We’ve learned a lot. Now we actually have to start getting the mainstream doctors to really embrace this and then get the researchers to create a clinical way of using the hormones to manifest like the way the ovaries manifest with us. And that’s not happening. Not yet.

Robyn: So interesting. You’re talking about the ebb and flow, and that our prescriptions for bioidentical hormone then should ideally create those highs and lows of the hormones, which makes it that much more complex to get it right.

My girlfriend up here in Park City, Utah where I live, Dr. Trevor Cates told me that she trained under the Jonathan Wright method, and, when she was in practice, would have people go off their progesterone and go off their estrogen, maybe even go off their thyroid for a few days each month.

And I’m curious what you have to say about that, because I’ve had six different practitioners since I was diagnosed with Hashimoto’s about 17 years ago and I’m totally in remission. I never even have any antibodies show up in my annual testing, and that’s largely due to bioidentical hormones and being pretty darn clean with my eating habits.

So I wonder, should I be going off of hormones for a few days every month?

Dr. Gersh: I understand the motivation behind that and its intent is very good, because the people, I guess it was Jonathan Wright who is saying, “Well, in nature you don’t have incessant hormones at the same level, that’s not physiologic.” And I’m a big one to say, nature is really complex.

The more you learn about how cells work, the more complex you understand them to be, and the more you realize that we are not nearly smart enough to micromanage a cell. It’s not going to happen. And all you end up with is with lots of side effects like pharmaceuticals. And the same thing with hormones. We can’t really micromanage hormone receptors. We have to try to give the body hormones, the way they’re physiologically designed to receive them.

So about this idea, that you’ll take a break. I understand, because they’re trying to be a little more physiologic, but that’s still not being physiologic; there’s never a time in a woman’s menstrual cycle – if we figure a 25 year old who’s healthy and cycling – there’s never a time during her cycle that she simply has no hormones being produced. It doesn’t drop to zero. It doesn’t do that. It’s not like it’s the same for three weeks, and then suddenly it disappears for three days.

I understand the intent is good, but the reality is that that’s not even close to being physiologic. The idea with that is that you’re going to reboot your receptors; if you give the receptors a time when they don’t have exposure to the hormones, they’ll suddenly reboot. And this is all theoretical. There’s no data to support any of this. Nevertheless it’s a good intent, but it’s certainly not physiologic.

My wish, and my goal, is trying to work with raising money to create research because nobody in the conventional medical world is going to accept anything unless there’s at least some study to show something. That’s just where it is in science, and theory just won’t hold it together for them.

We have to have some studie,s and we’re going to try to create protocols. It’s somewhat similar, but hopefully more sophisticated than what people have produced and recommended or suggested in the past to try to mimic the rhythm of a normal menstrual cycle.

But like you said, it’s really complex; even when we put hormone cream on somebody’s skin, even for that same person, how can we think that they’re going to absorb exactly the same amount, even from the same dose, every day? Talk about concocted. The skin of our bodies were never evolved to be a hormone delivery system. We just do it because, fortunately, things can absorb through the skin; but the temperature of the skin, the time of day, the blood flow, how hard you rub, all these different things can actually change even for the same person, change how they absorb it. We’re just making do. We’re trying to do the best we can.

The best thing would be something that doesn’t exist. And that would be something like the way people have an insulin pump; we would have an estrogen progesterone pump where we can actually have it pulse through the day, and have different amounts, and give it what the body needs. But we are so far from something like that. And we need researchers, and they have to see some money to be made because money is always what drives these kinds of inventions. Unfortunately. Or fortunately, depending on how you look at it.

There’s not a lot of money to be made in giving bioidentical hormones because you can’t patent it. So it’s really a challenge. But I’m not giving up because I know that we can do better. What we’re doing now is better than nothing, but it’s certainly not where we should be.

Robyn: I absolutely agree. And you’ve said a lot there.

There’s so many things that I want to ask you, but very quickly (I don’t think this is super self-indulgent because while I’m asking this for a dear friend of mine), I think there are lots of women who have this question.

We certainly get asked this quite often, but there are so many women now who have had their hormones in misfire for so many years, even decades. They have things like fibroids, and, gosh, I can’t think of the name of it right now, but all the fibroids covering the whole inside of their uterus and literally gluing organs together.

Dr. Gersh: Oh. Like endometriosis?

Robyn: Thank you. That’s it. I had it two minutes before I asked you the question and then, gone. Yes, thank you. I knew you’d supply that.

My dear friend who’s 45, she looks healthy. She’s active, but she has had endometriosis for many, many years. They tried to go in and scrape [the uterus], but they couldn’t get into the uterus very well. Obviously I’m not using her name because I’m giving some personal details here. But the reason I ask is that there’s so many women being prescribed hysterectomy, and you and I understand the ramifications of losing your ovaries and losing your ability to produce hormones.

But what do you think for people like my friend, where every doctor has said, “You’re kind of at the end of the line here, we just want to take it all.” Do you have any hope to offer her that isn’t surgical? Do you think that there’s a time and a place for hysterectomies? Do you feel like we’re performing too many hysterectomies? What would you tell women with endometriosis, fibroids and the like?

Dr. Gersh: Well, even the American College of OBGYN has come out in the past saying 70 percent of hysterectomies are not warranted, so I’m sure there are way too many hysterectomies for sure. And in terms of any disease, when we’re talking about uterine fibroids or endometriosis, for myself as a treating physician it’s far easier for me to do good the earlier I see them, of course, in the course of their disease progression. So if somebody came into me and they had uterine fibroids the size of a nine month pregnancy, I can’t make that go away. I don’t have that power.

Now, can I make things a little better? I can certainly do that. But you know, for someone that comes in with a gigantic uterus like that, we’re kind of stuck. They probably are the case where a hysterectomy is warranted.

For someone with endometriosis, I really like to try everything first because, generally speaking, it’s often going to involve their ovaries to be removed as well, and that is, like you mentioned, really tragic when you lose your ovaries and the hormones are never replaced. We just were talking about it, to be really physiologic. And they usually replace the hormones of a woman who has her ovaries removed at, say, 32, they replace the hormones as if she were 62. So they’re not giving her physiologic levels of hormones, not just even the rhythm of how they’re dosing it; she’s not getting levels that are typically comparable of a level that her age group should have. So it has so many problems.

Whereas with fibroids, generally speaking, you don’t have to take out the ovaries; although we now know that taking out the uterus does compromise the blood flow and the function and can set women into earlier menopause, so we certainly do not want hysterectomies that we can avoid.

For endometriosis, we now know it’s a very complex condition that is involving endocrine disruptors. It’s really mostly in women who are genetically predisposed, and they’ve been exposed to endocrine disruptors at key developmental times, like in early childhood, at puberty, and also in utero, when their estrogen and progesterone receptors are being formed.

We know that most women with endometriosis have malfunctioning progesterone receptors, which is why pouring progesterone into them has little effect in many, many women. Some of them you can override it, just like you can override receptor resistance to insulin, and even thyroid if you give enough of it. So sometimes by pouring in enough progesterone, you can override that receptor resistance; but you have a completely out-of-control immune system because there’s also estrogen receptor malfunction. And estrogen is really the master of the immune system.

For example, we now know that endometriosis is often triggered by explosions of mass cells that release all these inflammatory contents; all the inflammatory cytokines, for example – the cytokines like tumor necrosis factor Alpha and the histamine – is in there, and they also release the chemokines that call in the other troops, the other inflammatory cells, and it creates inflammatory chaos in the pelvis of these women.

And the way the estrogen should work is that they create the enzymes of these immune cells, like the matrix metalloproteinases, to actually dissolve the backwash of uterine cells that come out and float backwards through the Fallopian tubes, into the pelvic cavity. Those uterine cells should be dissolved by the enzymes of these immune cells.

Instead, these immune cells are misdirected, and they’re dissolving little holes in the peritoneum and in the ovaries and the backside of the uterus into the actual pelvic cavity. And then the lining cells, instead of being dissolved, are actually implanting; they’re creating little nests for them.

And estrogen, which is all about healing and creating new blood supply and healing damaged tissue, is actually inadvertently supplying blood flow; new blood vessels are growing to these endometriosis implants and the estrogen is nourishing it. So, estrogen is supposed to be helping damaged tissue, and nourishing and helping proliferate and grow new tissue, but it’s all being subverted in a very abnormal way to support this inappropriate growth of uterine-lining tissue, the endometrial tissue in the pelvis.

Then the progesterone, which sort of comes to the rescue and downs the inflammation of all of this, it doesn’t work because the receptors are not working properly.

So what can you do? Well, it turns out that, because these women are in a massive state of oxidative stress in their pelvis, if you give them really high quantities of polyphenols and antioxidants in their diet, you can see dramatic reductions in their pain.

There’s actually studies showing that, for example, vitamin C that you can get from foods, and vitamin E, and all these antioxidants, green tea, ECGC – when drinking and having concentrates of green tea, you have to be careful, always take it with food – you can actually downregulate a lot of this inflammatory process.

Also, if you do a fasting mimicking diet, they’ve shown that it also significantly lowers inflammation, because these women are like on fire in their pelvis.

So, before doing something like a hysterectomy for your friend, I would really put her on a diet that was 12 cups of varied vegetables and fruits a day. I would give her lots of antioxidants, probably an IV with some antioxidants, the B complex, Vitamin C. And I would put her on a program of stress reduction, because the brain modulates the immune system. You can actually train the brain to sort of downregulate the immune system and make things less on fire.

There’s a lot that can be done, and maybe with any luck she can avoid that hysterectomy.

Robyn: Okay. Because I think this is her last hurrah here before she goes to hysterectomy, I’m really excited to share this episode with her.

You mentioned fasting mimicking diet, and I noticed in your notes, I think, that we’re both students of The Longevity Institute at USC, and of Dr. Valter Longo, who’s been a guest on this podcast. It sounds like we have in common that we restrict the amount of time that we eat.

It’s being popularly called time restricted eating. I think it’s silly when people say intermittent fasting, because stopping eating at dinner and starting eating at breakfast isn’t fasting. But I too have done four long fasts in the last two years and I see that you’ve done fasting 13 times.

Because you’re 65, and I see that, I’m going to read the paragraph you wrote me about your take on nutrition. This is Dr. Gersh boiled down to one paragraph, here’s what she says; and then I want to ask you about being 65 and doing fasting. I know that you’re very precise about wanting to make sure that people 65 plus get enough protein and don’t lose muscle mass.

Here’s what Dr. Gersh said to me, “I’m a huge plant advocate and I’m for fermented foods, organic soy and other phytoestrogens, whole organic grains, nuts and seeds for women over 65. I recommend some healthy animal foods each day once in that age category; becoming frail due to Sarcopenia and osteoporosis is a grim reality.”

I’m hearing this from more and more 65-plus folks and the physicians who treat them, even if they’re heavily in favor of the plant based Diet. That’s been my diet for 25 years now. And we just interviewed Dr. Brian Clement, who’s been a 100% Vegan for 45 years and he’s healthy at 70. So is his wife, same diet.

You say body composition testing is important to check once you become a senior. We don’t want to lose lean body mass. So do you lose lean body mass when you are fasting? Tell me about your fast, how long you fast, and how you protect against that.

Dr. Gersh: Well, I don’t. And I do watch it. And I do the fasting mimicking diet, the Prolon that professor Longo developed with his team over at the Longevity Institute.

It’s really near and dear to my heart, his research; they actually put their own little caveats on it as far as people go when they’re over 65, because it’s not tested in that age group and they do not promote it for that age group. But as an individual doctor, I can do whatever I want. I just watch my own patients and I make sure that their body mass is such that they’re not to lean to begin with. That’s not my problem. I’m okay, but I’m not too lean; but I have enough body fat to burn. And I watch it, because I don’t want to and I can’t afford – none of us can – to lose our muscle mass or neural tissue or bone, certainly.

But because I myself am on hormones, that’s one of the things that I want to discuss with Professor Longo; doing some studies in menopausal women both on and not on hormones, and what levels [of estrogen] do they have.  Because estrogen is very important, obviously, for maintaining muscle. We know that there are receptors in bone – most people know about bone – but it’s also very important for muscle.

I think a lot of the worry that has come about for using a fasting mimicking diet in people over 65 is based predominantly on people not having any hormones – as far as any kind of hormone replacement therapy – at that age. I found in my own patient population that women who are on physiologic levels of hormones do well. I haven’t done it in 80-year olds; I’m being honest. I’m still very cautious. I am not doing fasting in 80-year olds. I do some time restricted eating, but I I’m not going to get into that age               group and start experimenting.

But in healthy people in their sixties or even early seventies, who have very significant amounts of body mass already and they’re not frail, then I watch them, we get body compositions. They can still get the benefits of a fasting mimicking diet and not have any of the negative.

I’ve done very well, but I’m very cautious and I do recognize that it’s not been well tested in that [80+) age group.

Robyn: I’m really paying close attention to all the evidence that comes out. Not just about fasting, which I think Dr. Longo’s right that probably there are people who really can’t handle that. People who are significantly overweight actually do pretty well because they’ve got plenty of body fat for their body to feast on.

I struggle with fasting. In fact, I have to go away. I have to go away. And I’ve fasted, for between one week and two weeks, four times. I think that the track record of fasting is inarguable, but people are really toxic these days, and when you fast you’re going to start flooding out a lot of toxicity.

I’m no longer going to go to this Ashram in Texas. I’ve gone four times, but they don’t have a sauna. I have an infrared sauna here at my house, but I just don’t have the tools there, so I wouldn’t send somebody to the Ashram to fast.

But I think it’s really interesting about the information coming out of Longo’s Longevity Institute, that we can eat 600 to 800 calories a day.

His Prolon program… I don’t want to be a critic because I understand what he’s trying to do, but it’s all packaged stuff. And when I’m getting 600 to 800 calories a day… I think you can get some of the same benefits, but I would rather steam some asparagus and eat it, or eat a nectarine or whatever.

But it’s definitely done for you. It’s very expensive. It’s not organic. So it’s probably their first, coming to market with their first product. But I think that the evidence is really exciting, what’s coming out.

I was pretty fascinated that at 65 you’re fasting because you know the risks there.

Dr. Gersh: The thing with the fasting mimicking diet is I know it’s on their side, in terms of it’s not all certified organic but it is coming from organic sources. But you have to be careful if you make up your own fasting mimicking diet, so to speak, by keeping the calories in that same calorie range.

Most likely you’ll end up having a low calorie diet, because they’ve created it over 20 years to be such that it can fly under the nutrient sensor detectors. So I call it stealth food, because if you eat but it’s not detected so you can play around with other foods in that same calorie range. But you really won’t know if you’re actually eating a low calorie diet or you’re actually getting the benefits of fasting, which are actually quite different.

Because when you have the true fasting, you actually trigger a programmed cell suicide and stem cell stimulation and autophagy where the cells rejuvenate themselves from within and so forth. But you get the low calorie.

You’re better than me, Robyn. I have never gone even more than 24 hours of a true water fast. That’s why I do the fasting mimicking diet because I can’t do it. And most of my patients are not that capable either, because we get too sad I guess, we just miss our food and we start eating. So that’s the one thing about a fasting mimicking diet, for people like me who just can’t seem to go more than one day with no food at all. It gives us a viable option.

But I definitely recommend, as you mentioned, an infrared sauna. I have one in my office and I have one in my home and I really think they’re wonderful and I’m glad that you’re using it.

Robyn: I think that fasting is not for everybody. I think fasting for a week or two… I just want to say I’m not Hercules here. I have to go away because if I were at home I literally don’t have the self-discipline. I would like get in my car and just lose it and go.

Dr. Gersh: I feel better because I’m thinking, well you are far better than I. I can’t do it. So you have to be locked away. Maybe I could do it if I was locked away too.

Robyn: Exactly. This place in Texas is two hours from the Dallas airport, and when you get there you actually cannot use your Lyft or your Uber Apps, so it doesn’t matter how desperate I got to go get some food. I would have to get a car company, and it takes 24 hours to get them there, so I can’t have a freak out and go walk someplace. It’s very rural.

You know, I’ve thought about going to True North because I think they do a really good job of supporting people while water fasting, but the reason I don’t is because I know it’s in California and I know I could walk across the street and get some food. And that’s not going to deal with my problem, which is the lack of self-discipline.

But you know my friend Katie who runs Wellness Mama, one of the biggest sites on the Internet, she does it for like two weeks, all while taking care of her six kids and homeschooling them and cooking them three meals a day while her husband’s out of town. So I don’t know if there’s just people with…

Dr. Gersh: I think she’s saving that time. She has no time to eat it.

Robyn: Well, she probably is keeping her mind off of it pretty well.

I really have been completely fascinated by this whole conversation, I wish we could just go on for round two; but you said a really interesting thing I just wanted to touch on before we ask you how people can learn more about you.

I know you have either just come out with, or are about to come out with, your first book. And again, just Kudos to you that you are. You know, [at an age] when a lot of people are thinking about retirement, you’re bringing great work out there in the world.

But I would love to know what this is about. You said that you love tea, you love organic dates – which you say are an underappreciated and much maligned superfood – and organic hot air popcorn. And you said it’s a great source of fiber plus nutrients. You said this combo combats the malady of so many seniors. And I know it’s not just the malady of seniors, it’s juniors too, kids and teenagers and young adults. They’re all constipated.

Tell us about those three foods, and why those are great for constipation.

Dr. Gersh: Well, the teas are great for so many reasons, but for the constipation it’s primarily for hydration. But I love so many different types of teas. I have so many ones; I love variety so you can experiment; try some of the herbals, green tea of course. And then black tea is excellent too. I like Earl Grey. Try to get, of course, organic tea, because like every food product, it’s grown with something bad on it if you don’t get organic, so try to do that.

So you get the hydration from the tea.

And the dates, now I really got into dates because the last couple of years I did a whole two-day women’s education program in Dubai. And the last time I was in Dubai, which was a few months ago, I then went and I did some speaking in Oman, and I toured around in Oman and the whole culture there was based on dates.

They had a date society. So, they used every bit of a date. The date palm tree, the leaves, the bark, of course the date itself they would crush, they’d make into liquid. They would use the seeds, and they would send people out into the Persian Gulf and they would have baskets of these beautiful dates and they would live on them for three weeks while they did their fishing. Then they would come back and they were fine, they were fine. And all they lived on were dates. So I started thinking what’s with these dates? I mean, this whole society lived on dates and they had these beautiful date markets, and I tried all these different kinds of dates, so I became a date aficionado of sorts.

And from then I’ve been eating dates on a very regular basis. And I’ve looked up the value of dates. They’re full of polyphenols, antioxidants and amazing fiber. A lot of people think, oh, if you eat dates, you’re going to get diabetes. That is really not the case. And the people in the Middle East in Oman, they were not diabetic. Now there’s a lot of diabetics there because they’re eating American food, but they lived very good lives.

And so the dates are amazing. I researched it, and they’re great for constipation. They’re better than prunes and they’re delicious and they have so much health benefit.

And then hot air organic – it has to be organic – popcorn. Corn has been, like all these foods are, maligned. Dates are maligned, just like estrogen; I’m here to defend the defenseless. So corn – now if you have crappy GMO grown corn, of course that’s a terrible food – but if you get organic corn and you hot air pop it, it has no oxidized oils on it, nothing like that.

It’s an amazing source of fiber. It also has nutrients in it, but just as a fiber source, [it’s great]. So if you have like six dates and you have a small bowl – like one small scoop of the dry popcorn and then pop it so it’s like one nice bowl – and then you have a few cups of tea, your GI tract is going to be great.

I tell you, I use this with all my patients. I’m finding amazing results. It’s wonderful food.

Robyn: Wow. I feel like maybe your second book could be the Date Diet or something like that.

Dr. Gersh: It could be. I will tell you, you go to Oman and then you can’t leave and not love dates.

Robyn: I’m feeling pretty good about the four dates that are in my breakfast every morning. And I don’t know, maybe that’s why I’ve never…

Dr. Gersh: Hey, Robyn, I didn’t know you were already another date lover.

Robyn: I’m a date lover, although I blend mine into this pretty famous smoothie that I’ve taught people for many years.

Dr. Gersh: Well, you can eat it different ways. Remember I told you they did everything under the sun, anything you could do with the date they did it.

Robyn: Mine is blended with cashews, beets, carrots, strawberries, and fermented coconut water, which I teach people all the time. But anyways, maybe that’s why I’ve never had constipation. Who knows? I did not know that.

Dr. Gersh: Well, you’ve got plenty of hydration going on in there too.

Robyn: I think your next book should be those three things. You just have to organize them into an acronym and make it the “whatever” diet, or whatever it is.

Dr. Gersh tell us about your book coming out, or has it released, and where people who want to follow you and learn more from you can find you.

Dr. Gersh: My book, which hopefully will be available for presale in maybe a month, is called “PCOS SOS”. And it has a little subtitle, “A gynecologist lifeline to naturally restore your rhythms, hormones and happiness”. It’s a whole new take and a new understanding on the most common endocrine disorder of women, which is PCOS.

Hopefully we can make some advances there and help women who traditionally are treated by the conventional world with birth control pills, which have a lot of problems associated with it. And Spironolactone, which is a terrible teratogen and metformin which is a recognized endocrine disruptor. There’s a lot of issues with our current treatments and of course none of them get to the underlying root causes.

That will be out soon. And you can go to my website – which is very easy, it has my middle initial in it though, that’s the only trick – which is: felicelgershmd.com

Robyn: That’s Felice. F E L I C E what’s your middle initial? L G E R S H. All right.

Well thank you so much. You’ve shared so much information that’s really useful to me personally, and I hope to my audience as well. Thank you so very much for being with us today.

Dr. Gersh: It’s been all my pleasure. Thank you for inviting me Robyn.