I have the honor of connecting with Dr. Felice Gersh today! Dr. Gersh is an incredible resource! She is a multi-award-winning physician with dual board certification in OB-GYN and Integrative Medicine. She is also a recognized expert on PCOS.
PCOS (polycystic ovary syndrome) is a syndrome of inflammation, imbalanced hormones, and insulin resistance. It is the most common female endocrine disorder and the leading cause of infertility in women.
This episode is the first part of a two-part series with Dr. Gersh. We dive into PCOS, discuss its foundation, and explain how we are often genetically predisposed to it. We discuss the symptoms and how they can predispose us to autoimmunity and endometrial cancer. We speak about estrogen, the role it plays in PCOS, and how it systemically impacts the ovaries, pancreas, liver, and intestines. We talk about how PCOS modulates inflammation and how shift workers and women with PCOS tend to struggle with circadian rhythm disruption. We also discuss lifestyle changes, supplements, and medication we can use for PCOS.
Dr. Gersh will return to the podcast in the fall to speak about perimenopause and menopause.
I hope you enjoy listening to our discussion as much as I did recording it! Stay tuned for more!
IN THIS EPISODE YOU WILL LEARN:
Dr. Gersh discusses her career trajectory and explains what motivated her to work with women’s health.
PCOS is a vital sign of everything to do with female health.
Oral contraceptives do not regulate women’s cycles. Dr. Gersch explains how they change the entire dynamic of a woman’s physiology.
Dr. Gersh explains why the bodies of women with PCOS are metabolically unhealthy.
Why do women who have estrogen do better?
Some common symptoms of PCOS.
Every organ in the body is involved with estrogen.
80-85% of PCOS women fit into the ovarian ideology and do not make enough estradiol. Dr. Gersh explains why that happens.
Dr. Gersh talks about the impact of PCOS on the different microbiomes in the body.
Research has found that the immune cells of women with PCOS take less to create a big inflammatory response.
Dr. Gersh explains how and why female hearts differ from male hearts.
Why is estrogen crucial for mitochondrial health?
Why do women with PCOS have the highest rates of pregnancy-related complications?
Dr. Gersh talks about the first step in solving the PCOS problem.
How does PCOD disrupt the circadian rhythm?
Dr. Gersh discusses supplements and other ways to address PCOS.
“Estrogen is key to maintaining the microbiomes of everything.”
-Dr. Felice Gersh
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Felice Gersh
On her website: Integrative Medical Group of Irvine
On Instagram
All Dr. Gersh’s books are available on Amazon
Transcript:
Cynthia Thurlow: Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent, is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
Today, I had the distinct honor of connecting with Dr. Felice Gersh. She's a multi-award-winning physician with a dual-board certifications in OB-GYN and integrative medicine. I had the honor of meeting her in person in 2019 and I can assure you, this is the very first of two collaborations in terms of podcasting. Today, we dove deep into PCOS or polycystic ovarian syndrome. We spoke about how this is the most common female endocrine disorder and the leading cause of infertility in women. We spoke at great length about the basis for PCOS, how we are genetically predisposed in many instances. It is a syndrome of inflammation, imbalanced hormones, and insulin resistance. We spoke about symptoms, how this can predispose you to autoimmunity, as well as endometrial cancer.
We spoke about estrogen and the role in PCOS in particular, how this has a net impact systemically on our ovaries, pancreas, liver, intestines, it's a modulation of inflammation, how shift workers struggle with circadian rhythm disruption, as well as women with PCOS, lifestyle changes that we can do to augment as well as supplements and medication. Dr. Gersh is an incredible, incredible resource. I am so very grateful to be able to share this information. I've had so many younger women asking for a good podcast on PCOS. But stay tuned. Dr. Gersh will be returning this fall and we will speak at length about perimenopause and menopause. I hope you will enjoy this podcast as much as I did recording it.
Well, Dr. Gersh, it's such a pleasure to reconnect with you. I actually was in Florida at the same time you were. You spoke at a forum and I spoke in a breakout session, and I missed having an opportunity to see you speak, because we spoke at the same time. I kept saying, “How can this happen? [laughs] So, welcome. It's so nice to have you on.
Felice Gersh: Well, the universe put us back together. Yay.
Cynthia Thurlow: Exactly, exactly. Now, I would love for you to share with the listeners. Did you always know that you wanted to be an OB-GYN? Was that the trajectory of your young adulthood that that was the direction you anticipated going in or was this just a random occurrence? Because it looks like your entire career has really been devoted to the care of women. And so, I know it'll be an invaluable conversation. For listeners to know, this is the first of two episodes. Dr. Gersh has very graciously agreed to come back because there were so much to discuss that we could not do it in one hour segment.
Felice Gersh: Well, no.
[laughter]
Felice Gersh: Actually, it was not I was born knowing my destiny or anything like that. But I did come from a family that gave a very limited menu of career opportunities and I never questioned it as it turns out. And so, growing up it was always understood that I would go into a career. My mom was an attorney, so was my dad and we just had a lot of expectations that women are going to do whatever they want to do. But I only had three choices that I understood. One was to be a lawyer like my parents, another was to be a teacher, and the third was to be a doctor. Well, okay, so, okay, get it, lawyer, doctor, teacher, which one am I best at? I said, “Well, I'm good in science and everything was supposed to be serving people and helping.” And so, I picked doctoring. And so, I didn't want to just exclusively learn about science, I really had interest in many things.
In college, I actually majored in history and dabbled in history across the whole history of mankind and did a lot of art history. But then I had to take all the prerequisites, of course. I had all these other science courses that I had on the side. And then I got into medical school and my parents went away for two years. When I spoke to these really hotshots like, well, renowned hundreds and hundreds of published articles on PubMed and everything else, all they told me was, “You're not trying to get pregnant. So, just go on birth control pills, just go on birth control pills.” It's like, but something is wrong with me. And that was really the spark that set me on my journey is like, “Okay, so many people.” We always make jokes about psychiatrists, but we won't go there. It's either something in our family, something in ourselves that triggers us to learn more, to want to understand. Trying to figure out what was wrong with me have made me want to go into women's health.
And then when I did my rotation in medical school, in OB-GYN and I was doing the labor and delivery rotation, and I was delivering babies, and I saw how sick many of these women. This was a county hospital. They were very sick and I saw how much medicine you needed to know. You know what, and also, I became an adrenaline rush addict. I didn't realize that that was in me. But just the life and death scenarios that presented themselves in a labor and delivery scenario and I wanted to do that. I said, “You have to know everything.” To do obstetrics properly, you need to know about medicine, you need to know surgery, and you have all of this-- When you see ER, because you've been in there, where you have truly immediate life and death situations, where you can save lives two at a time.
But also, what I liked about OB-GYN was the continuum of care. Because you not only just did like a surgeon or a trauma surgeon, where you just had that one intervention, and then next, next, next. No, you could create lifelong relationships with the women, because they would come to you. And that was the time when it was being debated, “Are women going to go to an OB-GYN just for pelvic care or is the woman going to use the OB-GYN as their primary care physician?” And I took that position, because I loved medicine and learning how to deal with a lot of things. So, I wanted to do more than just pelvic stuff.
And I also saw the context that everything is linked to everything that when women have-- Before it was even discussed, because I go way back that the menstrual cycle meant something to the woman's health status. It wasn't just, “Oh, well, I guess, you can't get pregnant easily.” No, it meant, she's not healthy when she has a menstrual cycle dysfunction. I guess, I saw everything in that field and that's where I am today. Then I've made many twists and turns since I began as we all evolve and led me to wanting to be with you here today to really help educate women about what it takes to be a healthy woman.
Cynthia Thurlow: Yeah. Well, I'm so very grateful that you had that trajectory of your career and has gotten you to where you are today. I think there are a couple things. First of all, as a former ER nurse in Inner City, Baltimore, we were terrified of pregnant women. We did everything we could to immediately get them to the OB floor, because we were terrified of women at that life stage, because we never liked having women deliver in ER bathrooms and that happened quite a bit.
Felice Gersh: Yeah.
Cynthia Thurlow: We would say, ”No one goes to the bathroom.” If you're a pregnant woman, you're not allowed to go to bathroom.
Felice Gersh: [laughs]
Cynthia Thurlow: You have to be with a healthcare professional in the bathroom. Number two, how many women listening including myself experienced menstrual cycle irregularities and were prescribed a pill? I remember being 16 years old. [crosstalk] Exactly. I was 16 years old. I probably had very mild PCOS, which we're going to talk about today. I didn't fit the typical phenotype of someone with PCOS. But my cycles were so irregular and my GYN very kindly said, “We have something that can fix this problem.” And I then remained on oral contraceptives until I got married. I thought in my brain, even as a nurse practitioner didn't even think about what the net impact was. But when we talk about oral contraceptives, oftentimes, masking those menstrual irregularities, it is a huge issue. In fact, I feel with good intent they are prescribed and I always say, “Listen, there's no judgement when women are looking for reliable contraception that oftentimes can be a viable option. But we don't realize what the net impact is, it's masking whatever that irregularity is.” And so, you are recognized expert on PCOS or polycystic ovarian syndrome.
When I was reading your book, which is my favorite book about PCOS to recommend PCOS SOS is that book. One of the things that I found really startling is that you mentioned that PCOS is the most common female endocrine disorder and I thought to myself, “Gosh,” in my mind, I'm thinking diabetes. That's usually what I think about that it just diabetes, and insulin resistance, and PCOS, all go together. But that was such a profound sentence that I read. I thought I have to really take that in. From your perspective, in terms of looking at PCOS as a disorder and it's a disorder related to menstrual irregularities, but it's so much more than that. As I dove into your book, which I mentioned I reread last week, it really reminded me why it's so important to have these conversations. Because PCOS is not benign. And I think many of us think of it as being this benign entity and it really isn't.
Felice Gersh: No, and it's really interesting how just in the last few weeks, several articles have been published that have been out there on things that those of us in the medical field see all the time like med page and Medscape and they always putting out some of the newest articles. They're like, “Oh, PCOS is pregnancy is associated with heart failure, more heart dysfunction. Or, women with PCOS are more likely to have hypertension when they get older.” Of course, this is like, “Duh. There's so many things that they discovered.” It's like, “Excuse me, we actually knew this before. You didn't discover it.” And PCOS is about everything involving female health. Because we were chatting about this before that the menstrual cycle and you alluded to this just a few moments ago is really a vital sign of female health status. Just like you go into the ER and you say, “What's the blood pressure?” “Oh, no, it's 60 over 30. That's a big problem. Or, it's 180 over 120. That's another big problem.” So, it's a vital sign.
Instead of recognizing that when it's all messed up, it's irregular, it's incredibly heavy, it's prolonged, it's terribly painful or you get horrible PMS. That is a giant red flag that this female's body is in trouble, something is wrong. And it's all smoking mirrors when you give oral contraceptives. It drives me crazy and so, you, too. When the doctor, like you said, well-meaning says, “This is going to regulate your cycles.” You're not regulating, you're covering up. So, you're taking the ovaries offline, you're completely shutting them down and replacing the human beautiful natural hormones and rhythms, which you deal with intermittent fasting. If we know that, it's not just what you do. It's when you do it. It's not just that you have some kind of hormones. It's when they come out in pulses, and the rhythms, and the beautiful lunar cycle, and there's even circadian cycles of hormones. None of that happens when you're on a birth control pill.
You're changing the entire physiologic dynamic of the female. And of course, there are repercussions. They're just not immediate in most cases occasionally and they're always subtle. They're long term. When people are exposed to endocrine disruptors, chemicals in our world, they don't fall over dead. If you have a lot of chemicals that are inappropriate, that's everybody has a lot. But BPA, which has the most research in PCOS, that's why I brought that up. It's ubiquitous, it's everywhere, endocrine disruptor, it doesn't just kill you immediately, but it can have all kinds of profound long-term effects. And that's what we're looking at. We live in a world where we can only associate causal relationships when they happen immediately. But no, there are causal relationships that can happen even decades.
For example, they have now found out that young women back in the day when DDT was sprayed all over for mosquito control on beaches, and they would just go around and spray DDT, and young girls like 12, 13 years old were literally sprayed with DDT, those women have substantially increased risk of developing breast cancer in their 40s. We wonder, “Why are all these young women, suddenly, why do we have a seven-fold increase in premenopausal breast cancer?” It's because of chemicals that they may have been exposed to many years earlier. We know that in utero exposure to various toxic and chemicals can increase childhood leukemia and that could be years later. The bottom line is that birth control pills and we could talk forever on that. Maybe someday we'll do another just on what it means to have contraceptives, all the different types out there. Because it's really a huge, important deal that every woman know about.
But birth control pills are not human hormones. They don't regulate anything. They take down your own hormones, they don't fix you, and they have a proinflammatory propensity. That's really important for women with PCOS to know. Women with PCOS live in bodies that are metabolically unhealthy. They're not just reproductively challenged. They are truly metabolically unhealthy. If you say, “Well, what the heck is metabolism anyway?” People throw the word metabolism around all the time. So, what are you talking about? Metabolism is the creation, utilization, storage of energy. What's the difference between you and a person who isn't alive? Well, you make energy. That's why everyone has seen TV shows where they have the EKG, and you see the heartbeat, and then, “Uh-oh, it's flatlining.” That means the heart is no longer creating energy. That's an electrical signal. The same thing with the brain. “Uh-oh, flatlining.” That mean your brain dead. The brain is not creating energy. So, you need energy in order to function.
Old people, they're sitting on the bench in a park is that because they love benches? No, it's because they don't have the energy. They would love to be running around like the kids out there on the field, but they're tired. They don't have the ability to make that kind of energy. So, metabolism is like a critical thing and women with PCOS have an altered not healthy metabolism. They don't make energy well. And that's for every organ system in their body, because estrogen is critical for the creation of energy. And it has many, many functions. But that's a huge one, because we have these little energy factories in every cell called mitochondria. They create the energy by burning our energy source aka food. Glucose, and fatty acids which turn like into ketones and so on. But in order for that to happen, you have to have proper estrogen in the form of estradiol, the estrogen made by the ovary, that is not what is in a birth control pill. When you don't have proper estrogen, you also don't have proper functioning of your immune system because estrogen holds the key to immune function, which is critical for survival and very involved in reproduction. Because we don't want to kill with our immune cells our little fetus, and we don't want to kill the sperm. It's an amazing thing.
Estrogen regulates the immune system. Now, that means it works the switch that turns on and turns off inflammation response based on what the body needs. If you have an infection like COVID, you want instantly the inflammatory process to be turned on, but then you want resolution, which some people don't get. They get the cytokine storm? Well, estrogen, which by the way, there have now been reports, but finally, I knew this from the get go that women who have proper estrogen are going to do better. That's why women statistically do better among other reasons. So, the bottom line is that when you have proper estrogen, the immune system is regulated, you make proper energy to all the organs work properly, and then it goes on and on, which we can touch on a lot of these other things. But when you don't have the estrogen like women with PCOS and you have immune cell dysfunction, you are going to be in a proinflammatory state. Because by default, you go into that proinflammatory state. So, you are more prone to blood clots.
Birth control pills. Most people have heard of this. Birth control pills increase blood clots. Now, why is that? Is that an isolated fact that birth control pills have this single effect on platelets that create blood clotting? No, it's because they initiate a low-level state of inflammation by decreasing the production of nitric oxide, anti-inflammatory, antioxidant gas that is required to maintain proper immune function in a whole different set of ways. And also, it activates the innate immune cells like the attack cells to be in a proinflammatory state because birth control pills have only one effect on one estrogen receptor, whereas estrogen from the ovary has a balanced effect. So, you get stuck in that proinflammatory state? Well, now, it's additive. And there are published studies to show this that when you take birth control pills and you have PCOS, you are even more proinflammatory and increases even more the risk of blood clots. We know that we don't give birth control pills to women who have uncontrolled high blood pressure. We don't give them to women who just had a heart attack. If they're so great, why don't we say everyone has a heart attack? Let's give you birth control pills. Of course, that never happens. We know that there are women who've had blood clots, we don't give them birth control pills.
To me, women with PCOS should be in that category of high risk like women who are elderly, we don't give women who are smokers. There're so many of these, don't give kind of categories for birth control pills. To me, women with PCOS actually fit into that group. So, it's really important. I know there's a lot of time on birth control pills, but it's important because that's the mainstay treatment of PCOS like for you, for me, because I'm like you. I'm like the smaller percentage of PCOS women who were not the 80%, who are overweight and substantially obese. But don't underestimate the seriousness of the so-called lean PCOS because they can suffer and develop all the same complications. They just have a little bit of advantage of not carrying as much adipose tissue, but they have a lot of disadvantages too, because they often have poor body composition and lower muscle mass. So, don't think that they're so great off. They have a lot of potential risk, especially as they get older into the menopause years of having a lot of cardiovascular problems and other problems.
PCOS is important for every woman to understand, even if she doesn't have PCOS. But like you said, it's such a prevalent condition. There's no one actually keeping records. No one is actually out there trying to collect data. The only data we actually have is from insurance billing data. That's really, we have the data and a lot of times doctors code it wrong. They'll put down a symptom or they've had so many published reports about women go to 11 doctors before they even make the diagnosis, which is weird, because it's obvious in most cases, I think. But the bottom line is that we don't know the exact incidence, but we know it's at least 10% of all reproductive aged women. That's a lot. It may be at least 25% have their-- it's a spectrum, because it's a syndrome. That's why there's different severity, somewhat different manifestations, and so on. But every one of you listening either has PCOS or know someone with PCOS, and the information that goes into treating PCOS properly, the lifestyle part, which is the key part really is really relevant to everyone because it's really foundational lifestyle medicine.
And women with PCOS just have a more severity status of everything that we talk about, but everyone has toxins in them. Everyone has to live with circadian rhythm challenges. Everyone has to live with dietary challenges, stress challenges, sleep challenges. So, everyone, regardless of whether you have a full-blown diagnosis of PCOS have some degree of challenges that all women with PCOS have on steroids. So, it's good to really understand all of this.
Cynthia Thurlow: Well, and I think it's really relevant because how many of us weren't diagnosed with PCOS until we tried to get pregnant. For myself, I had a really excellent GYN and I was temping. I was doing all the right things. I was temping, and I kept bringing in my charts, and I said, “I think I have a luteal phase defect” and we can describe what that is. Because it was evident that I probably had low progesterone. Anyway, a whole bunch of things.
Felice Gersh: Mm, of course.
Cynthia Thurlow: My GYN very appropriately said, “We need to refer you to reproductive endocrinology,” went to see the reproductive endocrinologist, he confirmed that I indeed likely had this thin phenotype of PCOS. I ended up doing Clomid and IUI to get pregnant with both my children. For me, it was very humbling because I had assumed I was very healthy and all of a sudden, I'm looking at my husband and I'm thinking like, “If we're really healthy and we're having trouble getting pregnant, and the more I talk to patients and friends, I’ve realized there's a whole generation of us that are struggling with infertility.” For many people, they're told it's male factor, they're told they don't understand why they're infertile. For many of us, it was because of the PCOS piece. And once that was addressed, then I was able to ovulate and get pregnant. But I think it's important for people just to understand that the leading cause of infertility is undiagnosed or diagnosed PCOS.
Felice Gersh: Absolutely.
Cynthia Thurlow: And so, it is a huge issue. My hope is that through this podcast we can help build awareness and know you're doing wonderful work in this area as well. What are some of the common symptoms? Some of them ones in your book were the traditionals and then there were a couple that were surprising and I'll give an example to listeners. I had been told for years, I had great teeth. But I was told there's my gums, very inflamed gums. I’d gingivitis. I even got referred to a periodontist. And thankfully, the periodontist put the brakes on and said, “Listen, I think it's because you're on oral contraceptives. I think when you stop oral contraceptives, your gums will get better” and sure enough they did. But gingivitis, just inflammation of the gums can be a sign of PCOS. What are some of the more common ones that people may recognize?
Felice Gersh: Well, I'm just going to backtrack for one second just for people out there who are like, “What the heck is PCOS anyways?
Cynthia Thurlow: [laughs]
Felice Gersh: It’s just in terms of like manifestations. Because we're talking about symptoms, because a lot of what PCOS is, is diagnosed based on symptoms. You get a committee of doctors, they get together, and they define what is the name of the condition. That's another battle that's ongoing. What are the criteria for getting that label? To get the label of you have PCOS, you need according to this committee, I don't totally agree there were outliers like me and many others, The Androgen Excess and PCOS Society, who disagreed that you need to the following three though, officially. You need to have irregular cycles of any kind of irregularity to any degree. You need to have elevated androgens. Androgens are like the male type hormones. But women have them just in much smaller amounts and that includes testosterone and that is produced by both the adrenal and the ovaries. 50-50 in a normal reproductive age women from each of those organs and DHEAS, which comes solely only from the adrenal and/or manifestations like you have to shave every day, which is unfortunate and common. And now, they've included recalcitrant cystic acne, the hormonal acne on the jawline, that type of thing, and androgenic alopecia. So, it's like the female version of male pattern baldness.
The last criteria is PCOS ovaries on ultrasound. I want to just mention that in young teen that's within say of just five years of onset of their menarche, their first period, this is not a useful diagnostic tool, because part of becoming reproductive and maturing is having what look like PCOS-type ovaries, you can call it the ovaries are still on their training wheels and they can look like that. You don't want to over diagnose and that's another issue. The young teenage years is a little harder, because, as you know, 90%, well, now you know, 90% of teens have acne, which is a whole other topic because of gut dysbiosis, and inflammation, and diet, lifestyle, and everything. But since 90% of girls have acne and young girls will have PCOS ovaries, even if they're not going to develop PCOS, you got to be careful about the diagnosis in that age group and you have to do other things. We won't talk about the very young teens right now. But just be careful about not doing those kinds of things and making those judgments on those girls like a 14-year-old. But you could say, PCOS tendency, something like that. So, those are the criteria you need two of three.
Now, once you understand that PCOS is by its foundational nature, a woman functioning in a deficient state, an insufficient state of estradiol, the estrogen from the ovary and then you understand that estradiol has a role, I call it gluing together, reproductive functions and all metabolic functions. Every organ system in the body has estrogen receptors. And there're different estrogen receptors and they have a predominance of one type or another in different organs. That's why you need estradiol, the one that has the balanced effect on the different estrogen receptors. In medicine, they're trying to create what they call designer estrogens that work on only one of the receptors, but you're naturally then creating an imbalance to try to get an effect and you're always going to end up in trouble, if possible, unless you're short-term treating some specific condition like we'll say breast cancer. That's a whole unique situation where everything is altered. But if you're just treating to have a healthy body in a woman, then you don't want to try to treat only one estrogen receptor.
But recognizing that there are these tremendous complexities of different estrogen receptors, different amounts in different organs, but every organ has an involvement, a huge involvement with estrogen. And hormones which estrogen is a hormone and estrogens are a family of hormones. And estradiol is the estrogen made by the ovary that we have different interactions between the receptors. They can up and down regulate each other. There are even receptors in different organs like the heart that work with estrogen as a cofactor. We call them estrogen-related receptors, where estrogen isn't even what's binding to the receptor, but it needs to be there like a coenzyme in order for that receptor to bind properly with what it is supposed to bind with and then create. We even have receptors especially in the brain and the heart that bind to certain specific estrogen metabolites that are made when estrogen goes through the liver and gets transformed that we call biotransformation. That's how unbelievable estrogen is.
We even have a specific gut microbiome dedicated to dealing with estrogen called the estrobolome. I cannot underestimate the critical importance that estrogen plays in the female body. And women with PCOS have ovaries and this is 80% of women with PCOS. There's also a version that predominantly adrenal, which has similar manifestations, but somewhat different etiology. We like to talk about the mainstream, which I focus on in the book, which is at least 80% to 85% of all PCOS women fit into the ovarian etiology. They don't make enough estradiol and now, we know that due to exposures of the fetus in utero to endocrine disruptors like BPA, that's what's had the most research is phenol A which is everywhere. It's what's in hard plastics, can liners, cash register receipts, a lot of dental appliances, and so on. It actually is a huge endocrine disruptor in a multitude of ways and it can actually alter the way the endocrine system develops in terms of the receptors, so that you have receptors that don't work properly. It doesn't matter if you have a hormone, but if it can't work on the receptor, you're not going to get the desired effect.
Basically, the thing to remember is that women with PCOS have a problem with the production of estrogen in the form of estradiols in their ovaries, the receptors are not working optimally. And so, basically, they have an insufficient amount of estrogen in the form of estradiol working throughout their body and every organ system of the body needs it. Basically, all the microbiomes, so, we have now this incredible new understanding that we are just one part of who we are that we have these collections of trillions of microbes that live everywhere and the biggest collection is the gut microbiome. But we have other microbiomes, vaginal skin, every organ system. I was taught incorrectly, I bet you were, too, even you were taught later that everything in the body was sterile. It's just the thought of that. I don't know why I believed it at the time. Now, I question everything. But is there a stop sign at the cervix that says, “Bacteria do not enter?”
Cynthia Thurlow: [laughs]
Felice Gersh: They enter. How else do you get PID, like gonorrhea and Chlamydia and-- They could go up. You have microbiomes of the placenta, the uterus, the tubes, the ovaries, the brain unit, everything has different degrees of bacteria, different types, and so, does the mouth, the oral cavity. Getting back to your gingivitis which, by the way, I'm like you. And I also had gingivitis and I kept wondering, “What is happening? Why do my gums bleed? I'm doing everything right.” It's because the mouth microbiome, it turns out that estrogen is key to maintaining the microbiomes of everything. That's one of the reasons why women with PCOS can get this recalcitrant cystic acne and they've shown this. The microbiome of the skin is different. It doesn't have the protective, what we call the commensals, that actually--
There's a war going on. Everywhere in your body with good guys, with the bacteria, the microbes are fighting off the bad guys. When we don't have enough good guys, guess who wins? The bad guys. And then we have colonization with pathogenic bacteria that actually create harm and that's true for women with PCOS, unfortunately, because estrogen works with the immune system as I've mentioned and it works with creating the proper secretion of sebum, and in the vagina, glycogen, which is the food source. It's like a starch that the vaginal lining cells like to feed the good lactobacillus, which keeps the vagina in an acid state, so, you don't have overgrowth of Gardnerella and these other anaerobes, and then you have the BV, and you have the yeast infections, and you don't have the right bacteria to help you fight off these things. So, that happens in the mouth as well.
They've now a few studies-- I'm so happy when anyone does any studies on PCOS, because it's really a talk about insufficiencies. We have tremendous research insufficiencies with PCOS, even though like you said, it's the most common endocrine disorder of reproductive women and it's so minimally researched and funded. But we now have data that shows that, duh, it's another duh, of course, because every microbiome is altered, the microbiome of the mouth. And so, you have the good guys in the mouth, the commensals, the helpful bacteria that are fighting off the bad bacteria. They're not enough of them. So, the bad bacteria take over, and then they start creating inflammation, and inflammation causes, of course, whenever you hear ‘it is’ that means inflammation. Like, appendicitis, arthritis, gingivitis. It means that you have inflammation in your mouth, in your gums. That's because you don't have the right mouth microbiome.
There's research now. I recommend a probiotic toothpaste. There’s not enough research, but there is some data to support probiotics for a lot of different things, but it's in its infancy. But helping to get the right microbiome established and that means don't use poisonous stuff in your mouth on a regular basis, which is a problem. Because back in the day, they had certain types of mouthwashes that they used as little saying like, “Kills germs on contact.” Well, duh, that's a problem because not all of those so-called germs are bad dudes, a lot of them are the good dudes. Like antibiotics, you're not just killing bad ones, you're killing good ones. That's another thing that of course happens a lot is a lot of antibiotic use. And so, we have problems in many people with gingivitis. But women with PCOS, that's why I say, it's everyone else, only worse. [laughs] They just have the worst case scenarios of so many different things like women with PCOS.
The first research came out of China that they have gut dysbiosis. They have the wrong microbiome of their gut, which results in impaired gut barrier known as leaky gut, which then the toxins that are produced by the wrong microbes in the gut, leak out between the cells of the lining of the gut into the body proper, where 70 plus percent of all the immune cells of the body reside, and those immune cells of women with PCOS have a lower threshold to creating inflammation. This actually was published out of research in the University of Indiana back in 1998. A friend of mine, who is a researcher, one of the few in PCOS found that women with PCOS, their immune cells take less to create a very big inflammatory response, like, putting out all those inflammatory cytokines. You have the worst of all worlds. You have the impaired gut barrier, the leaky gut, the endotoxemia, the toxins coming in, and immune cells that have a lower threshold to creating more substantial inflammation. And so, there you have it. It's like a perpetuation.
You have multifactorial things happening in women with PCOS creating this chronic state of low-grade inflammation, which drives problems in their vascular system, in their heart, in their brain, in their joints. That's why the multitude of symptoms. And that's why women, sometimes with PCOS will have more of a dominant, something like gingivitis or they can have palpitations, they can have mood disorders, which are so much more prevalent. Anxiety, and depression, and ADHD because the brain has inflammation and lowered energy production. That's the worst of all worlds. And so, we need to help. And now, they have the new articles. I've mentioned that women who are pregnant with PCOS are more prone to developing heart failure. Well, that's another for me a big duh, because it's so fascinating.
Women have different hearts than men. This is not even recognized by cardiologists, because of pregnancy. Pregnancy changes everything. When a woman is pregnant, what happens to her blood volume? It doubles. That means her heart has to pump twice as much blood around. That means that heart has to do double duty work. What is unique about a female heart versus a male heart is the number of mitochondria, the capability of creating energy. In a female heart, it has to be dramatically higher than in a male heart. Well, as I told you at the beginning, what is critical to the creation of energy? It's estrogen working in the mitochondria at all different levels, both through the creation to what they call the electron transport chain and also working with a very important enzyme called superoxide dismutase. Because when you have the creation of energy, you create byproducts that are toxic and those have to be eliminated. One of those is called superoxide. It's two oxygens together poison as can be, but it cannot get out of the mitochondria. It's stuck in the mitochondria.
If you can't do something to get rid of it, to change it into something less toxic, then it's going to kill that mitochondria. That will happen if you have a deficiency of estrogen, because estrogen works to keep the enzyme that works to take that toxic toxic superoxide and converts into hydrogen peroxide. Now, you’ll think hydrogen peroxide, that's poison, too. But hydrogen peroxide can diffuse out of the mitochondria and then there are other enzyme systems that are also involved that’s converted to harmless water. You have to have estrogen, so, you don't have the killing off of the mitochondria that they work properly. Well, women with PCOS don't have proper functioning of the receptors and so on. They're going to have problems with creating energy in their heart during pregnancy, where there is a double energy need, the heart has to pump twice the amount of blood around the body. So, it can fail.
And in fact, women when they have ener