I have a special treat for you today. I’m speaking with Dr. Felice L. Gersh. She speaks all over the world on all aspects of female health and she’s especially renowned for her expertise on hormonal dysfunctions.
Dr. Gersh is a rare combination of board certified OB/GYN doctor and board certified and fellowship trained in integrative medicine. She started out at Princeton for her undergraduate degree, went on to the University of Southern California School of Medicine for her medical degree, and then to the University of Arizona School of Medicine for a specialty in integrative medicine.
Dr. Gersh is the full time medical director of the Integrative Medical Group of Irvine. Her distinguished career has also included many years serving as assistant clinical professor of OB-GYN at the Keck USC School of Medicine and as a frequent guest lecturer to medical and MBA students at the UCI Paul Merage School of Business.
She’s been a Physician of Excellence in Orange County, California for 14 years in a row, a SuperDoctor of Southern California, and has been named a topDoc.
Dr. Gersh is talking straight with us and you’re going to be blown away about what she has to say. She’ll make you think twice about some popular diet trends, the kind of toothpaste you’re using and what’s right for you regarding hormonal therapy.
DR. GERSH ON INTEGRATIVE MEDICINE
The definition of medicine should be what integrative medicine is. It’s looking at the whole person, all aspects of their life, their emotions, their history, their relationships, their lifestyle, all the different things that come into play to make a person who they are.
We look for a therapeutic tool box that’s much greater than just pharmaceuticals and surgery. We look at all kinds of lifestyle modifications, nutrition, better ways to handle stress, mind-body medicine, fitness, exercise, herbals, and healthnutritionals. We have a much more expensive therapeutic tool box to help people obtain optimal health always with the idea that we’re going to try to give the body what it naturally needs rather than try to intervene with pharmaceuticals which always will have some collateral damage. No matter what good they do, they’re also going to have a whole list of unintended consequences and that’s what we’re trying to avoid.
It’s integrative, not alternative. We don’t shun all Pharma or modern science. I do surgeries still and I do prescribe pharmaceuticals but we want to create a hierarchy of what we’re going to do from the least dangerous to the most dangerous. They estimate somewhere like 100,000 people die in the US every year from pharmaceuticals taken correctly. We have to recognize there really are no studies looking at the array of pharmaceuticals that go into one individual. When they do studies, they do them for a very limited period of time. They cherry pick the subjects and they’re on one pharmaceutical at a time.
Now we have people that are sometimes on ten or more pharmaceuticals for longer periods of time than have ever been studied. We’re really doing experimentation. We need to recognize that. Our goal is not to say never use pharmaceuticals but to look for ways to help people without having to go that route.
I spent many years of my career delivering babies as a board certified OB-GYN. I think I was too tired and too over worked to really think about too much else than making sure my patients had what they needed for healthy babies.
I did a lot of GYN surgery and taught surgery at USC Medical School. From the very beginning of my career, I was never completely conventional because in my private practice I had a Chinese medicine practitioner, a nutritionist, a massage therapist, biofeedback and a psychologist. I’ve always had what I called my ancillaries from close to the beginning of my career. Intuitively, I knew that I couldn’t handle every way to help people. I never got additional training myself. I just would refer. I was a conventional doctor working with other partners who had other skills.
About eleven years ago, it was my time to stop doing deliveries. I had done them for twenty-five years and I loved it and I was great at it but I really needed to get some sleep. So I stopped doing obstetrics and I was left with just gynecology.
I looked at what I was doing for the first time and I said to myself, all I have to offer people are surgical procedures and that’s mostly for late stage disease. Why can’t I be more proactive? People come with different conditions. Why do I have to say we’ll wait and when it gets really bad, we’ll cut you open? That doesn’t seem like the right approach. As far as other kinds of therapies, it seemed like all I had to offer as a conventional doctor was birth control pills and other pills for over active bladder that had very little efficacy and quite a lot of side effects.
Suddenly, for the first time in my career, I demanded of every pharmaceutical rep that came to my office that they show me their study. I wanted to see exactly what you presented to the FDA to get your drug approved. I looked at their drug studies with a critical eye and I often found very little deviation from the placebo. I saw all the different side effects and I started thinking how am I going to help people if I don’t want to wait for late stage disease? I want to be proactive. I have a Chinese medicine practitioner and a massage therapist but what can I do?
I had done a lot of surgery and a lot of the tools I had used in surgery had been recalled. They had problems. Some of you may have heard of like the Essure Sterilization got taken off the market. There’s been a lot in the news recently about medical devices. They don’t really test them and then they put them into the hands of surgeons. They’re operating on people. They’re implanting them in people. I lived through all of that stuff and I saw lots of problems.
When you take out a woman’t uterus it actually creates harm for her. There’s issues with cognition and blood flow to the ovaries.
I wanted to do other things. I felt very lost. I had like a midlife crisis as a doctor and I started taking courses wherever I could. I ended up taking courses with a lot of naturopaths. I didn’t know who they were but they seemed very nice and they had a philosophy that feels right.
Their philosophy is to give the body what it should have and let it heal itself. We’re not really healers. The body has to heal itself. You could take a broken bone, put the two ends together but the person’s body has to heal it. Sometime they don’t and they call them non-union fractures where the bones don’t actually heal. Sometimes people have chronic wounds in their skin that don’t heal. We can put things together but we can’t make them heal. That’s a whole different view of what a doctor is. They’re really facilitators. They’re not healers.
I took more courses and I was at one and there was an MD and I was an MD and everyone else in the room was a naturopath. I went up to her and I said to her, you and I are the only two medical doctors and physicians in this room. The rest are naturopaths. I’m really lost. I’m doing things and learning some things from them but I don’t really have a strategy. She said, in two weeks they start the fellowship in integrative medicine at the University of Arizona. You are clearly qualified. You should come. So I flew home, I filled out the application, and two weeks later I was in Tucson.
I did the two year fellowship. I completed it in 2012 and there’s been no looking back. I’ve been on a journey of learning more, reading research articles at night as entertainment. I really enjoy trying to decipher and understand how the human body works to be the best puzzle that anyone could ever create. Now I’ve become a national and international speaker.
I’ve always been an educator because I was an assistant clinical professor at the University of Southern California where I taught surgery for many years. Now I’m a consultative faculty member with the University of Arizona School of Medicine with a fellowship in integrative medicine. So I’ve always had a teaching role. Now I’ve just transferred it into this new world of integrative medicine.
I’m traveling the world and lecturing all over and helping doctors to see that there is much more to the body than what you’re taught concerning big Pharma. Unfortunately, they rule the educational system. A lot of the tests for medical students are memorizing how pharmaceuticals work and not even really how they work, more how they should be applied and prescribed. There’s much more to trying to help people stay healthy.
From an integrative point of view, we don’t look at health as the absence of disease. We look at it as a state of true wellness and vibrancy and energy and feeling alive and really good in your body. We don’t just want to treat disease. We want to promote optimal wellness. It’s been such a joy and such a wonderful journey from my compete state of confusion and despair when I said what the heck is my role.
Now I feel like it’s a whole new world of practicing medicine for me. I want to spread the word to everyone that there are so many ways that we can help people that go far beyond the conventional. Not that we should abandon the conventional. We just have to put it in its place.
ABOUT WOMEN’S HEALTH AND MENOPAUSE
A foundational piece of information for women at midlife is knowing the primary directive of life is the creation of new life. That’s not that every woman has to go out and have umpteen babies but the reality is that the female body is designed for reproduction and everything about it is designed to support that function. We are the only creatures that actually want control of this function. Every other creature wants to mate. They’re not thinking they don’t want to have a baby this year. We want to control our reproduction.
Metabolic health is really the force of life itself. It’s regulating and producing energy in the body. That’s what makes a human or any living creature different from a rock. We actually create energy. We don’t just reflect energy. That’s the force of life.
The whole function of metabolism—of creating energy—is linked to the processes of reproduction. How could the body create a reproductive system that’s completely disconnected from every other function of the body? You cannot have successful reproduction if you don’t have a healthy body to support it.
A woman who is ill who has autoimmune disease or heart disease or hypertension and get’s pregnant will have a high risk pregnancy. Nature wants a healthy body to have a healthy baby. It’s all linked.
ABOUT ESTROGEN AND BIOIDENTICAL HORMONES
What really links it all together is the hormone estrogen. Nature makes it so that you have estrogen which connects all the functions in the body. There are receptors for estrogen in virtually every organ in the body and of course in the reproductive organs as well.
Nature does not give human females an endless timeline of reproductive function. It stops it. Every woman will hit menopause. It’s universal. You can’t meditate your way out of it or exercise your way out of it. You may delay it a year or two by living a healthy life but you’re never going to eliminate menopause. It’s inevitable. With that comes a lot of medical conditions that are problematic.
How healthy a woman is when she hits menopause can often dictate what condition she’s gonna be in for the rest of her life. A lot of women, when they hit menopause, don’t have good bones or great vasculature. They don’t have muscles.
If you hit retirement and you have no savings, you’re going to have trouble for the rest of your retirement years. It’s kind of like that for menopause.
You have to be super healthy in your young years and that doesn’t always happen. Women now are often on contraception that has chemicals in them that alter normal hormones so that there are a lot of things that can contribute to having diminished health when you hit menopause.
Understand that you lose estrogen and progesterone production from your ovaries when you go through menopause and that estrogen is key to every single organ’s health and function in the body including things like the joints, the brain, the heart, the gut, and the bladder. Everyone knows there’s an estrogen relationship with bone and the bladder or the vagina but it’s with everything.
Estrogen has a relationship with the health of every organ and when you lose estrogen you don’t make it up by making more elsewhere. We make estrogen in our bodies in many organs. That’s how men get estrogen. They have a lot of estrogen but they don’t circulate it in their blood. They make it on-site in the specific organs. Women do too but they don’t make as much as men and they get the contribution from their ovarian reproduction but after menopause, no more ovarian contribution. Women are in a chronic state of estrogen deficiency which impacts the health of every organ.
If you look at what can happen in menopause, they have problems with sleep, gut problems, acid reflux, joint problems, osteoporosis, mood problems, irritable bladder, urge incontinence, stress incontinence, prolapse, vaginal atrophy. With eyes, there’s more risk of glaucoma and cataracts and macular degeneration. By the time the average woman hits the age of seventy-five, 85% will be hypertensive. All these array of problems and symptoms, they’re all linked to estrogen deficiency.
Every woman has to decide whether she would like to go on estrogen replacement therapy in the menopause years to try to support all the functions that now are not being supported by adequate amounts of estrogen or if they want to focus just on lifestyle.
To be truly healthy, it’s like putting a thousand piece jigsaw puzzle together and the center four hundred pieces are your hormones but six hundred surrounding pieces are everything that has to do with lifestyle. Your sleep, your stress, your exercise, your fitness, your diet, and so forth. In order to have the full picture, you should have the thousand pieces but you can get an idea of what the picture is even if you’re missing some of the pieces.
When you hit menopause, you lose a whole bunch of those middle pieces because you lose your ovarian production of hormones but you can still work really hard to keep the six hundred of the perimeter and then you can decide if you want to try to fill that hole by taking hormones in menopause.
I know the conventional world has looked at hormones as killers. That estrogen will give women breast cancer and heart attacks and strokes but it has to be understood that the studies that came up with those conclusions were based on oral estrogen from the urine of pregnant horses — not anything like bio-identical hormones. You have to look with a skeptical eye at some of the study results. We do have other studies that show the safety but I always leave it to my own patients. I just present all the information and let them decide how they want to deal with this.
No matter whether they do hormones or not, we have to be realistic and honest. We can’t replace our ovaries. We can’t give hormones to be like you’re twenty-five. We do the best we can but you have to do other things. That’s where my integrative approach comes in. What can you do for those other six hundred pieces of the puzzle to try to keep that as in tack as possible? That’s where we really shine in integrative medicine, focusing on all the lifestyle issues that can really help to support you and keep those puzzle pieces in tack.
It turns out there are a few ways you can look at diet. One is what you eat. Another is when you eat. And there’s when you don’t eat.
We now know you can do a lot to help maintain the health of the gut. With aging comes the aging gut. With the loss of estrogen, the receptors throughout the entire gut (the lining, the nervous system that creates peristalsis, the neural tissue, and the immune system) are affected. In menopause there are tremendous changes that occur. The microbiome, the bacteria that live within the gut, actually change composition and has lower levels of diversity.
People tend to have more impaired barrier function, what we call leaky gut, and more inflammation so it’s really key to choose the proper diet to nurture that gut microbiome to help maintain a healthy gut. This is really ket to healthy longevity. The kinds of foods that are really great are fiber foods.
A lot of people are going this route that they call a ketogenics diet where they’re eating tons of fat. My opinion is that is the wrong approach. Short term when people do that they may feel better because they’re basically starving out their bad bacteria because there’s no fiber in that diet. They’re actually killing off some of the bad bacteria but there are much better ways to do it.
Long term, being on a high fat diet actually increases the leaky gut problem and also alters the circadian rhythm which is a very critical feature of menopausal years. As we age, we often get out of sync with our circadian rhythm that leads to tremendous problems so we definitely don’t want to eat tons of fat and a lot of saturated fat.
We want a diet that has lots of fiber from all kinds of vegetables. Eat the color of the rainbow. There’s no vegetable that’s a bad vegetable. They are all wonderful. Eat purples and greens and yellows and oranges.
Don’t be afraid of fruit. Nobody got diabetes because they ate too many apples. I like a ratio of 5 to 1 meaning 5 servings of vegetables to 1 serving of fruit. Eat lots of fresh fruits and vegetables. If you can’t get fresh, make the second best choice which is frozen and try to eat a lot of root vegetables. People say carrots are full of starch. Now we know vegetable starch is wonderful. Starch is what feeds microbes. They have to ferment that starch and fermentation products are critical to maintaining a healthy liver. They also help our brain.
What we don’t want to eat is processed starch that turns into sugar and we don’t want to eat lots of things that have been milled like milled flour foods. We want to eat them whole. I don’t care if once upon a time a certain product used to be whole. I want them to be whole when you eat it.
Try to eat nine servings a day which would be like nine cups of vegetables. You could have a sweet potato as a breakfast item and it could replace cornflakes or toast.
Having a large breakfast gets into when you eat. You never want to skip breakfast. For metabolic health and circadian rhythm function, the biggest meal of the day should be breakfast. Eat lots of vegetables at breakfast. Have a sweet potato and chop up some nuts and seeds. Add any kind of fruit that you like. You can cook up some quinoa and buckwheat. These foods lower you blood sugar.
There are studies that show when you eat a super high fiber diet that’s filled with all these foods, in one month you can reverse early stage diabetes. You can lower you insulin levels. You can’t burn fat when you have high levels of insulin. You can only create and store fat. These diets with high fiber and nuts and seeds and legumes are great for you.
Eat beans but make sure you wash them and cook them so they’re really soft. Don’t eat a lot of animal protein until you’re over sixty-five. It turns out that once you’re over sixty-five you should eat more animal protein but up until that age, you want to keep it to a minimal amount. There are studies that show that plant based proteins are better for your bones than animal proteins. Plant based proteins are beans and lentils and whole grains.
I avoid the wheat products unless you know you’re not gluten sensitive and it’s organic wheat. Everything optimally should be organic. We don’t want to eat the GMO foods and processed chemicals for your GI track.
A lot of people don’t realize that one cup of mustard greens has more calcium than one cup of milk. There’s no lobby for plants. Soy is 90% GMO. Don’t eat that kind but when you eat unprocessed, non-GMO soy or tofu or miso, it acts as a phytoestrogen. People are afraid of phytoestrogen but they shouldn’t be. Estrogen is your best friend. Phytoestrogen also includes things like flax seed. They combine to the estrogen receptors, typically beta receptors in the lining of the gut so it can improve the health of your GI tract. It can make you calm and happier and healthier. It can even help your bones. If you like soy, don’t be afraid of it.
I defend vegetables and carrots and yams and sweet potatoes. I defend organic soy. People in the far east had amazingly healthy bodies. They were slim and had almost non-existent breast cancer. They ate enormous amounts of soy. Organic soy is a great food.
There are always exceptions. There’s been a lot of talk out there not to eat foods with lectins. That’s ridiculous. The people in India lived for thousands of years eating lentils. They were furtil, healthy people. Now there are many problems in India with pollution and the changing diet but before all that happened their diets were amazingly healthy for them.
If you’re really ill with your GI tract, then it makes sense to limit your lectins and nuts and seeds and grains and so on.
You can also use whole husk organic psyllium seed. A couple of tablespoons in water is wonderful fiber for your GI Tract.
ABOUT ORAL HEALTH
Another huge problem with aging after menopause is the mouth. Doctors aren’t taught anything about the mouth. We’re told that’s for the dentist. It turns out the mouth is critical to the health of the entire body.
With the loss of estrogen in menopause, women’s mouth’s microbiome also changes. They have a lot of gingivitis, tooth loss, inflammation of the gums. The bacteria can break through and go into the blood vessels and there’s a supported theory that when people get heart attacks and strokes, it’s actually bacteria seeding from the mouth that gets into the plaque and creates inflammation causing rupture. I cannot emphasize the importance of a healthy mouth.
People talk about losing teeth like it’s a normal part of aging like gum recession. We can help to avoid that by eating a high vegetable diet and watching what we use as far as mouth washes and toothpaste. We don’t wan to kill off the good bacteria in our mouth. It’s really important that you use natural, organic toothpaste and that you not use any chemical antiseptic mouthwashes. You want to work with a good dentist to get out the plaque that forms.
I do use a lot of probiotic blends. You want to get one that has at least 5 billion and has a nice blend of bifodan bacteria along with lactobacillus. You want to rotate different blends. Probiotics don’t actually grow in you. They pass through but there’s some miracle that happens that they sort of communicate with the bacteria that are there and get them excited and they make more bacteria. It helps the ones that are there to replicate so we get more of them. We don’t know who to re-introduce and get ones that are missing.
The worst thing you can do is snack and eat all day long because as you get older, your circadian rhythm gets damaged and you have trouble with sleep. You wake up early at 3AM. Your brain is out of sync with the real rotation of the earth. This becomes epidemic as we age. Women after menopause are living these lives essentially in jet lag.
They’ve done studies to show the rhythm of the cortisol is supposed to be high in the morning and low in the evening and rock bottom at 2AM when melatonin is at it’s peak. In women in menopause, they often have flipped rhythms. It’s like they’re living in the wrong time zone.
We should try to stop eating by 7PM and have a thirteen hour fast from dinner to breakfast. They’ve shown that by fasting for thirteen hours from dinner to breakfast, it very substantially lowers the risk of breast cancer. Most people with breast cancer have abnormal gut mibrobiomes and circadian rhythm disfunction. There’s much more breast cancer in women after menopause than before menopause.
Eat a big breakfast, a small lunch, a medium early dinner and no snacks. If you absolutely must have a snack, try to make it something fatty like olives or avocado or pecans or macadamia nuts with herbal tea.
It’s perfectly fine to eat a big breakfast and then skip lunch. You don’t want to be malnourished. Eat all the food you need but don’t spread it out over the course of the day.
This is recommended by Professor Valter Longo who is the Professor of Longevity Institute at USC, who has done some of the most advanced and respected research in the field of longevity. He’s a friend of mine. He taught me quite a bit of what I know in terms of the diet because this is what he’s been researching for over twenty years.
Up until you’re sixty-five, it’s really marvelous for your health if you do some sort of fasting. No one likes fasting so they created the fasting mimicking diet at the University of Southern California. You get to eat for 5 days — not a ton but adequately so you get to eat three meals a day for five days but it flies under the radar of the nutrient sensors of the brain. It’s so low in protein and cards. It’s predominapredominantlyntly fat and a lot of water.
The fasting mimicking diet is practical. L’Nutra is the company and ProLon is the product. It stands for promoting longevity. I work with the company now. I now educate on fasting. When done properly, it’s a reboot to the microbiome and the circadian rhythm. There are over twenty studies in process now and so much published data that we’re going to be seeing in terms of it’s impact on reducing cancer and dementia and autoimmune disease and metabolic syndrome and hypertension.
We know from the studies that it reduces inflammation. It increases brain drive neurotrophic factor which is a brain growth factor which makes you feel calmer and smarter.
We do the fasting mimicking diet for five days for three months in a row and then after that it’s individualized.
ABOUT THE MUSCULAR-SKELETAL SYSTEM
I cannot emphasize how important a healthy muscular-skeletal system is. Over half of women will suffer a fragility fracture based on poor bone health. This is epidemic and there’s no real pro-active measures. Bone is living, dynamic tissue and it’s always remodeling. In order to have strength and balance, you need to have muscles.
You need to work with a professional fitness specialist who’s certified by the American College of Sports Medicine and they can give you advice about how to create a workout program and weight training that’s so important for healthy longevity.
In my practice, we do fitness assessments to look at your balance, flexibility, strength, and so forth. We give an exercise prescription so you can be the fittest you can be. Fitness is a vital sign of health. Modern, traditional medicine leaves out one of the most critical components of health which is your state of fitness.
I’m a big fan of any form of yoga. When you do yoga, you’re stretching and moving the fascia where all the nerves and blood vessels pass. It helps the energy of the body. I applaud everyone who does yoga but just add to it.
ON WORKING WITH AN INTEGRATIVE MEDICAL PROFESSIONAL
To find someone local for you who is board certified in functional integrative medicine, you can check out the lists of doctors on these websites:
The Institute of Functional Medicine
The American Academy of Anti-Aging Medicine
The Fellowship In Integrative Medicine at the University of Arizona School of Medicine
Dr. Gersh does full scale tele-medicine in the state of California and tele-wellness consultations for residents of other states and countries.