55. SOS for PCOS Part 2 with Dr. Felice Gersh

Dr. Felice Gersh 0:04

Just try to bring some recognition in the mainstream world of cardiology, that yes, estrogen is a key player in women's cardiovascular systems, and menopause is been a major event in a woman's cardiovascular life. And giving hormones to maintain a physiological level of these hormones can help to maintain physiological performance of the cells. If you give the cell what it needs, it's going to do what it should do. And that applies to nutrients and it applies to hormones. So I'm hoping little by little to make a dent in the common thinking among the conventional medical world.

Dr. Stephanie Gray 0:50

Welcome to the longevity blueprint podcast, I'm your host, Dr. Stephanie gray. My number one goal with the show is to help you discover your personalized plan to build your dream health and live a longer, happier, truly healthier life. You're about to hear from Dr. Felice Gersh. She wrote the book pcls SOS. So today we're going to dive into that topic amongst other important recommendations for balancing your hormones. Let's get started.

you've alluded to some labs but just for everything you've said, Can you go through I I'm speculating that the panels you've run with your patients are going to be much more comprehensive than a patient with it from there maybe regular camp, you know, conventionally trained ob gyn because you're talking about looking at insulin, looking at thyroid hormones, shpd, maybe advanced cardiovascular testing, like what do you start with the hormones but what do you check? What do you recommend patients with PCs have checked?

Dr. Felice Gersh 1:46

Well, they will always need to have their total testosterone checked on you. free testosterone is not very accurate in women because the levels are too low. You can order free testosterone, but honestly you get as much information as you need by ordering total. And yes, I would get sex hormone binding globulin because you want to have an idea of what's going on in that regard. Very low sex hormone binding globulin is associated with metabolic dysfunction. So you it has certain implicit implicit meaning to it as well as what it does to the hormones. So then we would always want to get the adrenal androgen tha sulfate. And if that is high, you definitely would want to get an 8am fasting cortisol, and then you would also want to get a 17 hydroxy progesterone, because that can distinguish If a woman has acquired adrenal hyperplasia. So basically, as I've mentioned, androgens and male type hormones come from both the adrenal gland and the ovaries.

And a syndrome like PCs incorporates women who have the primary pcus problem, which is really the ovarian issue that I described. But there's another smaller subset where the problem is really originating in the adrenal gland, that the agreement the adrenal gland is producing too much tha s which then converts down to da da and also to testosterone. So in the healthy reproductive age woman, heifer testosterone comes from the ovaries and half from the adrenal. So having high testosterone in itself doesn't tell you which of those two organs it's coming from. So that's what you look for da da f DHS is only made by the adrenal, none of it comes from the ovary. So if you have high levels of androgens coming from your adrenal, you need to look for other issues going on with the adrenals like valving cortisol and and these other enzyme systems. So that's really important that anyone who deals with PCs or has PCs, makes sure that they get actually evaluated like what's going on, is this primarily adrenal or ovarian? And then you want to look at estradiol levels, progesterone levels, and lH luteinizing hormone FSH follicle stimulating hormone, I often we'll get anti mullerian hormone that is a crazy name for a hormone because it's reflective of what it does when you're an embryo.

But when you're a woman, a reproductive age woman Hmh anti mullerian hormone is I think it should be changed to a different name, follicle recruiter hormone because it's the hormone that recruits all the little follicles. And then they all come to the party and they say Pick me Pick me I want to be the one that oscillates. But some miracle happens and only typically one occasionally two, twins, but usually one gets chosen, and the others what we call regress, they kind of like fade away. But within pcls you don't get that special one chosen, you just keep recruiting you just come more to the party. So you keep getting all these little follicles. That's how come you get the the signature ultrasound finding of all these tiny little cysts around the rim of the ovaries. It's because the anti mullerian hormone, which levels are very high, keeps recruiting and you don't have the feedback system which is the proper SSH. That should be shutting down the production. The engineering home the whole system is not working right. So, so we'll measure anti malaria and hormone so and then in terms of thyroid, we always want to look for thyroid antibodies, which are not typically done because there's high rates of Hashimoto. So we want to see our anti TPO, we want to look for thyroglobulin antibody. And, of course, we will get the full array, we want to get TSH and we want to get free t three, t three, and we want to get three t four.

So we definitely want to look across the board at all of those. And then occasionally, I will get adiponectin. So especially in my younger girls, where it's, it's questionable, like you can't really make a diagnosis in a 14 year old, not definitively there. ultrasounds will often show PCs even in a young, normal woman. And a lot of young women have high androgens. That's why there's so much teen acne. So it's really you can't definitively make the diagnosis, but you can be suspicious. But if they have very low adiponectin levels, then that's unfortunately a sign that they probably are going to be a pcls woman. And we want to make sure that we take well In any case, we always want to be proactive, but even more so because adiponectin is an adipokine. It's a hormone made by adipose tissue that is very linked to the production of energy from fat. It's about triggering a MP kinase kinase signaling factor that causes mitochondria to burn fat. So even little girls who are destined to be PCs, because remember, these problems are developing in utero in most cases, they actually from birth are not able to burn fat as well as they often are, like the seven year old that never got rid of their like, toddler belly, you know, they have the choppiness to them.

And it's like, why is this little girl so chubby, you know, sound like she's eating differently than the other little girls, but she just says it's like chubbiness to her. And that is often a prelude to developing PCs, but you can check the adiponectin. So I will often check that. And then I like to check some of the genetic markers like the mthfr. Because I'm finding that some of the most severe manifestations of PCs are in women who have the homozygous for mthfr, like the double t. So their capability of doing this process called methylation is about only 30% or so 20 to 30% of what the optimal woman say, who doesn't have any of these variations in her genetics will have. And that makes it harder for her to get rid of these chemicals that are coming into her body. So you know, we will get all of those types of things.

Dr. Stephanie Gray 7:40

And what about more advanced cardiovascular screening? I mean, maybe not in a, you know, 20 year old,

Dr. Felice Gersh 7:45

right? So, right, so it crosses all age groups, so and PCs and menopause just fades into all the other problems of menopause. But all the underlying issues are still there. So yeah, they used to say, and it never made sense that after menopause, women with PCs have no higher risk of anything. Well, that made no sense. And it turns out Now, of course, that is not true. You know, but there's so many misconceptions about PCs, that I mean, just logically thinking, how could that be? And of course it isn't. So they do have higher rates of all these problems that go on through the menopause years, but their ovaries are no longer functioning. So the androgen part kind of goes away from the picture, but all the metabolic stuff is still there, right?

So I absolutely do the most sophisticated cardiovascular testing. So the old fashioned lipid profile makes no sense. I mean, my goodness, it's like what 50 years old, we now know that you have to look at the carrier particles, the APR lipid proteins, we need to know how much reverse cholesterol particles are out there, how much the liver is producing. And you can look at LP little a, that is another significant risk marker. So there's like a definitely a whole host of cardiovascular testing that should be done in my older patients. I'd like to do imaging, so I have a vascular check in my office. So I can look at their like the intima of their carotid artery to see what's going on in there. It's great. And then I do a lot of inflammation markers. So I said, inflammation is driving a lot of the problems of women with PCs, but they don't have inflammation just randomly. It's all related to the diet that we've talked about. And as well I didn't mention it but because estrogen is very key to maintaining our master clock and our circadian rhythm. So women with PCs essentially are living a life of jetlag. So because their master clock is like off the beat. So it's very important for like your liver and your pancreas to be working in the same timezone.

That doesn't happen in women who have PCs. So there's like a disjunction between the timing of the different organs. And that is one of the things that I approach in terms of my therapy to try to get women back on the beat. In terms of looking at inflammation markers. I like to look at not just A high sensitivity c reactive protein, but micro albumin, which is a measure of leaky arteries, so we can understand, like how the vascular health is really working, looking at the intima through a marker like micro albumin. And then I will sometimes look at some of the enzymes like Milo peroxidase, or lipid protein lipase, these are enzymes made by white cells that are involved in plaque stability or not having, you know, or stability. And if you have high levels of these enzymes, it's showing that the white cells are infiltrating into the artery wall and creating an potentially unstable plaque, which is what kills people when plaque ruptures. So we actually markers for those things. And I can look at lipid peroxides indirectly by getting f2 ISO prostates, which is a measure of like oxidized fats in the body. So we have so many these wonderful inflammation markers.

And then I like to look at homocysteine, which is going as an independent cardiovascular risk marker, and will often go up in people who don't have adequate certain B vitamins, especially if they need methylated. And they don't have it. And so we now know that NAC and acetylcysteine can also help to lower homocysteine as well. So which women with PCs, that's one of my mainstays as one of the supplements is an acetal system. So I'd like to know check on that. And then I get a lot of nutrient markers, like, I'll look at B 12. And then I like to look at copper and zinc and their ratio. And then I want to look at omega three, and I want to look at co q 10. So you can look at RBC magnesium. So there's a whole array of micronutrients that can also, I always look at omega three, you know, they're my chest, so I can look at my fatty acids. And so I want to know, my nutrient status many wynwood PCs, as true of all Americans are malnourished, right? So we want to recognize that the cells cannot work properly, if they don't have the right machinery working.

And that means that they have to have these micronutrients. Because when you look at like the TCGA, the Krebs cycle, you know, you need these nutrients, you know, you need to have zinc, you can't function without b 12, you've got to have your magnesium, you know, these are all critical in order to create energy for for the health of every organ system. So look at all of those things. So it's a lot of labs, and then I look at markers for autoimmunity, like I like to look at the anti nuclear antibody, if there's any issues whatsoever, I get like celiac a standard celiac panel to see because we know that, unfortunately, autoimmune related issues with gluten are very prevalent throughout the population. And once you have gut dysbiosis, abnormal microbiome, your if you have the genetic propensity, which exists in like 40% of the population, you're more likely to activate it and then develop the autoimmunity involving the gluten. So

Dr. Stephanie Gray 12:54

that's very thorough. Yeah, so I'm sure this has given a lot of listeners ideas for labs to have run on themselves, speaking to the inflammation and what's contributing to that inflammation. What about food sensitivity testing, like beyond just looking at celiac risk? I mean, is there a diet that you recommend across the board? Or do you advise for food sensitivity testing, or?

Dr. Felice Gersh 13:13

Well, I used to do a lot of food sensitivity testing. And then the more I did it, the more I felt that it really was more a marker of leaky gut, that when people had lots and lots of food sensitivities, they had leaky gut. And I was pretty good at figuring out who had leaky gut more empirically. And you know, these tests can add up and so on, and most of them are covered by insurance, but not 100%. So we've kind of gone sort of the old fashioned route, now we do an elimination diet. So we do they be like the The truth is in the life, you know, so we have what we call a reset that we do on every patient like this category, with few exceptions. We put them on what we call our reset, which is an elimination diet, which means that you take out the of course, all processed and chemical foods, but also foods that are not innately evil, they're actually good foods, but they're the foods that most often trigger some sort of inflammatory response or some kind of unpleasant response in people, we take them out. We see how people do we give gut support liver support with supplements, you know, for helping liver detoxification improvement with its processes, reducing leaky gut, you know, at glutamine, the most sense and, you know, milk to the soul related products and NAC and Damn, you know, all the ones that people in functional medicine are very familiar with.

So we have our own protocol, and we do the elimination diet, and then we slowly add things back. We also teach a lot about having a lifestyle that's going to lower your exposures to endocrine disruptors and other toxic chemicals out there in the world. So we do that for a month. And it's dramatic. We do like a little survey, you know, looking at different symptoms and so on. How just in one month, people feel enormously better and it's not a weight loss program, but women who knew To lose weight will typically lose about six pounds, just by part and parcel of just getting healthier. So we don't actually call it a detox because the conventional medical world looks down on that so much. But so we call it a reset, that it's basically helping the detoxification pathways, helping to restore gut integrity, gut health, and then looking at what foods may disagree with the person getting them off of the process garbage, and all the processed sugar laden foods and so forth, and getting them out a whole farm to table organic type of a diet. And then we incorporate time restricted eating, so we try to get them to eat regular time meals, no snacks, every time you eat food, you're going to raise your glucose and insulin. So we want to try to put the food into the morning as much as possible.

That's when we're genetically programmed with the most insulin sensitivity. And there's so much data now that shows that if you can push most of your food or big significant proportion into the morning, that your glucose and your insulin levels will not rise as much. And it also reprograms the way the brain thinks they've actually done functional studies like imaging studies of the brain, and the amygdala, which is all about impulse, and you know, and anger and all those emotions, and the frontal lobes which are about thinking and processing, that they've worked better. They've actually done brain imaging, functional imaging showing that when you eat a big breakfast of healthy foods, that the brain is going to work better that you have fewer urges and binges and you don't even you eat a really great breakfast, you don't even want to snack and you don't want to eat at night. And it really is real, the brain is altered, visibly altered in very good ways. So, you know, we try to re educate on all of these right out the gate so that people can feel dramatically better just in one month.

Dr. Stephanie Gray 16:54

It's interesting that you say that because I've had some other guests that I've interviewed on intermittent fasting and so you know, right now that's kind of like the I don't know that the kind of I want to say the rage, but a lot of individuals are skipping breakfast. But to be honest, I feel way better if I have breakfast. Yeah. And it's like in my book, I say eat breakfast like a king lunch like a queen. And then what is his dinner like a pauper? I

Dr. Felice Gersh 17:15

don't say, I have to lie to you. I'm so happy. You said that. Because there is this crazy thing about fasting for really long periods of the day, which isn't inherently wrong. They're just doing it during the wrong period of time. Why don't you Yeah, once you understand that we are genetically programmed as diurnal creatures, we're day creatures. And we are genetically programmed to be more insulin sensitive. In the morning, everything is on a timer. Like we know men make more testosterone at this morning. That's right. And we are timed up insulin peaks in its efficacy at this time in this day, and adiponectin. And everything you can you know, they have slides that you can get, you know, pictures from studies that show clockface. And it shows that each time of the day like this is when you're Have you lowest temperature This is when you have your peak blood pressure going up. You know, that's why heart attacks are more likely to happen in the early morning hours and stroke. Everything is on a timer. So we cannot change that that's built into our genes. So people who say I'm a night owl, I tell them you're messed up. You humans are not ELLs.

Dr. Stephanie Gray 18:22

So if someone wants to eat for fewer hours, it almost sounds like it'd be better to not eat, you know, dinner not not to eat guide or in the day and the next morning, and I feel better that way I do. So yeah, I'm glad you're confirming that for me. Yeah. You've already really gone in to this now with your the protocol that you guys offer it your practice, kind of the healthy habits and some lifestyle changes for PCs. So for the listeners again, and I'll probably turn this into two episodes because we're getting a lot. But can you I want to go back to the endocrine disrupting chemicals for a moment here. Can you just speak to some of the lifestyle changes? So you mentioned getting plastic out just straight up getting plastic out of your life as much as you can? Yeah. is very hard. What are some other? Are there other blanket rules that you

Dr. Felice Gersh 19:13

Yes, yeah, sure. Luli. So I mean, there have been people who've done like my year without plastic and it was like impossible, right? So you have to do your best but at least don't store food in plastic. Okay, if you put a lid on that's plastic, make sure the food is cooled before you put the lid on and try not to have the food touched the lip. If you do take out food. As soon as I mean they always say bring your own container but I don't know who's really doing that. But if you take the food home immediately get it out of that container and put it into stainless steel or glass and make sure your cookware doesn't have stick resistant stuff that is potentially toxic. So you don't want that in that off gases while you're cooking and also gets into your food and personal care products are a significant contributor to an toxins in In the body so you don't you want to look at like does this have metal parabens?

Does this have so called fragrance, that means it's a foul late, you know, so look at the ingredients of what you're getting. There's so many natural organic things like for skincare products, you can buy expensive stuff and it says has lavender essential oil has this neem oil it has, you know, Rose geranium oil, and it will say in shea butter, well, you know, we buy like really inexpensive organic shea butter and all the essential oils and just mix your own thing, then you don't have any of those natural parabens or the you know, the preservatives and your everything is organic. And it costs a tiny amount of money, you know, compared to like, you're not paying for all this fancy packaging, you know, you get your own little containers. So you know, it doesn't take that long to do those things. And it's kind of fun, you know, and you can experiment a little bit because you know, if you put one or five drops in it's not going to change anything unless you're using a very highly irritant oil like tea tree, you know, we have to be careful, but most of it you know, it's you know, just experiment a little bit and get like there's so many books and recipes for how to make your own personal care products.

But you know, be careful like sunblock, we know that that can be quite toxic, you should only use the metal ones like the tight the titanium oxide, zinc, zinc oxide, but definitely the zinc oxide but definitely don't use the ones that have the all the different chemicals in them that are really toxic, yeah, oxy. And you can go to the Environmental Working Groups website, you know, where they rate not every product, I walk around with it. And as I tried to buy something, it's not in their databank, you know, but you know, you have a lot of products that are in their databank, you can look at things that are rated based on their content of poison, so you can get air purifiers, get water purifiers, you know, those are really important things.

Because we now know, this isn't a lot of studies coming out. Not shocking for us to know about this, but like, you know, air pollution kills how many people millions of people around the world every year, you know, it's like a lot, you know, and it causes all kinds of learning disabilities and kids and all kinds of things. So you definitely want to lower your exposures. And then, of course, you want to have healthy liver healthy gut, so that you can actually deal with it. I like saunas a lot. And if you don't have a sauna, you can also sweat, you know, so if you do exercise or create your own little sauna, like in your bathroom by putting on the hot water and making steam, but you know, exercise, as

Dr. Stephanie Gray 22:34

long as your water is purified and you're not dead.

Dr. Felice Gersh 22:38

That's right, you have a whole house, let's write a whole house water purifier. But there's nothing like exercise and just ordinary sweat that is within you get all the benefits of exercise, which is fantastic. So, you know, it's literally what you buy, and you know, wash your clothes before you put them on sale. So literally, literally wash your clothes before you put them on. And you know, as much as you can buy natural products, you know, natural fibers. It's challenging. Definitely. You know, like, when I saw what GoreTex does, it's like, Oh, darn, you know, because I like what, you know, proofing things, you know, if you're going skiing, but you've got to, you know, be aware that the more you put in into your life, the more that's going to be into your body. And so we got to do what we can

Dr. Stephanie Gray 23:25

totally, you alluded to nutrients that are extremely important. But I I do want to ask about I we opened this episode, talking about why at least I made a joke about birth control Metformin. So I do want to come back to medications for a moment. But first I want to talk about supplements, because I commonly get asked about inositol using pcls. So are there a few top supplements that you for for or are there any supplements that you are against for pcls? that were there any myths around? You know, well, these patients?

Dr. Felice Gersh 23:57

Well, definitely, there are a few like very useful ones that are pretty much across the board for like officially. Yeah, actually vitamin D and fish oil and B complex, like a good prenatal vitamin. Those are all like really mainstays I could get forgotten when you learn nation or esoteric. Exactly. So for women who have the ovarian version or have issues with ovulation, Myo inositol is really a very important one. There's a lot of data on that the decaro inositol is a little bit more controversial in terms of what is the right dosing because just as a quick note, so inalsa talls are a family and that what what makes decaro Nashville different from Myo inositol is not their chemical formula, that chemical formula is identical. It's their stereotactic orientation. So it's how they are in 3d. So like, if this is my arm, it's the same arm if it's straight up, or if it's like that. So that's like a stereo isomer. So this is a stereo isomer of my arms and this so it's the same formula. It's just in a different position in space, how it's arranged. So that's what makes them different, but they actually have different effects because of that.

And the decaro inositol works very well in the liver to help with glucose function and glucose transfer, but in the ovary decaro inositol can actually impair the ability of Myo inositol to work and can actually, that's what I heard. Yeah, a trans transformation of testosterone into estrogen worst. Okay, and Myo inositol works to upregulate the enzyme but polymerase, which is important for then the function of the other enzyme, aromatase, so I'm waiting for more data to come out on the de Cairo. Also, if you give de Cairo in some ratio orally, that doesn't mean it's going to get anywhere in particular in the body in that ratio. And the de Cairo Myo ratio is different in different organs. So it's different in the plasma than it is in the ovary than is in the liver. So what exactly is the ratio you're looking for? And if you give it, how do you know it's going to stay in that ratio, or any organ? How do you even know how it's getting, you know, digested and utilized. So all of this is still in the works. And so I generally stick just with Myo inositol for now. And then I do other things to help with glucose regulation, because that's really the biggest thing with D. Cairo. For women who are older, there may be some more benefit to giving the Cairo because we're not trying to get them to undulate, you know, so we need more research on this.

So but Myo inositol is a mainstay and then as I mentioned, and acetal cysteine is a mainstay in acetylcysteine has so many functions with glucose transport, and with detoxification and liver health. So it's, it's a mainstay for so many different things in the body. And then now we know chrisitan is a which is a poly phenol has a lot of benefits for obesity for many metabolic dysfunctions. So quercetin is another one that I use a lot. Melatonin has receptors in the ovary and a women have the problems with their rhythms with their circadian rhythm. And taking melatonin can also help with not just sleep, but it's a potent antioxidant helps with glucose regulation. Melatonin is a multifaceted hormone. And it turns out that women with PCs may also have some disruption of their melatonin receptor function as well, just to make things more complex. So that's another important one. And then berberine can be very, very helpful. It has many functions, glucose regulation, gut microbiome. So those are some of my real and then the foundational ones that that were mentioned.

And then, you know, after we do our reset, we go into that it's very hard because there's so many like, there's data on co q 10. With helping as well. There's no poly phenol I've met that I don't love like cumin, curcumin is really great. And then for insulin resistance, we know that, you know, chromium and sort of magnesium, I didn't mention, but I can overwhelm people I can like send him out with 100. So I do kind of like look at each individual situation. So that I sometimes just like okay, I'll give you a multi mineral supplement, I'll give you a prenatal vitamin, because it's just like how much you know, and then and a lot of times when you give blended products, unfortunately, they have a lot of things that look good on paper, but when you look actually at what they're getting, they're getting sub optimal amounts of each one. So it only looks good on paper, but you know, you're getting a teeny bit of this and a teeny bit of that and teeny bit of this, you know, and then I like to use a lot of teas, because herbal teas, you know, like ginger is great. And spearmint tea helps lower testosterone. And holy basil is very relaxing and kameel helps with gut and sleep. So there's I love using teas. I like using essential oils because Lisa I'm not giving more pills, you know, like I call it politesse, you get pills, you know, so I like that.

Dr. Stephanie Gray 28:56

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Dr. Felice Gersh 30:35

a lot of my patients come in as pregnant I left when I met format and birth control pills, I take them off the birth control pills, and then I leave them on the Metformin by going to laptop initially, of course, like you cannot get pregnant when you're uncertain electone because birth defect producer to do Ratjen. So if you have to look at the risk of pregnancy as well, at that point, especially I'm taking off birth control pills, but depending on if they're sexually active or not, I will leave them on their medications initially, and then I wean them off, okay, in terms of initiating it, I almost never, never start by initiating with those drugs, because I can usually do so much just do lifestyle. Now if someone comes in and they have massive cystic acne, it always I definitely have no sky high testosterone, I may very well put the months by run electone because I have to have them feel better about themselves. And I'm not averse to giving some of the incretins the the drugs that are the GLP one agonists they help with diabetes, you know, insulin resistance and weight loss, but not forever. You know, these are a bridge to health for women say a woman is 100 plus pounds overweight, that is overwhelming. So if I can give something that's going to accelerate her weight loss over a few months, while I'm making all these lifestyle changes, then I'm using pharmaceuticals, I think the right way, you know, looking at an exit strategy, using them as tools to help my patients to facilitate their goals. So, you know, I individualize every single case. on that.

Dr. Stephanie Gray 32:12

I have two last questions for you. So I know you recently had a publication, which I thought was amazing. And you've already drawn a very strong parallel between similar risks that PCs patients have as menopausal patients due to the lower estrogen. And your paper was about you know, I believe in the importance of estrogen for reducing vascular risk, do you want to quickly speak to that?

Dr. Felice Gersh 32:33

Oh, I would love to so estrogen, as you know, all know is critical for all aspects of metabolic health. Well, they always call it cardio metabolic health, because it's all linked the cardiovascular system, the metabolic functions of the body. And when you lose your estrogen, you lose your metabolic homeostasis, you lose that that critical vibe that you need to stay optimally healthy because estrogen keeps everything working together unified and facilitating proper immune function and the proper response for inflammation resolution, and you know, production of energy healing, everything is all related to proper estrogen levels. So without estrogen your vascular system starts to deteriorate. The heart, which is a massive user of energy becomes energy deficient, becomes different, which you can actually see on on echocardiograms as it's called mild diastolic dysfunction. So women are very unique in how their bodies adapt in good and bad ways to loss of estrogen from their ovaries.

As you know, the ovaries go through this aging process or senescence. And so the manifestations in terms of cardiovascular effects are really dramatic. And this is not recognized and appreciated by our conventional medical world. And they just describe all the things that happen to women from menopause on as aging, like this sort of nebulous thing called aging. Well, can you think of aging as the accumulation of deficiencies and in abilities of the body to perform properly? Well, once you acknowledge and accept that estrogen is critical to having proper function at the cellular level, and mitochondrial organ, the level of every single organ in the body, then, of course, every single system in the body is going to suffer. And the cardiovascular system is obviously a very dominant system in the body that's going to manifest with many ills and the cardiovascular events of women, heart attacks and strokes are the number one cause of death in women, more than other causes, like cancers, and so forth. It's it's just dominant is cardiovascular events.

And they're not all happening in 90 and 100 year old women, we're talking about women in the prime of their lives like 55 to 70. There were more and more of these incidents of strokes and heart attacks. women often unrecognized until too late in the game, and they call women's heart attack presentation often a typical, well, they're not a typical for women stop calling it that they're typical for women, they're just a typical for men, we could call men's presentations, a typical, you know, so women have been under recognized as having issues, they're under appreciated in terms of the role of estrogen. And because of that, they're simply put on the sidelines. And it's like you wait, well, most women will develop hypertension, then you put them on this drug, and then another drug, another drug, because usually, they don't work over the long haul. And then they have hard problems. So then you put them on other, you know, statens, and all this kind of thing, which, by the way, statens don't even work for primary prevention and women, they just give them much higher risk of diabetes. drugs don't work the same in men and women, and they didn't really study women, they studied men.

And so we need to see the differences between men and women, the uniquenesses of women's cardiovascular system, and the role that estrogen plays and the loss of estrogen in terms of stiffening of the vascular system loss of nitric oxide stiffening of the heart. And that women's cardiovascular problems are different in terms of like heart attack, it's usually microvascular is the tiny little vessels in the heart that create the problems as opposed to the main thoroughfares like the the big coronary arteries like they are in men. So stenting in women is usually more harmful than beneficial, unless it's right in the middle of a heart attack. And it's actually the vessel that you're sending is the one where the blood clot, you know, is actually landed and is blocking the flow, which is usually not the case, because it's usually in those tiny little vessels, which you cannot stand. And it's usually causing an A arrhythmia, not a dead area of the heart, but rather a shock to the heart.

And women are more prone to this other condition takotsubo, which is also known as broken heart syndrome, which is because the autonomic nervous system of women is very much more dysregulated, after menopause, they're more sympathetic. So they're more like stress response, which can cause an overwhelming shock effect on the heart. And that is, in 80 90% of those cases are female, and they're menopausal women. So my goal with this first article is to just try to bring some recognition in the mainstream world of cardiology, that yes, estrogen is a key player in women's cardiovascular systems. And menopause is then a major event in a woman's cardiovascular life. And giving hormones to maintain a physiological level of these hormones can help to maintain physiological performance of the cells. If you give the cell what it needs, it's going to do what it should do. And that applies to nutrients and it applies to hormones. So I'm hoping little by little to make a dent in the common thinking among the conventional medical world.

Dr. Stephanie Gray 38:02

estrogens not the devil women need Well, from a cardiovascular standpoint, so thank you. Okay, top longevity tip, what is your comp 132?

Dr. Felice Gersh 38:15

Well, it's interesting that when they study if talking about like cardiovascular health, when you get into the older age groups, probably the biggest thing that differentiates life and death is purpose and love. So loneliness, with aging is a huge cause of death. So what I would like to focus on as my main longevity tip is to always hold those dear to us to maintain connectivity with other people to main purpose, to remain purposeful, and have love in your life.

Dr. Stephanie Gray 38:49

Beautiful, beautiful. So I know you have a special gift for our listeners, and then we'll wrap up here. So tell the listeners what that is.

Dr. Felice Gersh 38:58

Yeah, well, I wrote a ebook, on menopause. And it gives lots of basic, necessary foundational information, and lots of helpful hints on how to stay really healthy during the menopause years. We would like to give it Yes, and I'll provide a link.

Dr. Stephanie Gray 39:17

Thank you so much for that. for that. We will post a link to that free book in the show notes. So thank you. And speaking of books, for the listeners, I know you probably are very overwhelmed with everything you've heard today. But hopefully this has shed a lot of hope and light on your situation. I encourage you get her book pcls SOS, which is incredible. And she dives into pretty much everything that we covered today. So I have heard you speak several times. And you certainly are a prolific lecturer. So I thank you so much for coming on the show today. Thank you for being the synthesizer of all that information. Right in the book that you did, and just really providing hope for patients with ACLs because I think you're one of again one of the very few individuals that I could even bring on the show and you clearly were the expert and the best guest for His topic today so thank you so much for your time for coming on the show.

Dr. Felice Gersh 40:03

My pleasure. Hope to see you again.

Dr. Stephanie Gray 40:09

Well there you have it two full episodes of expert info on PCs, contributors risk considerations, lifestyle changes, supplements, medications and hope. I encourage you to get her book pcls SOS where she talks in great more depth about all things mentioned in this podcast. And please follow Dr. Gersh on Instagram at Dr. dot Felice Gersh Fei Li si je r sh and on Twitter at Dr. Felice Gersh. Her website is integrative mgi.com and check out her free menopause book link which I will post in the shownotes Be sure to check out my book your longevity blueprint. And if you aren't much of a reader, you're in luck. You can now take my course online where I walk you through each chapter in the book plus for a limited time the course is 50% off, check this offer out at your longevity blueprint comm and click the course tab. One of the biggest things you can do to support the show and help us reach more listeners is to subscribe to the show. And leave us a rating and review on Apple podcasts or wherever you listen. I read all the reviews and would truly love to hear your suggestions for show topics, guests or how you're applying what you've learned on the show to create your own longevity blueprint. The podcast is produced by the team at counterweight creative. As always, thanks so much for listening and remember, wellness is waiting.

The information provided in this podcast is educational. No information provided should be considered to be or used as a substitute for medical advice, diagnosis or treatment. Always consult with your personal medical authority.

Transcribed by https://otter.ai