balance hormones

Transcript for Naturally Restore Rhythms, Hormones and skin

Dr. Cates: Hi there. I’m Dr. Trevor Cates. Welcome to The Spa Dr. Podcast. Today we’re talking about how to naturally restore your rhythms, hormones, and skin. My guest today is Dr. Felice Gersh. She is double board certified in obstetrics and gynecology as well as integrative medicine. She received her undergraduate degree from Princeton University and her medical degree from the University of Southern California School of Medicine and she completed a two year fellowship program in integrative medicine at the University of Arizona School of Medicine. She specializes in all aspects of women’s health with a particular focus on managing hormonal dysfunctions. Dr. Gersh has recently completed her first book, PCOS SOS: a Gynecologists Lifeline to Naturally Restore Your Rhythms, Hormones, and Happiness. She is a well known and respected international speaker and works full time as a medical director of the Integrative Medical Group of Irvine. In today’s podcast interview, Dr. Gersh is back on the podcast by popular demand and she is sharing important aspects of women’s health cycles and hormones.

Dr. Cates: There is additional information that she is adding onto as a result of her popularity of the last podcast on hormones, fasting and skin. So we dive even deeper and she shares the best ways to adjust your food, sleep, and other lifestyle habits to help regain balance for optimal health. She also shares her knowledge on cutting edge research and her own clinical experience with ways to balance hormones such as how to effectively use intermittent fasting. And we also talk about things like the endocannabinoid system and things like hemp oil and CBD, and if they’re the right answer for helping address issues within this system that plays such a big role in our health and our hormones. So this, there’s so much that we cover in this and it’s quite a long interview. So when you get to a certain point, if you don’t get through the whole interview, you might want to pause and watch the rest later. Or you can also download the transcripts at thespadr.com/podcast. You go to the her podcast interview, you’ll find a place to download the transcript so you can also read the podcast because there’s so much great information in here. So please enjoy the interview.

Dr. Cates: Dr. Gersh it’s so great to have you back on The Spa Dr. Podcast. Welcome.

Dr. Gersh: Well, thank you for inviting me back. It’s a pleasure to be here with you and all of your audience.

Dr. Cates: Yeah. So as I told you, I ran into a conference and I told you your interview, this last interview that that you did was our most watched on YouTube and people are loving it, commenting on it, wanting you back. So to keep the conversation going because we’re talking about women’s health and our skin hormones are such an important key part of this and you really have figured out a way to bring it all together. So you know, when it comes to your practice, what is it that’s unique about women’s health?

Dr. Gersh: Well, I tried to see women as equal beautiful creature and by looking, I consider myself a person who synergizes all of the data. So I look and read through all the different research across every different landscape. I look at environmental medicines, veterinary medicine. I look at everything and every different organ system because I like to put it together. That’s why I consider myself a synthesizer. I put it all together. So I understand much more now than I ever did in all the other years of my practice. What it really takes for a woman to be healthy. And the problem is it’s complex. You know, there’s no magic pill that will ever restore the beautiful health of a woman and give her the life that she deserves. So I always start with foundational things. It sounds so basic, but you cannot have a healthy woman if she doesn’t actually have healthy hormones because hormones are messengers within the body.

Dr. Gersh: They deliver information. So it would be like you had an entire country where no one could communicate because no one spoke the same language, so that that would be a catastrophe. So basically foundational is getting the hormones, right. And in order to have hormones properly being produced and distributed, we need to reduce exposures to endocrine disruptors, toxic chemicals. We need to lower it rates of chronic in sessions, which can alter the way the immune system works, which interrelates with those hormones, of course. And we need to have the beautiful rhythms of women that circadian rhythm and for reproductive age women, we need really, I know people don’t want to hear this, but we really should have the beautiful lunar rhythm of women because we’re now coming to understand that hormones work in a beautiful interplay with each other up and down regulating their own receptors in order to have proper function.

Dr. Gersh: So I always start with all the different ingredients that go into having a beautiful symphony of hormones in a woman. And it is complex because it means eating the right foods, sleeping the right amount, and at the right times, eating and sometimes not eating. Of course, that brings in fasting and all the things that are with fasting time restricted, eating, intermittent fasting periodic fasting. And then we have to work with stress because we know that mood changes everything and are very different from men. We have very different cardiovascular systems, brains, immune systems, and we’re much more sensitive. Women have much higher rates of anxiety and depression, mood disorders. So we really need to recognize our beautiful differences which the conventional medical system really doesn’t. In fact until 2015, the companies that ran pharmaceutical studies didn’t even have to include women. So what does that tell you?

Dr. Gersh: So basically I take elaborate histories. I spend lots of time with my patients and I look at them. So that means I actually look at their skin. I actually look at their hair, their nails. These are manifestations of their inner health. And this is so neglected as well that the skin, our greatest largest organ in the body really is a reflection of inner wellbeing or not wellbeing depending on the case.

Dr. Cates: So when you look at your patients and you look at their skin, their hair, nails, those sorts of things, what, what do you notice and what do you, what do you connect it to?

Dr. Gersh: Well, if I start with the skin, does the skin look appropriate for the person’s age? Okay. So I know that there’s going to be aging. Now if I see a woman who is say 55 and her skin looks and I don’t just mean on her face, I mean the total body because a lot of people do a lot of things with one little part of your body. But I look at the, all of the skin, so I would say that she’s 55 but her skin looks amazing, like she’s 30 you know, and that, what does that tell me? Number one, it tells me she has some hormones going on in her body. She’s probably on hormone replacement or she’s one of the lucky women that has, that has a very late menopause. There are some women, I’ve had women not hitting menopause until 57 but that’s the exception to the rule because hormones maintain health. So looking at the skin of the body, I can get an idea of what their hormonal situation is and then it tells me something about their nutritional status. If their skin is really flaking and very dry, I know they’re going to be deficient in very key fatty acids, they’re not going to have the right balance of fatty acids.

Dr. Gersh: And often they will have deficiencies of things like zinc and magnesium, vital minerals, so looking at the skin and of course the nails. If they’re rigid, if there are ridges in them, if they’re slitting in there, they also have nutrient deficiencies. These are really key things. We don’t want to just go to a salon and get funny nails to cover them up, that’s what big pharma does. We’re not trying to cover things up. We really want to heal from the inside and then have beautiful manifestation of skin and nails. And when I look at the hair, if the hair is dry and braking, then I also know that she has probably high levels of stress, high levels of cortisol. She’s probably not getting enough sleep and she also probably has nutritional deficiencies. If she has male pattern balding, hair loss, then she probably has an excess of androgens which can go along with polycystic ovary syndrome and also happens to a great many women, especially as they go through the menopause because they lose their balance between estrogen and testosterone and the testosterone becomes more dominant.

Dr. Gersh: And then they start having the male pattern baldness, which actually affects about 50% of women. They don’t go bald like some of the famous men, but they do have significant hair loss, which is very depressing. And lowers self esteem of women. So I take a look at all of them. I look at their eyebrows. So when a woman is thinning of her, especially her outer third of her eyebrows, that’s usually a sign of low thyroid. And then I have to think, does she have Hashimoto’s? Does she have iodine deficiency, selenium deficiency, protein deficiency. So just looking at a patient, it’s like amazing. Cause now I’m so into, I like, I’m going traveling a lot. So I’m in an airport and I’m sitting next to people in my area waiting to board in the, at the gate. And I’m like diagnosing people. I always wanted to tell them, it’s like, did you know you have a problem?

Dr. Gersh:             On rare occasions I’ll say, you know, you should have that skin lesion checked out. You know, I said to a man not long ago, he was waiting to get off the plane with me after we landed. And he pulls his cell phone out and it was being stored in his pocket, right over his heart with the battery facing his heart. And I said, you know, I’m a doctor, I just want to let you know you should not do that, you might get atrial fibrillation. And he said, he put that phone in his bag that he was carrying, and he said, I was diagnosed with atrial fibrillation a month ago. It’s like, oh my gosh. So there’s so much you can tell even without expensive labs or expensive imaging tests about the health of a person just by being observant.

Dr. Cates: It’s so true. And unfortunately it’s something that’s missing in conventional medicine for the most part. I mean, obviously you’re a medical doctor and you practice this way, you’re very observant. But I think with the typical medical model, doctors are so rushed to fit in, you know, a seven minute consult so that health insurance will cover it and they, you know, they can, they stay within the parameters so they get paid. And it’s, the system is, really, it’s really unfortunate the way that the system is set up. So, I really appreciate that doctors like you are taking, well, I myself, naturopathic physicians, that we take the time to really look and observe and listen to our patients because like you said, there’s so many clues that are right there. If you just pay attention, just watch. And also I find it so frustrating with all of the beauty tips online and in magazines of if, you know, quick fixes for your skin to make it look healthier, to make it look, you know, what to do with your nails, with your hair. And the problem is, is you’re not paying attention. A lot of those people aren’t paying attention to these signs that we’re talking about and that we’re just ignoring it with some sort of cover up quick fix and I’m so glad that you’re calling attention to this also.

Dr. Gersh: Yeah, and it’s the conventional medical system doesn’t pay attention to the really the emotions of our patients because we now know that when you have a lot of stress, which is so prevalent in our society that it really alters the way hormones are produced, the quality of sleep and then in turn it changes how our GI tract works, which is you know, very, very in tune with our brain. That’s where the gut brain axis comes into play. And when we have stress, we’re going to have a stressed out enteric nervous system. The nervous system of our gut, which has its own inherent immune system and is very complex the way it works with Paracelsus. And of course then people have acid reflux and instead of saying you’re probably not getting the sleep, you probably have a poor diet. You probably, you know, are very stressed.

Dr. Gersh: No, they they give them drugs to block stomach acid production, which is essential for proper digestion for making a very key signaling agent, which is a potent antioxidant called nitric oxide, which can also not only make your arteries dilated and healthy, your brain function, but it’s going to impact your skin as well because it’s going to affect everything in the body and that’s not being addressed. It’s instead of saying, why is this happening? They simply do something which is really long term, terrible by giving stomach acid blockers. Then they actually will have dramatically lower levels of magnesium and I just gave a lecture in China on magnesium, so I’m like totally into magnesium, it works in over 700 reactions in the body. Without adequate magnesium you don’t actually make receptors that work properly with our neurotransmitters. You don’t make serotonin, you don’t create energy and energy is life itself.

Dr. Gersh: So we’re giving drugs that block our ability to actually make energy and to be healthy. Because when you look at skin, skin is one of, it’s one of the most dynamic organs it has rapid turnover. It can rejuvenate, it has the amazing ability to heal. And one of the things that I talk about is that when you get older, if you get a gash or a scrape or an injury to your skin, you will heal more slowly. So why is that? Because you have reduced amounts of these very important nutrients, you don’t because your digestive tract isn’t working as well and don’t have as much estrogen production. Estrogen is made in the skin as well as of course from the ovaries in a woman. So after menopause for example, or if a woman is on birth control pills, she doesn’t have an estrogen production from her ovaries.

Dr. Gersh: So her skin is not going to react the same. When it’s traumatized, it’s not going to heal as fast. So all of these things are being impacted. And then we, I hate to include myself in the conventional medical system because I actually exclude myself, in most cases, we’re giving drugs that actually impede the body’s proper mechanisms to heal that, a proper nutrition for the gut to even work properly. So it’s really devastating the way our Pilsen, the ill formulae, it’s kind of healthcare that has developed in this country, has taken over medical education and the medical schools, they’re really taught to memorize pharmaceuticals instead of really coming out and understanding these incredible microbiomes of the body. The endno, the new, a new, it’s new old because it’s been around, oh for about 600 million years, you know, the endocannabinoid system, which is amazing. And we have endocannabinoids in the skin.

Dr. Gersh: It’s a whole new way of understanding the human body and of course every organ in the body and they’re not teaching this. It’s like so frustrating because when I have students rotate or I meet them, I feel like I have to start from scratch and try to educate them on how the body really works and what the body really needs to be optimally healthy. And of course, environmental medicine is not nearly dealt with the way it should be in medical education or in medical practices. You know, people don’t ask, so what cleaning solutions do you use in your home? Do you have an air purifier or water purifier? You know, what products with makeup or other products that you’re putting on your skin? I am shocked when I see pharmaceuticals that are for inter-vaginal use and they have methylparabens.

Dr. Gersh: It’s like how is this even allowed? I don’t know. But yeah, that’s why I love that you have this. Every woman out there can have the tools and the fortitude to take matters into her own hands at times to demand that they get the proper care and the attention that they deserve.

Dr. Cates: Yeah, absolutely. So you mentioned the endocannabinoid system. You’d explain a little bit more of that cause that’s not something we talked about last time.

Dr. Gersh: Absolutely. So the endocannabinoid system, it’s a funny name. So we discovered we, the human race discovered thousands of years ago, maybe 6,000 years ago, that this plant and this family of plants called cannabis had impact on the human body and many in many good ways. But nobody understood the mechanism. And then was only in the early 1990s that they discovered the receptors or the CB1 and then the CB2 receptors in the early 1990s and then they understood that there was this innate system, our own endogenous system that reacted with plants.

Dr. Gersh: But our own system is really the foundation. It’s just a miracle that there are plants that have components that can actually interact with our own receptors and create very often beneficial or sometimes harmful. That’s really important to know. They can also create harmful if that’s when used inappropriately. So they named our system after cannabis, so it’s endo for within us cannabinoid based on the word cannabis. So it’s our own system. Now it’s actually been expanded now just very recently, like in the last year, and it’s so new that it’s not just about the two primary cannabinoids, better calls enendomide and to AEG that they coverage also a back just in the last couple of decades now, they know that there’s a much more complex system that includes, these are all what we call lipid mediators, so they’re made out of fatty acids. So it’s a whole new understanding of the human body that is circulating in us and locally in different tissues are fatty acids that come from arachidonic acid, like Omega six products, and a lot of the people down, you know, they always say negative things about Omega six.

Dr. Gersh: We need all of our fatty acids and there’s a beautiful balance that goes on when things are right between Omega three and Omega six, you need them both, but we need them both in the proper balance. So from these long chain fatty acids come these lipid derived signaling agents and they’re lipid mediators and they’re not just the two foundational endocannabinoids that I mentioned, anandamide and two AG. It turns out that there’s probably, you know, dozens and dozens of these limited signaling agents and they all work in this really complex, intertwined system that they’re now labeling the endoccanabinoid dome. So it’s a more expanded system and it’s also all over the body every day. And now of course, we know that you can have a dysregulation of this system. And when people had a metabolic syndrome, which is now at epidemic levels, they have diabetes, prediabetes, hypertension, obesity, all of these are related to an over production of some of the lipid healing mediators and a decrease in some and an alteration of the receptors where the receptors can become resistant as well.

Dr. Gersh: Just like we can have insulin resistance and then that can lead to diabetes and we can have a leptin resistance and that can lead to appetite dysregulation and overeating cause leptin is opposed to suppress appetite and then the receptors aren’t working. We can have receptor dysfunction of the endocannabinoid system. Now why would that matter? Well because these limits signaling agents actually are like the workhorses of many of the functions of the body that we did not know how they actually worked, including estrogen for example. We now know that there’s this beautiful by directional relationship between estrogen and the endocannabinoid system. So estrogen actually works to block the degrading enzyme of anandamide. Now anandamide works as a partial agonist or partially on the receptors of CB1 predominantly, and it’s known as the feel good endocannabinoid. That’s the one that THC works on as well.

Dr. Gersh: Now THC is from like marijuana, but it can bind to the CB1 receptor in a manner similar to our own product that our body makes, which is anandamide. And that’s what can cause people to have what the munchies. So when people smoke marijuana, which by the way, I’m actually not in favor of, but they have high levels of THC and it works on our CB1 receptors, which regulates appetite. Okay, so estrogen works with this system in a bi-directional way. And when people have dysregulation of this, that’s when they have appetite dysregulation and they have binge eating cravings, that’s actually a manifestation of a dysregulation of the endocannabinoid system. Nobody understood this before. So estrogen actually is considered anxiolytic it lowers anxiety, but we didn’t really understand all of the mechanisms. Well, part of the mechanism at least is by increasing this particular endocannabinoid anandamide. But when you get higher levels of an anandamide it then down-regulates the production of estrogen.

Dr. Gersh: So it works in a balance. But if you smoke, say as a person, a woman, smokes a lot of marijuana, the same thing actually happens for males. But if they talked about a woman, it can actually down-regulate the production of estrogen. So smoking marijuana can down-regulated estrogen production, can lead to fertility problems, irregular cycles, miscarriages, if this is happening in early pregnancy or preterm deliveries in your pregnancy and estrogen, as I told you, is really about, well everything. And it’s about a skin. It’s about having beautiful skin, about skin healing and about mobilizing when you need to platelets to have all the beautiful healing properties of platelets. A lot of people know about PRP, you know, so that’s when people take platelets and they inject it into skin. Well, it’s estrogen that activates the platelets, that estrogen, that causes the platelets to release all of their growth factors.

Dr. Gersh: And that causes beautiful healing, new blood vessel formation. Estrogen is actually the modulator of that. So the last thing we want is to smoke a lot of marijuana and then down-regulate our production of estrogen so that we don’t have healthy skin. You know, and there’s not been a lot of look at that and there is actually now more and more data coming out the endogenous endocannabinoid system of the skin and now we’re finding that a dysregulation of the endocannabinoid system can lead to things like, especially of eczema. Atopic dermatitis is heavily related but not just that. Also inflammatory conditions like acne is related to a dysregulation of the endocannabinoid system in the skin. And know we’ve known for a long time that it’s skin when it has acne, has an altered composition of fatty acids than the fatty acids act in certain ways. And you need to have certain ones and they can also act to kill bacteria and they have all these relationships, but nobody understood what was going on.

Dr. Gersh: Now we understand these fatty acids, these incredible lipid signaling agents are all regulated by the system called the endocannabinoid system, which is interrelated with our hormones. Progesterone and estrogen actually had this beautiful lunar rhythm, you know, that’s called the menstrual cycle and estrogen upregulates the production of anandamide progesterone down-regulates the production. So there’s this beautiful balance which you will not get in the body if you don’t have a rhythm. And that’s why women after menopause, their skin really starts rapidly aging. It’s really you know, and because all of this is now gone, this beautiful rhythm. But of course women take care of this at early age, not because they want to harm themselves, but because they don’t want to have unwanted children. But we need to understand that when we alter our beautiful hormonal rhythms, we are altering the endocannabinoid system. Nobody understood this when birth control pills and similar things were invented a few decades ago.

Dr. Gersh: Nobody knew there was an endocannabinoid system. Nobody knew about these amazing lipid signaling agents, which is now more than the endocannabinoid system and the endoccanabinoid dome we have, there are lipid signaling agents that are called resolvents that actually can converge from a state of inflammation to resolution of inflammation. But all of this requires this beautiful harmony between the hormones and the endoccanabinoid system. But of course it gets even more complex because the microbiomes are part of this as well. So that’s what I mean, that’s why when we take chemicals and weirdest things and wash our skin with it, like when they did, oh, when it used to be that tricolsan could be used, you know, these, that antibacterial soaps and gels and things, we’re altering the foundational microbiome of our skin, which now it turns out interrelates with the endocannabinoid system which interrelates with our hormones.

Dr. Gersh: It’s all one complex but beautiful system. And the gut, of course, the biggest microbiome of the body now we have found has a bi-directional relationship with everything. So we have the gut brain axis. We have a gut heart axis, we have a gut skin axis and the endocannabinoid system interrelates with all of this. There’s endocannabinoid receptors and production of endocannabinoids in most every single organ of the body. And we definitely know that there is an endocannabinoid system of the skin, which requires a proper microbiome of the skin and of the gut and having proper hormones as well. So it can seem overwhelming, but the good news is that the same things that are so harmful to one system are harmful to them all. So we just avoid them. You know, chemicals, stress, of course, that’s hard to avoid. So we have to have one mind, body medicine.

Dr. Gersh: I love guided imagery in fact there was a study that I learned about when I did my fellowship it was a single case study. It was one person an of one, but a young woman who had horrendous acne, horrendous acne, and they put her on a program of learning self-hypnosis. Nothing else. Her acne completely cleared. It just shows you the relationship of stress. Every woman knows this, they get stressed out and there comes a pimple right on the big day because the emotions alter our hormones and now we know that relates to the endocannabinoid system and that it changes the microbiome. So I consider it mind body medicine, whether it’s meditation, hypnosis, guided imagery, breathwork, to be an essential part of maintaining health and beautiful skin and beautiful hair. And then we can do all of this.

Dr. Gersh: But it’s really impossible to be optimally healthy, I know people don’t want to hear this, but you as a female, you can’t be optimally healthy if you’re on oral contraceptives, it changes your microbiomes. They’ve done studies out of Harvard showing it. It changes the microbiome of the guts. We haven’t done enough studies, but there was no reason to think it doesn’t change the microbiome of the skin. And, you know, we know it changes the vaginal microbiome. We know that women on oral contraceptives after 10 years have at least doubled the incidents of cervical cancer. Kind of crazy. We try to prevent cervical cancer, while we’re giving a drug that has been proven, this is on cancer.gov this is the U S website that it 100% increases cervical cancer risk. And part of that is by altering the immune system in a negative way and altering the vaginal microbiome, which has been ignored forever.

Dr. Gersh: And we need to start paying attention to it because this relates I’m sure to a lot of the fertility problems and also complications in pregnancy that nobody is putting two and two together. So, and you can think of the vagina as an extension of our skin. It has an epithelium that has very similar to skin. It doesn’t have hair follicles, it doesn’t have keratin but it is an epithelial lining that is very comparable to skin and it has the microbiome and needs to be nurtured and cared for. Just like every other microbiome of our body needs to be recognized for its critical importance and then nurtured and cared for.

Dr. Cates: Yeah, absolutely. I know you just covered so much valuable information. Thank you. This is so great. I, you know, I want to make sure that we’re giving people tools to help them support these. Like, you know, you talked about the microbiome and, and they’re, and, and you’ve talked about the endoccanabinoid system and hormonal balance. And I know, and you know, there are a lot of the things that we do for one of these, it helps the other. So it’s not like it does, it’s not that complicated in addressing these different systems because of they’re so interconnected, but when it comes to recommendations for your patients, where do you like to start? And I’d like to, because people probably haven’t heard as much about the endocannabinoid system. What specifically do we know? How can we impact the endocannabinoid system?

Dr. Gersh: Absolutely. There are actually are now a few research articles coming out on the care and nurturing of the endocannabinoid system. And so that is wonderful. But the good news is it’s really just about identical to the care and nurturing of your microbiome, of your brain health. Like you said, they interrelate. So number one, I always start with nutrition, it’s foundational, most everyone in this country is malnourished. It’s horrendous. And that could be people of every weight, particularly overweight people tend to be malnourished. They often skip meals and they then binge eat. And it’s not their fault. I understand this so much better now than I ever did that their neuro-transmitters are off, their signaling agents are off, their whole endocannabinoid system is off. So you have to use to some degree willpower for maybe six weeks because you will have cravings. It does take time, but the body will adjust.

Dr. Gersh: So I start with eating a whole plant based diet. If people are willing, I ask them to go vegan for six months. If not, then I use what is called the sustainability diet where they eat no more than three ounces a day of a healthy natural, hopefully organic type of animal product. So it would be like one large egg or like a little bit of chicken or a little bit of fish cause we’re talking three ounces. So it’s really using it almost like a seasoning, like a flavoring. And you’re just like sprinkling it on your vegetables. And then I aim for, I know this is a big hefty goal, but to try and to go for nine cups of vegetables measured raw, nine cups of vegetables a day, across the colors of the rainbow because the potent antioxidants, the polyphenols are amazing. I mean, when people talk about, you know, getting vitamin A for skin, well we can get it from food, the all the carotenoids, these all come from food, you know.

Dr. Gersh: So I try to limit what I call collitis that’s eating too many pills, you know, cause people need to leave room in their tummies for real food. So I start with food and by eating like nine cups of vegetables, people will never be hungry. I can tell you. And they need to work with recipes. And I have a chef now in my office to help people to understand how to cook vegetables, to purchase and to care for them. And so that they can love them because I talked to people and they roll their eyes and stick out their tongue because they say I hate vegetables I’m saying vegetables are not what you think. You probably have never had them prepared properly. Okay, they’re delicious. So we work with also altering some of these taste buds, you know, cause people get used to this high fat, high salt, high sugar diets and then their taste buds are altered so it takes a little time.

Dr. Gersh: And they’ve actually had studies that show that you can adjust your taste buds to liking healthy food over time. Just give it some time and you know, you have to go through like a detox, not, you know, I’m getting all the toxins out of your body and I’m getting all the processed foods out of your life, you know, so that’s, I’m detoxing off of crap off of processed foods. I do farm to table. You don’t need that middleman in the plastic, you know? So we don’t want that. That’s putting in all kinds of chemicals that we are trying to avoid that are really harming our systems. And I recommend what absolutely everyone must know that they eat a lot of their food in the first half of the day, preferably at breakfast or if they can’t do breakfast an early lunch because this is now proven, this is built into our clock genes.

Dr. Gersh: You know, we are primarily timed creatures with our circadian rhythm and our insulin works totally differently in the early part of the day than it does in the latter part of the day. Our tissues are insulin sensitive, so glucose gets into muscle and it’s liver and everything is processed better. You’re much less likely to develop insulin resistance or diabetes, prediabetes, when you eat the bulk of your food in the early part of the day, and there’s been so many studies now, you lower your risk of cardiovascular disease, mood problems, and in fact they’ve shown that you can lose weight eating the exact same food when you eat it all in the morning versus in the afternoon or at night especially. It’s really terrible. There was one amazing Israeli study with women with PCOS in just one month of eating two thirds of their calories for breakfast and one third for lunch. Like one bite for an early dinner in one month their insulin level drops by over 50% now you can’t lose weight when you have high insulin and high insulin drives up blood sugar and that drives up inflammation.

Dr. Gersh: When you have high chronic insulin and inflammation is going to manifest in every organ in your body, including in your skin if you want to take it to early aging and be high on insulin resistance and have high levels of insulin circulating in your body. So by eating a lot of your food in the morning, this is a re-framing how you think of when you should eat. And of course sometimes you’ll go out, you’ll have the events, but for the bulk of the time trying to eat your food in the morning is going to be anti-aging. It’s going to reduce inflammation, including in your skin, your age. You know you’re, and I get this myself though because I’m trying to live, you know, off the top myself and people say, what are you doing? And I’m saying, you know, I’m not doing anything, you know, I’m just trying to live the way my body was designed to live.

Dr. Gersh: And it really makes you feel awake and alert when you eat in the morning. It lowers that cortisol, which otherwise will stay high. Cortisol creates inflammation over the long haul. Now it’s anti-inflammatory in a short term, but when it’s chronically elevated, which it happens in people these days, then it becomes inflammatory, creates leaky gut, and then you get the endotoxins. You get altered gut microbiome, you get these endotoxins produced in the gut coming out into the body. Which then the immune cells lining the gut, create these inflammatory products called cytokines, which circulate all around the body to the skin, to the brain so you don’t feel well you have brain fog and all of this can be tremendously improved by eating a high plant-based site and trying to eat based on our beautiful clock genes and the rhythms. So we want to eat a big breakfast. If we can eat a moderate lunch and a tiny dinner and when you get more advanced, go to eating big breakfast and if you want to be more social, have no lunch.

Dr. Gersh: And if you eat a big breakfast you don’t need lunch or having like a fast bar like on the El Nutra which is not a meal substitute, it’s a fasting substitute so it keeps you with your insulin low. So I usually have a fast four for lunch, but you can also have a few olives or a little piece of avocado and that will keep your insulin down and then have an early moderate dinner forks down most of the time by 7:00 PM. I know this is not the standard, but this is what brings beauty and health because they go together. And so I started with that and then I work on sleep because when you sleep your flow of blood to your brain goes super high and you get that high peak of melatonin, which is one of the most potent antioxidants in the body and there are melatonin receptors all over the place that we haven’t even understood before and in the gut as well. And so we make melatonin there and in our ovaries. So women who don’t get adequate sleep have more fertility problems, mood problems poor hormonal production. So we, you know, melatonin is hugely important. We can’t get it unless we sleep. So you should try to get to sleep by no later than 11, preferably even a little earlier. Try to get seven to eight hours of sleep, but at least seven anyway. And try to make the room really dark. Even a little bit of light filtering through your eyelids will reduce the melatonin production.

Dr. Gersh: I sleep with a very comfortable, I have no problem with it a sleep mask. And then what I do is I set my alarm. Usually I wake up anyway, but just in case I have, I said it, but when the alarm goes off I just let it go on snooze mode and then I keep my eyes closed and I take off you know, I leave enough time for this, I take off the sleep mask but I keep my eyes closed and then the ambient light is filtering in and it’s starting to then, you know, lower my cortisol and wake me up and then after another like 10 minutes, maybe seven minutes, I open my eyes. And so you can also do that with a dawn simulator if you don’t have light in the room because there’s amazing things that happen in the body when you live the way nature intended us to live, which is that we get light in the morning. It’s really helps us wake up with the light. But when you wear a sleep mask, you know, it’s really black. So you really have this sort of dawn simulator type effect. So really sleep in a dark, cool room. Your temperature should drop during the night, you will not have proper sleep if you’re really huddled at times at night.

Dr. Gersh: And so try to make the room as cool as possible. I have a really nice standing fan that I have blowing on me all night. It’s like cool ocean breeze only it’s just a fan feels and it keeps me nice and cool and I really enjoy it, having that coolness. If you have trouble falling asleep, this is a little trade secret. You take a really hot shower or bath really, really hot and then you jump out and you just quickly towel dry just a little bit, you jump into bed with a fan on you and it knocks you out. That’s actually been shown that you go hot to cool and it actually improves the melatonin, shuts down cortisol and it will help you fall asleep. So that’s one of my tricks I use all the time. And of course cutting out the blue light, turning off computer screens, I never watch anything on a computer for at least an hour before I go to bed.

Dr. Gersh: Two is even better. But you know, some of us have to work. It’s like part of our lives. But so we want to work with our time restricted eating, eating a plant based diet with tons of vegetables, polyphenols, antioxidants, and then work on sleep. And then of course, stress always started off with lots of, we just do it simply, you know, I don’t do psychotherapy. You know, if people need that, then they should get whatever they need if they need a counselor. But we give tools, we use essential oils, we do breath tape, we teach guided imagery or meditation if they prefer. So everybody needs to get into some sort of a stress reduction program. And then we include fitness. Even if you start with just a vigorous walk after meals for 15 minutes, it will lower your insulin. Remember that will lower inflammation just a 15 minute brisk walk.

Dr. Gersh: What we do, in my office, we actually have a gym and I have a fitness specialist. So we do body compositions, fitness assessments, exercise prescriptions. But even if you can’t have access to that, then just take a brisk walk after, after every meal and then tryto use your body stop sitting. You know, sitting is really inflammatory, so we should get up and move and do things that are fun. You know, some people hate gyms, some people love gyms, but you know, taking a hike, you’ll give community hikes. There are groups you can do a beach cleanup, or community park cleanups, do things that have purpose. If you don’t like going to a gym, you know, just just get out there and do things that you love. That involves using your body and getting under the sun. I’m sure you talk in your program so much about the importance of vitamin D, well, vitamin D is starts with sunlight, but it’s not just about vitamin D, you make other antioxidants in your skin. When you’re exposed to sunlight, you also make serotonin. There is special receptors in the eye that when you get light in, it actually causes the brain to make more serotonin. And then from serotonin comes melatonin. That’s why people go to the beach, they’re earthing, they’re on the ground, their electrons are getting balanced, they’re getting sunlight, they’re getting antioxidants made, make their skin. Hopefully they’re not putting on toxic sunscreen. And that’s another whole subject of I”m sure you’ve covered. And that’s why they seem so great. Young people go out and they spend a beautiful day at the beach lying on the sand out in the sun and they can hardly keep their eyes open when the sun goes down. That’s what nature intended. Take that as a hint about what nature wants you to do, to really be healthy. So, um, the skin is a reflection of all of these things and the nurturing and care of the endocannabinoid system is all of these things.

Dr. Gersh: And now understanding that metabolic syndrome, obesity, insulin resistance is actually endocrin problems. Of course there’s hormone problems, but there’s this endocannabinoid disruption, endocannabinoid disruption, and we need to nurture and care for endocannabinoid system. It never ends how much we have to care for, right? Our job never ends as caretakers of our own bodies. But by knowing this and understanding how fatty acids, things that we never understood the significance of are suddenly recognized as key players in the foundational issues involving every organ of our body, including our skin. It’s phenomenal what we have now, the understanding that we have. And that’s why eating crappy foods that have oxidized fatty acids. So if you eat a lot of foods that have really crappy, you know, oils from saffola oil or oxidized oils, these oils do not help us make proper endocannabinoids. These are oxidized oils.

Dr. Gersh: We need healthy fats. That’s why this whole thing about you know, fats are not evil fats are not evil. You have to eat these fats. But these are fats that are not coming by the way from animals. These are all plant based fats. All of these fats I’m talking about come from plants with the exception of the Omega 3 which comes primarily these days from fish. But the other fatty acids that are coming to make a lot of the endocannabinoids are really coming from plants. And that’s why when people don’t even know plants, they can’t possibly make proper endocannabinoids. And remember the endocannabinoids, that’s the feel good one that is all coming from plant based fats. So you’ve got to be eating plants and then you have to get Omega 3 because that balances the whole system out. And if you can’t get enough fish, because fish is challenging now because of PCBs and all the mercury, you know, so it used to be, you can just say eat a ton of fish that you fish several times a week.

Dr. Gersh: I can’t say that anymore. So I say take a really high quality Omega 3 supplement and krill oil is actually has been shown to probably support the endocannabinoid system better than fish oil, which is new to me. That’s new data.

Dr. Cates: Wow, that’s amazing. And yeah, so covered so much information here. I have one last question for you before we end and we’ve been talking a lot about the endocannabinoid system. What about CBD supplements?

Dr. Gersh: Okay, so this is like the new frontier. So the difficulty is the endocannabinoid system, which is now the endoccanabinoid dome system because it includes, you know, a myriad of different lipid stimulating agents that go way beyond the conventional endocannabinoids is so complex and now we’re learning that the receptors that they work on are all over the body and there are different kinds of receptors. So there are now the new vanilloid receptors and there was a PPAR receptors and there’s these other orphan receptors that they’re talking about from gene proteins or it’s such a complex system that we really need to first be honest that we don’t really know exactly what we’re doing.

Dr. Gersh: That’s said there is data that using the CBD and I call it, and because it’s not just CBD, I like to use hemp oil. I don’t actually use marijuana products. I don’t know that I can trust them yet. Also THC is mind altering in different ways. There has some been some studies that it can help with sleep in some people it can help with cognition in some patients with Alzheimer’s or maybe it’s calming them down, but right now I personally don’t feel comfortable with using THC products, so I am, but this is going to come I’m sure. But right now I’m using the pure high quality hemp oil and I use and it has all the different products, not just CBD in it. So we call that the entourage effect because there’s like a hundred different compounds that are found in high quality hemp oil.

Dr. Gersh: Now because these endocannabinoid receptors are throughout the body. There are a myriad of uses, and I am using it now in women who have dysmenorrhea, menstrual cramps because it moderately is a lot of receptors on immune cells. It reduces inflammation. It can reduce inflammation when it’s proper, right, and when it gets imbalanced, it can actually be part of creating inflammation. That’s why you have to be aware that it’s a very delicate system that needs to be balanced, but in women who have clearly inflammation going on, they have terrible menstrual cramps. That’s a sign of inflammation going on in the uterus that’s causing contractions. That’s what menstrual cramps are by giving in suppository form and also orally by giving the hemp products that have the entourage effect of the, of all the CBD and friends, as I call it, I am getting very good results and I’m using in women, particularly with endometriosis where they have so few options and this is really helping, but it’s not just reducing the symptoms, it’s actually modulating the immune cells.

Dr. Gersh: So like the mass cells, the first responders, they explode okay in the pelvis and they release all kinds of inflammatory products and histamine and chemokine that’s calling the other immune cells to create this massive inflammatory response. And then in response to inflammation, the body upregulates the production of estrogen, which can be made in many sites. So now you have this poor estrogen is being dragged into the scene and estrogen doesn’t know what the heck is going on and it’s nurturing this terrible, you know, the endometrial cells that are coming out in women with endometriosis. So it’s nurturing them because it was never designed to deal with the situation. And estrogen it’s very important to know. Estrogen is about healing. It’s about proliferation for the purpose of this element and healing, creating new blood vessels. That’s why when estrogen is sabotaged I call it sabotaging poor estrogen. It’s putting it into a situation it was never designed to face like being exposed to a lot of endometrial tissue in that tells us or breast cancer, estrogen is being sabotaged because its role is healing and nurturing. Like on the skin. When you have a laceration, estrogen helps to heal it. But when it’s healing the enemy, it doesn’t understand that it’s not recognizing the enemy. So I’m using CBD with its friends and I’m having great results in endometriosis and in pain and in insomnia and in mood and anxiety. So there’s not as much data for depression, but anxiety, it does seem to help and you have to finesse it. You know, every person is different. You have to get a high quality product that’s tested and then you have to start low, go slow. And it’s amazing what the results can be for so many things. The greatest users of medicinal hemp are women.

Dr. Gersh: Women are the biggest audience and the biggest growing market for hemp based products because women are more sensitive, women have more pain, more inflammation than men. And especially after menopause or women who’ve been on birth control pills for years and years for a good part of their lives, they tend to get a much more tendonitis, bursitis, osteoarthritis, you know, they’re like having advanced aging, right? Because, and then you get more advanced aging of their skin as well and of their gut. So there’s a huge potential and I’m right on the forefront with it and and hemp products for the skin as well. So I also use it now on my patients who have lichen sclerosis, which is an autoimmune condition of those older skin for which there is no conventional, really effective treatment except high potency steroids of course, go-to for everything when you don’t know what else to do.

Dr. Gersh: And I’m getting good results there. For things like a topic, dermatitis, eczema, and I’m really very, very optimistic. We need a lot more studies, more data, but it’s only been legal across all 50 States for about a year. So I have to be a little bit patient but I am on the forefront of using it and getting good results. And I say to every patient, you’re an N of one, you’re unique. We’re going to try this on you. We’re going to see start low and see what dose and I use it in under sublingual, I use gel-caps, I use topical salves and creams. I would love, you know, more options that people can present to me. And I use vaginal suppositories as well.

Dr. Cates: Yes. All right. Well Dr. Gersh, thank you so much for all your valuable information today. Will you tell everybody where they can find you, find out more information about you and where your clinic is?

Dr. Gersh: Sure. So most of my time I see patients, I have a practice in Irvine, California called the Integrative Medical Group of Irvine. I have a little team here of integrative people that work with me to help women at every stage of life to optimize their health. And my website is integrativemgi.com and I would love people to follow me on Instagram cause I’m trying to get it started with social media and its Dr.FeliceGersh.

Dr. Cates: Great. All right, thank you again, Dr. Gersh for coming on and sharing all of your valuable information. I really appreciate it.

Dr. Gersh: My pleasure.

Dr. Cates: I hope you enjoyed this interview today with Dr.Gersh and to learn more about her, you can go to thespadr.com, go to the podcast page with her interview and you’ll find all the information and links there. And while you’re there I invite you to join The Spa Dr. community so you don’t miss any of our upcoming shows and information. And if you haven’t taken the skin quiz you can go to theseskinquiz.com to find out what information your skin might be trying to tell you about your health and what you can do about it including how to help balance your hormones. Just go to theskinquiz.com. And I invite you to join me on social media, The Spa Dr. Is on Facebook, Twitter, Instagram, YouTube, and Pinterest, and I’ll see you next time on The Spa Dr. Podcast.