By: Kristen Nicolai

The Westchester Rockland Dietetic Association (WRDA) held a live webinar on May 19 titled, Understanding and Addressing the Unique Needs of Women with PCOS, presented by Dr. Felice Gersh, MD. Dr. Gersh is board-certified in OB-GYN and Integrative Medicine and the medical director of Integrative Medical Group of Irvine. She is a globally recognized expert on a wide range of female and integrative health topics.

To start off the webinar, Dr. Gersh provided background on PCOS and explained that for women to have optimized health, they require optimized hormones. We live in a world of endocrine disruptors, including pollutants, toxicants, poor diet, and disrupted sleep-wake cycles. Women develop PCOS by being exposed to endocrine disruptors in utero, including exposure to higher levels of BPA. This causes high oxidative stress causing the endocrine system to be dysregulated. Women with PCOS therefore have altered endocrine receptor function, causing a state of estrogen deficiency. 

Since estrogen receptors are located throughout the body, every organ system is impacted by this low estrogen, creating pro-inflammatory conditions. Dr. Gersh explained that inflammation is the driving force of PCOS, causing the dysbiosis, abdominal fat, insulin resistance, altered immune cell reactivity, and impaired circadian rhythm seen in PCOS. Because of this, PCOS patients experience a wide range of symptoms including acne, hirsutism, alopecia, irregular cycles, obesity, fatigue, joint pains, gingivitis, mood disorders, and IBS. Therefore, modulating estrogen is a key part of helping women with PCOS.

When treating PCOS, it is critical to have and maintain a healthy gut microbiota, which supports all systems of the body. Food plays a big role in this as PCOS patients have impaired gut barrier and lower microbial diversity. Dr. Gersh has an integrative approach that includes feeding the gut or microbes, and eating to beat, which includes recognizing the important role of the circadian rhythm in women. Dr. Gersh emphasizes a plant-based diet that includes organic, raw, and minimally processed foods. She stresses eating the colors of the rainbow and lots of fiber. She also advises to limit sugar, fat, salt, and avoid alcohol, antibiotics from agriculture, artificial sweeteners, dairy, emulsifiers, and gluten. She encourages patients to take a daily probiotic, and even eating vegan for six months to help the body reboot.

Dr. Gersh went on to explain that diet modulates the microbiome, and that a low fat and high complex carbohydrate diet has been proven to improve metabolic syndrome by altering the gut microbiome and increasing the bacterial strain F. prausnitzii that increases butyrate. Butyrate nourishes the cells of the gut ling, and even has a calming effect through its impact on the vagus nerve.  Dr. Gersh also emphasized the importance of a diet very high in fiber and resistant starch, which acts as pure food for the microbes of our gut. She recommended foods such as cold potatoes, plantains, and Jerusalem artichokes, which are high in resistant starch. She also encourages her patients to eat fermented, prebiotic and probiotic foods.

It was also highlighted that nitric oxide is reduced in PCOS patients, which has an affect on t-regulatory cell generation. Women with PCOS do not make enough of these cells which causes autoimmune disfunction. Since nitric oxide is very related to food, Dr. Gersh highlighted the importance of eating foods containing nitric oxide, such as kale, swiss chard, arugula, and spinach.

Dr. Gersh concluded that poor diets high in fat and sugar drive gut dysbiosis and the systematic inflammation seen in PCOS women. This also causes circadian rhythm dysfunction. To combat this Dr. Gersh explained her “eat to the beat” philosophy. This includes eating at same time each day, fasting through the night, eating dinner early, and eating a big breakfast, moderate lunch, and small dinner. She advises her patients to eat meals, not snacks, to stop eating at 7pm, and even try adding in a fasting mimicking diet or longer fasts. By correcting the clock to synch meal timing with the circadian rhythm, this can help women with PCOS see significant changes in their symptoms and reductions in glucose, insulin, testosterone, and other important biomarkers. 

For more information on Dr. Gersh you can visit her website at https://integrativemgi.com/ or follow her on Instagram (@dr.felicegersh).