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WA 044: Best Supplements for PCOS, Anti-inflammatory herbals for headaches, identifying PCOS symptoms, the fasting mimicking diet and more with Dr. Gersh!

Chantel Ray:                 Hi. Welcome to this week’s episode and I am so excited to have Dr. Gersh with us on today’s show. Dr. Gersh, tell us a little bit about yourself.

Dr. Gersh:                     Well, I’m a little unusual and that I’m board certified in OB GYN and I’m also board certified in integrative medicine. I’ve expanded my therapeutic toolbox to include much more than just surgery and pharmaceuticals. I incorporate things like acupuncture and homeopathy and herbal medicine and massage and mind-body techniques and energy medicine because it became very apparent to me that the paradigm that we used which we call the pill to the ill was definitely not helping women to resolve their medical issues.

Chantel Ray:                 I have to tell you a funny story. I was in the grocery store the other day and I happened to see my gynecologist who had delivered my son. Well, my son is seven years old and she was like, “Chantel, how are you?” I was like, “Good. Good to see you.” She was like, “How old is your son now?”

I was like, “Seven.” She’s like, “I haven’t seen you in seven years.” I was like, “I know. I have not been to the gynecologist in seven years.” I was like, “Well, my philosophy is if it’s not broke, don’t fix it.” And I don’t know what it is, but I just like, it’s like on the very bottom of my to do list. I know I need to go get just a regular check up or a regular exam, but I have not [crosstalk 00:01:32]

Dr. Gersh:                     This will serve as a friendly reminder.

Chantel Ray:                 Yes. This is my friendly reminder. I need to get in there. That’s funny. Well, let’s go right into the questions, but before we do, I know that you are releasing a book about PCOS and I’m really excited because I have personally struggled with PCOS and I know that we have tons of questions from different listeners that have struggled with PCOS.

Just tell me a little bit and I know that you had done a fasting documentary so I just want you to fill us in and tell us about how did you get involved in that fasting documentary and talk a little bit about PCOS.

Dr. Gersh:                     Well, PCOS is the most common endocrine disorder of reproductive aged women, although it actually is a lifelong condition. It’s just obvious during the reproductive years and it’s so underdiagnosed, poorly treated and it hasn’t really had any great breakthroughs in treatment ever really.

In fact, nothing has changed much in many, many years. None of the treatments that are currently used in any way get to the underlying root causes. I have been in practice for about three decades and I saw things changing in my reproductive aged women.

In the beginning, they had … There was an woman who had really bad cramps and had some issues, fertility issues, but over the years, I saw so many women gaining weight, struggling with acne, facial hair which we call hirsutism and infertility, crazy irregular cycles and it’s like something is really happening here and it’s not genetics because we know that people haven’t genetically changed in 20 years so something is causing their genes to manifest differently.

Chantel Ray:                 Yeah, and I know that my gynecologist told me I would have a really hard time getting pregnant and they told me, “You know, you have PCOS.” She told me and she’s like I had such a severe case of PCOS that I would have a really hard time getting pregnant and I ended up not having a hard time getting pregnant but …

Dr. Gersh:                     Wonderful. [crosstalk 00:03:47]

Chantel Ray:                 But that’s one of the things that she told me and we have been getting a lot of questions lately about people who are really struggling with infertility.

Dr. Gersh:                     They both sometimes happen, but definitely fertility is one of the hallmark problems that women with PCOS suffer from.

Chantel Ray:                 Right.

Dr. Gersh:                     In our conventional medical world, the way it’s typically treated is with pharmaceuticals and assisted reproductive techniques like IVF, In Vitro Fertilization.

Chantel Ray:                 Right.

Dr. Gersh:                     The problem is it actually has a very low success rate for one thing and when it is successful, there’s a very high rate of miscarriage, pregnancy complications and actual complications with the children who are born from those pregnancies. When you get a woman pregnant, we’ll say by trickery, the woman is not really physically optimized to carry that baby and so all kinds of things go wrong.

One of the things that I emphasize is you need to be healthy long before you get pregnant and most of the time when I work with my women patients, they get pregnant naturally and then they have uncomplicated pregnancies and I’ve seen that time and again and that’s just not what’s really emphasized.

In fact, when they talk about weight loss, you’re normal weight and I’m actually a PCOS patient myself, I actually self diagnosed a long time ago because I was also misdiagnosed which many women with PCOS are.

20% are what we call lean, the normal weight PCOS and 80% really struggle with very severe weight resistance in terms of obesity and so forth. It’s really, really hard for them to lose weight. What they do for those women is they basically starve them for about 12 weeks. They put them on a weight loss drug which long-term is not going to help them. It’s not going to keep the weight off long-term.

They can’t spend their life on these weight loss drugs and they of course don’t get to underlying issues, but they put them on a weight loss drug and then they starve them for three months to try to help them to get pregnant, but then once they get pregnant if they do which is not the majority, then of course they really aren’t healthy at that point.

They’re nutritionally deficient and they’re metabolically unhealthy. We don’t want to … We’d never want to really do that to help them [crosstalk 00:06:12]

Chantel Ray:                 Do we know what cause of PCOS is? Do we know what that causes?

Dr. Gersh:                     I believe we do now. Of course, it’s probably even more complicated than what I think and what some others are now thinking and that is in women who are somewhat genetically predisposed in utero and during other critical developmental phases perhaps in very early childhood and at puberty, they are exposed to endocrine disruptors.

These are environmental chemicals and sometimes pharmaceuticals because they can also be endocrine disruptors that mess with our hormones with the receptors, with the formation, the distribution, the elimination of our key hormones in our body and hormones are the information delivery systems that tell the cells what to do. If for example estrogen which I call a master of hormone of women.

Chantel Ray:                 Yes.

Dr. Gersh:                     If that is, we’ll say messed with, with chemical endocrine disruptors, we’d call them xenoestrogens, that’s the most common kind of endocrine disruptor then the cells don’t get the right information. In utero, when we’re developing very key things like our hormone receptors, the way our bodies are developing our … You get one chance to make a baby right.

You can’t get it like, “Let’s do a redo.” If the receptors don’t form properly for estrogen, then the child and then ultimately the woman can’t really function properly.

Chantel Ray:                 Those people who have PCOS, their estrogen is high, correct? Their levels or is it low?

Dr. Gersh:                     No. I’m so glad you brought that up. That’s such a common misunderstanding that they talk about women with PCOS have estrogen dominance. I wish that little expression would just go away because as it turns out, women with PCOS improperly make and process estrogen.

Estrogen has functions, metabolic functions as well as reproductive functions all over the body. Women with PCOS actually have lower levels of estrogen, but because they don’t have the right rhythm of hormones, they don’t have the proper menstrual cycle, the beautiful …

Chantel Ray:                 Because you have to have the right amount of estrogen, progesterone and testosterone. I remember one time I did get my blood taken and my testosterone was extremely low when I got my blood taken. Talk about that, just that balance of progesterone, estrogen and testosterone.

Dr. Gersh:                     Right. We have this beautiful rhythmic system in our female bodies and we call it the lunar rhythm, right? That’s the menstrual cycle and it’s dynamic. The levels change on a regular basis even from day-to-day and of course even throughout the day, hormones are not in the same proportions or made at the same exact levels.

It’s this beautiful interplay and dynamic between these different hormones. When people talk about estrogen dominance, it’s really more like progesterone deficiency because you’re not ovulating.

In order for the female body to work properly, to allow conception, to allow everything to flow the way it normally should, you need exactly as you said, you need this perfect balance between the hormones and it’s a very dynamic interchange between these hormones.

Actually, for example, when you ovulate, you’re preceded by a very big spike in estrogen that precedes ovulation and that big spike of estrogen actually opens up or up regulates the receptors for hormones like progesterone, testosterone and thyroid.

The receptors open and close and they’re dynamically related to the hormone level. The high level of progesterone in the second half of the menstrual cycle actually then down regulates the estrogen receptors. You have this beautiful interplay which is not working properly in women with PCOS.

Chantel Ray:                 Just for me personally, the day or the day before that I’m about to get my period, I have the most and I don’t get headaches very often, but the only time I get headaches is the day before my period and the day kind of of and then the day that I’m ending my cycle, just excruciating headaches. What would you suggest for that? Do you have any suggestions for those kind of headaches?

Dr. Gersh:                     Well, first thing is when a woman starts her period, what triggers that is a very significant drop in her progesterone levels and progesterone production and that triggers the production of what are called prostaglandins.

Now, prostaglandins are like little hormonal signals themselves and they’re present all over the body, but especially within the uterine cavity and these create in this case inflammation because shedding the lining of the uterus which is what a menstrual period is is actually an inflammatory process because the cells die, they fall out.

You get a state of inflammation locally, but not just locally throughout your body and in some women, they actually have inflammation in their brain and that’s where you’re getting those headaches. Anything that lowers some of this inflammation that’s why people take and this is not what I advocate for, but they take NSAIDs.

These are anti-inflammatories like Ibuprofen which is not a great drug, but sometimes for one day, that’s one or two days and that’s it because even one dose, they show even one dose of Ibuprofen will significantly alter your gut microbiome which is [crosstalk 00:12:07] topic.

Chantel Ray:                 It is a big topic and that’s funny that you say that because I absolutely like I am such an anti, I’m organic everything. I’m such anti Ibuprofen, Advil, all of that, but there are two times I’d basically take it two times a month and it’s the day I start, day I’m going to start and then the day I end because it’s … I finally just break down and I’m like, “Give me an Advil.”

Dr. Gersh:                     I’ll give you a few more natural tricks that you can use, okay?

Chantel Ray:                 Okay.

Dr. Gersh:                     Magnesium. Magnesium works in many, many ways. It’s worked in over 300 different enzymatic processes in the body and it is very anti-inflammatory. It has many wonderful beneficial effects. If you take about 700 milligrams on, I would recommend like calcium, rather magnesium glycinate because that [crosstalk 00:13:03] doesn’t give you diarrhea. Okay.

If you take too much magnesium, it’s great if you’re constipated, but that’s not what we’re dealing with here. If you actually have a constipation say anyone out there …

Chantel Ray:                 Oh, I’m always constipated so that’s good.

Dr. Gersh:                     But those people they might want to take Magnesium citrate, but so Magnesium. The other thing is Curcumin.

Chantel Ray:                 Hold on. Say that one more time. If you struggle with constipation and you need to help in that, then which Magnesium should you be taking?

Dr. Gersh:                     Citrate.

Chantel Ray:                 Okay. But if you say no. I go regularly, I don’t have a problem then take?

Dr. Gersh:                     Glycinate.

Chantel Ray:                 Got it. Okay. That’s one trick. What was the other … what’s the other one that you were going to say?

Dr. Gersh:                     A couple of different anti-inflammatory herbals can be very helpful. One is Curcumin which is useful for just about everything under the sun and has been shown to improve brain function in all sorts of ways. We know that cognition, mood, headaches are all interrelated. You can take Curcumin. You can also take another herbal which is called butterbur.

What’s really interesting is that butterbur was the first herbal treatment that a national medical organization or society, the neurological society actually endorsed butterbur which was like a breakthrough for a conventional medical organization to endorse an herb.

They actually came out and said, “Butterbur is as good as drugs like Imitrex for headaches.” Yeah, yeah, yeah, the triptan. It’s as good as a triptan which was fabulous that they came out with that.

Chantel Ray:                 Tell me about this fasting documentary that you were a part of and how did you get involved in that?

Dr. Gersh:                     Well, back a number of years ago now, it’s about three or so years ago, I was approached by a marketer who was just doing interviews of people who were integrative doctors like functional integrative medicine doctors and it was just to say, “Would you ever be involved with fasting? Would you incorporate that for your patients? What’s your views on that?” That was the main agenda, but there was a subtext.

There was another agenda and that was to find a medical practice that would be the first site to actually use the fasting mimicking diet which was being developed at the Longevity Institute at USC. Out of over a hundred people, I ended up going through the whole interview process and I was selected to actually have the privilege to use with myself and my patients the fasting mimicking diet which was developed there.

Through that, I got to know the people, the main key players like Professor Valter Longo, what a wonderful privilege that was and has maintained … We’ve maintained our relationship to get to meet these people, these amazing, brilliant researchers in the nutrition and fasting world and I got to become part of it.

Chantel Ray:                 You do fasting yourself. Is that part of your lifestyle?

Dr. Gersh:                     It was not before. It is absolutely now. I have done the fasting mimicking diet myself 13 times. In fact, next week is going to be number 14. It’s an absolute mainstay of my own. I call it my reverse aging program for myself and I incorporate it with the vast majority of my patients because there were just a few exceptions who really shouldn’t be using any kind of fasting like people who are very old or frail or very ill or obviously pregnant or too young, but the vast majority of people will benefit so it’s really like a reboot.

Chantel Ray:                 Talk about this [crosstalk 00:16:54], talk about the fasting mimicking diet in an easy to understand way, what do people do for that.

Dr. Gersh:                     Well, the fasting mimicking diet which was developed at USC ultimately evolved into an actual company so that people could access it because what’s the use if it’s just in an ivory tower, right? Now, it’s available for everyone and the name of the product is called ProLon for promoting longevity, but it does much more than that.

They use that because it came from the Longevity Institute and in mice, they actually lived longer which is amazing. Basically, what it does is it brings up and calls into action the survival mechanisms are intrinsic capabilities to survive when there’s not food around.

What happens is it’s five days of eating, but you actually get the benefits as if you actually fasted with nothing, but water for four days. Now, I don’t know if anyone including yourself has ever tried to truly water fast for multiple days.

I’ve never gotten through one, not even one, but this I can do easily because what they have created is a diet where you get three meals a day and it’s quite tasty and quite adequate, you get a nut bar for breakfast and a soup for lunch and dinner plus little extras depending on the day.

You get either some olives or a coco crisp or you get kale crackers and the first day is extra. You get some extra calories. You get two nut bars and a few extra of these little extras and then the next four days is about a little under 800 calories.

The first day is about 1100 calories, but it’s formulated in such a way which is the brilliance of it that you get to eat, but your body doesn’t see it. I call it, I’ve named it myself, I call it stealth food that your body doesn’t see it so you get the benefits as if you truly fasted for four days while you get the pleasure and the health benefits of eating for five and the benefits are astounding.

It’s really quite amazing. The way I look at it is once you’ve been fasting for about three days, that’s when you go into real ketosis and your body says, “Okay, I’ve waited around, I’ve hoped food would show up.” And none has because it doesn’t recognize the food you’ve been eating.

What happens is your body says it’s now or never, I’ve got to get smarter, stronger, leaner, meaner. I’ve got to really be get my act together if I’m going to go find food because I have this window of opportunity, after which I’ll be too weak.

What happens is in order to really rev up everything, you rev up your engine to start earning fat. I mean, this is wonderful. You burn fat and the fat you burn first is the visceral fat, the crappy, inflammatory fat that we develop in our mid sections, our belly fat around our organs.

You have to be smart if you’re going to find food now because no food is around now for a few days. You’re going to have to be smarter so it increases brain growth factors, brain derived neurotrophic factor.

You actually are calmer and you actually feel smarter and you actually are. They’ve done studies that show in mice for example, they can run their little mazes and do fabulously. They actually get smarter. For myself, by the time I get to day five, I feel like I can beat anyone in chess and I don’t hardly every play chess.

Chantel Ray:                 Right.

Dr. Gersh:                     It makes you feel like you can do anything because you’re so focus, you’re so [crosstalk 00:20:25]

Chantel Ray:                 Well, they’re doing so many studies now like … I mean it’s just the benefits of fasting just water fasting in general are just … Every day, I’m hearing more articles. It’s funny because I’ve wrote a book on intermittent fasting. Any time there’s an article on intermittent fasting or fasting and all the benefits, someone sends me the link which I love.

It’s so nice, but it just … It’s powerful. Is there any other … Is there any amazing stories that you’ve seen from fasting from your patients that you’ve seen?

Dr. Gersh:                     Oh, absolutely. The key players that I see that most benefit from are the people who obviously have some metabolic issues to begin with, right? If I give it to someone, it’s more for healthy longevity than I have to wait a number of years to see if they live longer, but it’s really the health span and health span means living your life with quality, with the optimal ability to do what you want, but so … That’s like a lot of people, but some people have clear cut problems.

I’ve turned around people who had hypertension, who’ve had high cholesterol. I do a lot of lab testing because it’s not invasive, I can’t monitor what I never measure. I look at inflammatory markers. I’ve seen them go from very high states of inflammation back to normal and a lot of women in menopause. Menopause is a state of inherent inflammation.

Chantel Ray:                 What ages are you seeing people starting to go through that menopause? What is that age range?

Dr. Gersh:                     Well, it’s variable, but it’s a huge, a huge impact on women’s health. The average age for menopause when the period stops is 51, but it varies like for me, I was in my early 40s I think because I did obstetrics for so many years.

I had chronic sleep deprivation. Anything that creates inflammation, nutrient deficiencies will give you an earlier menopause which is not a good thing. Some women will go into menopause in their early 40s, but anything under the age of 50 especially under 45 is really considered a big red flag, a health problem, but it could be [crosstalk 00:22:47]

Chantel Ray:                 One of my friends who’s 48 just called me and she knew that you were coming on the show, but her question was, she said, she was 48 and she said that she heard about this new procedure where they could literally singe something and so that you wouldn’t have a period anymore and she’s really struggling with heavy periods and so forth. What would your advice to her be?

Dr. Gersh:                     Well, what she’s talking about is [crosstalk 00:23:22] What she’s talking about is having an endometrial ablation and there’s a number of different techniques basically if you destroy the uterine lining, there’s nothing to come out. It won’t change your hormones, but it will make [inaudible 00:23:35]. It’s like the substitute for hysterectomy, you still have your uterus, but you’ve destroyed the lining.

In some cases, that can be a go to, you can’t just hemorrhage every single month, but it’s not … Even if you have that done, it has to be recognized that there’s something going on in that woman, right? Because that’s obviously not normal most of the time, especially during the transition, the menopausal transition by using bioidentical hormones and also lots of anti-inflammatory tactics like doing fasting, like using the fasting mimicking diet which is my personal favorite, by putting people on an anti-inflammatory diet where they eat lots of vegetables, avoid all processed chemical foods so that they don’t have that inherent inflammation because like I said, having a period is an inflammatory process.

Chantel Ray:                 [crosstalk 00:24:27] Wow. I never really [crosstalk 00:24:29]

Dr. Gersh:                     Yeah. When you really have heavy periods, it’s saying unless you have an inborn clotting disorder that’s like Von Willebrand. That’s a whole different thing, but assuming that this is a newly acquired thing that you don’t have a platelet problem or something, then it means that’s a clue. I look at all medical problems as clues to what’s going on, what’s causing this.

Clearly, when a woman had really heavy periods, she has a problem with uncontrolled inflammation ongoing in her uterine cavity and it’s probably everywhere in her body because things in one’s place transfer to every place. We want to really look at what’s your diet, what’s your … If you have hormonal imbalances, lack of estrogen or inability to have enough estrogen, that in itself will create an inflammatory state.

Even if a woman says well, we figure this out. I just got to stop this. I’m going to have an ablation of my endometrium. Still we want to go the next step and find out what’s going on because you know what? If you don’t, you may see something down the line.

This woman is going to have a different problem. It’s going to … It’s like play whack-a-mole. It’s going to come out somewhere else and there’s going to be another medical problem that may not be so easily solved like burning something up.

Chantel Ray:                 Makes sense. Recently, you wrote a blog about the endocannabinoid system and estrogen which I find fascinating because we actually just recorded a podcast, you’ll be able to hear it and we have another guest that is an absolute expert on the endocannabinoid system and it’s so popular now.

I’m getting massive amounts of questions and so I was like, “We’re going to have to get some specialists on here about the endocannabinoid system.” Can you break down specifically how the endocannabinoid system can affect the hormone issues that we deal with?

Dr. Gersh:                     Well, I am the hormone connection. I’m just so glad you brought that up because one of the things that I do is all over the world, I go around and I defend the defenseless. Sometimes I have to defend cholesterol. Sometimes I have to defend real food and I always have to defend estrogen because it’s the most poorly treated maligned hormone.

It turns out that estrogen is key to virtually every function in the body. Guess what? The endocannabinoid system is no exception and most people have no clue the relationship.

Much of what actually happens that estrogen is responsible for is actually through the endocannabinoid system which you can think of as the link between the physical and the metaphysical, the emotional component of a human and the physical component is actually linked in this amazing endocannabinoid system and it has a bidirectional relationship with estrogen.

In other words, they up and down regulate each other. It’s really a fascinating relationship. Estrogen is an anxiolytic, meaning estrogen reduces anxiety in a woman and it does so through the endocannabinoid system. One of the things that estrogen does is it blocks the degradation of the enzyme which would degrade our natural endorphins, our natural endocannabinoid system.

Estrogen keeps our endocannabinoids, our natural ones around longer. It also increases their production. Estrogen is actually key to our own bodies making these wonderful, these innate chemicals, the endocannabinoids that do all these amazing functions.

The endocannabinoid system we now know has receptors largely in the brain, has a whole bunch and all over the brain, in the hippocampus, in the hypothalamus, in the limbic system that that’s the mood emotional centers and it’s all linked with estrogen.

They also have peripheral, that’s why it’s the connection between the body, the mind, the mood and it’s all interrelated with estrogen. Now, endocannabinoids for example THC which comes like from marijuana. This is a really important thing for women to know that THC, that component will actually suppress the body’s ability to make some of these, our own innate hormones what are called gonadotropins that create LH luteinizing hormone, the hormones that come from the pituitary that stimulate the ovary to [crosstalk 00:29:00]

Chantel Ray:                 Right here, I actually just bought some hemp oil, some CBD so for listeners who haven’t listened to last week’s podcast, we obviously, the marijuana plant has two different … You want to talk about that for just a second how we have the CBD and the THC and the difference between that?

Dr. Gersh:                     Right. The THC has some different components. It’s the one that can have more the psychotropic effects and the CBD has more immunomodulating effects. They actually work together in our bodies to create all these different interesting impacts and our own body’s endocannabinoid system has two receptors.

It’s comparable. We have the CB1 and CB2. We have these dual systems that are going on involving our immune system. The endocannabinoid system is very involved in our immune systems which is why there’s a lot of hope that research with some of these endocannabinoids that are coming from plants that actually work on our own receptors things like hemp oil and from marijuana, the CBD oils and so on can [crosstalk 00:30:11]

Chantel Ray:                 Are you a proponent of the CBD oil?

Dr. Gersh:                     I am. I want to see more research. It just pains me no end that we don’t have adequate research in this country that herbals that are so potentially helpful for conditions in women like PCOS for endometriosis. There’s so much potential that we can get to help women and we’re not getting the research that we need because I think that understanding the relationship of our own hormones and the endocannabinoid system and that there are herbal plants that can interface with these receptors to create some of the same impact and have all these health and healing benefits is really important.

Chantel Ray:                 With the CBD oil from what I’m hearing you say, you believe that is … Obviously, we need more research, but from what you know the CBD oil is effective to help your hormones, but the THC maybe is not beneficial. Is that what I heard you say?

Dr. Gersh:                     There’s evidence that THC will down regulate our pituitary gonadotropins so hormones that actually stimulate our ovaries to make the hormones that we need. Say a woman is taking whole plant marijuana, either taking the marijuana or using the combined with the THC and then the CBD, she may actually be reducing her fertility and altering her menstrual cycles and it’s what’s really important for women to know that and as well for whole plant when the women have exposure to THC, they are much more liable to become dependent and to have addictions.

Women are more prone to addictions than men and are more susceptible to the effects of the whole plant marijuana. These have to be really used with great caution. They should really be used in a medical setting and really by someone who has expertise in the use of these because they like everything, right?

It has great potential for good and it also has some potential for harm. We have to be very cautious about using these things. There’s actually data that in people under the age of 26 continually using any of these CBD products and THC products that they can alter, remember it has receptors all over the brain.

People don’t finish developing their brains until they’re about 26, 27 that you can actually affect brain development by using these because these are powerful tools. I really do not advocate recreational use of marijuana even in states like mine like California where it’s legal especially in younger people because this really can impact on their young developing brains.

We have to use these with caution. I think there’s amazing potential, but we just have to realize that these aren’t toys that these are powerful chemicals derived from these wonderful plants that can have both good and both problematic effects.

Chantel Ray:                 We’ve got to dive into our questions since you’re writing a book currently right now about PCOS, correct?

Dr. Gersh:                     Yes. I’m so excited. It’s been …

Chantel Ray:                 What’s the name of the book?

Dr. Gersh:                     It’s going to be PCOS-SOS. [crosstalk 00:33:30] PCOS-SOS, an integrative gynecologist lifeline to restoring your rhythms, hormones and happiness.

Chantel Ray:                 Awesome. I love that.

Dr. Gersh:                     That’s coming out and it’s going to be really [crosstalk 00:33:46] Probably in October and November and it will be available for purchase on Amazon and it will also be hopefully not too long after that in some bookstores and it will also be available on my personal website which is very simple. It’s just my name felicelgershmd.com.

Chantel Ray:                 Awesome. We will put that in the show notes and if you’ll send us a link, I’ll make sure we put that on today’s show notes and we’ve never had a guest come on specifically to talk about PCOS. We did put a post that you were coming on and have some specific questions for you. This is Jennifer in Little Rock.

“My mom was in Arizona, I mean Arkansas.” I’m saying Arizona. Arkansas. She lives in Jonesboro, but this says, “When I visited my gynecologist, she told me she thought that I had PCOS, but that there is no true way to tell. She knows that I’m not trying to conceive at this time in my life and brushed it off like it was something I shouldn’t be concerned with since I’m not trying to get pregnant. I do want to have kids one day and I’m not comfortable with the fact that something could potentially be wrong. What can I do to improve my health so that when I am ready to have children, I can maximize my chances of conceiving?”

Dr. Gersh:                     Well, it breaks my heart first of all to hear that a doctor is so under aware of all the ramifications of having PCOS and doesn’t know how to diagnose it either. This is actually a rampant problem. In fact, there was a study that just was published showing that many women have to go to something like seven doctors before they actually get diagnosed and even after they’re diagnosed, they’re like this.

They’re just brushed aside saying whatever or they’re put on birth control pills until they have to take it and so forth, but in reality, this is a very big deal and it isn’t hard to diagnose and it’s somewhat of a spectrum. It has to be understood. Everyone with PCOS is not identical. There is a very broad range of symptoms and severities, but basically, if a woman has two of the following …

Chantel Ray:                 Run through those systems, those symptoms real quick for people and you kind of go, “Look, if you’ve got these symptoms and this sounds like you …” Run through those for us.

Dr. Gersh:                     One of the classic symptom is androgen excess manifestation. Androgen are what we call male hormones. Of course, they’re not just male, they’re just predominant in male. They’re female hormones as well that would be testosterone and the other androgens out of the adrenal like the Dehydroepiandrosterone sulfate, that’s DHEA sulfate. That would manifest as facial hair. If you’re growing a beard, that’s a clue.

Okay. If you have excessive hair like if you have hair on your chest or lots of hair growing on your breast and so on, under your abdomen, it looks like a hairy guy is tummy, that is a real sign of androgen excess. If you have cystic, recalcitrant acne, especially the lower part of the face and you have these big cysts, they’re painful and they just don’t go away and they try terrible things like Accutane which almost the vast majority, it’s like 70% of women who try Accutane with PCOS.

It may clear and then it comes right back with a fury. It damages the gut so please don’t go to Accutane, but they have cystic acne. It’s a terrible thing and then they lose hair. They have what we call androgenic alopecia so they start having male pattern baldness. They lose the hair in the front, the temporal areas and so and so. Their hair just comes out, it’s really think and fine hair. Those are signs of androgen excess.

Then the other key finding would be irregular menstrual cycles or no menstrual cycle like I for myself, I went two years without a period and I was told by one of the high level people at the medical school where I was training … It doesn’t matter, it’s okay, two years, it doesn’t matter, just go on birth control pills. It’s like, “Is there something wrong with me?” I get it. Not having periods or very irregular periods, that’s another big clue.

The other is remember, 80% will have really terrible problem to losing weight so that is like you think like you’re doing the right thing, but you can’t lose weight. That’s because women with PCOS have now we know a lot of problems with their gut microbiome which is another common, not always there, but irritable bowel syndrome, problems with your gut, problems with your mood.

A lot of women with PCOS have extra anxiety because their hormones are so imbalanced, we just talked about the endocannabinoid system and about mood and so on, their hormones are out of whack. They have anxiety and depression, insomnia, sleep apnea. There’s so many of these things and of course, if they try to get pregnant, they have fertility problems. They have complications. They have insulin resistance so they’re more prone to diabetes.

They often can get also the hidden epidemic which is called fatty liver, but you won’t know that unless you get an ultrasound of your liver which is very important. It’s a lot of metabolic dysfunction, menstrual dysfunction, mood dysfunction and these cosmetics things that are …

Chantel Ray:                 Talk about that fatty liver for just a second because the … How does your hormones affect having that fatty liver?

Dr. Gersh:                     Well, estrogen which has receptors virtually everywhere in the body also has receptors in the GI tract. In turns out that about 70% of the immune system lines the GI tract. It’s all filled with our different types of immune cells, what we call the innate ones, the ones that are the first responders to infections and then the B and T cells which make antibodies are all lining the gut and ready to go and do whatever they need to do to defend our bodies.

Well, when you have the wrong bacteria, we have this amazing civilization, we didn’t know existed within our bodies and on our bodies and the biggest, one of these collections is in the gut call the gut microbiome. It’s trillions of bacteria.

Women with PCOS we now know have an altered gut microbiome. They have the wrong bacteria, they do not create the right products and they create what we call endotoxins. Actually, toxins in the gut and these can leak out. We call that leaky gut, it’s impaired gut barrier function.

It goes into the surrounding immune system and it turns out women with PCOS have powder keg immune system, they’re very super sensitive. It takes less of a stimulus to cause an inflammatory reaction. These cells see this endotoxin that’s coming into them and they explode with inflammation.

There’s a conduit from the gut right to the liver. This inflammation travels to the liver. The signaling is off. You have the wrong metabolic products produced and you get inflammation in the liver. Once you get inflammation in the liver, the whole system is now functioning.

The liver starts to produce fat which we call triglycerides without control. It starts to produce sugar, we call that gluconeogenesis without normal controls. The liver is just turning out fats and sugars and it actually incorporates the fats into itself in this inflammatory liver state so you get fatty liver, but you also get these fats circulating so you get fatty other things, you can get fatty heart, you can get fatty muscle like your skeletal muscles.

You have this uncontrolled system and you now have the ticket to getting diabetes because you have abnormal production of sugar and these inflammatory products are actually directly toxic to the beta cells of the pancreas so you actually harm your pancreas’s ability to properly even make insulin in control of this.

The transport system that we call the glut system is estrogen control. That system is now malfunctioning. You don’t transport the sugar into the cells properly. The cells are now struggling if they don’t get … They’re living in a sea of energy, but they can’t metabolize it so you don’t get the right energy in the cell, but you’re struggling with lots of sugar.

You get really what I call metabolic chaos and it actually starts in the gut. That’s where we for women. We have to start by healing the gut, by working to eat the right foods, to try to get on the right signal and that’s one of the beautiful things about fasting is that it turns out that it’s a reboot to our circadian rhythm.

Chantel Ray:                 It really is because I personally just so you know, I feel like my PCOS has really either it’s probably still a little bit there, but I’ve really healed it through fasting. My face, I literally … You know the laser hair removal place? Since I was 21 years old, I have been going every six to eight weeks since I was 21 and I’m over 40, for the last 20 years, I’ve been going and they’re like, “Well, we don’t understand why the hair just keeps coming back and the hair keeps coming back.”

It’s because of the PCOS and the hormone issues. Now, I still go a little bit, but I’m not going near like I was over the last 20 years. I believe it’s through that fasting.

Dr. Gersh:                     That’s all that I deal with in my new book. I deal with how to implement fasting, change your diet, work with your circadian rhythm because it turns out that women with PCOS are actually living their lives essentially in jet lag. It’s like they’re always in jet lag because their rhythms are off and their master clock and their brain is actually very regulated by estrogen which is malfunctioning, you don’t have the right levels.

It’s like they’re always living in a world of jet lag and we now know jet lag produces horrendous effects all over the body in terms of increasing insulin resistance and having all kinds of inflammatory processes, increasing cancer risk and mood disorders and so on.

We have to get the rhythms right in women. We have to heal the gut, we have to get nutrients back into them because when you have an abnormal gut, you’re not digesting your food properly, then you can become nutrient deficient, it becomes a downward spiral.

There’s so much we can do that is natural. For example, birth control pills I’d like to mention actually create harm because they actually alter the gut microbiome in negative ways.

Chantel Ray:                 Jordan, let’s move on to our next question. Jordan in North Carolina says, “My doctor prescribed me with birth control as a way to treat my PCOS and said that I needed it to keep my period regular. I personally hate birth control side effects, the weight gain, the mood swings, et cetera.

Also, I just don’t like taking medicine every day, but I have remained on it because my doctor told me to. Is it true that this it the best treatment for PCOS or is there a more natural remedy that you recommend?”

Dr. Gersh:                     I hate birth control pills. I hate to say I hate, but I do because it’s like you have a wall and it’s fill with mold and termites. Your solution is cover it with wallpaper.

Chantel Ray:                 I love that analogy, that’s really good.

Dr. Gersh:                     It’s like the menstrual cycle is a vital sign of a woman’s health. Fertility is a vital sign of a woman’s health. Like I mentioned, if you’re having heavy periods, that’s a sign. You want to deal with the period, but you want to deal with why.

If a woman has irregular cycles, you don’t just put the wallpaper on it. No, you’ve got to help to get it right and figure out why it’s so off because as a woman who has irregular cycles has clearly medical issues going on, abnormalities that need to be addressed because the body, the female body is all towards reproduction.

Remember, the prime directive of life whether you like it or not is reproduction. When reproduction is off, that is a key sign. Ancient civilizations, they all had fertility gods because they knew fertility was the vital sign of health. A woman’s reproductive system is linked to every other system because obviously, nature created everything to be interlinked so you wouldn’t want an unhealthy woman reproducing.

When you have an irregular cycle, nature is saying, “You’re not good material to make a baby.” That means you’re unhealthy. We’ve got to work on that. Giving birth control pills is actually harmful. Why do we not give birth control pills to women who are heavy smokers when they’re younger or smokers of any degree in their 30’s or older?

Why would we not give it to a woman who has really high blood pressure? Because it’s harmful, because birth control pills increase risk of clotting, of heart attack, strokes, it increases atherosclerosis. Birth control pills are not about creating health, they’re about preventing pregnancy and when you recognize that fertility is vital to a woman’s health even when you don’t want to conceive, you want to maintain your fertility because that’s what you are.

Chantel Ray:                 That’s what drives me crazy and it’s so nice to see a doctor. It’s funny because I went to the pool the other day and I’m a member at the Princess Anne Country Club and it’s like every person there is a doctor. I’m always having conversations and I always tell them, I say, “I’ll be honest with you, I’m not a huge fan of our regular medical doctors.”

Because I feel like all they want to do is just slap a prescription, slap a prescription, slap a prescription and they never get to the root of the problem to figure out what is really going on.

Dr. Gersh:                     That’s what we call the pill to ill. A person could end up going to five doctors, getting five different prescriptions. Often one prescription negates or harms with the other one [crosstalk 00:48:10]

Chantel Ray:                 I think you need to place something like that in your title of the book because that pill to the ill is really catchy and I think that needs to be somewhere in your book. We need to find a way to get it in there because it’s really catchy and really sticks with people. All right [crosstalk 00:48:27]

Dr. Gersh:                     To write an introduction, you’re really catchy with your titles and your words. You’re good. [crosstalk 00:48:33]

Chantel Ray:                 Sarah [Toga 00:48:35]. She says, “I love your podcast and I’m excited that you’re having a doctor on to talk about PCOS because sometimes I feel very alone in my struggle with it. What are some of the best natural supplements that a woman with PCOS should take and are there certain foods that I should be sure to include in my diet and certain foods that I should leave out?” Great question Nicole.

Dr. Gersh:                     Of course, I’ll go into much more detail into all this in my book with doses and everything else, but some of the key ones would be Myo-Inositol which is a B vitamin derivative which has amazing properties, it’s anti-inflammatory, it helps regulate cycles, it helps reduce insulin resistance.

Myo-Inositol is a definite. Another one is N-Acetyl Cysteine which has many benefits in and of itself, but it also is a precursor to the master detoxifier and antioxidant, the body called glutathione. N-Acetyl Cysteine is a must. We can often get women to start having regular cycles just with that alone.

Additionally, berberine. Berberine is an alkaloid extract from a number of different plants and it actually works as an anti-microbial. It actually kills bad bacteria in the gut. We didn’t know how it worked, but now it turns out that the mechanism is always more complex, but it includes killing off and helping to regulate and get a right microbiome so it’s very helpful and it actually has many other benefits.

It’s also what we call a fasting medic. There are a number of substances that mimics fasting like Resveratrol. Berberine and Resveratrol and Alpha-Lipoic Acid, these actually can …

Chantel Ray:                 Do you sell these? Do you sell these on your website or anything where if they go to your site, do you actually sell these?

Dr. Gersh:                     I will. I’m putting up a new website for my practice and I’m going to be adding a store. It will probably be about another month and I will be having that available that you can actually get my protocols and you can actually buy some of these supplements.

I always wanted to say that everyone should hopefully have some doctor somewhere that actually understands and helps them. I’m totally-

Chantel Ray:                 You can help people … Obviously, you can see all over that are asking these questions. You can help people, you do consultations and so forth over the phone, correct?

Dr. Gersh:                     Right. I’m still what I call an [inaudible 00:51:11] doctor. I have a brick and mortar practice which people actually do come to from all over the country and all over the world, I just saw someone from Ecuador a few days ago. It’s in Irvine California.

We can help people if they come from far away, we can help them by staying a few days, even a week and we can do a lot because I have a team. I really believe for PCOS and for most healthcare issues that it really takes a village as they say.

I have naturopath, I have different types of massage therapy, I have fitness, I have a gym in my office, I do acupuncture and homeopathy and mind body medicine. I have a team, I can’t do all of those things myself.

Chantel Ray:                 They could just go to Irvine, California and just have a week of spa and get themselves together?

Dr. Gersh:                     Right. We work with them and if people can take a week because I’m right in the heart of vacation land in southern California. Touching Irvine, touches Laguna Beach and Newport Beach and it’s right down the street from Disneyland.

There’s plenty to do here, a lot of people will come from around the world come and make it a vacation like a medical destination vacation. Medical tourism.

Chantel Ray:                 That’s a great idea, make it a vacation. This next question comes from anonymous. He didn’t give her … He or she, I guess it’s a she. She didn’t give her name. She says, “One of my least favorite side effects of PCOS is the embarrassing hair on my face. When I went in for laser hair removal, they even told me that they told me that they wouldn’t even guarantee that this would work with someone who struggles with PCOS.

I was so discouraged that I don’t want to deal with this beard forever, do you have any recommendations for natural hair removal that are effective or any way that I can curb my facial hair growth.

Dr. Gersh:                     Well, the majority of women with PCOS have elevated levels of testosterone and then a smaller percentage have elevated levels of DHEA-S which is the adrenal hormone. Until you get these androgens down, the hair growth will never stop. There’s always another follicle somewhere.

When you do laser, that’s why they don’t call it laser hair removal anymore. They call it laser hair reduction. It helps, but it’s for you, it’s never ending because there’s always another hair follicle, it’s not typically killing all the hair follicles, it’s putting them, it’s like a stun gun, but if you have this great stimulus from all these androgens, it just keeps generating new hair.

The only permanent hair removal is electrolysis. Unfortunately, it’s becoming a dying art. I’ve actually spoken in front of electrolysis organizations and most of the women are in their 50’s who are the practitioners of this art.

The very few younger people are training in it because they’re doing laser, but for women with PCOS, the lasers are helpful, but it’s never-ending because the hair just keeps on coming.

Chantel Ray:                 Again, you got to get to the root of why that hair is growing.

Dr. Gersh:                     We have to lower the testosterone level. Now by fasting by the way will lower the levels of testosterone.

Chantel Ray:                 Regulating it.

Dr. Gersh:                     Yes. When you do time restricted eating. For example, there’s a study out of Israel and it was on lean PCOS, but I found it also works with any women with PCOS if they’re willing to do this. If they ate in this study two-thirds of their calories for breakfast and then one-third for lunch.

That leaves nothing, but just a little bitty-bit for dinner. Very little. They ate a big breakfast, a medium lunch and a teensy, teensy dinner. In one month, their testosterone levels fell by 50%. That’s amazing. There were other things like spearmint tea by the way, the spearmint tea is in ProLon.

I don’t know how they figured out to put spearmint tea in, but spearmint tea has been shown to lower testosterone levels. Resveratrol lowers testosterone levels. A lot of the treatments that I implement for PCOS will lower the testosterone levels and help to curb this relentless hair growth.

There was a study out of UC San Diego that showed that giving Resveratrol can actually lower testosterone levels. All these things that lower inflammation, that help to reset the circadian clock, these can be amazing to reduce testosterone levels and healing the gut because we now know that when you have an inflamed gut, that also can lead to elevated testosterone level.

All the different things that we do naturally to help resolve these conditions that women with PCOS is suffering from will lower the testosterone.

Chantel Ray:                 Awesome. Ashley in Springfield says, “My sister struggles with PCOS and had a really hard time conceiving. Sadly, she also had a miscarriage on one of her pregnancies. I was also wondering if miscarriages can be related to PCOS or if PCOS only affects your ability to conceive. I ask because my doctor told me that it’s common for PCOS to run in sisters and I’m curious what my future would be like if I decide to have children.” Ashley in Springfield.

Dr. Gersh:                     Well, in terms of the genetic component, yes. If you have a sister with PCOS, there’s a good 50-50 chance at least that you will have at least some degree of PCOS. They’ve shown that in mothers of women with PCOS even if they say they did not have PCOS, they have a dramatically higher rate of developing diabetes.

There is definitely something within the genetics. I think women are not as good at detoxifying and I found that with looking at certain methylation factors and genetics, what we call MTHFR that the women with the worst case [crosstalk 00:57:14]

Chantel Ray:                 Sweating. That’s another thing is like I have found that when I … I got a new, it wasn’t new, but I’ve had it, I just haven’t been using it, but we have an infrared sauna. When I go in there and I do a good sweat, I’ll just go in there and just sweat it out.

I’m telling you, I am a new woman when I go in there and I think that’s a good point about detoxing your body and getting that stuff out.

Dr. Gersh:                     Well, women they’ve actually shown that women with PCOS carry higher body burdens of chemicals like Bisphenol A. It’s not that they’re exposed to more Bisphenol A, it’s that they can’t get rid of it as well. I really believe that some of the problems with women with PCOS is that we live in this poison world unfortunately where we’re exposed to all these chemicals.

We did not evolve as a species to deal with all these chemicals. This is a really new development in our history as humans on planet earth. Some people are just not genetically programmed to get rid of this toxic stuff as well.

It’s like we’re all born with a bucket and it’s our toxic bucket. When that bucket is overflowing, we get sick. Some people have smaller or larger buckets. That’s why you can have … Different people exposed to exactly the same thing, but they manifest in different ways.

Women with PCOS tend to be more susceptible to these chemical toxins and they’ve actually shown that they carry higher levels within their body. It’s really essential for women with PCOS to try not to use plastic for stuff. Avoid plastic, try to use natural products, eat out of glass and stainless steel, don’t drink your coffee out of plastic, bring your own containers with you if you go to a coffee shop and don’t do the coffee with the lids, the plastic lids, they’re terrible for us.

It all dissolves into our drinks. We really want to avoid these toxins as much as possible. That’s one thing is the genetics, the toxins, in terms of miscarriages, yes unfortunately. Women with PCOS have every king of reproductive problem at a higher rate.

They have more infertility, they have much higher rates of miscarriages, they have high rates of pregnancy-related complications like pre-eclampsia also known as toxemia, gestational hypertension, gestational diabetes, pre-term labors and pre-term deliveries and very large babies.

Sometimes very small babies. They have the whole gamut of pregnancy-related complications at a higher level. That’s why we don’t want to just trick women into getting pregnant when they have PCOS because they’re likely to just miscarry or have complications.

We don’t need that. We want to really be healthy long before we’re pregnant. That’s why every day of a woman’s life, she anticipates getting pregnant should be a day of healthy. Really, we should never take a vacation from being healthy because it all matters, right? It all matters.

Chantel Ray:                 It does. All right, this is our last question and again, this one is anonymous. We have a lot of anonymous this time where they weren’t sharing their name. “I struggle with PCOS which means that I don’t get a period consistently. Sometimes I can go three to four months without a period and when I do, the cramps are out of control.

I almost can’t function because they’re so bad extending to my legs and my back. Without being too gross, the flow is extremely heavy as well. What are some ways I can alleviate these symptoms of my out of control periods?

Dr. Gersh:                     Well, that’s a wonderful question because it ties in so many things we’ve already spoken about that when you have a period, it’s an inflammatory process. Women with PCOS we now know are inherently inflamed. This was discussed and researched back in the 1990’s when it was first discovered that women with PCOS have higher markers of inflammation.

This becomes a body wide process. In the uterus, remember that when you trigger a period, that’s an inflammatory process. They have too many prostaglandins, it’s out of control, they don’t have enough progesterone. What we want to do is work on fundamentals.

We want to number one, just to help the woman to feel better. There were certain things that we can do. There are even pharmaceuticals. There’s a pharmaceutical I use occasionally, it’s called Lysteda. It’s tranexamic acid which actually helps to prevent really heavy bleeding.

Sometimes I look at pharmaceuticals as a short-term bridge to health. If you use it for just a few months while we get your body inflammation down by getting you on an anti-inflammatory diet, taking out the gluten, taking out the dairy, taking out the processed foods, anything with added sugars and high fructose corn syrup.

They are all inflammatory. If you have terrible cramps, if you have heavy periods, your body is inflamed and it’s manifesting in this way. It could manifest with migraines, it can manifest with joint pain. These are all manifestations of inflammation.

We’ve got to get this person on an anti-inflammatory diet. We’ve got to get her on unless she doesn’t qualify on a fasting regimen. She should definitely watch the fasting movie which by the way is on Amazon and Netflix. She should watch that because that will give her some other helpful clue. She should do the [crosstalk 01:02:44].

Chantel Ray:                 Yeah, I agree with you.

Dr. Gersh:                     Got to get her [crosstalk 01:02:48]

Chantel Ray:                 Let me ask you this because a lot of times, I think someone told me, maybe I misunderstood that they said when you’re about to get on your period and you’re getting these headaches that progesterone cream is good for you to put a little bit of progesterone cream during that time. Do you agree with that or no?

Dr. Gersh:                     I do use progesterone sometimes. Also, hopefully not indefinitely because that’s not getting to the root cause, but once again, sometimes we have to do things short-term while we get the problem fixed, right? Low progesterone, when progesterone drop, that’s the trigger to having a menstrual period.

Some women, they don’t make enough progesterone. We now know that. When they drop, they still don’t have enough progesterone on board. Giving very small amounts of progesterone like if I gave it orally, I might give just 12 and a half milligram.

I’m not going to be giving a lot. I’m going to be giving small amounts of progesterone and it can sometimes really help, that little bit of progesterone. Progesterone is also very neuroprotective, neuro calming and sometimes that helps because we know that anxiety exacerbates pain and inflammation. It’s a strong link which it’s back to the whole endocannabinoid system, right?

Sometimes, that’s where I think for some of these women that have really bad cramps and really bad periods, very small amounts of some of the CBD and so forth might help them short-term while we get to the root cause which is really getting their gut microbiome and their circadian clock and their hormones imbalance and getting their rhythms back on track and getting all that together, but we need tools to help women symptomatically while we get them fixed basically.

The tool that we don’t want to use is birth control pills because that is only actually creating more harm. It’s kicking the can down the road because eventually, people go off with them and they have more and more problems than they had before they began.

We sometimes use different tools to help symptomatically, but we ultimately must fix the underlying root causes, the circadian rhythm dysfunction, the environmental toxin loads, the gut dysbiosis, the endocrine malfunctions and the nutrient deficiencies and we get all of this put together and we get this puzzle put back in the right place and then a woman can have an optimized life and have [crosstalk 01:05:22].

No woman wants to look in the mirror and start shaving every morning. That is the ultimate anti-feminine feeling. So many women with PCOS have such negative self-esteem. They have negative self-perception and that is so important that we give them back their love of life and their self-esteem that is critical to well-being.

Chantel Ray:                 Yeah. Well, I am so excited about your book coming out and I know everyone listening today is going to be excited about it. One more time, say your website and we’ll also put it in your show notes. Tell us your website one more time Dr. Gersh.

Dr. Gersh:                     Felicelgershmd.com.

Chantel Ray:                 I think you should make it easier. I think you should have it be drgershmd.com.

Dr. Gersh:                     I think someone stole that. When I tried to get [crosstalk 01:06:15]

Chantel Ray:                 I’m going to work out getting you an easier. We need an easier website.

Dr. Gersh:                     Maybe Dr. Felice? That’s a good idea. Definitely you have great ideas.

Chantel Ray:                 We need an easier one. Yeah, we need a shorter, easier one. We’ll put that in the show notes. Thank you so much. This was an absolute pressure and it’s so, so nice to meet you, so glad you came on this show and we will all run out and get your book as soon as it gets on the press.

Dr. Gersh:                     It’s going to be up on the website very shortly within the month and people can put [crosstalk 01:06:45]

Chantel Ray:                 We can pre-order.

Dr. Gersh:                     Pre-order, right. Yeah. First on your block with it.

Chantel Ray:                 Yes, so exciting. Well, thanks again. Guys, if you have a question that you want answered, go to questions@chantelrayway.com. Have a great day. See you guys next time. Bye bye.