Sleep with Dr. Felice Gersh: Rational Wellness Podcast 135
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Dr. Felice Gersh discusses Sleep with Dr. Ben Weitz.
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Podcast Highlights
3:21 Sleep is so important for our health and for rejuvenating our brains and our bodies. And it’s also important to sleep at the right time. Our bodies are designed for us to go to sleep when the sun is down, so we should ideally go to sleep at around 10 pm and get between 7 and 8 hours of sleep.
5:35 But many of us today, esp. women with PCOS, fail to get enough, deep, quality sleep. Watching late night television and eating late at night throw off our body’s natural rhythms. And we have all these bright lights that contain a lot of blue light in our homes. And besides television, we sit in front of computer screens, iPhones, and iPads and all this blue light suppresses our melatonin, which under natural circumstances, would gradually rise with the sunset. And our television and computer screens stimulate our cortisol, which keeps us awake. Higher cortisol also leads to elevated blood sugar and causes metabolic syndrome, which raises our risk of obesity, diabetes, heart disease, dementia, autoimmune disease, and even cancer. Some folks claim that they are naturally night owls and they stay up until three in the morning, but they are really ignoring their natural circadian rhythm and they are putting their health at risk.
8:48 There is a lot of talk about the dangers of blue light at night, but blue light is not necessarily inherently bad. In fact, we’re supposed to have blue light and white light in the morning to wake us up. It’s just that it’s supposed to change as nightfall comes. We have scientific data showing that watching the sunset with all the yellows, oranges, and reds of the sunset will actually trigger the production of melatonin and shut down our cortisol production. A weekend of camping outside with natural light and being grounded and sleeping on the ground will help to reset our circadian clock. It makes you want to go to sleep at the right time and wake up at the right time. Dr. Gersh points out that we need to understand that we are part of the animal kingdom.
13:04 Dr. Gersh said that she likes to think of the human body like a heart, which basically has two phases. The heart contracts and pumps blood out and it relaxes and refills with blood. Even a lot of cardiologists today pay little attention to the filling or resting or diastolic phase. But resting is just as important as running and acting out and doing things. So that’s why we’re like a heart. Sleeping, just like for the heart when it’s resting and filling is just as important, if you’re going to have healthy longevity.
16:40 When we are born, we each get on our own individual conveyor belt. Some people have a rough ride and bounce off really fast and others have a long ride but it’s rough and goes down and down. We want to have a smooth ride that goes sideways rather than down. We want to avoid that descent into all the chronic diseases that reduces the quality of our lives. In order to maintain the health of our brains, we need to maintain our circadian rhythm. If we get good, quality sleep, our melatonin will be peaking around 2 AM and that is when the flow of blood to the brain is also peaking. This is when the lymphatic system of the brain drains garbage from the brain and rejuvenates it. But this requires good, quality sleep and many people aren’t getting it. If the go to sleep with the television on, then they have this blue light coming through their eyelids that lowers their ability to produce melatonin and lower their cortisol. They will stay in an insulin resistant state all night long, creating inflammation. They won’t be producing enough melatonin in their GI tract and their guts will be messed up and they will develop an unhealthy microbiome in their gut. When we produce melatonin at night in our guts, it causes the microbes to swarm like insects and they produce different metabolites that lower our risk of colon cancer, which is an epidemic today, including in young people.
20:31 Dr. Gersh explained that a lot of older folks are sad and depressed and lonely, so they think of their television as their company. But this interferes with their sleep. Or they they have dogs or cats, which can be great pets, but if they sleep in their beds with them, then this can negatively affect their sleep, esp. if their dog has to go out to the bathroom at 3 AM.
23:28 Some patients will turn to alcohol to help them to sleep. But they don’t get good sleep from alcohol and it’s a brain toxin, a gut toxin, and a liver toxin. They often get a paradoxical reawakening in the middle of the night. Women with PCOS have problems with their master clock due to their estrogen/androgen balance problems and they often end up with disturbances in their circadian rhythm. If your master clock is working properly, you should be hungry in the morning but not at night. This usually means that you have low production of the endocannabinoid called enendomide in the morning and a high production of enendomide at night. They will also likely have high cortisol at night and low in the morning.
27:37 We have an epidemic of sleep apnea in the US today, which is really related to a circadian rhythm disorder, which can be related to hormonal deficiencies, such as in menopausal women. Sleep apnea is not just about having a fat tongue that blocks the airway, it’s related to your hypothalamus in your brain, which is not putting out the right signals for breathing and sleeping and appetite and blood pressure and urine production. Your autonomic nervous system is out of whack. Sleep apnea can disrupt the normal phases of sleep, so you don’t get the restorative functions of sleep. Make sure to get all the devices out of the bedroom and go to bed at the right time and make sure that your bedroom is cool and dark. You may want to take a warm or hot bath before bed to relax you and drop your cortisol levels. We don’t want television or ipads in the bedroom because they emit blue light and this lowers their ability to produce melatonin and doesn’t allow our cortisol levels to drop. Then you will stay in an insulin resistant state all night long, creating inflammation. This will also negatively affect our microbiome and our gut health since when we get good sleep, we also produce melatonin in our guts and this causes our microbes to swarm like insects and they produce different metabolites that keep our guts healthy and this lowers our risk of colon cancer, which is rising now in younger folks.
32:34 Melatonin and Cortisol are two of the key substances regulating our sleep and awake cycles. Cortisol is produced by the adrenals and it starts to rise in the morning should peak around the time we wake up. Cortisol makes us feel activated and stimulates our appetite and elevates our blood sugar levels. Dr. Gersh does not think that it is a good idea to skip breakfast, since we are designed to eat in the morning and this helps to reduce our cortisol to a moderate level. If you skip breakfast, your cortisol will tend to stay at this higher level, which is harmful and it can cause leaky gut and hypertension. High cortisol levels tends to lead to low T3 (thyroid) levels. Eating in the morning is when our insulin is most effective and sensitive. When we eat breakfast, the glucose that is produced will go readily into our muscles, into all of our tissues and our brain. Because we want to utilize glucose. Glucose is the preferred energy source for most every organ in the body.
Dr. Felice Gersh is a board certified OBGYN and she is also fellowship-trained in Integrative Medicine. Dr. Gersh is the Director of the Integrative Medical Group of Irvine and she specializes in hormonal management. Her website is IntegrativeMGI.com, and she is available to see patients at 949-753-7475, she lectures around the world, and her first book, on Polycystic Ovarian Syndrome is PCOS SOS: A Gynecologist’s Lifeline to Restoring Your Rhythms, Hormones, and Happiness, which includes a wonderful chapter of sleep. Her second book, PCOS Fertility Fast Track will be available soon.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com.
Podcast Transcript
Dr. Weitz: This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health. Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts or your favorite podcast app and give us a ratings and review, that way more people find out about the Rational Wellness Podcast. Also you can go to my YouTube page and there’s a video version and if you go to my website, drweitz.com you can find complete show notes and a detailed transcript.
Today our topic is sleep with Dr. Felice Gersh. Dr. Gersh, recently authored a wonderful book on how women can overcome PCOS, polycystic ovarian syndrome called, PCOS SOS: A Gynecologist’s Lifeline To Naturally Restore Your Rhythms, Hormones, and Happiness. This is an excellent book for women with PCOS but it’s also a treatise on how to lead a healthy lifestyle. And her chapter in the book on sleep has so many clinical pearls that I thought we would focus on this for our discussion today. We all know that sleep is important for our health, but that doesn’t mean that most of us pay any attention to it. Many Americans today are not getting enough sleep due to working longer hours around the clock, entertainment and poor diet and lifestyle. Getting good sleep however, is crucial for the rejuvenation of our brains and our bodies. And a chronic lack of quality sleep increases our risk of heart disease, high blood pressure, diabetes, obesity, et cetera. And when we sleep we cycle through different stages. Actually four stages of sleep, multiple times per night, two periods of lighter sleep, one period of deeper sleep and one period of rapid eye movement sleep. Dr. Felice Gersh is a board certified obstetrician and gynecologist and she’s also fellowship trained in integrative medicine. Dr. Gersh is a Director of the Integrative Medical Group of Irvine where she continues to see patients. She also lectures around the world and I just mentioned her bestselling new book, PCOS SOS, that’s available from Barnes & Noble and Amazon. Dr. Gersh, thank you so much for joining me again today.
Dr. Gersh: Well, it’s my pleasure and I just love just listening to your beautiful summary of sleep. I think we can all take a nap now. That was so good.
Dr. Weitz: You’re such an amazing doctor that you can talk about so many different topics. I am just amazed. But let’s talk about sleep and what constitutes a good night of sleep?
Dr. Gersh: Well, like everything we’ve learned about our human bodies, we need to not only sleep, we need to sleep at the right time. So everything is about quantity and quality and timing. So in terms of sleep, we are designed as diurnal human beings, right? We are not nocturnal. So we need to sleep at night. So our bodies are designed for us to go to sleep when the sun is down. And typically we have adapted and this is probably not the same as what ancient people did or prehistoric people did, but we have adapted to a lifestyle that would be very good for us if we went to sleep between 10:00 and 11:00 at night, even closer to 10:00 is better. And then getting somewhere between seven and eight hours of sleep every night. Hopefully it was not too much disturbance in the middle. Now, probably in the ancient times, people went to sleep even earlier, and when the sun went down, because in early times age, they maybe didn’t even have fire. They weren’t going to stay up late at night.
So when the sun went down, they went to sleep and they would get up with the sunrise. So that’s probably really how we evolved, but we can do quite well because we have to realize that we invest not like prehistoric people, so we have to make some concessions. I can’t expect everyone, the sun is down, jump in bed. But probably, during the times when it was cold out and the nights were longer, they didn’t necessarily want to sleep longer. They may actually have gotten up in the middle of the night and did a few things, chatted, maybe they had sex or whatever. And then they went back to sleep for another few hours. So we do have some adaptive lifestyle, but I’m perfectly happy with anyone who can get to sleep between 10:00 and 11:00 at night and then have a nice continuous sleep for seven, eight hours. And your body will have a lot of wonderful opportunity to do all that rejuvenation that you mentioned in your little introduction.
Dr. Weitz: So why do so many of us fail to get enough deep quality sleep and especially women with PCOS?
Dr. Gersh: Well, if we talk first about the general population, a lot of the things that you mentioned, people are just doing so many things wrong. We are enticed to watch late night television. They say, what’s the late, late show? And people get, they think of these people on TV as their friends. They really want to see their funny monologues and everything and they forget this is all now recorded and you can have it on demand, you can watch it at a different time. But they get used to getting into that pattern. And people often are eating very late at night and they just don’t really feel as tired because their body’s rhythms are so off. And then we have all this ubiquitous lights, they have bright lights.
Remember ancient peoples didn’t have all that artificial light maybe in less ancient times. But still long time ago they had candle light, which puts out a whole different hue, the candle light compared to the all blue lights that we have now, the fluorescent light bulbs and so on. And they’re bright light. And then we watch computer screens, iPhones, iPads. And then with television screens, with all that blue light, it’s just totally suppressing our melatonin, which should be gradually rising with the sunset. So our rhythms are so off, then people are often not feeling as tired, they’re often feeling more alert at night because they’re eating, they’re watching television and computer screens. They’re actually being so stimulated to wake up and their cortisol is going up that they don’t feel tired. And so they say, you’ve heard this a million times, I’m a night owl and I don’t feel tired. I’m fine, but they’re not really fine because their bodies are not getting what they need and then not realizing the incredible metabolic risks that they’re putting themselves into.
And of course, we now know that metabolic ills are the ills of everything. That’s what leads to cancer, to autoimmune disease, to dementia, to cardiovascular events. Everything is linked to metabolism and your metabolism will be off guaranteed, like you mentioned, you’re going to gain weight. Is that your goal? You don’t even have to eat really unhealthy foods if you eat at the wrong time of day. So we have a society that sort of pushes people to be up and now we know that, close to like one third of people or 3% of people, are working at night because our society demands a 24 hour worker crew. And so those people have the worst of all worlds because no matter what they do, their circadian rhythm will never really be properly fixed because some days they’re up until three in the morning and then other days they’re working at a different time of day. ER doctors are among the worse off. But I was in that category when I did obstetrics for 25 years.
Dr. Weitz: Sure late night…
Dr. Gersh: I was up all night, so many nights. It’s like a wonder, still in recovery mode.
Dr. Weitz: So you were talking about blue light. So blue light is not necessarily inherently bad. In fact, we’re supposed to have blue light and white light in the morning to wake us up. It’s just that it’s supposed to change as nightfall comes.
Dr. Gersh: Absolutely. So it’s really wonderful how humans have adapted to live on planet earth. It’s like the … I love science fiction. My favorite show when I was a kid was Star Trek. And I love all these sciences, the science fiction, Star Wars and all of that. But we really are earthlings and we evolved with the beautiful rhythms of earth in our planetary system. It’s so amazing. We have a 24 hour rotation of earth and so we are the day creatures and there are other creatures that are night creatures. And it’s just so amazing how we have evolved. So the light of the morning, like you mentioned is our wake up lights. And it has a different spectrum of light than when you look at the sunset. And now there’s actually data that watching the sunset and the beautiful sort of yellows and oranges and reds of the sunset will actually start triggering the production of melatonin and shutting down our cortisol.
So living outside, and so many of us are so, we’re living in constructed man-cave. We’re in buildings where so many people they don’t even have the lighter day, people who work in basements or they work in cubicles that are interior to buildings where there are no windows. They’re just surrounded by these phony walls and things. And they really have very little natural light. They don’t get outside. And if they live in a big city, like New York City or Chicago where you have really tall buildings, it’s like blocks the sun. So they’re always in the shadows, except when the sun is right overhead, which is very brief in the course of the day. So it’s so important for us to be outside. There’s data that when people go camping and they live with the natural light of the sun, the way we evolved, where they actually have the sun, they’re sleeping outside maybe in a little tent where the light comes right in and the sunlight actually really wastes them up because that’s just what happens.
And then when the sun goes down, there’s no television, there’s not much to do. Hopefully, they didn’t bring in all their equipment so that they could watch free recorded stuff. Hopefully they didn’t do that with the batteries. So they’re actually camping like people should in the woods without any of that stuff. And then after the sun goes down, they’re tired. And when people are in the sun all day long, it changes how their brain works, how they produce serotonin and melatonin. So they’re really tired. Everyone has spent a day at the beach, right? Something like that where you’re outside in the bright sun and then when the sun goes down, you just can’t even keep your eyes open. It’s like, I just want to go to sleep. And that’s what nature intended. So you’re doing your own thing, you’re grounding, you’re on the ground, you’re getting all that beautiful sunlight and it makes you want to go to sleep at the right time, wake up at the right time.
So just a weekend of camping outside with the natural light coming and going from the sun and the moon will actually help reset your circadian clock and you will sleep so much better. And it’s just an amazing thing, how when we’re out in nature, how much better we do. And there’s so many studies about the calming effect of nature, just looking at a tree can lower your cortisol level. And so even looking at a picture of a tree can lower your cortisol level. So we need to understand that we are part of the animal kingdom.
Dr. Weitz: It’s actually a therapy now, they call it forest bathing.
Dr. Gersh: Oh, really. I should have discovered that one. Well, maybe we can promote it on our own word, we’ll call it and stuff. We’ll modify it, we’ll call it jungle something. You should look like, this is so beautiful. So basically we need to rethink so much of what we have done in our lives because we cannot neglect the value of sleep. It’s like the heart. I really think about the human body like a heart. So a heart sounds so simple. It just has two things. It contracts and it relaxes, right? It pushes the blood out and then it refills with blood. And people, in fact, many cardiologists today, pay very little attention to the filling or diastolic, the resting phase. They only look at the contracting phase. And of course, when people have congestive heart failure, the standard, that’s when they don’t contract well, okay? But now we know how the heart rests. The diastolic filling phase is equally important, the diastolic phase. So we can’t think that resting is not as important as running and acting out and doing things. So that’s why we’re like a heart.
And during the day we’re busy and we think that that’s all that matters. But sleeping, just like for the heart when it’s resting and filling is just as important, if you’re going to have healthy longevity. What we call health span, right? Because we are very good in conventional medicine and keeping people alive, but with pretty low quality of life, right? If you’ve ever been to a nursing home, it’s pretty darn distressing and depressing. People alive who have no quality of life and that is so not what my, I want my future, my patient’s future to be like … Everyone should have a role model of someone who does things right and has good results. So my personal favorite right now is my aunt, my mother’s sister, and she’s heading into her mid 90s. She lives by herself, she goes out for outdoor walks. Every day, she gets the sun and she gets the exercise the way nature intended and so she can travel, she travels around the world. She does everything just as if you were 40 years old, and she’s in her 90s and she’s amazing.
So we should all find a role model because if all we know as role models are the people who are in nursing homes, who are really having poor quality of life, because I have patients and say this to me, “I don’t want to live long.” Because the only role models they have are people who are living long with no quality of life. Then it doesn’t have to be that way. It really doesn’t. But we have to be really actively going against what most in society are doing. We have to live off the beaten path because the beaten path is full of people having poor quality of life. We were talking earlier about statins, and does every person have to understand I would qualify for statins simply based on age. They made it into their protocol. It’s built into their algorithm that it doesn’t matter what the quality of your life is, your health, what your labs show, anything, nothing. All that matters is your age. So if you hit a certain age, you qualify for statins. What is that all about? We can define-
Dr. Weitz: It’s all about accepting that there’s this inevitable decline in your health. After your 30s or 40s, it’s all downhill after that. And really anti-aging medicine, like both of us practice is not just about lifespan, it’s much more about your health span and yours can you have a long healthy functioning life. And then the decline maybe happens quickly towards the end. It’s-
Dr. Gersh: That’s right.
Dr. Weitz: Long, slow, gradual-
Dr. Gersh: That’s interesting. When we are born we each get on her own individual conveyor belt, right? And some people have a really rough ride, they bounce off really fast and others have a long ride, but it’s really rough and it goes down, down. So we want a smooth ride on our conveyor belt. It always goes in only one direction, it can never go backwards, it can’t go sideways. And then you get to the highway conveyor belt, about get to get to this and then it goes to happen. But that’s how we’re having a smooth long ride. And what has to happen. I have, in one of my talks, I have a slide, I just love this slide because it shows what happens in the 24 hours. So it has 2:00 PM, 2:00 PM and in the middle it’s 2:00 AM. So it really shows you what happens and it shows you the circadian rhythm of flow of blood to the brain. I love it. You look at that and you see that when melatonin is peaking at 2:00 AM the way it should, the flow of blood to the brain is also peaking. Oh my gosh. It’s like if you don’t have that amazing flow of blood to the brain, that’s what nature intended so that your brain can rejuvenate. And now we’ve discovered that there’s a whole lymphatic system to drain garbage from the brain. But all of this requires quality sleep, and people aren’t getting it. The other thing is the environment of the bedroom. So I have so many patients. The first thing I ask is, “Do you have a television set in your bedroom?” And the answer is overwhelmingly yes. I have so many patients they go to sleep with the television on and you can’t come up with a worse scenario than that. So they have this blue light blasting at them along with all the noise and the sound, and then they’re so tired that they just fall asleep. But what they don’t know, what they don’t understand is that even a little bit of this light coming through their eyelids is lowering their ability to produce optimal amounts of melatonin and it’s not lowering their cortisol properly.
So they’re going to stay in a somewhat insulin resistant state all night long, creating inflammation instead of anti-inflammation, which is what the body designed. They’re not going to get all of that amazing antioxidants and reducing free radicals and everything by the melatonin, their guts are going to be messed up. They’re not going to produce enough melatonin in their GI tract, which is key to having a healthy gut microbiome we now know. They’d sat there are microbes, all the microbes in our gut and all the microbes everywhere, they all have clocks too. They have clock genes and they actually are sensitive to the way that we eat, when we eat and so on. And when we produce melatonin at night in our gut and also we make it from our own cells and also the microbes make melatonin as well. When we have this surge of melatonin in our GI tract at night, the rest of the different microbes actually swarm like insects, they actually swarm and they produce different metabolites that have all these different effects, that help to keep the gut healthy, so we lower our risk of colon cancer, which is a modern disease which is at epidemic levels. Now even in young people, I’m sure you’ve seen that young people having higher and higher rates of colon cancer. It’s shocking because they too are not having proper lifestyle. They’re born with all this light at night, not getting enough melatonin in their GI tract, which is protective as well and it helps to develop the right microbiome. So the implications of having inadequate sleep or whole body white systems, white cell is every single system of the body is going to be harmed.
And then, as well, we just have to understand that a lot of people are tired and sad and depressed and they think of the television as their company. And they may have a sound snoring next to them but they’re still feelings lonely. There’s a lot of isolation, we don’t have the family tribes the way we used to and so people watch television for companionship. So we have to have better ways for people to relate to other people. We know, for example, that one of the biggest factors for elderly people dying is loneliness. But we can’t use a television to help put us to sleep because we’re not going to have quality sleep. We have to have other ways to have relationships and meaning in life. And there are ways, some of them, I spend my time with my patients who are elderly, exploring what they can do to have relationships with people, volunteer work, working with, even going to animal shelters, if they love animals. I mean, there are ways that people can access other people, and if you need to, you get a few pets. But I don’t want them sleeping in bed with you. That’s the other thing I’m finding. They’re lonely, they love their animals and they’re all over them at night. They’re sleeping in the bed, like these big dogs and cats. They talked about the baby family bed, now it’s the pet bed. So you can’t get a really good night sleep when your animals are roaming all over. And then my patients who have elderly animals, like dogs that need to somehow go out at three o’clock at night, so they have poor bladder function. I mean, we have to figure this out. We can’t destroy our health for the animals.
But I had one patient recently who said that her cat is very picky and likes to get wet cat food at two o’clock every morning. Oh my gosh, your cat needs to be retrained, getting up at two o’clock in the morning to feed the cats. No, this is not good to happen. So we need to control cats also children. Okay, I have young women patients who just don’t understand that kids need to sleep and they don’t know how to control their kids and they don’t help their kids to have good sleep habits. So this is starting from very young ages and their kids are all on all these other blue light emitting devices and they can’t sleep. So the kids are roaming the house in the middle of the night-
Dr. Weitz: They’re on their phone or on their iPad and-
Dr. Gersh: I know.
Dr. Weitz: Keeping the TV out of the bedroom. They got to keep their phones and their iPad and those devices out of the bedroom.
Dr. Gersh: All of that out of the bedroom. That’s the phrase that they get all of that stuff out of the bedroom and the kids’ rooms too. So they have the kids playing on these things in bed before they go to sleep. And then the kids-
Dr. Weitz: Not to mention EMFs that are being emitted from these devices and the blue light.
Dr. Gersh: Yes. And then what some of my patients do, they turn to alcohol. Oh my God, they say, well the alcohol puts me to sleep, but they don’t understand that it’s not a good sleep. Alcohol is a brain toxin, it’s a gut toxin, a liver toxin. And then they get this sort of paradoxical reawakening in the middle of the night. So you have children roaming the house, you have animals roaming the house, you have people drinking alcohol to try to sleep, you have the television on all night. We have to stop, stop in its tracks. And then you have women, like all my women with PCOS, and they have also on top of all of that that’s going on like in everybody else’s life, they have inherently a problem with estrogen. And estrogen is very key to brain health and brain function and mastering the master clock and keeping the clock on beat. The master clock that sits at top of the optic nerve in the brain. So their master clock is not set properly do this. So they have often what they call phase disorder. So they wake up too late, they go to bed too late but if they have to wake up early so they can’t. They’re like shifted so that they want to go to bed later and then wake up later. Kind of like, a lot of teenagers are like that. And our society is not tuned to that, so you got to get up and go to work. So they go to bed too late, they get up earlier than their bodies want to. They’re still at that point having more melatonin, although they don’t have proper functions on their melatonin. But they have of course melatonin and so they’re feeling really groggy in the morning. And then because they don’t have the proper circadian rhythm of their cortisol, they’ll have high cortisol at night, low in the morning.
They have no appetite. Nature made it so our appetite has a beautiful circadian rhythm. When things are right, you’re not supposed to be healthy at night. If you’re hungry at night, that’s a sure sign you have circadian rhythm dysfunction, and now we know and we can talk about this more another time too. The whole incredible endocannabinoid system, which goes with our hormones and is incredibly circadian. And everyone knows that, whether they do it or not, hopefully not, but if they smoke marijuana, people who smoke marijuana get the munchies, right? People always talked about that. Now why is that? Well, that’s because there’s a component called THC in marijuana that can act on the receptors or one of our endogenous cannabinoids, an endoccanabinoid called enendomide. Now enendomide is part of the appetite regulation system. But if you stimulate it a lot, you will have uncontrolled appetite, you’ll have the munchies.
And people who have circadian rhythm dysfunction have what they shouldn’t have. You should have very low production of enendomide at nights, very low. And you should have no appetite at night and then it should rise in the morning. But people with dysregulation of this system, they have high production of enendomide at night, so they are really hungry. Remember our bodies are finely tuned for input of food to match our metabolic needs, but we are so dysregulated now that our appetites are not matching our metabolic needs and or the timing. So people who, the people out there who have this or their patients, if they are really hungry at night, that is a red flag. You have circadian rhythm dysfunction. You’re producing a lot of enendomide at night when you should have none. And people who urinate a lot at night, they’re always getting up to go to bathroom, that is another sure sign that they have circadian rhythm dysfunction. Because at night you should be making a lot of the hormone, antidiuretic hormone. And I have on my beautiful slide that shows what happens during the day. It shows that urine is being produced at very low rates during the night when you’re doing things right. Because nature did not want people to have to get up and go to the bathroom all night long or have to go and poop in the middle of the night. That’s a sure sign. If you’re going to the bathroom for any purpose in the middle of the night, especially multiple times, you have a problem with your circadian rhythm.
And now we know this epidemic of sleep apnea, which is hugely exacerbated in women with PCOS, women after menopause have high, high rates of sleep apnea, that’s really a circadian rhythm dysfunction. And people are not putting that together. And of course elderly people who have hormonal deficiencies and so on and they also do things that are not proper for their circadian rhythm, they have a lot of sleep apnea. And obese people have a lot of sleep apnea. It’s not just about their tongue is big and their throat is getting blocked at the top. That’s just part of it. They really are having a brain inflammation problem and their area of the hypothalamus that controls breathing and sleeping and appetite and blood pressure and urine production, all of that. The whole autonomic nervous system is out of whack, it’s off the beat. And so sleep apnea is not just about your tongue, though that’s part of it. It’s also a problem in your hypothalamus, in your brain, that your brain is not putting out the right signals for breathing, coordinating with sleeping. So it’s really a significant issue. And then people shouldn’t just do a CPAP machine and call it a day. If you have high cholesterol, even if you go on a statin that is not the solution to the problem, that may lower your cholesterol, but it’s not getting to why is your cholesterol high in the first place, right? So we need to look at that. So we do in functional medicine, right? We look for root causes.
So we don’t want to just say like, Oh, it just breaks my heart, my conventional medicine. Somebody goes into the doctor and they say, I can’t sleep my insomnia. They don’t even do a study of, often if they have sleep apnea, if they do, they never talk about why they have sleep apnea. They don’t ask about their sleep hygiene, they don’t ask about what’s happening in the middle of the night with the pets, the kids, the spouse. The spouse keeps them up because the spouse is snoring all night, all kinds of things are happening. The television light all the time. They don’t take any history and then they just give them a sleeping pill. And sleeping pills do not allow the normalcy phases that you alluded to at the beginning in your wonderful introduction about, we have sleep phases. And we know that for example, women who have sleep apnea, they don’t have long pauses in their breathing. There can be a tiny fraction of a second. They often are not snoring. You can’t witness this kind of cause, it’s only seen if you do a monitor of it, but it disrupts their sleep patterns.
So they don’t get the proper phases of sleep, so they don’t get the restorative functions of sleep. So these are huge deals, but we have to start. Sometimes I think I’m into simplistic thinking. It’s like you just have to do certain basic things in life. And I’m not against hyperbaric oxygen and all kinds of electrical magnetic waves to the brain and all these things that people are doing, high tech stuff. I’m so foundational. It’s like major bedroom cool. Because you sleep better and your temperature should dip at night. So try to make your bedroom really dark and really cool and really comfortable. Get all the devices, like you mentioned, all the devices out of the room. Go to bed at the right time. Oh, another great tip. If you take a really hot bath for as much as an hour, I do this myself. This is my part of my routine. It dramatically drops your cortisol.
Dr. Weitz: I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.
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Now, back to our discussion.
Dr. Weitz: can we just talk about cortisol, melatonin for a minute, for some those who don’t know. So these are two hormones that are playing an important role in regulating our circadian rhythms and our sleep. And so cortisol is a hormone produced by the adrenal glands, right? And it tends, it’s supposed to spike in the morning and that helps us wake up.
Dr. Gersh: Yeah. So it’s all beautifully, perfectly aligned for what we need to be healthy. So cortisol starts to gradually rise and then it peaks right about the time that we should be getting up. So what does cortisol do for us? It makes us feel activated, it increases appetite and it makes us a little bit insulin resistant. What does that do? It helps to elevate our blood sugar levels, right? So in the morning when you’re still fasted, you want to have higher blood sugar so that you can get going. Because if you think about ancient times they had to go out and do stuff like get the food and actually make sure that the other wild animals are now up, right? So they need to be on alert to protect themselves and their families. So cortisol makes you more on high alert. It makes your blood sugar go up, it starts mobilizing fats so that your body really can just get going. But then if you don’t eat, what if you don’t eat? What if you’re into this problem? I call it problem, where people think that they should fast through the morning. They don’t get it. So they think I’m fasting, I’m doing time restricted eating, so I don’t eat until one or two o’clock in the afternoon, and they think they’re doing themselves a favor. They’re really harming themselves because our bodies were designed, just like we’re supposed to sleep at night, we’re supposed to eat in the morning. Now we’re adaptable, resilient creatures. That’s why we can get away with all kinds of stuff and still live, but we’re not going to be living optimally. And that’s really important because if you don’t eat in the morning, your cortisol is not going to start dropping.
So you’ll maintain a high cortisol and consistently high cortisol is actually harmful. Then you are going to get leaky gut, you’re going to get more stressed out, you’re going to start getting more hypertension, you’re going to have fluid retention because you’re going to get into a more chronically inflamed safe. So cortisol should not be chronically high. It’s critical. In fact, it’s the only hormone that you cannot live with. In 24 hours, if you don’t have any cortisol, you’ll be dead. You could live without thyroid hormone or estrogen or testosterone for a day, you will not die but cortisol you’ll be dead. That’s how critical cortisol is. So we should, I sometimes have to defend cortisol because people stay down with cortisol, no it’s about having the right amount at the right time. It’s essential but we don’t-
Dr. Weitz: In fact, patients who have very low cortisol throughout the day, that’s associated with the worst prognosis in cancer and other chronic disease.
Dr. Gersh: Terrible. That’s right. And then those people always have really high cortisol, they always have low T3 because cortisol and thyroid are so intimately related and it turns out that our insulin sensitivity is also on the clock. Just like I said, if you eat at night, you’re going to be insulin resistant, you’re going to be prone to diabetes and weight gain because we are eating on the clock. If you eat in the first half of the day, in the morning time, that is when our insulin is most effective, our insulin receptors are most sensitive and that really matters. So when you eat food in the morning, the glucose that is produced will go readily into our muscles, into all of our tissues, our borne, our brain. Because we want to utilize glucose. Glucose is the preferred energy source for most every organ in the body. We can use ketones fats as a secondary source, that’s because we we’re so resilient and food is not always available. So you have to use your backup source, your own body fat as a source of energy when you can’t eat, right?
But the preferred source of energy is glucose. But the problem is people are so insulin resistant, the receptors don’t chase up the glucose. And so they just set higher and higher levels of sugar in their blood, which becomes very inflammatory and damaging. And then you have high levels of insulin but it doesn’t work well. And high levels of insulin is also inflammatory and it increases IGF-1 which you need. But you don’t want it all the time because then it’s called cancer because your pro grows. So insulin promotes fat production, fat storage and IGF-1 promotes growth and proliferation, which you need but not all the time. Because chronic proliferation and when you have chronic inflammation, that’s the perfect team for DNA breakage in cancer. So we don’t want all of that. We want to have the beautiful rhythms. And if you keep fasting through breakfast and you don’t eat until the afternoon-
Dr. Weitz: But they’ve been told that the way to reduce your IGF-1, to reduce those growth factors is by fasting. And so that’s why a lot of people are doing it.
Dr. Gersh: That’s why I’m telling you, when you do time restricted eating, so here’s these definitions. So fasting is when you’re not eating, right? So that’s pretty obvious. But we have these words that just sort of tell what you’re doing-
Dr. Weitz: So the other one is intermittent fasting, that’s-
Dr. Gersh: So if you don’t eat for certain periods of time in the 24 hour day, that’s time restricted eating. If you don’t eat for a full 24 hours, that’s intermittent fasting. If you don’t eat for a few days, that’s periodic fasting. If you don’t eat for more than a week, that’s prolonged fasting. So these are just definitions so we know what we’re talking about. But so if you want to do time restricted eating, that’s doing periods of fasting during the 24 hour day, it matters which portion of the 24 hour day. Just like it matters when you sleep, it matters when you eat, it matters when you don’t eat. So I’m all for time restricted eating, but the time that you should stop and be fasting is in these later part of the day. So you should get 13 hours. You can have more than 13 hours of fasting in the 24 hours, but the return on investment goes down so you don’t get as much bang for the buck. If you fast for 14 hours versus 15 hours versus 13, but the difference between 13 and 11 or eight is very significant. So you so plateau, that’s what I would say. But if you fast from say five o’clock in the evening or six o’clock and then you don’t eat until nine o’clock then I’d say something like that’s fabulous. But if you don’t eat from like nine o’clock at night until two o’clock in the afternoon that you got it wrong. Because, I am so sorry for those of you who are doing this to tell you this, but you’ve got it wrong. Because you’re eating too late at night, if you’re stopping eating at nine o’clock and then you’re not eating when your body is most prepared and evolutionarily designed to receive food, which is in the first half of the day.
They’ve done studies on prisoners because they’re our captive audience. So where they’ve taken the same food and giving it to them either in the morning or the night, the same food. So they give almost all their food in the morning and then they do a watch out for two weeks, and then they do the same thing where they give all the food at night. It would just about, and they found that you can give the exact same food, but when you give it will determine if you gain weight or lose weight. It’s not just about calories in, it’s about your metabolic state. So you’re metabolically prepared and equipped to properly handle food in the first half of the day and not once you get past about seven o’clock at night. And don’t blame the messenger. For those of you who like to eat late at night, it just is what it is. We are who we are. We’re not owls, we’re not bats, we’re humans. That is so so what it is.
And I used to wonder, why are all my patients going into labor at night? It’s like, are they doing this to torture me? Why do I have to have all these laboring women in the middle of the night? Because I thought that was like a white sail until now, of course, I understand circadian rhythm. Women are designed to go into labor when it gets dark, to labor through the night and deliver in the early morning hours because that’s the safest time. Because when women are in labor, they are very vulnerable. What are they going to do? Get up and run away when they’re about to have a baby? So that’s nature’s way to protect women. So women are designed to labor during the night, have their babies in the early morning hours and then they can move, they can protect themselves and their baby. So that’s why women labor during the night, that’s actually totally natural.
And we even have seasonal rhythms, right? Left to nature. Have you ever seen the movie Bambi? All those babies born in the spring? Because if a baby from an animal is born in the spring, then were likely to survive because there’s so much more food available right in the spring. And the summer they can set a nap so that the mum will have a fat source. So that they can continue to take care of their little offspring through the colder winter time. And so everything is based on our beautiful solar system, all the rhythms. And that’s the part that drives me crazy is that, and now we have evidence that women on birth control pills have altered it’s weak, because you do not have rhythms when you’re on birth control pills. There are no hormonals in birth control pills. They are chemicals, they’re not hormonal, they should be called anti-hormonal contraceptives.
And the problem is, and I feel very sorry about this because I know that I don’t have all the most amazing solutions for contraception, but we need to define the problem if we’re ever going to get better solutions. And the problem is that everything in the female body is designed to support successful reproduction. Whether we want to have babies or not. That’s how our bodies are designed. Just like if we want to work at night, I am sorry but we are not designed to work at night, it’s just so we will pay the price. If we really don’t want to conceive, we need to understand that that’s how our bodies were designed. So all the systems in the female body are designed to support the health of the woman for the purpose of successful reproduction. That’s why I talk a lot about estrogen as the hormone, the master hormone of metabolic homeostasis that links reproductive functions and metabolic functions. And birth control pills alter our rhythms.
You don’t have normal rhythms, either lunar rhythms or even circadian rhythms when you’re on birth control pills and there’s higher rates of depression. We know people who don’t get adequate sleep have much higher rates of mood disorders. It’s horrible. They’re depressed, anxious. And women on birth control pills have higher rates of depression, anxiety, and we need to recognize this and we need to develop contraceptive methods that don’t poison reproduction because you’re poisoning reproduction, you’re poisoning the whole body. We just need to understand that we need these beautiful rhythms. In fact, part of the aging is loss of these beautiful rhythms, right? And women after menopause, when they no longer have rhythms and they don’t have these hormones being produced by the ovaries, that’s the onset of the whole array of metabolic dysfunctions that are assigned to the aging, but they’re really about estrogen deficiency.
And of course, not just that, everything that goes with it. They’re beautiful rhythms. That’s why women in menopause have tremendously high rates of insomnia and gurge, acid reflux, mood disorders, increased in all the pain syndromes. They have a lot more osteoarthritis, osteoporosis, they have a lot, women have almost three times as much dementia as men. They don’t sleep as well. And that’s a big part of it. Remember we need that big blood flow to our brains at night. So it’s all late and we’re giving birth control pills to young women. I see them getting it at age 14 now, 13, 14. So what is happening to their brains and their beautiful rhythms? And what’s happening to their sleep? They’re not having the same sleep. The blood flow to the brain is not there. So nobody links things that happened 40 years later, right?
But what happens is it turns out that all the women that send most of their lives on birth control pills, is they have higher rates of dementia and I’m seeing muscle skeletal problems. I’m sure you are too. They’ve been on birth control pills for 20 years and they’re only in their early 30s and they want to have kids now at 36. They delay it because they’re busy going to school and having a career, and they were put on birth control pills when they’re 14 and they’re on a continuously, now they’re 34. They go out Zumba dancing and they just pick up their own videos dancing and they’re doing nothing. They’re just dancing and they rip their shoulders, things like that. And then go to the orthopedist and they say, you need to have shoulder surgery or we’re going to inject you with steroids which great the tissue more, and all these things.
And nobody’s saying what on earth is a young woman in her early 30s getting her shoulder ripped, just because she goes dancing and lifts her arm. And because they don’t develop proper musculoskeletal health from being on all those years, not having proper sleep, not having proper hormones, not having proper development of their muscle cell system. And you don’t know, we don’t know how to fix that. We can’t go back and do a redo. And all of this is interlinked with sleep and with nutrition and gut health because everything is one in the body. It’s like, that’s when you said, how do I talk about everything? Because unfortunately for me as a lecturer, if I don’t understand the whole body, how am I going to put it all together? So it’s kind of fun.
But once you realize that every system links with every system, like you have lines going everywhere, so you have the access to everything. You kind of have to learn about everything. Not necessarily everything on the cellular level, about every single, I’m trying to, it’s really complex, but at least on a more macro scale to really understand how all these systems interlink. And sort of if we’re going to create a pyramid at the top, if we put sleep at the top, because if you don’t have sleep, everything below is going to kind of crumble. It’s going to just fall apart. So we have to have sleep. It’s just part of being a healthy human. Got to have that sleep.
Dr. Weitz: I got it. That was awesome. Let’s touch on one more topic in terms of helping us to sleep. In your book, you talk about using melatonin and it was interesting. I’d never seen anybody recommend taking two separate dosages of melatonin. And the dosages you’re recommending are very, very small which is different than what I’ve heard with other practitioners.
Dr. Gersh: Yeah. Well, sometimes less is more so it turns out, everything I do is I try to be evidence-based physiologic. So when we see the sunset, which is so important for people who have trouble sleeping or have mood disorders, just go outside every day unless it’s pouring or snowing or something like that and see the sunset. It’s a beautiful spectacle and it just helps to do what for so many things. It starts slowing the production of cortisol and starts increasing the production of melatonin. So, but little bits, so it doesn’t make us want to go instantly to sleep. It’s just the process begins, the process of preparing us for sleep by decreasing cortisol. And the melatonin just starts to come up a little bit. And the trigger to that can be to give a half a milligram of melatonin. We don’t have to do it at the time of the sunset but we can do it like a couple of hours before we go to bed. You can even do it earlier. You can do it as early as six hours before you go to sleep.
So somewhere in that time frame, depending on what you’re, you can play with it. So you can do a two hours, three hours, up to six hours even before you actually will go to sleep and try that little bit of melatonin. It’s just a half of a milligram. And that can just sort of set the tone for your body transitioning because remember everything is a beautiful curve. The cortisol rhythm, it’s just, it’s not like jaggedy, it’s curves. It’s like beautiful curves. And so this will help start you on the curve to up the melatonin, down the cortisol. And then, specifically in women who are menopausal and women with PCOS because they don’t have the proper amounts of estrogen or estrogen receptor function and so on.
And this is all linked, if everything is linked, all these different hormones are interrelated. Giving a little bit at bedtime. So like a half hour or so before bedtime. And not a large amount, because remember melatonin is also on a curve, right? So in peace to 2:00 AM, but if we give a whole gigantic bolus of melatonin early on, right before when you’re starting sleep, you may knock people out. You may sedate them heavily, but you’re going to alter those sleep phases. And remember, so sleep is a dynamic process. Otherwise, we could do things like give everybody Ambien, right? That’s all that matters. Who’s knocking people out. But we don’t want to go from a drug to a supplement or a hormone to effectively do the same thing, knock people out. So we don’t want to knock people, we want to get them into a natural sleep rhythm.
So giving a smaller amount of melatonin and you can do other things like ashwagandha. I know you know that. Ashwagandha is wonderful at lowering cortisol. You can’t, I always say things like, you can’t multitask. We keep talking about multitasking, you can’t burn fat and build fat at the same time. You can’t lose weight and gain weight at the same time. It doesn’t work that way. And you just have to look at what you’re doing so you can’t lower cortisol and raise cortisol at the same time and get any of fat. So what we want to do is have our bodies naturally start to lower the cortisol and raise the melatonin but we have to do it in a gradual way so that everything will work out probably for the whole sleep phase. So this is how we’re going to do it.
Dr. Weitz: So you talked about using a half a milligram a couple of hours before bed and then two or three milligrams 30 minutes before bed. Right?
Dr. Gersh: Right. So what that will do will be to help start you on your sleep process and then your body will make melatonin in the natural space. So we don’t want to push the melatonin too fast so that you get disrupted, improper sleep phases. Now, there are people that sometimes can benefit from a very, very high dose of melatonin, but we’re not really using it to get a proper sleep phase. They’re using it for its antioxidant value. For like anti-cancer, like people have breast cancer. So we’re using it like a drug.
Dr. Weitz: I know one prominent functional medicine doctor who takes 50 milligrams.
Dr. Gersh: Well, if you’re trying to use it as a drug to deal with cancer, then that’s a whole different thing than if you’re trying to-
Dr. Weitz: [crosstalk 00:52:14] like preventative anti-aging purposes, there’s that-
Dr. Gersh: I think that is misguided. Okay. I think not just-
Dr. Weitz: [crosstalk 00:52:23] anybody else who takes that much.
Dr. Gersh: Okay. Well, I’m also open-minded. If there’s documentation, some kind of study that really proves that if you take 60 milligrams of melatonin at bedtime, you’re going to prevent all kinds of diseases of aging, I’m all for it. But right now, like I said, I’m a little bit simple minded that I just figured nature does, we evolved in such a way that nature does everything best. So I just tried to try to get people back on track with what nature intended. Now that said, I actually go against nature when it comes to menopause. And of course, if you have a medical problem, like PCOS, because nature has not really done anything wrong to you. It’s our society that really has damaged women who have a genetic predisposition to something that happens with a lot of things. The lifestyle, the food, everything else has come to play to alter women so that they don’t function properly. But menopause is universal for women and every woman when she goes through menopause is going to have some disruption of her sleep and her metabolic state. So I don’t care that it’s natural, I don’t like it. So I go against nature. I say, I love you nature, but in this case I am going against you because nature only really supports reproductive creatures. We’re sorry that nature doesn’t like us much after we’re no longer reproductive. Most creatures on this planet are no longer alive when they stop being reproductive. Most animals die at the end of the reproductive function but humans are among the very few that continue to live. The women can still live but they don’t necessarily live long.
Women live longer than men because we do have more robust immune systems and we tend to survive infections better. And that’s built into our X chromosomes and it’s not just hormonal, it’s actually in our X chromosomes. So we tend to live longer, but we actually live with more chronic diseases than the men. And so I go against nature when it comes to menopause and I’m very open to bash. It’s like I love you in nature, but sorry, I’m not accepting menopausal status as what nature dishes out. Now the other thing is that in earlier times people went into menopause with, I called it like, more health in the bank. They had better musculoskeletal systems, they didn’t spend their life on birth control pills, they ate real food and so forth. And because they didn’t have all these electrical devices, they actually went to sleep at the right time.
So when women hit menopause, they had more reserved and more resilience to deal with it. So I look at menopause, it’s like you’re in a plane and the engines go out. Now if you have a lot of health to begin with and you have great reserves, then your plane without the engines goes into a glide and it becomes like a glider and it goes down but it’s like a slow decline and maybe a softer landing, but it will land. But if you have no reserves and then you hit menopause and the engines go off on your plane, you go into another a nose size. and that’s what’s happening to women more. Because when they hit menopause, they don’t have reserves because they haven’t had good health their whole lives. They’ve not had proper sleep, they’ve not had proper food, they’ve not had exercise, fitness, and all the things that go into making a person healthy and resilient, they don’t have it. So they hit menopause and they lost their last support system, which is their estrogen and their progesterone so they do go into a nose size. And we now know, for example, that hot flashes are associated with increased risk. So everything bad you can think of because it’s really a sign of brain inflammation. Neuroinflammation is actually an ominous sign of [inaudible 00:56:10] and we know that. So women who go into menopause and they have no hot flashes, that’s a very good prognostic sign for their future because it shows that they have resilience and they don’t have a lot of neuroinflammation that’s happening in their bodies. That’s it.
Dr. Weitz: Interesting. Awesome. Okay. So thank you so much Dr. Gersh. You’re still seeing patients at your office in Irvine, right?
Dr. Gersh: I sure am. I’m a regular brick and mortar doctor. I’m in my office. This is my exam room. So yes, I definitely see patients everyday. I’ll be seeing someone in a few minutes and I would love to see anyone who is interested in integrative women’s health care. And I also, and so I’m in Irvine, California and my group is called the Integrative Medical Group of Irvine. And so I have my support team, I have a naturopath, integrated PA, nurse practitioner, fitness specialists. We have a gym in my office and we do high tech ultrasounds for vascular health and of course abdominal and pelvic ultrasounds. I have a fabulous body worker, massage services. So we try to uncover, and I have a new person who’s going to be starting a holistic naturopathic, not naturopathic, natural chef. So she’s going to help people to not only see, Oh, I do things like I say eat more vegetables. And then I find out that people don’t even like vegetables, they don’t know how to cook them and they don’t know what half of them are. So my saying eat more vegetable is not really resonating too well. So I’m having a chef who will actually teach patients how to shop for vegetables, how to find good ones, how to cook them, find ways to enjoy them. Because just telling people eat more vegetables just doesn’t do it. So obviously I need help and so I’m getting it because it’s like one thing to tell people, but that’s the problem. You tell people do something, but then you don’t give them the real tools and they don’t like it. So we have to take it one step at a time. And we have to recognize that many people have grown up in families where they didn’t eat vegetables and they don’t know what it is, really. So we’re trying to help people to have a love affair with vegetables.
And I brought my book so that people can see it. You have it too. All right, we have matching books and I have my new book, which is actually out in Kindle version, but it will be officially debuting in January. And this is the PCOS SOS Fertility Fast Track. So for people who want to have a baby and has a healthy pregnancy and a nice healthy baby. But like everything, it’s all lifestyle medicine. So even if you, remember, I always say fertility and health are one. Fertility is a vital sign of female wellbeing. If you’re not fertile, then you’ve got a metabolic problem. And especially in the reproductive years, if you have a fertility problem, you have a health problem. So even people who don’t want to get pregnant, they just want to be healthy, you can follow this because this is how to get healthy. And then of course for women who want to be pregnant, this is a key. So we call it Trimester Zero, right? Two months before you even try to get pregnant, we have to optimize women and men’s health because just getting a baby is not the answer. We want to have a healthy baby and we want to have a low complication rate during pregnancy. And these things are really astronomically increasing. Pregnancy related complications and children who already at birth are having metabolic issues. So anyway, those are my new missions is to-
Dr. Weitz: When is your new book available?
Dr. Gersh: What? I’m sorry.
Dr. Weitz: When is your new book available, is it out now?
Dr. Gersh: Kindle version, it’s available on Amazon right now, but then the physical version of it will be available January one.
Dr. Weitz: Awesome. My pleasure. Thank you Dr. Gersh.
Dr. Gersh: My pleasure.
