Latest / The Body Pod / RE-RUN - Breast Cancer Prevention & Lifestyle Medicine – Expert Insights from Oncologist Dr. Amy Comander

Transcript

RE-RUN - Breast Cancer Prevention & Lifestyle Medicine – Expert Insights from Oncologist Dr. Amy Comander · The Body Pod

• 0:00
  Speaker 1: Hi everyone.
• 0:00
  Speaker 2: My name is Haley and this is Laura and welcome
• 0:03
  Speaker 2: to the Body Pod.
• 0:10
  Speaker 3: Hey.
• 0:11
  Speaker 1: Everyone.
• 0:11
  Speaker 2: On the episode of the Body Pod today, we are
• 0:14
  Speaker 2: actually rerunning doctor Amy Commander, who is a breast cancer oncologist,
• 0:20
  Speaker 2: and we thought this would be an appropriate time to
• 0:24
  Speaker 2: run it as it is Breast cancer Awareness Month, So
• 0:26
  Speaker 2: enjoy this rerun with doctor Amy Commander.
• 0:34
  Speaker 1: Amy.
• 0:35
  Speaker 2: We are thrilled to have you back for part two
• 0:38
  Speaker 2: and we are in Breast Cancer Awareness Month.
• 0:41
  Speaker 3: Thank you so much. It's great to be back with you.
• 0:44
  Speaker 2: Is this uh this is also menopause Awareness Month. I
• 0:47
  Speaker 2: feel like we should have broken those somebody should have
• 0:49
  Speaker 2: broken those up into different months because they're both like
• 0:52
  Speaker 2: heavy hitters.
• 0:54
  Speaker 3: They deserve their own months. Yes sir, but hey, let's
• 0:57
  Speaker 3: just go women's health or just flat to raise awareness
• 1:01
  Speaker 3: and provide education. So that's awesome.
• 1:03
  Speaker 2: Yes, great, And I was talking to last year at
• 1:07
  Speaker 2: this time, I was talking to doctor Jessica Shepherd, and
• 1:10
  Speaker 2: we were talking about how we need to have like
• 1:12
  Speaker 2: a color, you know, because breast cancer has like the
• 1:15
  Speaker 2: light pink, and then we were like, well, menopaus should
• 1:17
  Speaker 2: have a color.
• 1:18
  Speaker 1: Clearly nothing happened. Maybe someone's named to.
• 1:20
  Speaker 2: Color by now and I don't know, but anyhow, here
• 1:24
  Speaker 2: we are. So a few things that I wanted to
• 1:28
  Speaker 2: ask you kind of before we dive into this, you know,
• 1:33
  Speaker 2: lifestyle medicine, which is kind of our topic for today.
• 1:36
  Speaker 2: I'm fascinated by it. I love that the you know,
• 1:40
  Speaker 2: the greatest of the great are getting on board with
• 1:43
  Speaker 2: educating patients around this because I tell you, every time
• 1:47
  Speaker 2: I have someone on and obviously it has something to
• 1:50
  Speaker 2: do with lifestyle health nutrition, everyone is saying the same things.
• 1:56
  Speaker 1: I'm like, okay, so.
• 1:57
  Speaker 2: We see a pattern and you know, all of these things,
• 2:01
  Speaker 2: which doesn't it's not new information, but it's clearly we
• 2:05
  Speaker 2: have work to do from where, you know, to get
• 2:09
  Speaker 2: this into mainstream still, which we just maybe I just
• 2:13
  Speaker 2: hear it all the time. So I'm like, Okay, we're
• 2:15
  Speaker 2: saying the same things in every field, but there's still
• 2:17
  Speaker 2: a lot to learn.
• 2:18
  Speaker 1: So that's really exciting.
• 2:21
  Speaker 2: So I want to start with kind of some just
• 2:24
  Speaker 2: some basic facts. So we talked about the different kinds
• 2:27
  Speaker 2: of breast cancer last time.
• 2:30
  Speaker 1: I was just reviewing.
• 2:31
  Speaker 2: So one there's a one in eight chance of getting
• 2:34
  Speaker 2: breast cancer and there's over three hundred thousand cases a year.
• 2:40
  Speaker 3: Yeah, so, thank you so much for inviting me back.
• 2:43
  Speaker 3: By the way, I love chatting with you both. And
• 2:45
  Speaker 3: I just want to say it is Breast Cancer Awareness Month,
• 2:48
  Speaker 3: but I like to call it breast cancer Action Month,
• 2:52
  Speaker 3: which what are we doing to actually raise awareness, make
• 2:55
  Speaker 3: it impact, help improve women's lives. So that is our
• 2:58
  Speaker 3: shared goal. Have to say that. But you're absolutely right.
• 3:02
  Speaker 3: For women living in the United States, we all have
• 3:05
  Speaker 3: a one in eight lifetime risk for development of breast cancer.
• 3:09
  Speaker 3: It is what it is, and some of us it
• 3:11
  Speaker 3: may be higher because of family history or other factors.
• 3:14
  Speaker 3: We can talk about that, and you're right. The statistics
• 3:17
  Speaker 3: from the American Cancer Society, which were recently updated, do
• 3:21
  Speaker 3: state that this year it is expected there about over
• 3:24
  Speaker 3: a little over three hundred thousand cases will be diagnosed
• 3:28
  Speaker 3: in the US of invasive cancer. That also includes doctal
• 3:32
  Speaker 3: carcinoma insight to which is essentially like a stage zero
• 3:35
  Speaker 3: breast cancer.
• 3:37
  Speaker 1: Oh my goodness.
• 3:38
  Speaker 2: I was actually shocked when we start to go over
• 3:41
  Speaker 2: like the risks. Is breastfeeding a risk?
• 3:45
  Speaker 3: Actually, breastfeeding is protective. Breastfeeding is what I thought, Yeah,
• 3:50
  Speaker 3: decreases your risk.
• 3:51
  Speaker 1: Okay, I must have read that wrong.
• 3:52
  Speaker 2: Because I was like, wait, what great, but I don't
• 3:59
  Speaker 2: want someone.
• 4:00
  Speaker 3: Obviously, we know so many women have a tough time
• 4:02
  Speaker 3: with breastfeeding, so again taking that away, don't beat yourself
• 4:07
  Speaker 3: up or feel bad. We know many women have challenges
• 4:09
  Speaker 3: with that, but it does actually decrease risk, so that's good,
• 4:12
  Speaker 3: not increase risk.
• 4:13
  Speaker 2: Okay, I was like, wow, I shouldn't have stuck it
• 4:16
  Speaker 2: out the first run. My my youngest did not was
• 4:20
  Speaker 2: was all was all formula fed, and I mean he
• 4:25
  Speaker 2: was my easiest baby, so I have nothing to say.
• 4:27
  Speaker 1: There, eat, best sleeper, all of that.
• 4:30
  Speaker 2: But yeah, I was like, wait a second, Okay, got
• 4:32
  Speaker 2: that that fact straight. So as we look for these
• 4:37
  Speaker 2: risk factors, and obviously we know genetics is at the
• 4:41
  Speaker 2: top of the game, but what are the other risk
• 4:44
  Speaker 2: factors that that we're looking for when we're approaching this
• 4:50
  Speaker 2: this type of cancer.
• 4:51
  Speaker 3: Great question, and I think it is good to highlight.
• 4:54
  Speaker 3: You're absolutely right, genetics is so important to think about
• 4:57
  Speaker 3: in family history. But actually in the US, of all
• 5:01
  Speaker 3: breast cancers diagnos in this country, only five to ten
• 5:04
  Speaker 3: percent our dudes had genes that we can currently test for.
• 5:08
  Speaker 3: In twenty twenty four, there may be another ten to
• 5:11
  Speaker 3: fifteen percent due to like familial factors, which maybe we
• 5:15
  Speaker 3: can't find the gene yet, maybe it's a few genes
• 5:18
  Speaker 3: working together that increase risk. But the majority of breast
• 5:22
  Speaker 3: cancers are not due to genes that we can test for.
• 5:25
  Speaker 3: So that's why I encourage everyone who listens to your
• 5:28
  Speaker 3: podcast to like, know your family history, make sure you're
• 5:31
  Speaker 3: on top of screening, and recognize that even if you
• 5:34
  Speaker 3: don't have a family history, unfortunately, you're still at risk.
• 5:36
  Speaker 3: So then we talk about other risk factors. Great question,
• 5:40
  Speaker 3: what are some factors that we can potentially change, which
• 5:44
  Speaker 3: are what we call modifiable risk factors, and what are
• 5:47
  Speaker 3: some factors that we can't change, you know, like our
• 5:49
  Speaker 3: age for example. You know, so we wish we could
• 5:52
  Speaker 3: change that one anyway, So exactly right, So thinking about
• 5:56
  Speaker 3: the non modifiable risk factors. Yeah, so being a woman
• 6:00
  Speaker 3: and increasing age are your biggest risk factors, so it
• 6:05
  Speaker 3: is what it is. And then thinking about when I
• 6:09
  Speaker 3: see a new patient, you know, we ask about other
• 6:12
  Speaker 3: risk factors related to exposure to hormones over the course
• 6:15
  Speaker 3: of a woman's lifetime, So we ask about what was
• 6:18
  Speaker 3: your age of menarchy when your period started? If a
• 6:22
  Speaker 3: woman's gone through menopause, what was her age of menopause.
• 6:25
  Speaker 3: If a woman's been pregnant, when did she have her
• 6:28
  Speaker 3: first full term pregnancy? How many pregnancies did she breastfeed?
• 6:32
  Speaker 3: Did she take you know, exogenous hormones? Like we asked
• 6:35
  Speaker 3: all of these questions. Did she have chest wall radiation
• 6:38
  Speaker 3: for any reason? Sadly, some people have a cancer diagnosis
• 6:41
  Speaker 3: at a young age and need radiation to their chest.
• 6:43
  Speaker 3: So these are all the questions that we ask someone
• 6:46
  Speaker 3: that are sort of these are like facts about someone's
• 6:49
  Speaker 3: medical history that potentially can influence risk. But then there's
• 6:52
  Speaker 3: the modifiable risk factors that we can all talk about
• 6:55
  Speaker 3: what can women do to help reduce risk? And those
• 6:59
  Speaker 3: refer to things like what is her exercise level, how
• 7:03
  Speaker 3: much alcohol does a person drink, what does her body weight?
• 7:06
  Speaker 3: Does she smoke? You know those types of factors. So
• 7:09
  Speaker 3: all of these come together to play a role in
• 7:11
  Speaker 3: a person's risk. So I hope that helps address her question.
• 7:15
  Speaker 4: I have a question about the hormone the hormones, do
• 7:19
  Speaker 4: you see an increase in risk for anyone who's done IVF?
• 7:24
  Speaker 4: Like several rounds of IVF, so they are pumping all
• 7:27
  Speaker 4: of these hormones into their body.
• 7:29
  Speaker 3: That's a great question. And certainly we know that many
• 7:33
  Speaker 3: women need to consider techniques such as IVF to pursue pregnancy.
• 7:37
  Speaker 3: And I would say, for the most part, the data,
• 7:40
  Speaker 3: you know, the data suggests that IVF is safe. So
• 7:43
  Speaker 3: I don't want someone who's thinking, oh my god, I
• 7:45
  Speaker 3: had IVF, I'm at such great risk. Like you know,
• 7:49
  Speaker 3: the modern techniques that are used for in feature fertilization
• 7:52
  Speaker 3: are felt to be safe. And I think if a
• 7:54
  Speaker 3: woman wants to pursue pregnancy, she should do that. And
• 7:57
  Speaker 3: if a woman does have a strong family history of
• 8:00
  Speaker 3: breast cancer or if she's had breast cancer, the reproductive
• 8:03
  Speaker 3: endocrinologist does take that into account and may use it
• 8:07
  Speaker 3: modify the protocol that they use. So if someone's had IVF,
• 8:10
  Speaker 3: it's okay. I guess that's what I would say.
• 8:14
  Speaker 1: Well, I'm kind of interested in the if we.
• 8:18
  Speaker 2: Look at obviously we're all aging, and when you ask
• 8:23
  Speaker 2: about like the age of monarchy and the age of menopause,
• 8:27
  Speaker 2: what does that like does a later menopause help or hurt?
• 8:32
  Speaker 1: And does a later menarchy help or hurt?
• 8:35
  Speaker 3: Right, So actually it's thinking about our bodies exposure to
• 8:40
  Speaker 3: hormones like estrogen is the number one over the course
• 8:42
  Speaker 3: of the lifetime. So actually earlier age of menarchy, so
• 8:47
  Speaker 3: having a period at eight or nine actually is a
• 8:50
  Speaker 3: greater risk factor for breast cancer later in life, and
• 8:54
  Speaker 3: a prolonged like a later age of menopause, so that's
• 8:58
  Speaker 3: more years of exposure to hormones that is a risk factor.
• 9:01
  Speaker 3: So we look at all of these factors into account.
• 9:04
  Speaker 3: It's not like they're just all pieces of the puzzle.
• 9:07
  Speaker 3: It's a puzzle that we're always trying to put together
• 9:09
  Speaker 3: when we're trying to help understand risk. But for an
• 9:13
  Speaker 3: individual patient, it's actually we don't really comment particularly on that.
• 9:17
  Speaker 3: It's just we ask these questions, but it's really it's
• 9:20
  Speaker 3: just good to understand what potentially contributes to risk.
• 9:27
  Speaker 4: But breast cancer is the most preventable or one of
• 9:30
  Speaker 4: the most preventable cancers. Correct.
• 9:33
  Speaker 3: Well, obviously, I wish we knew all the reasons, oh
• 9:36
  Speaker 3: why someone would get breast cancer. I mean, I saw
• 9:38
  Speaker 3: a patient yesterday and her forties, healthy exercises, takes good
• 9:42
  Speaker 3: care of herself, healthy body weight, eats healthy and unfortunately
• 9:46
  Speaker 3: she's in my office right So there's so many factories
• 9:49
  Speaker 3: don't understand. And I think that's just what's hard about
• 9:52
  Speaker 3: medicine in general, with any medical problem, whether that's cancer
• 9:55
  Speaker 3: or some other things that we infections, we get whatever,
• 9:58
  Speaker 3: you know, sometimes we don't fully understand all the risk
• 10:01
  Speaker 3: factors and why a person may get a certain diagnosis.
• 10:04
  Speaker 4: Well, and environmental takes a big role in this, right.
• 10:09
  Speaker 3: Yeah, we're learning more and more about environmental factors and
• 10:13
  Speaker 3: cancer risk and you know, thinking about things like air
• 10:16
  Speaker 3: pollution and I hate to say it, our food environment
• 10:20
  Speaker 3: when we think about you know, our exposure to ultra
• 10:24
  Speaker 3: process foods, particularly here in the US with our sad
• 10:29
  Speaker 3: diet diet. I both are writing education about that. So
• 10:35
  Speaker 3: you know, there's lots of environmental factors that potentially are
• 10:37
  Speaker 3: planker worle too, plastics too, we're learning more and more
• 10:40
  Speaker 3: about that.
• 10:41
  Speaker 2: Does the USA have higher breast cancer rates than other countries.
• 10:48
  Speaker 3: Well, breast cancer is the most common cancer diagnosis in
• 10:51
  Speaker 3: women now worldwide, so in developed nations in particular, breast
• 10:56
  Speaker 3: cancer is still you know, after skin cancer or when
• 10:59
  Speaker 3: I say skin cancer, you know including like basil cell
• 11:02
  Speaker 3: scave of cell, and melanoma. But like you know, basil
• 11:04
  Speaker 3: cell and screen to sell. Those types of skin cancers
• 11:07
  Speaker 3: are obviously very common, but breast cancer is really the
• 11:11
  Speaker 3: second most common type of breast cancer, and it is
• 11:14
  Speaker 3: really worldwide the number one cancer, and you know, so
• 11:18
  Speaker 3: I think that's important for people to recognize too.
• 11:20
  Speaker 1: Yeah.
• 11:22
  Speaker 4: Wow, what have you seen a correlation to your dental health,
• 11:28
  Speaker 4: like the health of your gums and in relation to
• 11:35
  Speaker 4: breast cancer or infection or cancer of any kind.
• 11:40
  Speaker 3: Yeah, that's such an interesting question thinking about oral health
• 11:43
  Speaker 3: and cancer risk. Oh, I'm not particularly aware of a
• 11:46
  Speaker 3: risk of breast cancer per se, but I do think
• 11:49
  Speaker 3: if you think about it, I mean oral health. Are
• 11:52
  Speaker 3: we also thinking about our microbiome, which certainly is in
• 11:56
  Speaker 3: all aspects of our gi track, including our mouth and
• 11:59
  Speaker 3: all going. Yeah, so, you know, I think we're that's
• 12:02
  Speaker 3: an emerging field, like learning about the gut microbiome and
• 12:06
  Speaker 3: certainly risks for many chronic diseases, including cancer. So I
• 12:10
  Speaker 3: wonder in the next ten years if we're going to
• 12:12
  Speaker 3: learn more about that. So, but it's such a exciting
• 12:16
  Speaker 3: breast cancer. Yeah, it's very exciting.
• 12:19
  Speaker 1: Yeah.
• 12:19
  Speaker 2: I love the whole gut microbiome. I mean, everyone's kind
• 12:22
  Speaker 2: of coming to the party for it, but it's it's
• 12:24
  Speaker 2: just like in its infancy. I mean, we're just really
• 12:28
  Speaker 2: scratching the surface of how that plays a part in everything.
• 12:32
  Speaker 2: So I read this on one of your I don't know,
• 12:37
  Speaker 2: in a blog or either listen to it in a podcast,
• 12:40
  Speaker 2: but forty percent of the risk factors for breast cancer
• 12:43
  Speaker 2: are lifestyle related.
• 12:45
  Speaker 1: I mean that's almost half.
• 12:47
  Speaker 3: It's huge. So yeah, so reputable organizations like the American
• 12:53
  Speaker 3: Cancer Society, American Institute of Cancer Research, you know, when
• 12:57
  Speaker 3: you look at large population data and try to understand
• 13:01
  Speaker 3: contributing risk factors for breast cancer and other cancers, it
• 13:04
  Speaker 3: is felt that up to forty percent may actually be
• 13:07
  Speaker 3: due to lifestyle factors. So these are risk factors that
• 13:12
  Speaker 3: we can control. And so I think it's really important
• 13:15
  Speaker 3: to highlight this and actually a great resource which is
• 13:20
  Speaker 3: on the American Institute of Cancer Research's website AICR dot org.
• 13:25
  Speaker 3: They have they list this figure with like the top
• 13:29
  Speaker 3: ten recommendations for cancer prevention, and these are all lifestyle related.
• 13:34
  Speaker 3: So what can each of us do? What can we
• 13:36
  Speaker 3: do to take action to hopefully lower our risk of cancer?
• 13:40
  Speaker 3: And I'm happy to talk about those and a lot
• 13:42
  Speaker 3: of it is stuff we've already talked about, but I
• 13:46
  Speaker 3: think it's really important for us to be aware that
• 13:48
  Speaker 3: our lifestyle does potentially play a significant role in risk
• 13:51
  Speaker 3: for cancer.
• 13:53
  Speaker 1: Well that's just alone.
• 13:54
  Speaker 2: I mean, I'm like, if I have a forty percent
• 13:58
  Speaker 2: less chance of getting breast cancer or any type of
• 14:02
  Speaker 2: cancer just from my lifestyle, that's like, you know, good,
• 14:06
  Speaker 2: good bets that if you're kind of on the fence
• 14:09
  Speaker 2: of like, well I may you know, I may know.
• 14:12
  Speaker 2: I know that substance abuse or you know, alcohol intake
• 14:16
  Speaker 2: and smoking is probably not great. Well, we all know
• 14:19
  Speaker 2: it's not great, But like if somebody were kind of
• 14:21
  Speaker 2: on a borderline there, it would be really easy if
• 14:24
  Speaker 2: I heard these statistics to be like, all right, how
• 14:27
  Speaker 2: important is this and how important it's going to be
• 14:31
  Speaker 2: in fifteen twenty years, you know, if I keep going
• 14:34
  Speaker 2: at the rate. We all have our vices, and it
• 14:38
  Speaker 2: can be different things for different different women. But let's
• 14:41
  Speaker 2: talk about those areas of the lifestyle medicine and how
• 14:45
  Speaker 2: we are helping, you know, prevent but then also helping
• 14:50
  Speaker 2: you know, with the cancer survivorship after and really seeing
• 14:55
  Speaker 2: how that goes with your patients once they have come
• 14:59
  Speaker 2: through breast cancer treatment and what that looks like.
• 15:02
  Speaker 3: The American Institute of Cancer Researchers recommendations. The first one
• 15:06
  Speaker 3: is being at a healthy body weight. We can, by
• 15:09
  Speaker 3: the way, go into greater detail on all of these.
• 15:10
  Speaker 3: We know that's a challenging one. Being physically active. Thank
• 15:14
  Speaker 3: you for all the work you do to help us
• 15:16
  Speaker 3: with that. But that is beif when we think about
• 15:18
  Speaker 3: cancer risk reduction. And then thinking about our diet, and
• 15:22
  Speaker 3: there are many recommendations eating a diet rich and fresh
• 15:26
  Speaker 3: fruits and vegetables, fruit lagoons, beans, whole grains so important.
• 15:34
  Speaker 3: Limiting the ultra processed foods that are so prevalent in
• 15:37
  Speaker 3: our diet, the fast foods, all these things out here
• 15:40
  Speaker 3: that we're exposed to in our environment here in the US,
• 15:43
  Speaker 3: which are things we need to cut down on. Limiting
• 15:46
  Speaker 3: red meat consumption and really eliminating a lot of these
• 15:50
  Speaker 3: processed meats that we consume. And then thinking about limiting
• 15:54
  Speaker 3: consumption of these sugar sweetened beverages. I know we all
• 15:57
  Speaker 3: love to go to Starbucks, but like being mindful of
• 16:00
  Speaker 3: what you're ordering there is so important. And then of
• 16:02
  Speaker 3: course alcohol is key, limiting alcohol consumption. And then the
• 16:07
  Speaker 3: last two are really focusing on you know, supplements unfortunately
• 16:11
  Speaker 3: do not prevent cancer. We can talk a whole thing
• 16:13
  Speaker 3: about that, and then breastfeeding is protective. So those are
• 16:17
  Speaker 3: all listed on the a I see our website, and
• 16:19
  Speaker 3: these are all steps we can all take to help
• 16:22
  Speaker 3: optimize our health in terms of our lifestyle to reduce
• 16:25
  Speaker 3: risk of cancer. And they're also important for cancer survivors.
• 16:29
  Speaker 3: So to follow these particular recommendations as well.
• 16:33
  Speaker 1: It's it's tough.
• 16:34
  Speaker 2: We just had a nutritionist on that lives in New Zealand,
• 16:38
  Speaker 2: and you know, she was like, our environment is just
• 16:41
  Speaker 2: not set up for success. And I'm like, well, I've
• 16:43
  Speaker 2: been to New Zealand and it's way better than.
• 16:46
  Speaker 1: What we're dealing with in America.
• 16:50
  Speaker 2: So true all of these things, and I feel like,
• 16:53
  Speaker 2: you know, where a lot of women may be like yeah, yeah, yeah,
• 16:56
  Speaker 2: we get you know, we get the message. We get
• 16:58
  Speaker 2: the message, but you know, it's also hard. I see
• 17:01
  Speaker 2: the other side, working one on one with women and
• 17:04
  Speaker 2: in these groups where you know, the healthy relationships and
• 17:08
  Speaker 2: the poor sleep and the stress. It's like, yeah, great,
• 17:13
  Speaker 2: I don't want to have any of those things, but
• 17:15
  Speaker 2: I have them. Yeah, And that's where it gets a
• 17:18
  Speaker 2: little bit trickier to really work on that, because that
• 17:22
  Speaker 2: not only helps with obviously reduction of cancer risk, but
• 17:25
  Speaker 2: that helps with body composition and that helps with you know,
• 17:29
  Speaker 2: our lifestyle there and how we're going to either lose
• 17:33
  Speaker 2: weight or gain muscle. I mean, so it really comes
• 17:37
  Speaker 2: full circle with everything that we do. So what do
• 17:42
  Speaker 2: you tell your patients when you know they're struggling with
• 17:46
  Speaker 2: any of these issues that are harder to tackle.
• 17:50
  Speaker 3: Right, I mean, you reaise such important points. Oh my goodness,
• 17:53
  Speaker 3: you're absolutely right. I'm just gonna When I first wanted
• 17:57
  Speaker 3: to start some type of lifestyle medicine based program and
• 18:00
  Speaker 3: for my patients with breast cancer, I actually wanted to
• 18:03
  Speaker 3: just you know, think about let's talk about the diet
• 18:05
  Speaker 3: and the exercise, and but you're so right. There are
• 18:08
  Speaker 3: so many components of our lifestyle, which is really what
• 18:10
  Speaker 3: lifestyle medicine focuses on, that are key when we think
• 18:13
  Speaker 3: about that, as you do in your programs too, Like again,
• 18:17
  Speaker 3: restoreative sleep so important. So many of us struggle with
• 18:20
  Speaker 3: that thinking about social connection the community, and you do
• 18:24
  Speaker 3: that so beautifully with your programs, and I love that
• 18:27
  Speaker 3: that is so key to help anyone affect behavior change.
• 18:32
  Speaker 3: Limiting risky substances such as alcohol. We could talk more
• 18:35
  Speaker 3: about that. That's a tough one, but we really should
• 18:37
  Speaker 3: focus on that since it is unfortunately a risk factor
• 18:40
  Speaker 3: for cancer as well. And then talking about stress management,
• 18:44
  Speaker 3: which you just alluded to, which is a challenge for
• 18:47
  Speaker 3: so many of us, in particular women. We're juggling so
• 18:49
  Speaker 3: many balls at the same time, and so we really
• 18:52
  Speaker 3: need to address that too. And so all of these
• 18:55
  Speaker 3: factors social connection, you know, I just highlight that again.
• 18:58
  Speaker 3: I think it's so important and sometimes overlooks. So all
• 19:02
  Speaker 3: of these factors are absolutely key to help us optimize
• 19:04
  Speaker 3: our health. And really, like where do you start? And
• 19:07
  Speaker 3: I think like what you would probably say, it's just
• 19:09
  Speaker 3: pick one thing to start on. Yeah, say that's sleep,
• 19:13
  Speaker 3: or let's say it's trying to get more protein in
• 19:15
  Speaker 3: your diet. Maybe just for breakfast, start with breakfast. But like,
• 19:18
  Speaker 3: just pick one thing because you obviously can't tackle it
• 19:21
  Speaker 3: all at the same time.
• 19:23
  Speaker 2: M h, Well, what would you say is too much?
• 19:25
  Speaker 2: How much is too much of alcohol? Because that's going
• 19:28
  Speaker 2: to be the question.
• 19:29
  Speaker 1: I feel like.
• 19:30
  Speaker 2: We live in this lat last decade where you know,
• 19:35
  Speaker 2: and especially since COVID, where we started having like women
• 19:39
  Speaker 2: started having like these wine online wine parties, and you know,
• 19:43
  Speaker 2: it's pretty much alcohol is at every almost every event
• 19:47
  Speaker 2: that you go to for adults.
• 19:51
  Speaker 1: Anyway.
• 19:51
  Speaker 2: That just reminds me of a Seinfeld episode where George
• 19:54
  Speaker 2: is trying to bring pepsi and he's like, why can't
• 19:57
  Speaker 2: I bring pepsi?
• 19:57
  Speaker 1: Because we're adults, George. So I mean, it's kind of
• 20:02
  Speaker 1: just like.
• 20:04
  Speaker 2: It's like it embedded into our all of our activities
• 20:08
  Speaker 2: in our social life. But there is this pull kind
• 20:12
  Speaker 2: of pulling back over the last I've seen it a
• 20:14
  Speaker 2: lot over the last couple of years and still very
• 20:17
  Speaker 2: new of like these you know, non alcoholic clubs opening
• 20:22
  Speaker 2: and a lot of mocktails on the you know.
• 20:25
  Speaker 1: So I feel like there is this kind of trend shifting.
• 20:29
  Speaker 2: Where have we been using this for a crutch a
• 20:32
  Speaker 2: little bit for some women?
• 20:34
  Speaker 1: So what would you say?
• 20:35
  Speaker 2: And I try to tell people like, Okay, well, it's
• 20:37
  Speaker 2: not like you have to eliminate everything. It's you know,
• 20:39
  Speaker 2: everyone thinks they have to come in. Okay, I can
• 20:41
  Speaker 2: have no, I can't have sugar anymore, I can't drink,
• 20:44
  Speaker 2: Like this is going to be the you know, great
• 20:47
  Speaker 2: fun life for me for the rest of the you
• 20:49
  Speaker 2: know second ever, you know, second part of my life.
• 20:52
  Speaker 1: But how much is too much? Or is there any
• 20:55
  Speaker 1: guidelines there?
• 20:56
  Speaker 3: Yes, such an important and timely question since it is
• 21:00
  Speaker 3: US Cancer Awareness Month or Action Month. And actually just
• 21:03
  Speaker 3: recently another baive organization, the American Association of Cancer Research AACR,
• 21:09
  Speaker 3: another reputable organization, came out with this Cancer Progress Support
• 21:13
  Speaker 3: for twenty twenty four and it did really highlight not
• 21:17
  Speaker 3: to be a downer, but that alcohol is a significant
• 21:20
  Speaker 3: risk factor for six different types of cancer, including breast cancer,
• 21:24
  Speaker 3: and also highlighted that over fifty percent of Americans are
• 21:28
  Speaker 3: not even aware that alcohol, unfortunately is a risk factor
• 21:32
  Speaker 3: for cancer. And we think about women you mentioned, like
• 21:35
  Speaker 3: you know, certainly for the pandemic, and people socializing you know,
• 21:39
  Speaker 3: even zoom alcohol parties things like that, Like you know,
• 21:42
  Speaker 3: so many women are so focused, like you know, on
• 21:44
  Speaker 3: like eating organically and getting the exercise, but maybe drink
• 21:48
  Speaker 3: two or three glasses of wine to night and don't
• 21:50
  Speaker 3: even think of anything of it. So I think it's
• 21:51
  Speaker 3: important that we spread the message that alcohol is a
• 21:55
  Speaker 3: cancer risk factor. It is what it is. So I'm
• 21:57
  Speaker 3: going to cite one recommendation from an another organization. I
• 22:01
  Speaker 3: like the AICR Worterity Reference American Institute of Cancer Research.
• 22:05
  Speaker 3: You can drink, but just think before you drink. Why
• 22:09
  Speaker 3: are you having that glass of wine? So I'll just
• 22:11
  Speaker 3: share it a personal example. The other night, I was
• 22:14
  Speaker 3: at a special dinner at an Italian restaurant honoring a
• 22:17
  Speaker 3: colleague who unfortunately is leaving our hospital for another opportunity.
• 22:22
  Speaker 3: And we were all celebrating and there's a glass of
• 22:24
  Speaker 3: red wine being poured for everyone, and I was like,
• 22:27
  Speaker 3: I'm going to have this glass of red wine. I'm
• 22:28
  Speaker 3: celebrating my colleague. It's a special occasion and so I
• 22:32
  Speaker 3: enjoyed it. But would I do that like every single
• 22:35
  Speaker 3: night when I'm at home having dinner. No, I don't
• 22:37
  Speaker 3: think that's a good idea. So, especially for women, we
• 22:40
  Speaker 3: really do need to be mindful of our alcohol intakes.
• 22:42
  Speaker 3: So I think that's a really important message that we
• 22:45
  Speaker 3: can spread through this podcast today.
• 22:49
  Speaker 4: Yeah, that's a good tip to be mindful. Yeah, and
• 22:54
  Speaker 4: why do I need to get a second glass? Do
• 22:57
  Speaker 4: I really need a second glass? And I love Haley
• 23:00
  Speaker 4: that you mentioned mocktails. They are having a moment and
• 23:03
  Speaker 4: there's so many like fun mocktails out there.
• 23:06
  Speaker 3: Like I'll be honest, I have not really made one yet,
• 23:09
  Speaker 3: but like I'm always inspired when I see someone showing
• 23:12
  Speaker 3: how they make their mocktail. I'm like, oh, that looks
• 23:14
  Speaker 3: really good. I should make that.
• 23:16
  Speaker 1: Yeah. Yeah, it's nice to have options there.
• 23:19
  Speaker 2: But you know, I've been seeing a theme in again,
• 23:23
  Speaker 2: just from this week in the podcast that we filmed
• 23:27
  Speaker 2: and the nutrition course, where we've talked a lot about
• 23:31
  Speaker 2: disassociation and really how women especially have gotten to this
• 23:37
  Speaker 2: point where we just like disassociate. We don't even subconsciously
• 23:42
  Speaker 2: maybe even you know, think about pouring the drink at night,
• 23:45
  Speaker 2: or eating the extra food or something of we're you know,
• 23:50
  Speaker 2: we're living in this high stress. We're trying to do
• 23:53
  Speaker 2: all the right things, and usually there is something obvious
• 23:57
  Speaker 2: that I always say, if I, you know, if me
• 23:59
  Speaker 2: or even you could go and be a ghost in
• 24:02
  Speaker 2: someone's house for twenty four hours and watch everything that
• 24:05
  Speaker 2: they did, it would probably be easy to spot, but
• 24:07
  Speaker 2: they might not even know what because we're just like
• 24:10
  Speaker 2: robotic a lot of the time, especially when we're so busy,
• 24:14
  Speaker 2: that these things are just getting missed because we're not present,
• 24:19
  Speaker 2: and it's really hard to be present when we have
• 24:23
  Speaker 2: everything going on all the time.
• 24:26
  Speaker 3: I totally agree, and that's why I think. I just
• 24:29
  Speaker 3: think about the programs you offer, which I'm so fortunate
• 24:31
  Speaker 3: to be involved with right now. The power of the community,
• 24:34
  Speaker 3: Like if you have obviously you're not going to have
• 24:37
  Speaker 3: someone in your house with you all the time saying
• 24:38
  Speaker 3: do you really need to eat those chocolate chips right now?
• 24:41
  Speaker 3: But like you know, the community support. I mean, we
• 24:44
  Speaker 3: can provide all the education about every health and wellness
• 24:48
  Speaker 3: topic in the world and make it as evidence based
• 24:51
  Speaker 3: and amazing as possible. But if we are not also
• 24:54
  Speaker 3: focusing on what are the steps we need to do
• 24:56
  Speaker 3: to help an individual make these behavior change is like
• 25:01
  Speaker 3: eat more fruits and vegetables, eat more protein in her diet,
• 25:04
  Speaker 3: strength train three or four times a week, whatever it
• 25:07
  Speaker 3: might be. You know, we are not going to make progress.
• 25:09
  Speaker 3: So that is really hard. As a doctor, I can
• 25:11
  Speaker 3: tell you was I taught, like how do you coach
• 25:13
  Speaker 3: your patient on behavior change? Like I wasn't really taught
• 25:16
  Speaker 3: the coaching strategies that you have that expertise, and I
• 25:20
  Speaker 3: think I've actually learned some of it along the way
• 25:22
  Speaker 3: since then, but I will say that is so important,
• 25:25
  Speaker 3: so the coaching piece and the community piece to help
• 25:27
  Speaker 3: people make these changes because it is really hard, especially
• 25:30
  Speaker 3: when we have so much going on.
• 25:33
  Speaker 4: I'm so glad you bring up social health because I
• 25:36
  Speaker 4: think it's something that is not talked about enough, and
• 25:41
  Speaker 4: I really think that social skills are off balance. And
• 25:46
  Speaker 4: I mean, it's a proven fact that social connection helps
• 25:49
  Speaker 4: you live longer for sure, and living a healthier and
• 25:52
  Speaker 4: happier life creates longevity too. I just have to commend
• 25:57
  Speaker 4: you that I was so impressed with this time we
• 26:00
  Speaker 4: interviewed you, that you really focused on asking your client
• 26:05
  Speaker 4: about their lifestyle, because I find that a lot of
• 26:09
  Speaker 4: doctors it's okay, you have this, this is X is wrong,
• 26:14
  Speaker 4: and this is what we do to correct it, and
• 26:17
  Speaker 4: they're not examining and taking a glimpse of the whole
• 26:22
  Speaker 4: big picture. And I just I am so glad that
• 26:27
  Speaker 4: you are doing this, and I just have to commend you.
• 26:30
  Speaker 3: Thank you so much, and I agree that we all
• 26:33
  Speaker 3: need to have There is this like a buzzword now
• 26:35
  Speaker 3: and the literature it's called like whole person care, and
• 26:39
  Speaker 3: it's like this new thing like take care of the
• 26:41
  Speaker 3: whole patient ask about her lifestyle, how she's sleeping, how
• 26:44
  Speaker 3: she eating, how she exercising. To me, I'm like, how
• 26:47
  Speaker 3: haven't we been doing this? Like this should be like
• 26:49
  Speaker 3: very bread and butter medicine. One oh one. And it's
• 26:51
  Speaker 3: interesting that you say that, Laura, I guess I hate
• 26:54
  Speaker 3: to say it, not first of all, to defend my colleagues.
• 26:57
  Speaker 3: We are very limited in time and really it and
• 27:01
  Speaker 3: it's just a fact. And also I will say when
• 27:03
  Speaker 3: it comes to the lifestyle piece, a lot of us
• 27:06
  Speaker 3: we're not really educated in medical school, residency, fellowship, whatever
• 27:11
  Speaker 3: about all these lifestyle factors to the degree that we
• 27:13
  Speaker 3: feel super comfortable talking and counseling our patients about it.
• 27:16
  Speaker 3: So these are all things that I think are going
• 27:18
  Speaker 3: to change. But you raise some really important points that
• 27:21
  Speaker 3: as a medical field, you know, we're wondering. It's great
• 27:24
  Speaker 3: that we can work with a wonderful team, but we
• 27:26
  Speaker 3: also need to be doing a better job addressing all
• 27:28
  Speaker 3: of these concerns for our patients. Yeah.
• 27:31
  Speaker 2: Absolutely, Well, if we look at a patient after treatment,
• 27:37
  Speaker 2: so say that they are kind of in recovery, they're
• 27:41
  Speaker 2: in a recovery period, and you know you're coaching them
• 27:45
  Speaker 2: what does the return to exercise look like? Now, obviously
• 27:49
  Speaker 2: I would treat it to someone who had any surgery
• 27:53
  Speaker 2: or injury or a long time off of fitness regular movement,
• 27:59
  Speaker 2: But are they there are any things that you would
• 28:02
  Speaker 2: stay away from? Obviously I'm thinking anything test related.
• 28:07
  Speaker 1: But what does that look like for.
• 28:08
  Speaker 2: Women that maybe out there that Because I get asked
• 28:12
  Speaker 2: all the time like do you have a breast cancer
• 28:15
  Speaker 2: kind of recovery program of where to start? And it's
• 28:18
  Speaker 2: just made me pause and think about the importance of that.
• 28:21
  Speaker 2: And I know that you offer something as well, so
• 28:25
  Speaker 2: let's dive into that.
• 28:27
  Speaker 3: Yes, so such an important question, because I promise you
• 28:30
  Speaker 3: I talk about exercise with all of my patients. Any
• 28:33
  Speaker 3: of them are listening, they know I do, and I've
• 28:35
  Speaker 3: shared your amazing program and I will continue to do
• 28:37
  Speaker 3: so too. So exercise is absolutely important for women with
• 28:43
  Speaker 3: a history of breast cancer. In fact, studies show that
• 28:47
  Speaker 3: doing regular exercise, and we can talk about what those
• 28:49
  Speaker 3: basic guidelines are can help reduce risk of recurrence and
• 28:54
  Speaker 3: improve outcome from breast cancer. So right there, exercise can
• 28:58
  Speaker 3: improve an woman outcome from her breast cancer. So that
• 29:02
  Speaker 3: is the most important thing. Right when it comes to
• 29:05
  Speaker 3: treating my patients and helping them optimize their health, well
• 29:07
  Speaker 3: being and well being. So what are the basic guidelines? Again,
• 29:12
  Speaker 3: let's just start with the basics, and it really is
• 29:14
  Speaker 3: similar to what the CDC would recommend for all Americans
• 29:17
  Speaker 3: on one hundred and fifty minutes of moderate aerobic activity
• 29:21
  Speaker 3: each week or seventy five minutes of more vigorous activity.
• 29:25
  Speaker 3: But let's just focus on the one hundred and fifty number,
• 29:27
  Speaker 3: and that could be walking, jogging, cycling, kayaking, vacuuming, zoomba,
• 29:34
  Speaker 3: whatever that may be. And two sessions of strength training.
• 29:38
  Speaker 3: I know it's not a lot, but two sessions is right,
• 29:40
  Speaker 3: very good. Yeah, but I will tell you, and you
• 29:43
  Speaker 3: know this from your work, like the majority of people
• 29:48
  Speaker 3: do not meet those criteria, and certainly when we think
• 29:51
  Speaker 3: about the cancer survivor population, the majority do not meet
• 29:55
  Speaker 3: those very basic guidelines. So that is where I often
• 29:59
  Speaker 3: start with a patient of cour of course, probably like
• 30:01
  Speaker 3: you do with the people you work with, like where
• 30:02
  Speaker 3: are you starting from? What are you doing at this time?
• 30:05
  Speaker 3: What are you comfortable with? And really for me, it's
• 30:07
  Speaker 3: helping my patient. Maybe she's going to start with walking.
• 30:10
  Speaker 3: Like I actually said this to a patient yesterday, we
• 30:12
  Speaker 3: set a smart goal together, Maybe you can walk for
• 30:16
  Speaker 3: fifteen minutes three times this week and see how you do.
• 30:19
  Speaker 3: Because she's someone who doesn't exercise at all, So start
• 30:22
  Speaker 3: with that and then gradually introduce more aerobic activity, introduce
• 30:28
  Speaker 3: the strength training, and you do raise really great questions.
• 30:30
  Speaker 3: What if a woman just had to mastect me, like,
• 30:33
  Speaker 3: what are her limitations? What can she do? When can
• 30:36
  Speaker 3: she start lifting weights? What is safe for her? What's
• 30:39
  Speaker 3: a warning sign? And I will tell you I'm very
• 30:42
  Speaker 3: fortunate where I work to work with physical therapists who
• 30:45
  Speaker 3: have specific training in how to work with women who
• 30:49
  Speaker 3: have had a history of breast cancer. But I will
• 30:51
  Speaker 3: tell you that many studies show that lifting weights is
• 30:55
  Speaker 3: safe and very much important for our patient population for
• 31:00
  Speaker 3: all the reasons you talk about muscle mass, bone health,
• 31:04
  Speaker 3: metabolic health. Can go on and on, and there is
• 31:07
  Speaker 3: a condition called lymph edema where a woman can have
• 31:10
  Speaker 3: swelling of her arm on the side where she had
• 31:12
  Speaker 3: her breast cancer, especially if she had many lymph notes
• 31:15
  Speaker 3: removed in her surgery or if she had radiation on
• 31:18
  Speaker 3: that side, and exercise does not increase the risk of
• 31:22
  Speaker 3: lymph DMA can actually help it. So it is we
• 31:25
  Speaker 3: do get into some of the technical aspects of how
• 31:27
  Speaker 3: a woman should be assessed, etc. But in general, exercise
• 31:32
  Speaker 3: is good and beneficial and she'ld be strongly encouraged for everyone.
• 31:36
  Speaker 2: Yes, and I just want to plug this and I
• 31:38
  Speaker 2: feel like I've been plugging it and I'm like a
• 31:40
  Speaker 2: broken record, but I'm going to say it again. I
• 31:43
  Speaker 2: think as women when they're coming into the field, because
• 31:46
  Speaker 2: I have obviously all levels, but the ones that are
• 31:50
  Speaker 2: really beginner, like they've received the message, they're ready to go.
• 31:56
  Speaker 2: There's so much information out there that's good information that's
• 31:59
  Speaker 2: throwing at them, but that we peel back and just
• 32:03
  Speaker 2: be like, it doesn't matter what you start with, Like
• 32:07
  Speaker 2: just start. Don't worry about the guidelines for optimal body
• 32:12
  Speaker 2: composition or optimal fitness or taking you know yourself to
• 32:16
  Speaker 2: this high level. Yes we can, we can program that
• 32:20
  Speaker 2: over time, but we start with just like what makes
• 32:22
  Speaker 2: you happy, what gets you out the door. I mean,
• 32:25
  Speaker 2: none of those should ever be discounted. And then it's like, well,
• 32:29
  Speaker 2: once you're there, now, do you want to add something?
• 32:33
  Speaker 2: Is there something else we can add there? But the
• 32:35
  Speaker 2: the you know, exercise in general there's a lot of specifics,
• 32:41
  Speaker 2: but I want women to know that, like you start
• 32:44
  Speaker 2: with what you can do and what you can manage,
• 32:47
  Speaker 2: and it doesn't it's it's it's meaningless of what you
• 32:51
  Speaker 2: know an someone else is recommending on their journey or
• 32:55
  Speaker 2: what's optimal. If for you, this is what is making youill,
• 33:00
  Speaker 2: okay and be active and do that. So anyhow, I
• 33:05
  Speaker 2: mean there's a place for everyone. There is a place
• 33:07
  Speaker 2: for everyone, and it's usually the very beginners that are
• 33:11
  Speaker 2: very timid and just feel like, you know, they don't
• 33:15
  Speaker 2: have the confidence yet to really get get out there
• 33:18
  Speaker 2: and do a lot of things. So they should be
• 33:20
  Speaker 2: doing just the bare minimum of what they can that
• 33:22
  Speaker 2: they feel comfortable with.
• 33:23
  Speaker 1: So let's talk about your.
• 33:27
  Speaker 2: Path to the path? What is path to pavement? Something
• 33:32
  Speaker 2: in pavement? I actually have a book. I didn't know
• 33:40
  Speaker 2: you had a book.
• 33:41
  Speaker 3: But actually I want to say one thing because it's
• 33:43
  Speaker 3: actually in the beginning of this book and it's totally
• 33:45
  Speaker 3: related to what you just said. And you're welcome to
• 33:48
  Speaker 3: use this quote. It's not my quote. It's from like
• 33:50
  Speaker 3: this Chinese philosopher Lao Zoo. But the journey of a
• 33:55
  Speaker 3: thousand Miles begins with a single step. So I love
• 33:59
  Speaker 3: what you just said. Just love the first step is
• 34:02
  Speaker 3: so key. So I love that you just talked about
• 34:06
  Speaker 3: how the beginners struggles so much. Just take that first step.
• 34:08
  Speaker 3: So yeah, paving the path to wellness. So this is
• 34:12
  Speaker 3: a wonderful collaboration that began with my colleague, doctor Beth Frady's.
• 34:16
  Speaker 1: Five years ago.
• 34:17
  Speaker 3: It's like hard for me to fully wrap my head
• 34:19
  Speaker 3: around really five years that's gone by really fast. But
• 34:23
  Speaker 3: it's a lifestyle medicine based survivorship program for women with
• 34:26
  Speaker 3: breast cancer who really want to learn about what we've
• 34:30
  Speaker 3: been talking about, the evidence based recommendations in terms of nutrition,
• 34:33
  Speaker 3: physical activity, sleep, stress management, all of these topics after
• 34:38
  Speaker 3: diagnosis of breast cancer. So we meet virtually and each
• 34:42
  Speaker 3: week and go over each of these topics in great
• 34:44
  Speaker 3: detail and also work together in the community setting to
• 34:47
  Speaker 3: help people make these behavior changes. And it's really been
• 34:51
  Speaker 3: such a wonderful undertaking. And we've also talked about the
• 34:55
  Speaker 3: power of community and that's been such a key benefit
• 34:58
  Speaker 3: of this program as well.
• 35:00
  Speaker 4: But this program is for people that have breast cancer
• 35:03
  Speaker 4: and then are learn living with it afterwards, like after
• 35:08
  Speaker 4: they got there.
• 35:08
  Speaker 3: I'm offering is specifically for breast cancer survivors and thrivers.
• 35:13
  Speaker 3: They like to call themselves that, and I love that.
• 35:15
  Speaker 3: But I will tell you that doctor Frady's when she
• 35:18
  Speaker 3: first came up with this program, she was offering it
• 35:20
  Speaker 3: to stroke survivors who at a hospital called Spaulding Rehabilitation Hospital,
• 35:26
  Speaker 3: which is here in Boston at Philly with Harvard Medical School.
• 35:28
  Speaker 3: So she was first offering the program there, and I
• 35:31
  Speaker 3: met with her many years ago to learn about lifestyle medicine,
• 35:35
  Speaker 3: and then we adapted this program and I started offering
• 35:38
  Speaker 3: specifically for women with breast cancer. But I know doctor
• 35:40
  Speaker 3: Fradi's and colleagues, we actually have a nonprofit and we're
• 35:43
  Speaker 3: hoping to bring this program to lots of populations, not
• 35:47
  Speaker 3: just women with breast cancer. But my passion, of course
• 35:50
  Speaker 3: is helping the breast cancer survivor community, and that's that's
• 35:53
  Speaker 3: really my why.
• 35:55
  Speaker 1: I love that. So you're a vegan, right.
• 36:00
  Speaker 3: I would say I've been having some salmon like once
• 36:04
  Speaker 3: in a while to get my omega threes in, but
• 36:06
  Speaker 3: like I do otherwise follow very much on plant predominant diet,
• 36:10
  Speaker 3: I call it that. But yeah, I was realizing I
• 36:13
  Speaker 3: needed to find some ways to in my omega threes,
• 36:16
  Speaker 3: which we know are so good for our crediovascular health.
• 36:19
  Speaker 4: How long have you been vegan?
• 36:21
  Speaker 3: Well, I mean I go back and forth. Right now,
• 36:23
  Speaker 3: I'm not totally vegan, I should say I'm but gosh,
• 36:27
  Speaker 3: when the d become like essentially vegetarian a long time ago,
• 36:30
  Speaker 3: I don't even remember. That's honestly the truth. Like, I
• 36:33
  Speaker 3: don't even remember. I guess my daughter was nine because
• 36:37
  Speaker 3: she she became a vegetarian at that time too, so
• 36:39
  Speaker 3: I can do the math. So she's now, so it
• 36:41
  Speaker 3: was eight years ago. Hell does she know? She camps
• 36:46
  Speaker 3: on the bandwagon too.
• 36:48
  Speaker 1: Yeah, that's great.
• 36:48
  Speaker 2: Well, I like how you talk about the plant based
• 36:51
  Speaker 2: diet here, and this is where it's going to be
• 36:54
  Speaker 2: like okay, well we hear protein, and even with the
• 36:58
  Speaker 2: importance of protein, that's never going away, or I don't
• 37:02
  Speaker 2: foresee it ever going away. But if we look at
• 37:05
  Speaker 2: the importance of that, it's hard for some women who
• 37:08
  Speaker 2: start to change their diet. And then it's really protein,
• 37:13
  Speaker 2: you know, muscle like a muscle centric approach, which is
• 37:16
  Speaker 2: a lot of protein to support the training, but then
• 37:19
  Speaker 2: a lot of the good fruits and vegetables might get
• 37:23
  Speaker 2: lost in the mix because we're so pro protein. So
• 37:28
  Speaker 2: do you have any advice on that, because you know,
• 37:30
  Speaker 2: ideally we're all getting the thirty fruits and vegetables in
• 37:34
  Speaker 2: a week and we're all having the right number of protein.
• 37:37
  Speaker 2: But I mean, in like real world, it's freaking hard.
• 37:42
  Speaker 3: It is. In fact, my colleague and I shout out
• 37:46
  Speaker 3: to my colleague, chef Laura Client, we taught a culinary
• 37:49
  Speaker 3: medicine cooking class on Wednesday to a group of women
• 37:52
  Speaker 3: with breast cancer, and we tried to do some education
• 37:55
  Speaker 3: about nutrition along the way. We talked about our favorite topic,
• 37:58
  Speaker 3: got microbiome, protein, fiber, and we did really talk about
• 38:03
  Speaker 3: the challenge of getting in those thirty plants, getting in
• 38:05
  Speaker 3: your protein. So one of the things we made was
• 38:08
  Speaker 3: this soup with lentils. Lentils are pretty awesome, by the way.
• 38:12
  Speaker 3: My colleague Cheflara showed there's like five different types of lentils,
• 38:17
  Speaker 3: all these different colors. I don't even know if you know,
• 38:19
  Speaker 3: there's black lentils, yellow lentils. I was like blown away.
• 38:22
  Speaker 3: I'm like, I need to go buy all of these
• 38:23
  Speaker 3: pretty lentils because packed with protein, Like one cup of
• 38:27
  Speaker 3: lentils has like eighteen grams of protein and they're packed
• 38:30
  Speaker 3: with fiber, so you're getting fiber and protein when you
• 38:34
  Speaker 3: have lentils, which are so yummy in a soup or
• 38:36
  Speaker 3: you can put them in a salad, so many things
• 38:38
  Speaker 3: you can do. So that was a tip and trick
• 38:41
  Speaker 3: we did share with our group because we all need
• 38:43
  Speaker 3: to get at least thirty grams of fiber a day
• 38:46
  Speaker 3: and most of us are not getting that either, not streggle.
• 38:49
  Speaker 3: We talked about this.
• 38:51
  Speaker 2: It's important, very important, and that's that's the hard transition
• 38:55
  Speaker 2: is like that's what I see with women that go
• 38:57
  Speaker 2: into like a fat loss.
• 39:00
  Speaker 3: You know.
• 39:01
  Speaker 2: Course with me is is the fiber takes the hit
• 39:03
  Speaker 2: because the plant and vegetables, like all of the plants
• 39:06
  Speaker 2: take a hit. And so if we're just like it
• 39:09
  Speaker 2: really is, it seems like it's simple information, have a
• 39:13
  Speaker 2: lot of variety of fruits and vege and like have protein.
• 39:17
  Speaker 2: We're like, okay, cool, but it's really hard to get
• 39:22
  Speaker 2: all of those balances.
• 39:23
  Speaker 1: But again, start somewhere.
• 39:25
  Speaker 2: If you're eating three vegetables a week, the same ones,
• 39:28
  Speaker 2: then maybe out of fourth. I mean that's how I'm
• 39:30
  Speaker 2: doing it, because it's it's tricky to do it, especially
• 39:33
  Speaker 2: when you're in limited time.
• 39:35
  Speaker 3: You know, Yes, I definitely agree, it's tricky, and that's
• 39:38
  Speaker 3: why I love that. There's also you have this wonderful
• 39:41
  Speaker 3: community so people can support each other and share ideas
• 39:43
  Speaker 3: with each other in strategies.
• 39:45
  Speaker 2: Yeah, I love that. And you know, we're running out
• 39:50
  Speaker 2: of time here. I'm so sad. I feel like, where
• 39:53
  Speaker 2: does the time go? We can't have been talking for
• 39:55
  Speaker 2: forty minutes.
• 39:56
  Speaker 4: I know I just saw the same thing, but I
• 39:59
  Speaker 4: do want to just touch on one thing because it
• 40:01
  Speaker 4: does breast cancer awareness. One, just to remind people, so screening,
• 40:07
  Speaker 4: you're supposed to get a mammogram once a year, correct.
• 40:11
  Speaker 3: Correct, And aren't recommendations starting at age forty unless you
• 40:16
  Speaker 3: have a strong family history or other significant rest factors,
• 40:19
  Speaker 3: and then you would talk with your doctor about potentially
• 40:22
  Speaker 3: starting earlier. But a woman of average risk should be
• 40:25
  Speaker 3: starting at age forty and doing it every year.
• 40:28
  Speaker 4: What do you think of the Pronovo scan? Am I
• 40:31
  Speaker 4: saying it correctly? The full body Pronova scan?
• 40:38
  Speaker 3: If you're referring to like, I'm not sure specifically about
• 40:41
  Speaker 3: that particular one, but if you're thinking about full body, yeah,
• 40:44
  Speaker 3: the ovagen like that. Again, I do not recommend testing
• 40:49
  Speaker 3: like that because I will tell you anytime you order
• 40:52
  Speaker 3: as a doctor, anytime I order a scan on any patient,
• 40:55
  Speaker 3: I have to have a good reason why am I
• 40:57
  Speaker 3: doing this? Because often there are incidental findings and what
• 41:00
  Speaker 3: does that mean? Something you will find that you were
• 41:02
  Speaker 3: not looking for, and now you're going to go down
• 41:04
  Speaker 3: that rabbit hole of chasing it and it may or
• 41:07
  Speaker 3: may not turn out to be anything of clinical significance.
• 41:10
  Speaker 3: I'll give a common example, and I know we're short
• 41:11
  Speaker 3: on time. Lung nodules. Lots of us have lung nodules.
• 41:15
  Speaker 3: They're usually super tiny, five millimeters. You see it on
• 41:19
  Speaker 3: someone's scan, you're going to follow it. So now she's
• 41:22
  Speaker 3: getting a scan maybe initially every six months for one
• 41:25
  Speaker 3: or two years to make sure they're stable and nothing
• 41:27
  Speaker 3: growing or whatever. But now that patient is getting all
• 41:30
  Speaker 3: these extra scans and extra exposure to radiation that she did.
• 41:33
  Speaker 3: So I am not a fan of doing scans on
• 41:37
  Speaker 3: people when you don't have a really good reason why
• 41:38
  Speaker 3: you're doing it. Okay, that's great advice.
• 41:41
  Speaker 4: I just wanted to ask, Yes, that's we're in this,
• 41:44
  Speaker 4: but mammograms, yes.
• 41:47
  Speaker 2: Yeah, oh, that's I didn't even think about that, but
• 41:49
  Speaker 2: that's I'm going to do the regular one that is
• 41:52
  Speaker 2: not as fun, but at least it's it's not cause
• 41:55
  Speaker 2: of me to get other scan. Is there anything new
• 41:58
  Speaker 2: since we talked to you last about six months ago
• 42:01
  Speaker 2: in the breast cancer treatment world, Any new information that
• 42:07
  Speaker 2: you can share or something that you found interesting.
• 42:11
  Speaker 3: Oh gosh, in the breast cancer world, their things are
• 42:14
  Speaker 3: always evolving, always changing. That's why my job is very
• 42:17
  Speaker 3: exciting because there's always new research studies with new treatments
• 42:22
  Speaker 3: and new findings that are being released. And I'll just
• 42:25
  Speaker 3: think of one that is super interesting. Recently, at my hospital,
• 42:29
  Speaker 3: we had a retreat to actually focus on the role
• 42:32
  Speaker 3: of artificial intelligence in cancer care. And that's obviously a
• 42:36
  Speaker 3: feel in your field too. That's really taking off the
• 42:38
  Speaker 3: power of these tools to enhance whether it's health and
• 42:42
  Speaker 3: wellness or maybe in the breast cancer field, helping us
• 42:45
  Speaker 3: identify cancers earlier on mammograms using all these really cool
• 42:50
  Speaker 3: AI algorithms. I do not claim to be an expert
• 42:53
  Speaker 3: on this, but it's super interesting. So that's an area
• 42:56
  Speaker 3: that I think we're going to really see takeoff in
• 42:57
  Speaker 3: the next few.
• 42:58
  Speaker 2: Years AI get in or Get Out. I just watched
• 43:04
  Speaker 2: that at Tesla with my son this morning. He's like, Mom,
• 43:07
  Speaker 2: look at these robots. You can you know you're gonna
• 43:09
  Speaker 2: be able to buy one in twenty twenty six, And like,
• 43:11
  Speaker 2: I feel like that's we're in Halloween.
• 43:13
  Speaker 1: My son loves animatronics.
• 43:14
  Speaker 2: I feel like it's an animatronic walking around the house.
• 43:17
  Speaker 2: I don't think I'm comfortable with with that quite yet,
• 43:20
  Speaker 2: but you know, I guess you know.
• 43:23
  Speaker 1: The AI world is is.
• 43:25
  Speaker 2: It's not going away, so it's it's quite interesting on
• 43:29
  Speaker 2: all spectrums there, but fascinating information. I think I love
• 43:34
  Speaker 2: the lifestyle approach and I love that there's so much
• 43:37
  Speaker 2: power in lifestyle medicine and that it's kind of getting
• 43:41
  Speaker 2: into the main medical stream and getting talked about because
• 43:47
  Speaker 2: it really is. We're all working together for someone's health.
• 43:50
  Speaker 2: I mean, and there's lots of participants in a client's
• 43:54
  Speaker 2: journey that you know, we all we all benefiting each
• 43:58
  Speaker 2: other by helping out with our specific area and so
• 44:02
  Speaker 2: there's lots of good.
• 44:03
  Speaker 1: It's an exciting time to live for surely.
• 44:05
  Speaker 3: I have to agree with you one hundred percent.
• 44:08
  Speaker 2: So Amy, can you tell us about is your book available.
• 44:14
  Speaker 2: I didn't know that there was an actual book same.
• 44:16
  Speaker 2: I'm like, we got to get the book.
• 44:18
  Speaker 3: So this is a wonderful workbook that I was fortunate
• 44:21
  Speaker 3: to collaborate with with doctor Beth Frady's and doctor Michelle Tollison.
• 44:26
  Speaker 3: It's called Paving the Path to Wellness Workbook. It is
• 44:29
  Speaker 3: on Amazon or on the publisher's site healthy learning dot com.
• 44:33
  Speaker 3: And by the way, the proceeds do not go to
• 44:36
  Speaker 3: meet They go to our nonprofit called Paving Wellness, and
• 44:39
  Speaker 3: that's Paving Wellness dot org. But bottom line is, this
• 44:41
  Speaker 3: is a great workbook that goes with our program. And
• 44:44
  Speaker 3: I am working on one focused on breast cancer, and
• 44:48
  Speaker 3: we also have one already written by my amazing colleague,
• 44:52
  Speaker 3: doctor Tollison. She was the first author focused on menopause.
• 44:55
  Speaker 3: And by the way, you would love it. It's all
• 44:58
  Speaker 3: about it's somewhere over there, but it's focused on lifestyle
• 45:05
  Speaker 3: strategies to optimize our health during menopause, which is something
• 45:09
  Speaker 3: that you're already an expert on. So but I think
• 45:11
  Speaker 3: you would love it because a lot that she does
• 45:13
  Speaker 3: focus a lot, We focus a lot about everything, but
• 45:15
  Speaker 3: certainly exercise is key in that too.
• 45:17
  Speaker 1: All right, I'm getting it. I feel like I order
• 45:22
  Speaker 1: more books from podcasts.
• 45:23
  Speaker 3: Let I know. It's going to be a gift for me.
• 45:26
  Speaker 3: I'm sending it to you, so oh, I helping all
• 45:29
  Speaker 3: I am sending it to you, so I will do
• 45:31
  Speaker 3: that because you will absolutely love it.
• 45:33
  Speaker 2: Oh, I'm so excited. Well, thank you so much for
• 45:36
  Speaker 2: your time, doctor Commander. We is always just a special
• 45:40
  Speaker 2: treat to have you, especially during the month of breast
• 45:43
  Speaker 2: cancer awareness and menopause month as well, so we kind
• 45:48
  Speaker 2: of tackle two big women's health yes, women's health. So
• 45:52
  Speaker 2: thank you so much for your time and we will
• 45:54
  Speaker 2: catch up with you soon.
• 45:56
  Speaker 3: Thank you so much for the opportunity, and thanks for
• 45:58
  Speaker 3: all the amazing work you do.
• 46:00
  Speaker 1: Thanks for listening everyone.
• 46:01
  Speaker 4: If you enjoyed this episode, please consider giving us a
• 46:04
  Speaker 4: five star rating and sharing the body Pod with your friends.