Latest / Clearly Hormonal / Ep 29: Metabolic Health & Breast Cancer

Transcript

Ep 29: Metabolic Health & Breast Cancer · Clearly Hormonal

• 0:02
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the podcast where women's health takes center stage.
• 0:07
  Dr. Komal Patil-Sisodia: I'm your host, Dr.
• 0:08
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, a triple board certified endocrinologist and women's health expert.
• 0:13
  Dr. Komal Patil-Sisodia: This show is all about empowering you with the knowledge to understand your metabolic health, navigate hormonal changes, and feel confident in the conversations you're having with your healthcare provider.
• 0:24
  Dr. Komal Patil-Sisodia: Whether you're managing symptoms, exploring treatment options, or just want to feel more in tune with your body, you're in the right place.
• 0:31
  Dr. Komal Patil-Sisodia: As a physician, my goal is to educate on this podcast.
• 0:34
  Dr. Komal Patil-Sisodia: The content shared here is for informational purposes only and should not replace personalized medical advice.
• 0:41
  Dr. Komal Patil-Sisodia: If something we discuss resonates with you, please talk to your healthcare provider at your next visit.
• 0:46
  Dr. Komal Patil-Sisodia: Now let's dive in and help you reset, recharge, and take control of your health.
• 0:58
  Dr. Komal Patil-Sisodia: Imagine two women in their fifties both have the same mammogram results, the same family history, even similar diets, but one has a little more belly fat, slightly higher blood sugars, and a cholesterol profile that her doctor says is quote, something to keep an eye on.
• 1:14
  Dr. Komal Patil-Sisodia: Fast forward 10 years and one is diagnosed with hormone receptor positive breast cancer.
• 1:20
  Dr. Komal Patil-Sisodia: The difference metabolic health, what's happening inside the body.
• 1:24
  Dr. Komal Patil-Sisodia: Your insulin, glucose, and lipid metabolism can quietly shape your cancer risk more powerfully than you might think.
• 1:31
  Dr. Komal Patil-Sisodia: Today we're diving deep into that connection and how modern tools from lifestyle changes to medications like statins, metformin, and GLP one receptor agonists are reshaping the conversation on metabolic health and breast cancer prevention.
• 1:48
  Dr. Komal Patil-Sisodia: Welcome to Reset Recharge, the show where we bridge science, medicine and mindful living to empower you towards better health.
• 1:54
  Dr. Komal Patil-Sisodia: I'm Dr.
• 1:55
  Dr. Komal Patil-Sisodia: Komal Patil-Sisodia, and since October is breast Cancer Awareness month, I wanted to bring you this episode that explores the metabolic blueprint of breast cancer.
• 2:04
  Dr. Komal Patil-Sisodia: What drives risk, what's reversible, and how new research is rewriting our prevention playbook.
• 2:11
  Dr. Komal Patil-Sisodia: Let's start with what we know.
• 2:12
  Dr. Komal Patil-Sisodia: The most significant metabolic risk factors for breast cancer include obesity, particularly what we call central adiposity.
• 2:19
  Dr. Komal Patil-Sisodia: So the belly fat that we hang on to.
• 2:21
  Dr. Komal Patil-Sisodia: It's not just based on BMI, because there are some people who can have a normal BMI, but a lot of belly fat.
• 2:28
  Dr. Komal Patil-Sisodia: Also, what we call visceral fat insulin resistance and hyperinsulinemia are next on the list.
• 2:34
  Dr. Komal Patil-Sisodia: These lead to elevated fasting glucose, which comes in at number three, and then rounding out at number four are low HDL and high triglycerides.
• 2:44
  Dr. Komal Patil-Sisodia: And number five, which is high blood pressure.
• 2:47
  Dr. Komal Patil-Sisodia: When three or more of these risk factors are present, we call this metabolic syndrome, and the science is clear.
• 2:54
  Dr. Komal Patil-Sisodia: Each additional factor increases breast cancer risk, especially in postmenopausal women, even women with a normal BMI.
• 3:01
  Dr. Komal Patil-Sisodia: But high waist circumference, meaning a larger waist measurement, or Even women with a normal BMI, but high waist circumference face elevated risk because that visceral fat drives hormonal and inflammatory changes that can stimulate tumor growth.
• 3:19
  Dr. Komal Patil-Sisodia: The most pronounced effects that we see happen in hormone receptor positive cancers, and those are the ones that have receptors for estrogen and progesterone because.
• 3:30
  Dr. Komal Patil-Sisodia: Insulin and estrogen pathways overlap, and this can lead to growth of those cells.
• 3:36
  Dr. Komal Patil-Sisodia: Here's the empowering news, though you can reprogram your metabolic health studies show that sustained weight loss, even as little as two kilograms, which is like 4.41 pounds in women over the age of 50, will significantly lower breast cancer risk bariatric surgery.
• 3:55
  Dr. Komal Patil-Sisodia: Shows an even stronger protection, largely because people who go through bariatric surgery will have massive improvement in their insulin sensitivity, and then they'll have reduced inflammation overall.
• 4:07
  Dr. Komal Patil-Sisodia: There are additional studies that confirm weight loss will decrease circulating estrogens, insulin, and C-reactive protein, a key inflammatory marker, and then exercise, particularly vigorous activity.
• 4:21
  Dr. Komal Patil-Sisodia: Five plus hours per week is associated with up to a 40% lower breast cancer risk.
• 4:28
  Dr. Komal Patil-Sisodia: Five hours is a lot of exercise.
• 4:30
  Dr. Komal Patil-Sisodia: That's almost 300 minutes, and our conventional therapy shows that too.
• 4:34
  Dr. Komal Patil-Sisodia: Maintain weight, we need 150 minutes of movement per week.
• 4:38
  Dr. Komal Patil-Sisodia: To lose weight, we need 210 minutes per week.
• 4:41
  Dr. Komal Patil-Sisodia: For most people.
• 4:42
  Dr. Komal Patil-Sisodia: Some ethnicities need up to 230, but to reduce breast cancer risk by 40%, that jumps up to 300 minutes, which is quite a bit of exercise, right?
• 4:51
  Dr. Komal Patil-Sisodia: That's almost an hour a day for five days out of the week.
• 4:56
  Dr. Komal Patil-Sisodia: We have to remember that exercise and nutrition are not cosmetic.
• 4:59
  Dr. Komal Patil-Sisodia: They are metabolic therapy.
• 5:00
  Dr. Komal Patil-Sisodia: They are going to help decrease breast cancer risk by improving insulin sensitivity and reducing inflammation.
• 5:09
  Dr. Komal Patil-Sisodia: Now, how you feel in your body, how you look in your body, if those things are important to you as well, there are added benefits there, which is wonderful.
• 5:16
  Dr. Komal Patil-Sisodia: Let's talk a little bit about the blood sugar and cholesterol connection.
• 5:20
  Dr. Komal Patil-Sisodia: There are two major, what we call biochemical drivers of breast cancer risk, and those are your glucose levels and your lipid or cholesterol levels.
• 5:29
  Dr. Komal Patil-Sisodia: When glucose is chronically elevated, it increases the risk of breast cancer and worsens outcomes.
• 5:35
  Dr. Komal Patil-Sisodia: Women with higher hemoglobin, A1C levels, even without diabetes, will have higher recurrence rates.
• 5:41
  Dr. Komal Patil-Sisodia: And a lot of this is because tumors thrive on sugar.
• 5:43
  Dr. Komal Patil-Sisodia: It's basically like feeding the tumor.
• 5:46
  Dr. Komal Patil-Sisodia: So if you have elevated insulin, which is a growth factor that will promote growth of these cells and potentially cancer progression with lipids.
• 5:55
  Dr. Komal Patil-Sisodia: Low HDL cholesterol and high triglycerides are especially harmful.
• 6:00
  Dr. Komal Patil-Sisodia: This doesn't even account for the LDL.
• 6:02
  Dr. Komal Patil-Sisodia: The HDL, which is our good cholesterol, high density lipoprotein acts as an antioxidant and anti-inflammatory molecule.
• 6:11
  Dr. Komal Patil-Sisodia: And so in patients where the HDL levels are low, we actually have more oxidative stress on our cells, which can cause damage and lead to progression of cancer cells.
• 6:24
  Dr. Komal Patil-Sisodia: On the flip side, improving lipids through diet, exercise, or pharmacologic therapy can reduce both cardiovascular and cancer related events.
• 6:34
  Dr. Komal Patil-Sisodia: With triglycerides, those tend to be elevated in people who are insulin resistant, so you kind of can use that as a marker for people who have also have elevated glucose level.
• 6:45
  Dr. Komal Patil-Sisodia: So let's talk a little bit about our pharmacologic allies, right?
• 6:50
  Dr. Komal Patil-Sisodia: They're not options for treatment of breast cancer or even primary prevention, meaning preventing the breast cancer from occurring in the first place.
• 6:59
  Dr. Komal Patil-Sisodia: But there are a few of them that have been associated with decreasing the risk of recurrence, which is huge, right?
• 7:05
  Dr. Komal Patil-Sisodia: Because once you're diagnosed, you don't want to go through.
• 7:09
  Dr. Komal Patil-Sisodia: Treatment and then have the cancer come back later.
• 7:11
  Dr. Komal Patil-Sisodia: It does happen for some, but if you have these metabolic issues, there are options that can help reduce that risk for you.
• 7:19
  Dr. Komal Patil-Sisodia: So let's talk about statins, which in my opinion are the unsung heroes on this story.
• 7:24
  Dr. Komal Patil-Sisodia: There are decades of research that show that statin use, especially particular statins like Simvastatin and atorvastatin.
• 7:33
  Dr. Komal Patil-Sisodia: Are linked to 20% lower breast cancer recurrence risk, reduced breast cancer, specific mortality, and improved overall survival.
• 7:43
  Dr. Komal Patil-Sisodia: Those are pretty significant outcomes, and I know they get a bad rap for.
• 7:49
  Dr. Komal Patil-Sisodia: Side effects and other things like that.
• 7:51
  Dr. Komal Patil-Sisodia: But there is data that shows that they prevent heart disease and now we have evidence that it can improve breast cancer recurrence and mortality, which to me is huge.
• 8:01
  Dr. Komal Patil-Sisodia: Right?
• 8:01
  Dr. Komal Patil-Sisodia: So the way that this happens is the statins will block.
• 8:06
  Dr. Komal Patil-Sisodia: The HMG COA reductase pathway, which is basically how cholesterol gets made in our body, and cholesterol is a precursor.
• 8:14
  Dr. Komal Patil-Sisodia: It's like a building block for estrogen.
• 8:17
  Dr. Komal Patil-Sisodia: So when that pathway gets blocked, that means there's less building blocks to produce estrogen and drive that tumor growth beyond.
• 8:29
  Dr. Komal Patil-Sisodia: Additionally, statins can also suppress inflammation.
• 8:34
  Dr. Komal Patil-Sisodia: They can inhibit cell growth and increase blood vessels to the tumor, and then they can actually promote cancer cell death, which is known as apoptosis.
• 8:47
  Dr. Komal Patil-Sisodia: There are randomized and genetic studies that suggest LDL lowering medications and mechanisms can also.
• 8:56
  Dr. Komal Patil-Sisodia: And like I said before, while statins can offer some degree of protection, the evidence is stronger for preventing recurrence than for the initial diagnosis of cancer.
• 9:05
  Dr. Komal Patil-Sisodia: For women who have high cardiovascular risks, statins also offer dual protection for the heart and for the breast.
• 9:11
  Dr. Komal Patil-Sisodia: So these medications, while they get a bad rap, they're doing some good things for us.
• 9:17
  Dr. Komal Patil-Sisodia: Now, next on the list is metformin.
• 9:19
  Dr. Komal Patil-Sisodia: Metformin is one of the most common drugs used for type two diabetes management and has long intrigued oncologists.
• 9:26
  Dr. Komal Patil-Sisodia: Early studies showed a lower cancer incidence among diabetes patients who were on metformin compared to other drugs.
• 9:33
  Dr. Komal Patil-Sisodia: But there was a landmark trial called the MA 32 randomized trial that found no improvements in invasive disease free survival in non-diabetic breast cancer patients.
• 9:44
  Dr. Komal Patil-Sisodia: So in patients who don't have breast cancer, metformin is not necessarily helpful.
• 9:48
  Dr. Komal Patil-Sisodia: There is some nuance to this though in women who have HER two positive breast cancer and in women who have insulin resistance at the time of diagnosis.
• 10:00
  Dr. Komal Patil-Sisodia: There may be benefit to using metformin, but as kind of like a blanket medication for anybody to prevent breast cancer it is not necessarily helpful.
• 10:09
  Dr. Komal Patil-Sisodia: So it's safe and valuable for metabolic control, but not really proven for direct breast cancer prevention.
• 10:16
  Dr. Komal Patil-Sisodia: I still think it's worth looking at when either studying or managing this connection between metabolism and cancer.
• 10:24
  Dr. Komal Patil-Sisodia: And finally we have the newest player, the GLP one receptor agonist like semaglutide and tirzepatide.
• 10:31
  Dr. Komal Patil-Sisodia: These medications mimic a natural gut hormone that regulates appetite and insulin, and they have revolutionized diabetes management and weight management, and they're now actually being studied for oncologic safety and potential benefit.
• 10:45
  Dr. Komal Patil-Sisodia: So here's what we know so far.
• 10:47
  Dr. Komal Patil-Sisodia: There are meta-analyses of randomized trials that show that there's no increased risk of breast cancer with the use of these medications.
• 10:55
  Dr. Komal Patil-Sisodia: And there's some genetic data that even hints that there's a possible reduction in breast cancer risk.
• 11:02
  Dr. Komal Patil-Sisodia: Early clinical use in breast cancer survivors shows significant weight loss, better insulin sensitivity, and no recurrence signal.
• 11:10
  Dr. Komal Patil-Sisodia: And how they work is that GLP ones will improve metabolic inflammation and lipid metabolism.
• 11:16
  Dr. Komal Patil-Sisodia: It's pretty common that I will see patients who have high triglycerides actually have that level lowered when they start a GLP one.
• 11:24
  Dr. Komal Patil-Sisodia: Both of those things, metabolic inflammation and lipid metabolism are linked to cancer risk.
• 11:30
  Dr. Komal Patil-Sisodia: And when you use the GLP one receptor agonist, it will reduce that cancer risk.
• 11:34
  Dr. Komal Patil-Sisodia: So it's important to note that none of these medications are cancer drugs, but for postmenopausal women with obesity or insulin resistance, they offer safe evidence-based metabolic benefits, which will likely translate into lower overall risk of.
• 11:50
  Dr. Komal Patil-Sisodia: Breast cancer recurrence.
• 11:52
  Dr. Komal Patil-Sisodia: There are also certain subtypes of breast cancer that have increased GLP one receptor expression in the breast tissue.
• 12:00
  Dr. Komal Patil-Sisodia: Those tend to be the hormonally driven cancers, and there is a thought that in that particular population, we may see a slightly decreased risk of breast cancer, but we still need a lot more studies to look at that.
• 12:14
  Dr. Komal Patil-Sisodia: So what does this mean for you?
• 12:17
  Dr. Komal Patil-Sisodia: I have several tips that I want to share with you.
• 12:20
  Dr. Komal Patil-Sisodia: The first being, start with your lifestyle.
• 12:22
  Dr. Komal Patil-Sisodia: Make sure you're moving daily.
• 12:24
  Dr. Komal Patil-Sisodia: Make sure you're managing your stress.
• 12:26
  Dr. Komal Patil-Sisodia: Make sure you're sleeping well, and make sure that you are nourishing your body with.
• 12:30
  Dr. Komal Patil-Sisodia: Fiber rich anti-inflammatory foods.
• 12:33
  Dr. Komal Patil-Sisodia: Having a plant forward diet can really help.
• 12:35
  Dr. Komal Patil-Sisodia: If you're eating a lot of fruits and vegetables, you're getting the fiber, you're getting the antioxidants that will help protect your cells, right?
• 12:42
  Dr. Komal Patil-Sisodia: So lifestyle is the cornerstone of everything.
• 12:44
  Dr. Komal Patil-Sisodia: You're probably sick of hearing me say that over and over again, but it really is true and it's been shown in studies time and time again.
• 12:51
  Dr. Komal Patil-Sisodia: Now number two on the list is get regular metabolic screenings.
• 12:55
  Dr. Komal Patil-Sisodia: Unfortunately, with how strapped our healthcare system is, a lot of times we put off going into the doctor to get regular checks, but keeping track of your waist circumference, your fasting glucose, your HDL, your triglyceride levels, and your blood pressure will all improve your health, not just from a metabolic perspective, but also possibly from a cancer risk perspective.
• 13:17
  Dr. Komal Patil-Sisodia: And then number three, discuss your medications.
• 13:20
  Dr. Komal Patil-Sisodia: If you're already on a statin or a GLP one receptor agonist for heart or metabolic health, you should know that they are safe and there are potential additional benefits when it comes to reducing breast cancer risk.
• 13:32
  Dr. Komal Patil-Sisodia: And number four, work with your care team.
• 13:34
  Dr. Komal Patil-Sisodia: Everybody's metabolic fingerprint is very unique.
• 13:38
  Dr. Komal Patil-Sisodia: Our genetics are so different from person to person.
• 13:41
  Dr. Komal Patil-Sisodia: What works for me may not work for you, may not work for the next person walking down the street.
• 13:45
  Dr. Komal Patil-Sisodia: So we need to tailor interventions to your body's specific needs.
• 13:49
  Dr. Komal Patil-Sisodia: I want to close out this episode by driving home one point.
• 13:52
  Dr. Komal Patil-Sisodia: Metabolic Health is the missing link between chronic disease and cancer prevention.
• 13:56
  Dr. Komal Patil-Sisodia: By improving insulin sensitivity, reducing your belly fat, and optimizing your cholesterol panel, you're not only protecting your heart, but you may be protecting yourself against cancer risk.
• 14:08
  Dr. Komal Patil-Sisodia: If today's episode inspired you, share it with someone who could use this message.
• 14:12
  Dr. Komal Patil-Sisodia: If you have more questions for me, send them to me through either our fan mail or through the contact form on my website for.
• 14:21
  Dr. Komal Patil-Sisodia: References, show notes and metabolic health resources, visit resetrecharge.com.
• 14:26
  Dr. Komal Patil-Sisodia: And remember, every healthy habit is an act of self-defense when you're protecting yourself from both metabolic disease and from potentially cancer.
• 14:35
  Dr. Komal Patil-Sisodia: Thank you for tuning in today, and I'll see you on the next episode.